Shelton B G, Kerbel W, Witherell L, Millar J D
PathCon Laboratories, Norcross, GA 30092, USA.
AIHAJ. 2000 Sep-Oct;61(5):738-42. doi: 10.1080/15298660008984585.
This review seeks to assist industrial hygienists in the prevention of Legionnaires' disease caused by Legionella bacteria. Breathing water droplets contaminated with Legionella bacteria, in which the organism has been permitted to amplify, causes this disease. Possible sources of transmission include nearly all manmade building water systems. Legionella organisms, found in most natural water sources but at very low concentrations, can thrive under conditions of warmth in these manmade systems. Primary prevention of Legionnaires' disease requires prevention of amplification of Legionella in water systems. This, in turn, requires familiarity with the system and all its components, and effective maintenance and water treatment. However, good maintenance and water treatment regimens alone cannot assure that amplification will not occur somewhere in the system. Systematic microbiological testing for Legionella and appropriate interpretation of the testing results can be powerful assets in prevention by enabling the detection and control of amplification. The occurrence of a confirmed or suspected case of Legionnaires' disease in a building occupant may indicate transmission within the facility; this poses an immediate crisis for the facility manager. An aggressive intervention is indicated to search for previously unknown additional cases of illness, to detect potential sources of transmission, and to decontaminate any suspected sources of transmission on an emergency basis. Once adequate remediation has been achieved and confirmed by microbiological testing, on-going control measures are essential with periodic microbiological investigation to assure continuing prevention of amplification.
本综述旨在协助工业卫生学家预防由军团菌引起的军团病。吸入被军团菌污染且该病菌得以大量繁殖的水滴会引发这种疾病。可能的传播源几乎包括所有人工建筑供水系统。军团菌存在于大多数天然水源中，但浓度很低，在这些人工系统的温暖环境下能够大量繁殖。军团病的一级预防需要防止军团菌在供水系统中大量繁殖。这反过来又需要熟悉系统及其所有组件，并进行有效的维护和水处理。然而，仅靠良好的维护和水处理方案并不能确保系统中不会出现病菌大量繁殖的情况。对军团菌进行系统的微生物检测并对检测结果进行恰当解读，通过检测和控制病菌繁殖，在预防工作中可能会起到很大作用。建筑物内居住者确诊或疑似感染军团病，可能表明该设施内部存在传播；这对设施管理人员来说是一场紧急危机。需要采取积极的干预措施，寻找此前未知的其他病例，检测潜在的传播源，并紧急对任何疑似传播源进行消毒。一旦通过微生物检测确认已实现充分的整治，持续的控制措施至关重要，要定期进行微生物调查，以确保持续预防病菌繁殖。
