Trop Skaza Alenka, Beskovnik Lucija, Storman Alenka, Kese Darja, Ursic Simona
Institute of Public Health Celje, Celje, Slovenia.
Scand J Infect Dis. 2012 Apr;44(4):263-9. doi: 10.3109/00365548.2011.635313. Epub 2012 Feb 19.
August 2010 marked the beginning of the largest outbreak of legionellosis in a Slovenian nursing home. This article presents our experiences with the outbreak investigation.
In order to collect the necessary patient epidemiological data, we used individual epidemiological questionnaires. Samples were available from 15 patients and were subject to laboratory investigation. Urine and sputum samples were difficult to obtain due to the underlying diseases of the patients. Serological diagnostics constituted an important part of the epidemiological investigation. Sixty-four environmental samples were taken to identify the sources of infection. By genotyping, we assessed the affinity of the allelic profile of Legionella pneumophila serogroup 1 in environmental samples and in patient samples.
Legionnaires' disease was diagnosed in 10 patients based on a combination of various tests. Legionella pneumophila serogroup 1, Legionella pneumophila serogroups 2-14, and Legionella sp., in concentrations of < 10 to 61,000 CFU/l, were isolated from 51 out of 64 environmental samples. The source of the outbreak was confirmed by genotyping the isolates from patients and the isolates from the water supply system. The 2 isolates had identical allelic profiles corresponding to that of L. pneumophila serogroup 1 allelic profile 2,3,9,10,2,1,6, designated sequence type 23 (according to the European Working Group for Legionella Infections).
We describe a Legionella pneumophila serogroup 1 outbreak in a Slovenian nursing home. The source of infection was demonstrated using sequence-based typing. Water flow disturbances were determined as the most probable cause of Legionella growth. Overall, the risk of a Legionella outbreak is underestimated in Slovenia.
2010年8月，斯洛文尼亚一家养老院爆发了规模最大的军团病疫情。本文介绍了我们在疫情调查中的经验。
为收集必要的患者流行病学数据，我们使用了个人流行病学调查问卷。从15名患者身上采集了样本并进行实验室检测。由于患者存在基础疾病，尿液和痰液样本难以获取。血清学诊断是流行病学调查的重要组成部分。采集了64份环境样本以确定感染源。通过基因分型，我们评估了环境样本和患者样本中嗜肺军团菌血清1型等位基因谱的相似性。
综合各项检测，10名患者被诊断为军团病。从64份环境样本中的51份分离出了嗜肺军团菌血清1型、嗜肺军团菌血清2 - 14型以及嗜肺军团菌属，浓度范围为< 10至61,000 CFU/升。通过对患者分离株和供水系统分离株进行基因分型，确认了疫情源头。这2株分离株具有相同的等位基因谱，与嗜肺军团菌血清1型等位基因谱2,3,9,10,2,1,6相对应，指定序列类型为23（根据欧洲军团菌感染工作组）。
我们描述了斯洛文尼亚一家养老院爆发的嗜肺军团菌血清1型疫情。通过基于序列的分型确定了感染源。水流扰动被确定为军团菌生长的最可能原因。总体而言，斯洛文尼亚对军团菌爆发的风险估计不足。
