Legionella and Influenza Preparedness Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; University of Chester, Chester, UK.
Legionella and Influenza Preparedness Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
Lancet Infect Dis. 2014 Oct;14(10):1011-21. doi: 10.1016/S1473-3099(14)70713-3. Epub 2014 Jun 23.
Legionnaires' disease is an important cause of community-acquired and hospital-acquired pneumonia. Although uncommon, Legionnaires' disease continues to cause disease outbreaks of public health significance. The disease is caused by any species of the Gram-negative aerobic bacteria belonging to the genus Legionella; Legionella pneumophila serogroup 1 is the causative agent of most cases in Europe. In this Review we outline the global epidemiology of Legionnaires' disease, summarise its diagnosis and management, and identify research gaps and priorities. Early clinical diagnosis and prompt initiation of appropriate antibiotics for Legionella spp in all patients with community-acquired or hospital-acquired pneumonias is a crucial measure for management of the disease. Progress in typing and sequencing technologies might additionally contribute to understanding the distribution and natural history of Legionnaires' disease, and inform outbreak investigations. Control of Legionnaires' disease outbreaks relies on rapid ascertainment of descriptive epidemiological data, combined with microbiological information to identify the source and implement control measures. Further research is required to define the actual burden of disease, factors that influence susceptibility, key sources of infection, and differences in virulence between strains of Legionella species. Other requirements are improved, specific, sensitive, and rapid diagnostic tests to accurately inform management of Legionnaires' disease, and controlled clinical trials to ascertain the optimum antibiotics for treatment.
军团病是社区获得性和医院获得性肺炎的重要病因。尽管并不常见，但军团病仍持续引发具有公共卫生意义的疾病暴发。该病由革兰氏阴性需氧菌属军团菌属的任何菌种引起；军团菌属 1 血清群是欧洲大多数病例的病原体。在本综述中，我们概述了军团病的全球流行病学，总结了其诊断和管理，并确定了研究空白和优先事项。对于所有社区获得性或医院获得性肺炎患者，早期临床诊断并及时开始使用适当的抗生素治疗军团菌属，是管理该疾病的关键措施。分型和测序技术的进步可能有助于了解军团病的分布和自然史，并为暴发调查提供信息。军团病暴发的控制依赖于快速确定描述性流行病学数据，结合微生物学信息来识别来源并实施控制措施。还需要进一步研究来确定疾病的实际负担、影响易感性的因素、感染的主要来源以及军团菌属菌株之间的毒力差异。其他需求包括改进、特异性、敏感性和快速的诊断检测，以准确指导军团病的管理，以及开展对照临床试验，确定治疗军团病的最佳抗生素。
