Microbiology and Virology Unit, Department of Laboratory Medicine, A. Manzoni Hospital, Lecco, Italy.
Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Monte Porzio Catone, Rome, Italy.
Environ Res. 2017 Jan;152:485-495. doi: 10.1016/j.envres.2016.09.018. Epub 2016 Oct 4.
Legionellosis is the common name for two infections, Legionnaires' disease (LD) and Pontiac fever (PF), both caused by Legionella bacteria. Although with low incidence, LD is an important cause of community- and hospital-acquired pneumonia. Among community-acquired cases, an increasing number was reported to be linked to the occupational setting, posing the need for better recognition of work activities at risk of legionellosis. In this work, we selected and reviewed relevant literature on cases of occupational legionellosis published between 1978 and 2016 in order to define the: i) etiology; ii) sources of infection, iii) work activities at risk, iv) infection rates, v) predisposing factors, vi) mortality and vii) country distribution. To our knowledge, this is the first review to provide an analysis of cases of occupational legionellosis. A literature search in the PubMed website was started on January 31, 2015 and ended on June 30, 2016. Cases of occupational legionellosis documented in the scientific literature were retrieved from PubMed upon interrogation with the following keywords: "Legionella pneumophila", "Legionnaires' disease", "Pontiac fever", and "legionellosis", in combination with "employees", "workers", and "occupational". Abstracts were reviewed, and applicable articles were obtained. Only articles that met the inclusion criteria were considered. Forty-seven articles were selected, reporting confirmed cases of legionellosis which occurred over 66 years (1949-2015), and involved 805 workers (221, LD; 584, PF). Fatalities were all associated with LD, resulting in 4.1% mortality. The most common etiologic agents were Legionella pneumophila (58.5%) and Legionella feeleii (39.4%), the latter being responsible for only one large outbreak of PF. Workplaces more frequently associated with occupational legionellosis were industrial settings (62.0%), office buildings (27.3%) and healthcare facilities (6.3%), though cases were also reported from a variety of workplaces, e.g. artesian excavation and horticultural sites, lorry parks, ships, water and sewage plants. With few exceptions, cases occurred in industrialized countries of the northern hemisphere. Overall, our review highlights an extended spectrum of occupational categories at risk for legionellosis. For all categories, infection originated from exposure to work-generated aerosols contaminated with Legionella spp., and industrial facilities equipped with cooling towers or coolant systems were the most common occupational settings. These observations should raise awareness of the risk of acquiring legionellosis at work, and help to improve prevention and control measures for this infrequent but still problematic disease.
军团病是两种感染的通用名称，军团菌病（LD）和庞蒂亚克热（PF），均由军团菌引起。尽管发病率较低，但 LD 仍是社区和医院获得性肺炎的重要病因。在社区获得性病例中，越来越多的病例报告与职业环境有关，这需要更好地认识到存在军团病风险的工作活动。在这项工作中，我们选择并回顾了 1978 年至 2016 年间发表的关于职业性军团病的相关文献，以确定：i）病因；ii）感染源；iii）有风险的工作活动；iv）感染率；v）易患因素；vi）死亡率；和 vii）国家分布。据我们所知，这是首次对职业性军团病病例进行的综述。于 2015 年 1 月 31 日在 PubMed 网站上开始进行文献检索，并于 2016 年 6 月 30 日结束。通过使用以下关键字在 PubMed 中查询“Legionella pneumophila”，“Legionnaires' disease”，“Pontiac fever”和“legionellosis”，结合“employees”，“workers”和“occupational”，从科学文献中检索到职业性军团病的病例记录。对摘要进行了审查，并获得了适用的文章。仅考虑符合纳入标准的文章。选择了 47 篇文章，报告了过去 66 年（1949-2015 年）发生的军团病确诊病例，涉及 805 名工人（221 例，LD；584 例，PF）。死亡均与 LD 有关，死亡率为 4.1％。最常见的病原体是嗜肺军团菌（58.5％）和嗜肺军团菌（39.4％），后者仅引起一次庞蒂亚克热的大规模暴发。与职业性军团病更频繁相关的工作场所是工业场所（62.0％），办公楼（27.3％）和医疗保健设施（6.3％），尽管也有来自各种工作场所的报告，例如自流井挖掘和园艺场所，货车停车场，船舶，水和污水处理厂。除了少数例外，病例发生在工业化国家的北半球。总体而言，我们的综述突出了职业类别中存在的广泛的军团病风险。对于所有类别，感染均源自暴露于工作产生的受军团菌污染的气溶胶，并且装有冷却塔或冷却剂系统的工业设施是最常见的职业环境。这些观察结果应引起人们对在工作中感染军团病的风险的认识，并有助于改善针对这种罕见但仍存在问题的疾病的预防和控制措施。
