Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine.
Department of Epidemiology, University of Iowa College of Public Health.
Curr Opin Infect Dis. 2018 Aug;31(4):325-333. doi: 10.1097/QCO.0000000000000468.
The present review summarizes new knowledge about Legionella epidemiology, clinical characteristics, community-associated and hospital-based outbreaks, molecular typing and molecular epidemiology, prevention, and detection in environmental and clinical specimens.
The incidence of Legionnaire's disease is rising and the mortality rate remains high, particularly for immunocompromised patients. Extracorporeal membrane oxygenation may help support patients with severe respiratory failure. Fluoroquinolones and macrolides appear to be equally efficacious for treating Legionnaires' disease. Whole genome sequencing is an important tool for determining the source for Legionella infections and for understanding routes of transmission and mechanisms by which new pathogenic clones emerge. Real-time quantitative polymerase chain reaction testing of respiratory specimens may improve our ability to diagnose Legionnaire's disease. The frequency of viable but nonculturable organisms is quite high in some water systems but their role in causing clinical disease has not been defined.
Legionellosis remains an important public health threat. To prevent these infections, staff of municipalities and large buildings must implement effective water system management programs that reduce Legionella growth and transmission and all Medicare-certified healthcare facilities must have water management policies. In addition, we need better methods for detecting Legionella in water systems and in clinical specimens to improve prevention strategies and clinical diagnosis.
本文总结了军团菌病在流行病学、临床特征、社区相关性和医院相关性暴发、分子分型和分子流行病学、预防以及环境和临床标本中检测等方面的新知识。
军团病的发病率正在上升，死亡率仍然很高，特别是对免疫功能低下的患者。体外膜氧合可能有助于支持严重呼吸衰竭的患者。氟喹诺酮类和大环内酯类药物似乎对治疗军团病同样有效。全基因组测序是确定军团菌感染源以及了解传播途径和新致病克隆出现机制的重要工具。呼吸道标本实时定量聚合酶链反应检测可能提高我们诊断军团病的能力。在一些水系统中，活但非可培养生物的频率相当高，但它们在引起临床疾病中的作用尚未确定。
军团菌病仍然是一个重要的公共卫生威胁。为了预防这些感染，市政和大型建筑物的工作人员必须实施有效的水系统管理计划，以减少军团菌的生长和传播，所有经医疗保险认证的医疗保健机构都必须有水管理政策。此外，我们需要更好的方法来检测水系统和临床标本中的军团菌，以改善预防策略和临床诊断。
