Wilczek H, Kallings I, Nyström B, Hoffner S
Transplantation. 1987 Jun;43(6):847-51.
A cluster of five cases of Legionnaires' disease in renal transplant patients is described. They were treated with erythromycin and rifampicin, and all five survived. Two of them had rejected their grafts prior to their Legionella pneumonia; two rejected their transplants after reduction of immunosuppressive therapy to combat the infection. L pneumophila was present in the water distribution system of the hospital. Eradication measures included flushing the water pipes to the transplantation ward with hot and hyperchlorinated water, raising the warm water temperature to 60 degrees C, and installing ultraviolet (UV) irradiation units on the warm and cold water pipes to the ward. These measures were successful in that no new cases of legionellosis occurred after wards. L pneumophila could subsequently not be demonstrated by culture in plastic shower hoses supplied with UV-irradiated water. L pneumophila could be demonstrated by direct fluorescent antibody technique, but nonspecific reactions cannot be excluded. A higher prevalence of elevated L pneumophila antibody titers was observed in patients nursed for more than four weeks in the hospital than in patients with a shorter hospital stay, in hospital staff members, or in the general population. It seems that, with appropriate control measures, transplantation activities need not be discontinued in the presence of a minor cluster of Legionnaires' disease in renal transplant patients.
本文描述了5例肾移植患者发生军团病的病例群。他们接受了红霉素和利福平治疗，5例均存活。其中2例在患军团菌肺炎之前移植肾已发生排斥反应；2例在为对抗感染而减少免疫抑制治疗后移植肾发生排斥反应。医院的供水系统中存在嗜肺军团菌。根除措施包括用热水和高氯水冲洗通往移植病房的水管，将温水温度提高到60摄氏度，并在通往病房的冷热水管上安装紫外线照射装置。这些措施取得了成功，此后未再发生新的军团病病例。随后，在供应经紫外线照射水的塑料淋浴软管中培养未发现嗜肺军团菌。通过直接荧光抗体技术可检测到嗜肺军团菌，但不能排除非特异性反应。在医院护理超过四周的患者中，嗜肺军团菌抗体滴度升高的患病率高于住院时间较短的患者、医院工作人员或普通人群。似乎采取适当的控制措施后，在肾移植患者中出现少量军团病病例群时，移植活动无需中断。
