Legionella

Legionnaire disease was first described in 1976 after an outbreak of fatal pneumonia in Philadelphia at an American Legion reunion held in a convention. The newly described organism that caused the disease was named Legionella pneumophila.

Morphology
L.pneumophila. Gram negative rods. Stains poorly by gram stain(carbol fuchsin).

Culture
Buffered charcoal yeast extract agar (BCYE). Aerobe,PH 6.9,temperature 35c. humidity 90%. Growth is slow .

Legionella on BCYE
Slowly growing bacteria after 3 days incubation.

Biochemical characters
Catalase positive. Oxidase positive.

Antigenic structure
There are more than 10 serogroups. The original Philadelphia strain serogroup1,is still the most common.

Mode of infection
Inhalation of aerosols carrying the bacteria from warm moist sources. (air conditioning system & shower heads) Its not transmitted from patient to others. L.pneumophila enters and grows within alveolar macrophages , followed by lysis .

Pathogenesis

Pathogenesis
Legionella are found in warm moist environments. Envionmental reservoir;protozoa including amoeba. Asymptomatic infection is common. The incidence of clinically significant disease is high in the old,debilitated &immunocompromised persons. Atypical pneumonia.

Immunity
Just as intracellular multiplication is the key to L.pneumophila virulence ,its inhibition by cell mediated mechanisms appear to be the most important aspect of immunity. The peak antibody response may not occur until 4-8 weeks after infection.

Laboratory diagnosis
Specimens: bronchial washings,pleural
fluid, lung biopsy or blood.

Smears: microcopic examination of direct fluorescent antibody staining of specimen.

L.pneumophila

Laboratory diagnosis
Culture:BCYE agar. Identification:by immunofluorescent staining. Serology: levels of antibodies to legionella rise slowly during the illness. Serological tests are useful in a retrospective diagnosis in outbreaks of legionella infections.

Treatment &control
Erythromycin,the treatment of choice.

Cleaning, chlorination & heating of water can help to control the multiplication of legionellae in water and air conditioning systems.
Not communicable disease