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Marchand G, Wingert L, Viegas C, Caetano L, Viegas S, Twaruzek M, Lacombe N, Lanoie D, Valois I, Gouin F, Soszczyńska E, Kosicki R, Dias M, Debia M. Assessment of waste workers occupational risk to microbial agents and cytotoxic effects of mixed contaminants present in the air of waste truck cabin and ventilation filters. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2024; 74:145-162. [PMID: 38166349 DOI: 10.1080/10962247.2023.2299424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/20/2023] [Indexed: 01/04/2024]
Abstract
Workers in the waste-processing industry are potentially exposed to high concentrations of biological contaminants, leading to respiratory and digestive problems and skin irritations. However, few data on the exposure of waste collection truck (WCT) drivers are available. The goal was to document the microbial risk of the waste collection truck (WCT) workers while in the vehicle cab. Long-period sampling using the truck air filters (CAF) and short time ambient air sampling in the cab were used. The potential release of microbial particles from CAFs was also investigated since it could contribute to the microbial load of the cabin air. A combination of analytical methods also helped assess the complex mixture of the biological agents. Aspergillus sections Fumigati and Flavi, E. coli, Enterobacter spp. and Legionella spp. were detected in the CAF of trucks collecting three types of waste. The highest levels of bacteria and fungi were found in the CAF from organic WCT. The highest endotoxin concentrations in CAF were 300 EU/cm2. Most of the CAF showed cytotoxic effects on both lung cells and hepatocytes. Only one mycotoxin was detected in a CAF. The maximal concentrations in the ambient WCT air varied according to the type of waste collected. The highest proportion (84%) of the air samples without cytotoxic effects on the lungs cells was for the recyclable material WCTs. The results revealed the potential microbial risk to workers from a complex mixture of bio-contaminants in the cabs of vehicles collecting all types of waste. The sustained cytotoxic effect indicates the potential adverse health-related impact of mixed contaminants (biological and non-biological) for the workers. Overall, this study highlights the benefits of using complementary sampling strategy and combined analytical methods for a the assessment of the microbial risk in work environments and the need to implement protective measures for the workers.Implications: Exposure to microbial agents is a well-known occupational hazard in the waste management sector. No previous study had evaluated the cytotoxicity of ambient air and ventilation filters to document worker exposure to a combination of contaminants during waste collection. This research confirms the usefulness of ventilation filters for long-term characterization of exposure to infectious agents, azole-resistant fungi, coliform bacteria and mycotoxin. Overall, this study highlights the importance of using several sampling and analysis methods for a comprehensive assessment of microbial risk in work environments, as well as the need to implement appropriate protective measures for collection workers.
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Affiliation(s)
- Genevieve Marchand
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Montreal, Canada
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montreal, Canada
| | - Loïc Wingert
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Montreal, Canada
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montreal, Canada
| | - Carla Viegas
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, In-stituto Politécnico de Lisboa, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Liliana Caetano
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, In-stituto Politécnico de Lisboa, Lisboa, Portugal
- Research Institute for Medicines (iMed. ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Magdalena Twaruzek
- Faculty of Biological Sciences, Department of Physiology and Toxicology, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Nancy Lacombe
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montreal, Canada
| | - Delphine Lanoie
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montreal, Canada
| | - Isabelle Valois
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Montreal, Canada
| | - Francois Gouin
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail, Montreal, Canada
| | - Ewelina Soszczyńska
- Faculty of Biological Sciences, Department of Physiology and Toxicology, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Robert Kosicki
- Faculty of Biological Sciences, Department of Physiology and Toxicology, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Marta Dias
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia e Saúde, In-stituto Politécnico de Lisboa, Lisboa, Portugal
- Research Institute for Medicines (iMed. ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Maximilien Debia
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Montreal, Canada
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Salambanga FRD, Wingert L, Valois I, Lacombe N, Gouin F, Trépanier J, Debia M, Soszczyńska E, Twarużek M, Kosicki R, Dias M, Viegas S, Caetano L, Viegas C, Marchand G. Microbial contamination and metabolite exposure assessment during waste and recyclable material collection. ENVIRONMENTAL RESEARCH 2022; 212:113597. [PMID: 35660405 DOI: 10.1016/j.envres.2022.113597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
Waste workers are exposed to bioaerosols when handling, lifting and dumping garbage. Bioaerosol exposure has been linked to health problems such as asthma, airway irritant symptoms, infectious, gastrointestinal and skin diseases, and cancer. Our objective was to characterize the exposure of urban collectors and drivers to inhalable bioaerosols and to measured the cytotoxic effect of air samples in order to evaluate their health risk. Personal and ambient air sampling were conducted during the summer of 2019. Workers from 12 waste trucks collecting recyclables, organic waste or compost were evaluated. Bacteria and fungi were cultured, molecular biology methods were used to detect microbial indicators, cytotoxic assays were performed and endotoxins and mycotoxins were quantified. Domestic waste collectors were exposed to concentrations of bacteria and endotoxins above the recommended limits, and Aspergillus section Fumigati was detected at critical concentrations in their breathing zones. Cytotoxic effects were observed in many samples, demonstrating the potential health risk for these workers. This study establishes evidence that waste workers are exposed to microbial health risks during collection. It also demonstrates the relevance of cytotoxic assays in documenting the general toxic risk found in air samples. Our results also suggest that exposures differ depending on the type of waste, job title and discharge/unloading locations.
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Affiliation(s)
- Fabiola R D Salambanga
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Canada; Institut de Recherche Robert-Sauvé en Santé et Sécurité Du Travail, Canada
| | - Loïc Wingert
- Institut de Recherche Robert-Sauvé en Santé et Sécurité Du Travail, Canada
| | - Isabelle Valois
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Canada
| | - Nancy Lacombe
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Canada
| | - François Gouin
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Canada
| | - Julien Trépanier
- Institut de Recherche Robert-Sauvé en Santé et Sécurité Du Travail, Canada
| | - Maximilien Debia
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Canada
| | - Ewelina Soszczyńska
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Magdalena Twarużek
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Robert Kosicki
- Kazimierz Wielki University, Faculty of Biological Sciences, Department of Physiology and Toxicology, Chodkiewicza 30, 85-064, Bydgoszcz, Poland
| | - Marta Dias
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Canada
| | - Susana Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Canada; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal
| | - Liliana Caetano
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Carla Viegas
- H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Portugal; Comprehensive Health Research Center (CHRC), Canada; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal
| | - Geneviève Marchand
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Canada; Institut de Recherche Robert-Sauvé en Santé et Sécurité Du Travail, Canada.
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Beekman RRAL, Duijkers RR, Snijders DD, van der Eerden MM, Kross MM, Boersma WWG. Validating a clinical prediction score for Legionella-related community acquired pneumonia. BMC Infect Dis 2022; 22:442. [PMID: 35534798 PMCID: PMC9081661 DOI: 10.1186/s12879-022-07433-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Legionella-related community acquired pneumonia (CAP) is a disease with an increasing incidence and a high mortality rate, especially if empirical antibiotic therapy is inadequate. Antibiotic treatment highly relies on clinical symptoms, although proven non-specific, because currently available diagnostic techniques provide insufficient accuracy for detecting Legionella CAP on admission. This study validates a diagnostic scoring system for detection of Legionella-related CAP, based on six items on admission (Legionella prediction score). METHODS We included patients with Legionella-related CAP admitted to five large Dutch hospitals between 2006 and 2016. Controls were non-Legionella-related CAP patients. The following six conditions were rewarded one point if present: fever > 39.4 °C; dry cough; hyponatremia (sodium) < 133 mmol/L; lactate dehydrogenase (LDH) > 225 mmol/L; C-reactive protein (CRP) > 187 mg/L and platelet count < 171 × 109/L. The accuracy of the prediction score was assessed by calculating the area under the curve (AUC) through logistic regression analysis. RESULTS We included 131 cases and 160 controls. A score of 0 occurred in non-Legionella-related CAP patients only, a score of 5 and 6 in Legionella-related CAP patients only. A cut-off ≥ 4 resulted in a sensitivity of 58.8% and a specificity of 93.1%. The AUC was 0.89 (95% CI 0.86-0.93). The strongest predictors were elevated LDH, elevated CRP and hyponatremia. CONCLUSIONS This multi-centre study validates the Legionella prediction score, an easily applicable diagnostic scoring system, in a large group of patients and finds high diagnostic accuracy. The score shows promise for future prospective validation and could contribute to targeted antibiotic treatment of suspected Legionella CAP.
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Affiliation(s)
| | - Ruud R Duijkers
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands. .,Department of Pulmonology, Medisch Centrum Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, Netherlands.
| | | | | | - Martijn M Kross
- Department of Pulmonology, Slotervaartziekenhuis, Amsterdam, Netherlands
| | - Wim W G Boersma
- Department of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
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Bell H, Chintalapati S, Patel P, Halim A, Kithas A, Schmalzle SA. Legionella longbeachae pneumonia: Case report and review of reported cases in non-endemic countries. IDCases 2021; 23:e01050. [PMID: 33511033 PMCID: PMC7817369 DOI: 10.1016/j.idcr.2021.e01050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
Legionella longbeachae pneumonia is much less common than Legionella pneumophila pneumonia in most of the world and may evade timely diagnosis in settings that rely primarily on urine antigen testing, which detects Legionella pnuemophila serogroup 1 only. It is, however, widely recognized in Australia and New Zealand, where it is endemic and associated with exposure to compost and potting soils, rather than contaminated water systems as seen with L. pneumophila. L. longbeachae can cause a similar spectrum and severity of illness as L. pneumophila. Here we present a case of a 47-year-old man with L. longbeacheae necrotizing pneumonia following exposure to possibly contaminated soil from a wastewater treatment facility. Initial presentation included cough, chest pain, and dyspnea, and progressed to hypoxic respiratory failure, tension pneumothorax, and cardiac arrest. L. pneumophila urine antigen was negative, but bronchioalveolar lavage samples grew L. longbeachae on buffered charcoal yeast extract agar. A review of cases reported in the literature in non-endemic regions over a 20-year period identified 38 cases in Europe, 33 in Asia, and 8 in North America. Average age was 65, 65 % were male, and 35 % had potentially relevant environmental exposures. L. longbeachae should be considered in cases of severe community acquired pneumonia, particularly following a consistent environmental exposure or if initial testing for other pathogens is unrevealing. A thorough exposure history including questions about contact with potting soil or compost, and utilization of specialized agar for culture can both be key in identifying this pathogen.
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Affiliation(s)
- Harrison Bell
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, United States
| | - Sai Chintalapati
- University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, United States
| | - Preet Patel
- University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, United States
| | - Ameer Halim
- University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, United States
| | - Andrew Kithas
- University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, United States
| | - Sarah A Schmalzle
- Institute of Human Virology, University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, United States.,University of Maryland School of Medicine, Department of Medicine, Division of Infectious Diseases, 655 West Baltimore Street, Baltimore, MD, 21201, United States
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5
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Mondino S, Schmidt S, Rolando M, Escoll P, Gomez-Valero L, Buchrieser C. Legionnaires’ Disease: State of the Art Knowledge of Pathogenesis Mechanisms of Legionella. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2020; 15:439-466. [DOI: 10.1146/annurev-pathmechdis-012419-032742] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Legionella species are environmental gram-negative bacteria able to cause a severe form of pneumonia in humans known as Legionnaires’ disease. Since the identification of Legionella pneumophila in 1977, four decades of research on Legionella biology and Legionnaires’ disease have brought important insights into the biology of the bacteria and the molecular mechanisms that these intracellular pathogens use to cause disease in humans. Nowadays, Legionella species constitute a remarkable model of bacterial adaptation, with a genus genome shaped by their close coevolution with amoebae and an ability to exploit many hosts and signaling pathways through the secretion of a myriad of effector proteins, many of which have a eukaryotic origin. This review aims to discuss current knowledge of Legionella infection mechanisms and future research directions to be taken that might answer the many remaining open questions. This research will without a doubt be a terrific scientific journey worth taking.
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Affiliation(s)
- Sonia Mondino
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Silke Schmidt
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
- Sorbonne Université, Collège doctoral, 75005 Paris, France
| | - Monica Rolando
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Pedro Escoll
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Laura Gomez-Valero
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
| | - Carmen Buchrieser
- Institut Pasteur, Biologie des Bactéries Intracellulaires, CNRS UMR 3525, 75015 Paris, France;, , , , ,
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Marchand G, Lord J, Pépin C, Lacombe N. Combining Environmental Investigation and a Dual-Analytical Strategy to Isolate the Legionella longbeachae Strain Linked to Two Occupational Cases of Legionellosis. Ann Work Expo Health 2018; 62:321-327. [PMID: 29304227 DOI: 10.1093/annweh/wxx109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/01/2017] [Indexed: 11/12/2022] Open
Abstract
Legionella has a global distribution, mainly in aquatic and man-made environments. Under the right conditions, this bacterium is a notorious human pathogen responsible for severe pulmonary illnesses. Legionellosis outbreaks are reported around the world, and exposure to water droplet aerosols containing Legionella pneumophila is usually the mechanism of its transmission. Even if L. pneumophila causes most outbreaks, Legionella longbeachae also accounts for some cases. Unlike most other Legionella strains, L. longbeachae is typically found in soil. Given the wide diversity and high concentration of microorganisms found in soil, isolating L. longbeachae by culture can be challenging. Because the chances of successfully isolating the strain are low, it is often not even attempted. This study reports the strategies used to successfully isolate L. longbeachae strain that was responsible of the two occupational legionellosis in Quebec. Fifteen random samples were collected from the soil of the metal recycling plant where the diagnosed workers were employed, covering 1.5% of the accessible surface of the plant. All samples were analyzed with both the quantitative polymerase chain reaction (qPCR) and culture methods. Four qPCR detection systems targeting Legionella spp, L. pneumophila, L. pneumophila serogroup 1, and L. longbeachae were used. Acid, heat, and acid/heat treatments were used for the culture method. For the qPCR method, all samples were positives for Legionella spp but only four were positives for L. longbeachae. For the culture method, only one isolate could be confirmed to be L. longbeachae. However, that strain proves to be the same one that caused the occupational legionellosis. Detecting the presence of L. longbeachae using the qPCR method made it possible to target the right samples to enable the cultivable strain of L. longbeachae to be isolated from the soil of the metal recycling plant. The complementarity of the two methods was established. This paper demonstrated the advantages of selecting the proper sampling and analytical strategies to achieve the isolation of the strain responsible for the infections. It also highlights for the first time in Quebec the potential occupational risks associated with L. longbeachae from soil and should motivate questioning soil exposures when all sources of water contamination have been eliminated from the causal analysis of legionellosis.
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Affiliation(s)
- Genevieve Marchand
- Department of Chemical and Biological Hazard Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Boul. de Maisonneuve Ouest, Montréal, Quebec, Canada.,Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Department of Environmental and Occupational Health, École de santé publique de l'Université de Montréal, Pavillon Marguerite d'Youville, Chemin de la Côte-Sainte-Catherine, Montréal, Quebec, Canada
| | - Judith Lord
- Direction de santé publique-CISSS de la Montérégie-Centre Équipe de santé au travail, rue Beauregard, Longueuil, Quebec, Canada
| | - Carole Pépin
- Department of Chemical and Biological Hazard Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Boul. de Maisonneuve Ouest, Montréal, Quebec, Canada
| | - Nancy Lacombe
- Department of Chemical and Biological Hazard Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Boul. de Maisonneuve Ouest, Montréal, Quebec, Canada
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Principe L, Tomao P, Visca P. Legionellosis in the occupational setting. ENVIRONMENTAL RESEARCH 2017; 152:485-495. [PMID: 27717486 DOI: 10.1016/j.envres.2016.09.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/07/2016] [Accepted: 09/22/2016] [Indexed: 05/22/2023]
Abstract
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.
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Affiliation(s)
- Luigi Principe
- Microbiology and Virology Unit, Department of Laboratory Medicine, A. Manzoni Hospital, Lecco, Italy
| | - Paola Tomao
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers' Compensation Authority, Monte Porzio Catone, Rome, Italy
| | - Paolo Visca
- Department of Science, Roma Tre University, Rome, Italy.
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