Talk:Legionellosis

From Wikipedia, the free encyclopedia

	This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
Unassessed	rated as Unassessed-Class on the assessment scale
???	This article has not yet received an importance rating on the assessment scale.

	Legionellosis is part of the WikiProject Philadelphia, an effort to build a comprehensive and detailed guide to Philadelphia and the Delaware Valley on Wikipedia. If you would like to participate, you can edit the article attached to this page, or visit the project page, where you can join the project and/or contribute to the discussion.
???	This article has not yet received a rating on the quality scale.
???	This article has not yet received a rating on the importance scale.

http://www.abc.net.au/science/news/stories/s1549987.htm France, 2004. 21 Dead, 65 with disease. --Copeland.James.H 21:31, 31 May 2006 (UTC)

http://www.hcinfo.com/outbreaks-news.htm#Return%20to%20list http://www.legionella.com/Documents/Fatal-legionnaires-outbr.pdf March 2006 One 85-year-old man died, and 9 people had legionnaires' disease. The outbreak A cooling tower caused the outbreak in Preston, near Melbourne Australia. --Copeland.James.H 21:16, 31 May 2006 (UTC)

The text on this page began as a direct copy of a page from the US Center of Disease Control web site. [1] I'm not marking it as a copyvio yet, because I *think* this is okay... I think that official US government information can't be copyrighted - is this correct? Even if there's no legal problem, I think there should be a disclaimer on the page citing its original source, and the section names shouldn't be questions. - Brian Kendig 07:11, 18 Jan 2005 (UTC)

Yes, info from US government pages are generally non-copyrighted (there are exceptions). Yes, please rewrite the headers. Rick K 07:16, Jan 18, 2005 (UTC)

I read the entire article and it doesn't mention anywhere that the bacterium can be contracted from soil. The bacteria also lives in soil worldwide. If someone doesn't want to edit this I will, but I have better things to do. --metta, The Sunborn ☥ 19:27, 18 Jan 2005 (UTC)

I did add a small section regarding Legionella Longbeachae, that is contracted from inhaling dust from soil or compost [[[User:Hongkonger|Hongkonger]] 07:22, 18 August 2006 (UTC)]

1 Second Norwegian outbreak
2 Toronto Seniors' Home Case
3 Fountains, Weekly clean and disinfect: Ponds, Spray Heads, all wetted surfaces
4 Major re-write and re-organization
5 Minor Alterations
6 Minor Alterations (more)
7 Noigel, please be more careful about your edits
8 Needs some clarification
9 Reverting changes by Copeland back to last version by 72.155.218.238
10 Date of first outbreak
11 New case in England

[edit] Second Norwegian outbreak

There is currently a second outbreak going on in Norway [2], 5 dead so far, 29 (93 suspected) confirmed infected, source is as of yet unknown. Dunno how often these outbreaks happen worldwide so it might not be worth mentioning, but I noticed the previous outbreak in Savanger was mentioned so I though I'd mention this one. Seeng as this is still "breaking news" I guess it's not wikipedia material yet, but once the dust settles it might be worth adding a paragraph about it. --Sherool 12:01, 25 May 2005 (UTC)

The source has now been found to be Borregaard Fabrikker in Sarpsborg.

sources: http://www.aftenposten.no/nyheter/iriks/article1055306.ece (in Norwegian)

http://www.aftenposten.no/english/local/article1055402.ece (in English)

[edit] Toronto Seniors' Home Case

It has been confirmed that 17 people have been killed by LD, it is believed that another 2 cases have appeared (October 12th, 2005)

[edit] Fountains, Weekly clean and disinfect: Ponds, Spray Heads, all wetted surfaces

Malta requires that Fountains (espcially indoors) have weekly cleaning and disinfection.Malta Dept. of Information Page 30 of 36 --Copeland.James.H 19:10, 30 June 2006 (UTC)

[edit] Major re-write and re-organization

I just finished about 8 hours of work on this article. I started out making some piece-meal changes. Then I decide to copy it into my Sandbox, re-work it completely and then install the re-worked version here. My changes included: copy editing, Wikifying the writing style, adding a few references, consolidating (i.e., merging) some of the sections), and re-arranging the order of some sections. In my opinion, the article is much more coherent now. It probably still needs some work (in particular, more source references). Also, I don't understand why the section entitled "Infections" is included ... I can't see what purpose it serves. Could it be deleted?? - mbeychok 03:58, 2 July 2006 (UTC)

[edit] Minor Alterations

I changed the Barrow outbreak source to cooling tower, the Bellevue Stratford Philly to unknown 1976

Added links to some outbreaks and added support and discussion groups, also added comments that it was never proved the Bellevue was the cause of the legionnaires disease outbreak

--Noigel2000 14:19, 5 July 2006 (UTC)

Noigel, thanks very much for your contributions here and also in the Legionella article.

I would like to point out that Wikipedia is an encyclopedia and comments like "It should be pointed out that it was never proved that the Bellevue Stratford Hotels Airconditioning was the cause of the Legionnaires' disease Outbreak, It is a shame that people never check their information when writng about LD and the Bellevue" is not the sort of comment to be in an encyclopedia. I don't know who wrote the original paragraph about the Bellevue, but it does include a verifiable source reference. I realize that you are new to Wikipedia ... as you get more familiar with Wikipedia, you find that it includes and strongly enforces what is called a "Neutral point of view" (NPOV) policy. That means that Wikipedia does not want comments or contributions that are not balanced and which do not respect all points of view on any subject.

Accordingly, I am changing your comment to read: "It should be pointed out that there are some who do not believe that it was conclusively proven that the air conditioning conditioning was the cause of the outbreak." It would be very useful if you could furnish some source references in support of that point of view. If so, please do it here on the Talk page before altering the article itself. - mbeychok 16:37, 5 July 2006 (UTC)

[edit] Minor Alterations (more)

You should read my first outbreak page, these comments by Dr Yu

The disease is still being misdiagnosed as pneumonia in many cases, according to Dr. Victor L. Yu. Yu, one of the most zealous researchers of the disease nationwide, is the chief of the Oakland VA medical center's infectious disease section.

He is displeased that the public carries misperceptions about the 1976 outbreak. Some still believe the source of the bacterium to be the Bellevue-Stratford's air conditioning system when, in fact, the source has never been identified, Yu said. "It disturbs us because many of these people are physicians," Yu said. "This is one of the great modern myths."

Visit his site at

http://www.legionella.org/

--Noigel2000 21:31, 5 July 2006 (UTC)

Taken from the commemoration of CDC’s 50th anniversary, MMWR reprinted this historical article.

Reprinted is the initial report published August 6, 1976, on an outbreak of respiratory illness among persons who attended an American Legion convention in Philadelphia during the summer of 1976.

Following that report is the special issue of MMWR published January 18, 1977, which announced the identification of the bacterium that caused Legionnaires disease.

[[The source of the organism in the outbreak is not known, but the search should now be greatly facilitated. Reported by the Leprosy and Rickettsia Br, Virology Div, Bur of Laboratories, CDC.]]

A copy of the report is on my first outbreak page

http://www.q-net.net.au/~legion/Legionnaires_Disease_Worlds_First_Outbreak.htm

You can try searching the MMWR pages for the report

--Noigel2000 00:51, 6 July 2006 (UTC)

I have added a sentence about Dr.Yu's opinion that the Bellevue Hotel outbreak source is still unknown and a reference to your website where that opinion is quoted by your website. However, that is as far as I am willing to accept your website's information.

Noigel, I must point out that you simply must learn how to cite a reference more correctly and more specifically. You must do better than just say "You can try searching the MMWR pages for the report" ... you must spell out what the MMWR stands for and you must give a specific location (what book or journal or website), date, author, and exact title. Also, as to Dr. Yu's site, you cannot say simply "Visit his site". Since his site has a great many different pages, you should spell out very clearly where to look in his site.

The tabulation of suspected sources in this article is just that ... a list of suspected sources (it doesn't say proven sources). For that reason, I am reverting the suspected source in the Philadelphia outbreak (the Bellevue Hotel) back to "cooling tower" until such time as you can furnish some credible, legible and correctly cited sources to the contrary. After all, most of your comments above are taken from your own website and, even there, it is difficult to find any specific, correctly cited sources. - mbeychok 02:56, 6 July 2006 (UTC)

I wonder why you dont know what MMWR stands for its the official mag of the CDC

The Morbidity and Mortality Weekly Report , Department of Health and Human Services Centers for Disease Control and Prevention

A copy of this is on my first outbreak page, atr the time there was no link back to CDC for this item as it was a special presentation

I spend 16 hours aday on my comp, I cant look out for everyone, I search the net on the slightest piece of information I dont expect people to wet nurse me I check for myself, the link you have which states the cooling tower is really not a true article and written by students

I will put this link on the page and change the source to unknown

http://www.cdc.gov/mmwr/preview/mmwrhtml/00045731.htm --Noigel2000 07:10, 6 July 2006 (UTC)

I will add that i search the net on the slighted piece of information I get, I dont expect people to give me things on a plate, I cant see the point of me having a CDC article on my pages and then putting a link back to the source, whats the point of my pages if i do that

--Noigel2000 07:29, 6 July 2006 (UTC)

Same as this place its all click click click, no point really, spend a couple of hours on my pages and you will learn everything about LD

Forgot to say the official total of cases is 180 with 29 deaths

--Noigel2000 07:52, 6 July 2006 (UTC)

This is getting to be a little rediculous. Noige, you are citing the issue of MMWR from January 1977 as your source for the statements that the source of the Philadelphia Legionnella was never found. That is the issue where they announced the identification of the causative bacterium, a mere 9 months after the disease cluster was identified, and some 29 years ago. In my opinion, its only reasonable use as a citation regarding bacteria source is as an indication of what was known three decades ago. I think we need a more current citation for a claim that the source has not been identified to this day.

I am going to make some changes in the hope that I can find some NPOV ground between you and Mbeychok

Pzavon 17:19, 6 July 2006 (UTC)

Pzavon, thanks for your input and I agree with your changes. I just want to clarify that I really had no POV one way or the other. All I wanted was a coherently written contribution substantiated by a clearly stated and verifiable reference ... but it seems that I couldn't get that across to Noigel. Thanks again. - mbeychok 18:15, 6 July 2006 (UTC)

Noigel, it doesn't matter whether or not you or I knows what MMWR means. What does matter is that many Wikipedia readers may not know and it is our function to tell them what it means. It also doesn't matter if you think Wikipedia is all "click, click, click" or that your web site is better than Wikipedia as a source of Legionellosis data. What does matter is that a Wikipedia article should furnish coherently expressed information backed up by clearly and correctly stated verifiable references. - mbeychok 18:15, 6 July 2006 (UTC)

You need to show me a citation from the CDC who investigated the outbreak that says the cooling tower was at fault, which I know you cant do, you can point to citations written by Phd's and MD's that write about the outbreak saying the cooling tower was to blame, but you cant show me one thats official, The truth must be told here for people to read....so show me an official document that says the tower was to blame and I have not put MMWR up on the legionellose page, you avoid the issue, i said you should know what MMWR stands for

Now show me a document that blames the tower

--Noigel2000 00:17, 7 July 2006 (UTC)

Ghad! CDC is not the only source of valid conclusions regarding such an event, especially after some time has passed. CDC was primarily interested in identifying the agent. They did that and others went on to use that information both in evaluating the Philadelphia incident and in dealing with other clusters of this disease.

For Wikipedia one important item is the fact, which YOU acknowledge, that most people believe the cooling system was the source. I am confident that we are never going to have more definitive information on the source than we have now. Even 15 years ago too much time had passed to expect to get better information. So, many/most think it was the cooling system, as has been shown to be the case in many other clusters. Some, or perhaps just two, say the cooling system was not conclusively shown to be the source (but apparently don't offer an alternative suggestion). Both opinions are now represented in the article. The goal is a good article, not to express the "one true fact." Let's move on. Pzavon 02:09, 7 July 2006 (UTC)

Perhaps you could point me to the official findings on this were it states the cooling tower was at fault, most people only believe its the cooling tower because misinformed people keep writing that its the cooling tower. In early outbreaks after the bellevue there was a number of hospital outbreaks whos cooling towers were blamed when in fact it was the HWS. and anyhow where did you pop up from Pzavon

--Noigel2000 06:28, 7 July 2006 (UTC)

[edit] Noigel, please be more careful about your edits

Noigel, in your last edit,when you changed a link (at the bottom of the section on Philadelphia) to a reference you closed the reference with ,/ref> which is incorrect syntax. It should have been </ref>. As a result of that incorrect syntax, all of the article beyond that point was deleted. You really must be more careful of what you do and you should use the "Preview" button to check the whole article before you submit an edit concerning References. I have fixed it now. - mbeychok 17:10, 7 July 2006 (UTC)

I think that was my error, not Noigel's. Sorry. Pzavon 01:59, 8 July 2006 (UTC)

Pzavon, the History page of Legionellosis clearly shows that Noigel made that error at 07:40, 7 July 2006. Are we both on the same page? - mbeychok 02:44, 8 July 2006 (UTC)

[edit] Needs some clarification

First it says that legionellosis is "also known as" Legionnaires' disease, then it says legionellosis has two forms, one of which is Legionnaires' disease. Not logical!--BillFlis 12:04, 16 July 2006 (UTC)

[edit] Reverting changes by Copeland back to last version by 72.155.218.238

James, this is an article about the disease Legionellosis and you are trying to turn it into a tedious, detailed maintenance manual on how to control Legionella in cooling towers. Everything you added is covered in even greater detail by the 11 external links prominently listed in the existing section "Gudelines for control of Legionella in cooling towers". Why clutter up this article with material covered in those referenced guidelines and maintenance manuals?

I am reverting your changes back to the last version of this article by 72.155.218.238. PLEASE don't start a reversion war. - mbeychok 22:08, 16 July 2006 (UTC)

Me thinks its you trying to start a war mbeychok , its you that keeps changing things, put james article back or i will

you had the sauce to rewrite everything without asking and then pat yourself on the back...good job mbeychok well done, stuff the rest..opps Mongo noigels at it again can we ban him, go back to your knitting mbeychok or pop over to the middle east seems they need a good chemical engineer not sure what for though could be target pratice--Noigel2000 07:51, 19 July 2006 (UTC)

Hey, mbeychok, get with the program. You need to ask Noigel's permission before you change anything on one of his pages. How rude of you to intrude! Didn't you smell his marking of his territory? Take a ball of chalk, or complain to your storm and strife. Go, Noigel! Noigel for benevolent dictator of all Wikipedia! (Not just the itty-bitty parts of legionella, legionellosis, and The Bellevue-Stratford Hotel.) All hail his private domain, his personal glory. And don't denigrate his personal pages, even if you don't know they're his, because it upsets him terribly. Fear his wrath!--BillFlis 03:32, 20 July 2006 (UTC)

Shucks not another clown on the page, seems you sll can alter the page other folks have msde alterations to, but i cant oh well will ask MONGO to ban you.... oppps thats mbeychok tune, sorry about that

If you study both legionella and legionellosis pages you have turned both of them into treatment for coolong towers and just reread the pages

take the following. people come to learn about legionella not cooling towers

Controlling potential sources of Legionella Common sources of Legionella include cooling towers used in industrial cooling water systems as well as in large central air conditioning systems, domestic hot water systems, fountains, and similar disseminators that draw upon a public water supply. Natural sources include freshwater ponds and creeks.

Recent research in the Journal of Infectious Diseases provides evidence that Legionella pneumophila, the causative agent of Legionnaires disease, can travel at least 6 km from its source by airborne spread. It was previously believed that transmission of the bacterium was restricted to much shorter distances. A team of French scientists reviewed the details of an epidemic of Legionnaires disease that took place in Pas-de-Calais in northern France in 2003–2004. There were 86 confirmed cases during the outbreak, of whom 18 perished. The source of infection was identified as a cooling tower in a petrochemical plant, and an analysis of those affected in the outbreak revealed that some infected people lived as far as 6–7 km from the plant.[3]

Several European countries established a working group known as the European Working Group for Legionella Infections (EWGLI)[4] to share knowledge and experience about monitoring potential sources of Legionella. That group has published guidelines about the actions to be taken to limit the number of colony forming units (i.e., the aerobic count) of micro-organisms per mL at 30°C (minimum 48 hours incubation):

Aerobic count Action required 10,000 or less System under control. more than 10,000 up to 100,000 Review program operation. The count should be confirmed by immediate re-sampling. If a similar count is found again, a review of the control measures and risk assessment should be carried out to identify any remedial actions. more than 100,000 Implement corrective action. The system should immediately be re-sampled. It should then be ‘shot dosed’ with an appropriate biocide, as a precaution. The risk assessment and control measures should be reviewed to identify remedial actions.

Temperature affects the survival of Legionellae as follows:

[edit] Guidelines for control of Legionella in cooling towers Many governmental agencies, cooling tower manufacturers and industrial trade organizations have developed design and maintenance guidelines for preventing or controlling the growth of Legionella in cooling towers. Below is a list of sources for such guidelines:

*****************************************************************************

NOW ON THE LEGIONELLOSIS YOU GOT THIS LOT

YOU CHANGED BACK TO LEGIONELLA, VERY CONFUSING, SO WHAT PAGE AM I ON BOSS LEGIONELLA OR LEGIONELLOSIS

SHIFT THE LOT ON COOLING TOWERS TO THE COOLING TOWER PAGE AND GIVE FOLKS THE INFORMATION ON THE DISEASE THEY ARE LOOKING FOR

BEFORE YOU GO RUNNING TO MONGO, I BEAT YOU THERE, TOLD HIM TO GET SOMEONE ELSE TO READ THE PAGES

BECAUSE IF YOU DONT LOOK AT WHAT YOU HAVE DONE, I'M THINKING OF A MAJOR REWRITE WITH A FEW FRIENDS

BYE FOR NOW, WHOOPPS YOUR OUT OF BREATH ALL READY RUNNING TO MONGO

--Noigel2000 15:10, 20 July 2006 (UTC)

Controlling the potential growth of Legionella in cooling towers Various studies have shown that some 40 to 60% of cooling towers tested contained Legionella.[5]

A recent research study provided evidence that Legionella pneumophila, the causative agent of Legionnaires' disease, can travel at least 6 km from its source by airborne spread. It was previously believed that transmission of the bacterium was restricted to much shorter distances. A team of French scientists reviewed the details of an epidemic of Legionnaires disease that took place in Pas-de-Calais in northern France in 2003–2004. There were 86 confirmed cases during the outbreak, of whom 18 perished. The source of infection was identified as a cooling tower in a petrochemical plant, and an analysis of those affected in the outbreak revealed that some infected people lived as far as 6–7 km from the plant.[6]

Several European countries established a working group known as the European Working Group for Legionella Infections (EWGLI)[7] to share knowledge and experience about monitoring potential sources of Legionella. That group has published guidelines about the actions to be taken to limit the number of colony forming units (i.e., the aerobic count) of micro-organisms per mL at 30°C (minimum 48 hours incubation):

Temperature affects the survival of Legionellae as follows:[8]

158 to 176 °F (70 to 80 °C): Disinfection range At 151 °F (66 °C): Legionellae die within 2 minutes At 140 °F (60 °C): Legionellae die within 32 minutes At 131 °F (55 °C): Legionellae die within 5 to 6 hours Above 122 °F (50 °C): They can survive but do not multiply 95 to 115 °F (35 to 46°C): Ideal growth range 68 to 122 °F (20 to 50°C): Legionellae growth range Below 68 °F: Legionellae can survive but are dormant [edit] Guidelines for control of Legionella in cooling towers Many governmental agencies, cooling tower manufacturers and industrial trade organizations have developed design and maintenance guidelines for preventing or controlling the growth of Legionella in cooling towers. Below is a list of sources for such guidelines:

Centers for Disease Control and Prevention - Procedure for Cleaning Cooling Towers and Related Equipment (pages 239 and 240 of 249) Cooling Technology Institute - Best Practices for Control of Legionella OSHA page on Legionellosis Association of Water Technologies - Legionella 2003 California Energy Commission - Cooling Water Management Program Guidelines For Wet and Hybrid Cooling Towers at Power Plants Marley Cooling Technologies - Cooling Towers Maintenance Procedures Marley Cooling Technologies - ASHRAE Guideline 12-2000 - Minimizing the Risk of Legionellosis Marley Cooling Technologies - Cooling Tower Inspection Tips {especially page 3 of 7} Tower Tech Modular Cooling Towers - Legionella Control GE Infrastructure Water & Process Technologies Betz Dearborn - Chemical Water Treatment Recommendations For Reduction of Risks Associated with Legionella in Open Recirculating Cooling Water Systems Wisconsin Division of Health, Control of Legionella in Cooling Towers: Summary Guidelines, June 1987, Wisconsin Department of Health and Social Sciences. The guidance issued by the UK government's Health and Safety Executive (HSE) now recommends that microbiological monitoring for wet cooling systems, using a dip slide, should be performed weekly.[9]

[edit] Date of first outbreak

I'm reading this: "The first recognized outbreak occurred on July 27, 1976 at ... " which seems too precise; previously, it read "... in July 1976", which I thought was specific enough. If we're going to put an exact date, shouldn't it read "The first outbreak was first recognized on (date)"? or at most specific, "... was believed to start on (date)"? Does any reference clarify this?--BillFlis 00:39, 28 July 2006 (UTC)

I don't know an exact date and one isn't immediately obvious, primarily for the reason that you mention - there should be no exact date. The outbreak unfolds over time and is recognized at a certain date. Feel free to change it back, IMO - InvictaHOG 01:57, 28 July 2006 (UTC)

Just to muddy the waters a little, although the first case of illness emerged in July 76, nobody knew what was the cause of the illness. It wasn't until six months later, in Jan. 1977 (cant lookup the date if you wish) that CDC identified the caustitive agent and called a press conference to inform the public - Hongkonger 18-8-2006

[edit] New case in England

Hi there, I hope you all don't mind, I added another case of Legionnaires' disease that has recently occured in Bath, England. --207.174.142.110 16:00, 8 August 2006 (UTC)

I removed that material. One case does not make an "outbreak" and this part of the article has been a list of significant outbreaks in which large numbers of people were infected. If we started listing all the single cases of infection the article would be nothing but a list of individual cases. Pzavon 02:33, 9 August 2006 (UTC)

Retrieved from "http://en.wikipedia.org../../../l/e/g/Talk%7ELegionellosis_ecee.html"

Categories: Unassessed-Class medicine articles | Unassessed-importance medicine articles | Unassessed Philadelphia articles | Unknown-importance Philadelphia articles | WikiProject Philadelphia articles