59
transports the
Legionella
to the lungs and triggers the infectious process.
In this way, we become infected by inhaling aquatic particles from nature
and pipes. As sources of infection we have: water heaters, air conditioning
systems, cooling towers, showers, spa baths, houses with well water
storage tanks, interruptions of water supply with release of dirt in the old
plumbing, among others. In hospitals we also include water contaminated in
humidifiers, plumbing, nebulizers, cooling towers, among others. The sub-
notification of the hospitals also causes variations in the actual situation: up
to 10% of the hospital-acquired pneumonias can be caused by
Legionella
,
and 2 to 15% of the pneumonias caused by
Legionella
are hospital ones.
2
Abrief interrogationof thepatientwithpneumoniaontheadmissionmay
give evidence of any inhaling condition of contaminated aerosols and then
reinforce the possibility of
Legionella
. Examples of this abound. In1999,more
than a hundred visitors of an agricultural and flowers fair became infected
in the Netherlands. The probable origin of the contaminated aerosols was in
the water spray guns for the flowers, in the ornamental fountains and in the
spa baths.
3
In that same decade, fifty patients were identified as being infected
during international cruise travels. The probable infection occurred through
the water of the whirlpool spa that they used.
4
The number of examples
increases. The cooling tower of an Australian aquarium was responsible for
the infection of more than a hundred visitors. An unexpected outbreak of
infection came from a North-American restaurant. The decoration fountain
in the lobby of the establishment dispersed aerosols at the entrance of the
restaurant implicated in the cases of
Legionella
pneumonia.
5
These examples
help us to set up a brief interrogation to detect a place with dispersion
of aerosols frequented by the patient, a fact easy to remember since the
incubation period of the disease is between 2 to 10 days, in average.
