315
12 “Legionnaires’ disease can be acquired by the inhalation of aerosols containing
Legionella
or by
microaspiration of water contaminated with
Legionella
. Aerosol-generating systems that have been linked
to disease transmission include cooling towers, respiratory-therapy equipment, and whirlpool baths. One
of the more fascinating outbreaks originated from an ultrasonic mist machine in a grocery store. This
machine aerolized mist over the produced section, and 28 shoppers contracted Legionnaires’ disease. We
have challenged the role of cooling towers as a reservoir for nosocomial Legionnaires’ disease, but this is
controversial. (…) “Aspiration has been underrecognized as a mode of transmission. Documented episodes
of aspiration have been noted in cases of
Legionella
pneumonia. Nasogastric tubes have been implicated
in several studies of nosocomial legionellosis, microaspiration of contaminated water was the presumed
mode of transmission. One of the highest reported incidences of nosocomial pneumonia due to
Legionella
(30 percent) was reported among patients who had undergone head and neck surgery – patients with high
propensity for aspiration.” Janet E. Stout; Victor L. Yu, Legionellosis, p. 682-683.
13 Other studies include people that are 50 years old or older. Gerald L. Mandell, John E. Bennett, Raphael
Dolin, Principles and practice of Infectious Diseases, p. 2715.
14 “Male sex, cigarette smoking, chronic heart or lung disease, diabetes, end-stage renal failure, organ
transplantation, immunosuppression, some forms of cancer, and age older than 50 years have all been
found to be host risk factors for legionnaires’ disease.” Gerald L. Mandell, John E. Bennett, Raphael Dolin,
ob. cit., p.2715.
15
accessed on 12/13/05.
16 At federal level, the Administrative Rule No. 104, from 01/25/11, of theMinistry of Health, has stipulated
the list of diseases appealing to mandatory and immediate notification.
17 Health and Safety Commission 2000, Legionnaires’ disease: the control of
Legionella
bacteria in water
systems. Approved Code of Practice and Guidance L8, HSE books, PO Box 1999, Sudbury, Suffolk CO 10
2 WA.
18 Health and Safety Commission, The notification of cooling towers and evaporative condensers
regulation, HMSO, 1992.
19 J. V. Lee, Guidelines for investigation single cases of Legionnaires’ disease, p. 159.
20 Donald Armstrong, Jonathan Cohen (org), ob. cit., p. 11.4.
21The rules in the Federal Constitution in the Environmental Law field were deeply inspired in Resolution
3.044 of the World Health Organization, at the 8th National Health Conference and the 2nd International
Health Conference.
22The sole paragraph of article 3 of the referred law regards to health, especially actions intended to ensure
physical, mental, and social welfare conditions for people and for the collectivity.
23 Police power means the set of attributions granted to the Administration to rule and to restrict individual
rights and liberties in favor of a proper public concern. Therefore, this power relates to assets, rights, and
activities.
24 With highlights by this author.
