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Back To Vidyya Legionnaires' Disease Outbreak

Health Advisory Issued In Australia

The Human Services Department, Public Health Division of the Government of Victoria, Australia has confirmed sixty-six cases of Legionnaires' disease, including 2 deaths. The patients, with one exception, had visited the Melbourne Aquarium after 11 April 2000.

Laboratory results for all the cases showed evidence of Legionnella pneumophila - serogroup 1. Test results are pending on a further number of patients who had been to the aquarium and had developed respiratory illness symptoms.

Laboratory test results have also confirmed the presence of legionella bacteria in the cooling towers of the Melbourne Aquarium, which were immediately disinfected.

The outbreak is under investigation. In the meantime, authorities have issued the following information for Australian health care providers:

In the presence of a cluster/outbreak of Legionnaires’ Disease, if a patient presents with a history of exposure to an implicated source such as a building cooling tower, it is important that you consider this diagnosis, particularly when the following features are present:

  • dyspnea but in the absence of significant cough
  • extensive bilateral pneumonia
  • upper lobe pneumonia
  • renal impairment or hyponatremia
  • liver function abnormalities

Cases also often report diarrhea.

Rapid confirmation (within 24 hours) of the diagnosis of Legionnaires’ Disease can be obtained through urinary antigen testing. However, sputum for culture must be sought in all cases. A four fold rise in titre between acute and convalescent sera, or a single high titre of 512 in a convalescent serum sample is also diagnostic. However, a rise in titre may take 2 to 4 weeks to develop.

The antibiotic of choice is IV erythromycin; rifampicin may be a useful adjunct but should not be used alone.

Legionnaires’ disease is a notifiable conditionin Australia and must be reported to authorities within 24 hours of diagnosis. The Communicable Diseases Section should be alerted on clinical suspicion of Legionnaires’ disease, particularly if the case has been exposed to an implicated source during an outbreak.

For Further information, visit the TARGET="_blank">Government of Victoria, Australia Web site, where you'll find information for practitioners, patients and cooling system owner/operators.

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Editor: Susan K. Boyer, RN
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