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Trends in Legionnaires Disease, 1980–1998: Declining Mortality and New Patterns of Diagnosis
Abstract
New diagnostic tests and empirical therapy for pneumonia may have important ramifications for the identification, treatment, and control of legionnaires disease (LD). To determine trends in the epidemiology of LD, we analyzed data for 1980-1998 from the passive surveillance system of the Centers for Disease Control and Prevention. During this time period, there were 6757 confirmed cases of LD (median annual number, 360 cases/year). Diagnosis by culture and by direct fluorescent antibody and serologic testing decreased significantly; diagnosis by urine antigen testing increased from 0% to 69%. The frequency of isolates other than Legionella pneumophila serogroup 1 (LP1) decreased from 38% to 4% (P=.003). The case-fatality rate decreased significantly, from 34% to 12% (P<.001) for all cases, from 46% to 14% (P<.0001) for nosocomial cases, and from 26% to 10% (P=.05) for community-acquired cases. LD-related mortality has decreased dramatically. The decrease in culture-based diagnosis limits the recognition of non-LP1 disease and impairs outbreak investigation, because fewer Legionella isolates are provided for further examination.
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Cited by
Causes of Outbreaks Associated with Drinking Water in the United States from 1971 to 2006
Craun, G. F., Brunkard, J. M., Yoder, J. S., Roberts, V. A., Carpenter, J., Wade, T., Calderon, R. L., Roberts, J. M., Beach, M. J., & Roy, S. L. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00077-09 · Cited by 469
Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations
Mercante, J. W., & Winchell, J. M. (2015) · Clinical Microbiology Reviews · doi:10.1128/cmr.00029-14 · Cited by 339
Falkinham, J. O., Hilborn, E. D., Arduino, M. J., Pruden, A., & Edwards, M. A. (2015) · Environmental Health Perspectives · doi:10.1289/ehp.1408692 · Cited by 277
Duncan, C., Prashar, A., So, J., Tang, P., Low, D. E., Terebiznik, M., & Guyard, C. (2011) · Infection and Immunity · doi:10.1128/iai.01304-10 · Cited by 63
Metadata
- Authors
- Benin, A. L., Benson, R. F., & Besser, R. E.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-11
- Volume
- 35
- Issue
- 9
- Pages
- 1039-1046
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2154631013
- Cited by
- 295
- References
- 0
- FWCI
- 8.82
- Type
- journal article
- Language
- en
- Open access
- closed
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- Benin, A. L., Benson, R. F., & Besser, R. E. (2002). Trends in Legionnaires Disease, 1980–1998: Declining Mortality and New Patterns of Diagnosis. Clinical Infectious Diseases. https://doi.org/10.1086/342903
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