[Occurrence of Legionella in technological water and studies of the total number of bacteria and fungi in indoor air at workplaces where water aerosol is generated]

BACKGROUND

The aim of the study was to confirm the fact that technological water is a significant carrier of Legionella, a potential serious threat to the health of operators of mechanical devices generating contaminated water aerosol.

MATERIAL AND METHODS

Microbiological analyses of water and indoor air were conducted in 8 different production facilities involved in mechanical processing of glass. The study covered 81 samples of water collected from technical water systems. Isolation of Legionella and the determination of total number of microorganisms were processed according to PN-EN ISO 11731-2:2008E and PN-EN ISO 6222:2004P, respectively. Air samples were collected using air samplers and total numbers of bacteria and fungi were determined.

RESULTS

The studies of process water, indicated the presence of Legionella in 27.2% of collected samples. These bacteria were present in both closed and open process water reservoirs at 10 cfu/100 ml to 2.9 x 10(4) cfu/100 ml. The count of other associated bacteria exceeded 10(3) cfu/ml. All strains isolated from Legionella-positive samples were identified as L. pneumophila SG 2-14. In 5 of 8 studied production facilities an increased total number of aerial bacteria and fungi was observed in samples collected in close vicinity of aerosol source.

CONCLUSIONS

To reduce the number of microorganisms in water it is required to introduce technological water quality monitoring and procedures for the cleaning and disinfecting of mechanical devices generating water aerosol.

[Respiratory symptoms among industrial workers exposed to water aerosol. A pilot study of process water and air microbial quality]

BACKGROUND

The frequency of respiratory symptoms in workers exposed to water aerosol was evaluated along with the preliminary assessment of microbiological contamination of air and water used in glass processing plants.

MATERIAL AND METHODS

A questionnaire survey was conducted in 131 workers from 9 glass processing plants. Questions focused on working conditions, respiratory symptoms and smoking habits. A pilot study of air and water microbiological contamination in one glass processing plant was performed. Water samples were tested for Legionella in accordance with EN ISO 11731-2:2008 and for total colony count according to PN-EN ISO 6222:2004. Air samples were tested for total numbers of molds and mildews.

RESULTS

During the year preceding the survey acute respiratory symptoms occurred in 28.2% of participants, while chronic symptoms were reported by 29% of respondents. Increased risks of cough and acute symptoms suggestive of pneumonia were found among the respondents working at a distance up to 20 m from the source of water aerosol compared to other workers (OR = 2.7), with no difference in the frequency of other symptoms. A microbiological analysis of water samples from selected glass plant revealed the presence of L. pneumophila, exceeding 1000 cfu/100 ml. The number of bacteria and fungi detected in air samples (above 1000 cfu/m3) suggested that water aerosol at workplaces can be one of the sources of the air microbial contamination.

CONCLUSIONS

The questionnaire survey revealed an increased risk of cough and acute symptoms suggestive of pneumonia in the group working at a shortest distance form the source of water aerosol.

[New rules of the bathing water quality management]

Directive 2006/7/EC concerning the management of bathing water quality and repealing directive 76/160/ EEC, adopted in 2006, resulted in changes polish laws and regulations of this topic, which were necessary to comply with the new Directive. These included Water Act and three regulations: on bathing water quality surveillance, on bathing waters register and on bathing water profile. The main changes in the sanitary surveillance on bathing waters quality and their consequences for bathers has been discussed in the article. According to new regulations conducting bathing water quality monitoring was handed over to organizers of bathing sites and local government. Bathing water supervision and water quality assessment is in Polish Sanitary Inspection competence. Unique solution of polish law is division of bathing places into two categories: bathing sites and places used for bathing. In a consequence regulations "create" another category of such objects like places used according to custom for bathing by neighbourhood people, which will be left without any supervision. There is significant threat that new formal aspects combined with organisers burdened with supervision and finance responsibilities, will lead to decrease number of bathing sites in favour of growing number of places used for bathing. This can in consequence diminish bathers health safety.

[Wegener's granulomatosis--disease course and treatment response of 18 patients]

Eighteen patients (12 female) with Wegener's granulomatosis (WG) treated from 1982-2001 were studied. Mean duration of patients' symptoms prior to diagnosis was 13.5 months, and mean age 41.2. Lung biopsy confirmed WG in 5 patients, nasal biopsy was made in 12, endobronchial in 3. In 11 of 14 patients cANCAs were found. Prednisone and 2 mg/kg/day doses of oral cyclophosphamide were used to treat 17 patients, prednisone was used alone for 1. Patients with severe symptoms were given i.v. 'pulse' methylprednisolone. Mean duration of treatment was 34.8 months and of follow-up, 71.9 months. A total of 4 patients died: 3 from complete renal failure. Four patients still undergo treatment, improving markedly. Complete remission was achieved in 6 patients. A total of 3 patients relapsed and are recently treated. In another one chronic renal failure developed. Three of them had moderate symptoms at diagnosis but were treated inadequately.

IN CONCLUSION

manifestation of WG and severity of symptoms may be different among patients. ANCA is not universally present in all patients with WG. The absence of ANCA does not exclude WG diagnosis. Complete remission can be achieved in WG patients, including the severely ill, if adequate therapy is given. Moderate symptoms at presentation do not justify less intensive treatment.

[Pulmonary lymphangioleiomyomatosis: presentation and results of treatment]

Lymphangioleiomyomatosis is a rare lung disease of unknown aetiology that affects only women. Eight premenopausal women with LAM confirmed by lung biopsy specimens were observed in 1984-2001. The most common presenting feature was exertional dyspnea (6) followed by chylous pleural effusions and pneumothoraces. In two women severe airflow obstruction was observed at presentation. HRCT revealed characteristic cysts in all cases. All women were given hormonal therapy (tamoxifen, medroxyprogesterone). The best results of treatment were achieved in cases with chylothoraces.

[Pulmonary manifestations of polymyositis and dermatomyositis: a report of 6 cases and a review of literature]

The group of 6 patients with interstitial pulmonary changes in the course of polymyositis or dermatomyositis treated in years 1986-1999 was assessed. In one woman pulmonary changes occurred ten years before other symptoms of the connective tissue disease. Lung function tests showed a restrictive ventilatory defect in all patients. High resolution computed tomography revealed different changes, from ground glass attenuation to honey--combing. Only one patient, probably with bronchiolitis obliterans organizing pneumonia, responded to corticosteroids. Four women died from respiratory failure. In 2 pneumomediastinum occurred, which is a rare complication.

[Usefulness of analyzing ANCA changes for diagnosis of Wegener's granulomatosis]

ANCA were described in 1982 as sensitive and specific markers for active Wegener's granulomatosis (WG). We analysed the results of ANCA test performed in 298 patients hospitalized in Institute of Tuberculosis and Lung Diseases in the period 1990-1998 because of different symptoms and syndromes of respiratory system which could be symptoms of WG. Presence of c-ANCA, p-ANCA and other not well defined types of ANCA in the titer greater than 1:40 in the serum was regarded as positive result of test. We found it in 60 patients. In 47 WG pts ANCA were present in 40 of 42 pts with active disease and 1 of 5 in remission. Further 19 positive results were found in a group of 251 patients with other diseases: 1 of 4 pts with Churg-Strauss syndrome, 1 of 2 with pulmonary renal syndrome, 5 of 28 with connective tissue diseases, 1 of 21 with tuberculosis, 1 of 23 with sarcoidosis, 1 of 6 with histiocytosis, 3 of 11 with hypersensitivity pneumonitis, 1 (lymphoma) of 34 with neoplasms, 1 of 20 with pulmonary fibrosis, 1 of 8 with cardiac failure, 1 of 5 with pleural fluid, 1 of 10 pneumoconiosis and toxic reactions (after furagin), 1 of 6 with BOOP. Sensitivity of ANCA test in our material is 87%, specificity = 95%, and positive prevalence accuracy is 68%. It means that 32% of the patients with positive results could be inappropriate treated as WG.

CONCLUSION

ANCA test could be not used as a screening test. Results of ANCA test alone cannot be used as basis for treatment. ANCA test is a helpful tool in diagnosing of WG.

[Diagnostic difficulties with detection of foreign bodies from the lower respiratory tract--late detection]

Five cases of aspirated foreign bodies in bronchial tree were described. The clinical symptoms did not suggest the real cause of the illness and most of patients did not remember the fact of foreign body aspiration. The foreign bodies were removed during bronchofiberoscopy performed in local anaesthesia.

Kabuki (Niikawa-Kuroki) syndrome associated with immunodeficiency

We report a case of a 19-year-old male with the cardinal features of the Kabuki syndrome (KS) and, in addition, with severe immunodeficiency. Finding immune deficiency in a KS patient, prompted us to determine whether this association was related to a deletion within the DiGeorge chromosomal region. Fluorescence in situ hybridization (FISH) with the Oncor probe N25(D22S75) revealed no deletion of 22q11.2 in the patient.

[Common variable immunodeficiency--analysis of the clinical aspects and results of substitution treatment]

The clinical picture and the effects of treatment with intravenous immunoglobulins of 14 adult patients (4 women, 10 men) with common variable immunodeficiency are presented. In most patients the disease began in the second decade of life (17.4 years on average), and the diagnosis was delayed by 7.5 years. Mean observation time was 38.5 months. Recurrent sinopulmonary infections were the most significant clinical feature and were observed in all patients, although chronic diarrhea and viral hepatitis, predominant of B type, were also frequently seen (both in 57% of patients). The diagnosis was made according to following criteria: frequent bacterial infections of the respiratory tract, serum IgG levels reduced below 300 mg/dl, (mean, 60.7 mg/dl), normal numbers of circulating B lymphocytes and exclusion of the secondary type hypogammaglobulinaemia. After 6 months of treatment with fresh plasma 20 ml/kg or intravenous immunoglobulins 200-400 mg/kg, mean serum IgG levels rose to 654 mg/dl. Treatment was clinically efficacious and markedly reduced the number of infections of the respiratory tract. The delay of the diagnosis, resulted in high rate of irreversible damage of respiratory tract observed in our group of patients.

[Use of methotrexate for treatment of corticosteroid-dependent asthma]

We evaluated the effects of methotrexate treatment in 20 subjects (10 men, 10 women) suffering from corticosteroid-dependent asthma. All patients had been treated with 15 mg of prednisone or more per day for at least 3 years before including in the study. Methotrexate (15 mg once weekly) had been given for 9.7 months on average. Oral steroid intake was reduced by 50% in 8 patients and it was possible to discontinue oral corticosteroids in further 6 patients without deterioration of spirometric parameters at the end of the study. Side effects of methotrexate therapy were observed in 40% of patients, and required the discontinuation of treatment in 6 subjects.