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class="vector-toc-numb">2</span> <span>Cause</span> </div> </a> <button aria-controls="toc-Cause-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Cause subsection</span> </button> <ul id="toc-Cause-sublist" class="vector-toc-list"> <li id="toc-Transmission" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transmission"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Transmission</span> </div> </a> <ul id="toc-Transmission-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Reservoirs" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Reservoirs"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Reservoirs</span> </div> </a> <ul id="toc-Reservoirs-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mechanism" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Mechanism"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Mechanism</span> </div> </a> <ul id="toc-Mechanism-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Prevention</span> </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <ul id="toc-Treatment-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Prognosis</span> </div> </a> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Epidemiology</span> </div> </a> <button aria-controls="toc-Epidemiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Epidemiology subsection</span> </button> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> <li id="toc-Outbreaks" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Outbreaks"> <div class="vector-toc-text"> <span class="vector-toc-numb">8.1</span> <span>Outbreaks</span> </div> </a> <ul id="toc-Outbreaks-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Legionnaires' disease</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 46 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-46" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">46 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AF%D8%A7%D8%A1_%D8%A7%D9%84%D9%81%D9%8A%D8%A7%D9%84%D9%82%D8%A9" title="داء الفيالقة – Arabic" lang="ar" hreflang="ar" data-title="داء الفيالقة" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%9B%D0%B5%D0%B3%D1%96%D1%8F%D0%BD%D1%8D%D0%BB%D1%91%D0%B7" title="Легіянэлёз – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Легіянэлёз" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target"><span>Беларуская (тарашкевіца)</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%9B%D0%B5%D0%B3%D0%B8%D0%BE%D0%BD%D0%B5%D0%BB%D0%BE%D0%B7%D0%B0" title="Легионелоза – Bulgarian" lang="bg" hreflang="bg" data-title="Легионелоза" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Legionarska_bolest" title="Legionarska bolest – Bosnian" lang="bs" hreflang="bs" data-title="Legionarska bolest" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Legionel%C2%B7losi" title="Legionel·losi – Catalan" lang="ca" hreflang="ca" data-title="Legionel·losi" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Legionel%C3%B3za" title="Legionelóza – Czech" lang="cs" hreflang="cs" data-title="Legionelóza" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Legion%C3%A6rsyge" title="Legionærsyge – Danish" lang="da" hreflang="da" data-title="Legionærsyge" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Legionellose" title="Legionellose – German" lang="de" hreflang="de" data-title="Legionellose" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9D%CF%8C%CF%83%CE%BF%CF%82_%CF%84%CF%89%CE%BD_%CE%9B%CE%B5%CE%B3%CE%B5%CF%89%CE%BD%CE%AC%CF%81%CE%B9%CF%89%CE%BD" title="Νόσος των Λεγεωνάριων – Greek" lang="el" hreflang="el" data-title="Νόσος των Λεγεωνάριων" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Legionelosis" title="Legionelosis – Spanish" lang="es" hreflang="es" data-title="Legionelosis" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Legiana_malsano" title="Legiana malsano – Esperanto" lang="eo" hreflang="eo" data-title="Legiana malsano" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Legionellosi" title="Legionellosi – Basque" lang="eu" hreflang="eu" data-title="Legionellosi" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A8%DB%8C%D9%85%D8%A7%D8%B1%DB%8C_%D9%84%DA%98%DB%8C%D9%88%D9%86%D8%B1" title="بیماری لژیونر – Persian" lang="fa" hreflang="fa" data-title="بیماری لژیونر" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/L%C3%A9gionellose" title="Légionellose – French" lang="fr" hreflang="fr" data-title="Légionellose" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Galar_na_L%C3%A9igi%C3%BAnach" title="Galar na Léigiúnach – Irish" lang="ga" hreflang="ga" data-title="Galar na Léigiúnach" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Lexionelose" title="Lexionelose – Galician" lang="gl" hreflang="gl" data-title="Lexionelose" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%A0%88%EC%A7%80%EC%98%A4%EB%84%AC%EB%9D%BC%EC%A6%9D" title="레지오넬라증 – Korean" lang="ko" hreflang="ko" data-title="레지오넬라증" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%BC%D5%A5%D5%A3%D5%AB%D5%B8%D5%B6%D5%A5%D6%80%D5%B6%D5%A5%D6%80%D5%AB_%D5%B0%D5%AB%D5%BE%D5%A1%D5%B6%D5%A4%D5%B8%D6%82%D5%A9%D5%B5%D5%B8%D6%82%D5%B6" title="Լեգիոներների հիվանդություն – Armenian" lang="hy" hreflang="hy" data-title="Լեգիոներների հիվանդություն" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Penyakit_Legionnaires" title="Penyakit Legionnaires – Indonesian" lang="id" hreflang="id" data-title="Penyakit Legionnaires" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Hermannaveiki" title="Hermannaveiki – Icelandic" lang="is" hreflang="is" data-title="Hermannaveiki" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Legionellosi" title="Legionellosi – Italian" lang="it" hreflang="it" data-title="Legionellosi" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9E%D7%97%D7%9C%D7%AA_%D7%94%D7%9C%D7%92%D7%99%D7%95%D7%A0%D7%A8%D7%99%D7%9D" title="מחלת הלגיונרים – Hebrew" lang="he" hreflang="he" data-title="מחלת הלגיונרים" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%9B%D0%B5%D0%B3%D0%B8%D0%BE%D0%BD%D0%B5%D0%BB%D0%BB%D0%B5%D0%B7" title="Легионеллез – Kazakh" lang="kk" hreflang="kk" data-title="Легионеллез" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Le%C4%A3ion%C4%81ru_slim%C4%ABba" title="Leģionāru slimība – Latvian" lang="lv" hreflang="lv" data-title="Leģionāru slimība" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Legionelioz%C4%97" title="Legioneliozė – Lithuanian" lang="lt" hreflang="lt" data-title="Legioneliozė" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Legion%C3%A1riusbetegs%C3%A9g" title="Legionáriusbetegség – Hungarian" lang="hu" hreflang="hu" data-title="Legionáriusbetegség" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%9B%D0%B5%D0%B3%D0%B8%D0%BE%D0%BD%D0%B5%D1%80%D1%81%D0%BA%D0%B0_%D0%B1%D0%BE%D0%BB%D0%B5%D1%81%D1%82" title="Легионерска болест – Macedonian" lang="mk" hreflang="mk" data-title="Легионерска болест" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Legionellose" title="Legionellose – Dutch" lang="nl" hreflang="nl" data-title="Legionellose" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%83%AC%E3%82%B8%E3%82%AA%E3%83%8D%E3%83%A9%E7%97%87" title="レジオネラ症 – Japanese" lang="ja" hreflang="ja" data-title="レジオネラ症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Legion%C3%A6rsyken" title="Legionærsyken – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Legionærsyken" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Legion%C3%A6rsjukdom" title="Legionærsjukdom – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Legionærsjukdom" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B2%E0%AC%BF%E0%AC%9C%E0%AC%BF%E0%AC%93%E0%AC%A8%E0%AD%87%E0%AD%9F%E0%AC%BE%E0%AC%B0_%E0%AC%B0%E0%AD%8B%E0%AC%97" title="ଲିଜିଓନେୟାର ରୋଗ – Odia" lang="or" hreflang="or" data-title="ଲିଜିଓନେୟାର ରୋଗ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Choroba_legionist%C3%B3w" title="Choroba legionistów – Polish" lang="pl" hreflang="pl" data-title="Choroba legionistów" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Doen%C3%A7a_dos_legion%C3%A1rios" title="Doença dos legionários – Portuguese" lang="pt" hreflang="pt" data-title="Doença dos legionários" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Boala_legionarilor" title="Boala legionarilor – Romanian" lang="ro" hreflang="ro" data-title="Boala legionarilor" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9B%D0%B5%D0%B3%D0%B8%D0%BE%D0%BD%D0%B5%D0%BB%D0%BB%D1%91%D0%B7" title="Легионеллёз – Russian" lang="ru" hreflang="ru" data-title="Легионеллёз" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Legionnaires%27_disease" title="Legionnaires' disease – Simple English" lang="en-simple" hreflang="en-simple" data-title="Legionnaires' disease" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Legioneloza" title="Legioneloza – Slovenian" lang="sl" hreflang="sl" data-title="Legioneloza" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%9B%D0%B5%D0%B3%D0%B8%D0%BE%D0%BD%D0%B0%D1%80%D1%81%D0%BA%D0%B0_%D0%B1%D0%BE%D0%BB%D0%B5%D1%81%D1%82" title="Легионарска болест – Serbian" lang="sr" hreflang="sr" data-title="Легионарска болест" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li 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noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Legionnaires' disease</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Legionellosis,<sup id="cite_ref-pmid26231463_1-0" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> legion fever</td></tr><tr><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:PMC5258191_cureus-0008-00000000937-i01.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fc/PMC5258191_cureus-0008-00000000937-i01.png/220px-PMC5258191_cureus-0008-00000000937-i01.png" decoding="async" width="220" height="195" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fc/PMC5258191_cureus-0008-00000000937-i01.png/330px-PMC5258191_cureus-0008-00000000937-i01.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fc/PMC5258191_cureus-0008-00000000937-i01.png/440px-PMC5258191_cureus-0008-00000000937-i01.png 2x" data-file-width="463" data-file-height="411" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Chest X-ray of a severe case of legionellosis upon admission to the emergency department</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Infectious_disease" class="mw-redirect" title="Infectious disease">Infectious disease</a>, <a href="/wiki/Pulmonology" title="Pulmonology">pulmonology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Cough, <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a>, <a href="/wiki/Fever" title="Fever">fever</a>, <a href="/wiki/Myalgia" title="Myalgia">muscle pains</a>, headaches<sup id="cite_ref-CDC2016Sign_2-0" class="reference"><a href="#cite_note-CDC2016Sign-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Usual onset</th><td class="infobox-data">2–10 days after exposure<sup id="cite_ref-CDC2016Sign_2-1" class="reference"><a href="#cite_note-CDC2016Sign-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data"><a href="/wiki/Bacteria" title="Bacteria">Bacteria</a> of the <i><a href="/wiki/Legionella" title="Legionella">Legionella</a></i> type (spread by contaminated <a href="/wiki/Mist" title="Mist">mist</a>)<sup id="cite_ref-CDC2016Start_3-0" class="reference"><a href="#cite_note-CDC2016Start-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-CDC2016Cau_4-0" class="reference"><a href="#cite_note-CDC2016Cau-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Older age, history of smoking, <a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">chronic lung disease</a>, <a href="/wiki/Immunosuppression" title="Immunosuppression">poor immune function</a><sup id="cite_ref-CDC2016Risk_5-0" class="reference"><a href="#cite_note-CDC2016Risk-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Urinary <a href="/wiki/Antigen_test" class="mw-redirect" title="Antigen test">antigen test</a>, <a href="/wiki/Sputum_culture" title="Sputum culture">sputum culture</a><sup id="cite_ref-CDC2016Diag_6-0" class="reference"><a href="#cite_note-CDC2016Diag-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data">Good maintenance of <a href="/wiki/Water_systems" class="mw-redirect" title="Water systems">water systems</a><sup id="cite_ref-CDC2016Pre_7-0" class="reference"><a href="#cite_note-CDC2016Pre-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><a href="/wiki/Antibiotic" title="Antibiotic">Antibiotics</a><sup id="cite_ref-CDC2016Tx_8-0" class="reference"><a href="#cite_note-CDC2016Tx-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data">10% risk of death<sup id="cite_ref-CDC2016Tx_8-1" class="reference"><a href="#cite_note-CDC2016Tx-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">~13,000 severe cases a year (US)<sup id="cite_ref-CDC2016Epi_9-0" class="reference"><a href="#cite_note-CDC2016Epi-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}</style> <p><b>Legionnaires' disease</b> is a form of <a href="/wiki/Atypical_pneumonia" title="Atypical pneumonia">atypical pneumonia</a> caused by any species of <i><a href="/wiki/Legionella" title="Legionella">Legionella</a></i> bacteria,<sup id="cite_ref-CDC2016Start_3-1" class="reference"><a href="#cite_note-CDC2016Start-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> quite often <i><a href="/wiki/Legionella_pneumophila" title="Legionella pneumophila">Legionella pneumophila</a></i>. Signs and symptoms include cough, <a href="/wiki/Shortness_of_breath" title="Shortness of breath">shortness of breath</a>, high <a href="/wiki/Fever" title="Fever">fever</a>, <a href="/wiki/Myalgia" title="Myalgia">muscle pains</a>, and headaches.<sup id="cite_ref-CDC2016Sign_2-2" class="reference"><a href="#cite_note-CDC2016Sign-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Nausea, vomiting, and diarrhea may also occur.<sup id="cite_ref-pmid26231463_1-1" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> This often begins 2–10 days after exposure.<sup id="cite_ref-CDC2016Sign_2-3" class="reference"><a href="#cite_note-CDC2016Sign-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>A <b>legionellosis</b> is any disease caused by <i>Legionella</i>, including Legionnaires' disease (a pneumonia) and <a href="/wiki/Pontiac_fever" title="Pontiac fever">Pontiac fever</a> (a related upper respiratory tract infection),<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> but Legionnaires' disease is the most common, so mentions of legionellosis often refer to Legionnaires' disease. </p><p>The bacterium is found naturally in <a href="/wiki/Fresh_water" title="Fresh water">fresh water</a>.<sup id="cite_ref-CDC2016Cau_4-1" class="reference"><a href="#cite_note-CDC2016Cau-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It can contaminate hot water tanks, hot tubs, and <a href="/wiki/Cooling_towers" class="mw-redirect" title="Cooling towers">cooling towers</a> of large <a href="/wiki/Air_conditioner" class="mw-redirect" title="Air conditioner">air conditioners</a>.<sup id="cite_ref-CDC2016Cau_4-2" class="reference"><a href="#cite_note-CDC2016Cau-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It is usually spread by breathing in mist that contains the bacteria.<sup id="cite_ref-CDC2016Cau_4-3" class="reference"><a href="#cite_note-CDC2016Cau-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It can also occur when contaminated water is <a href="/wiki/Pulmonary_aspiration" title="Pulmonary aspiration">aspirated</a>.<sup id="cite_ref-CDC2016Cau_4-4" class="reference"><a href="#cite_note-CDC2016Cau-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> It typically does not spread directly between people, and most people who are exposed do not become infected.<sup id="cite_ref-CDC2016Cau_4-5" class="reference"><a href="#cite_note-CDC2016Cau-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Risk factors for infection include older age, a history of smoking, <a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">chronic lung disease</a>, and <a href="/wiki/Immunosuppression" title="Immunosuppression">poor immune function</a>.<sup id="cite_ref-CDC2016Risk_5-1" class="reference"><a href="#cite_note-CDC2016Risk-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> Those with severe pneumonia and those with pneumonia and a recent travel history should be tested for the disease.<sup id="cite_ref-CDC2015SymP_12-0" class="reference"><a href="#cite_note-CDC2015SymP-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Diagnosis is by a urinary <a href="/wiki/Antigen_test" class="mw-redirect" title="Antigen test">antigen test</a> and <a href="/wiki/Sputum_culture" title="Sputum culture">sputum culture</a>.<sup id="cite_ref-CDC2016Diag_6-1" class="reference"><a href="#cite_note-CDC2016Diag-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>No <a href="/wiki/Vaccine" title="Vaccine">vaccine</a> is available.<sup id="cite_ref-CDC2016Pre_7-1" class="reference"><a href="#cite_note-CDC2016Pre-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Prevention depends on good maintenance of <a href="/wiki/Water_systems" class="mw-redirect" title="Water systems">water systems</a>.<sup id="cite_ref-CDC2016Pre_7-2" class="reference"><a href="#cite_note-CDC2016Pre-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Treatment of Legionnaires' disease is commonly conducted with <a href="/wiki/Antibiotic" title="Antibiotic">antibiotics</a>.<sup id="cite_ref-CDC2016Tx_8-2" class="reference"><a href="#cite_note-CDC2016Tx-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Recommended agents include <a href="/wiki/Fluoroquinolone" class="mw-redirect" title="Fluoroquinolone">fluoroquinolones</a>, <a href="/wiki/Azithromycin" title="Azithromycin">azithromycin</a>, or <a href="/wiki/Doxycycline" title="Doxycycline">doxycycline</a>.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Hospitalization is often required.<sup id="cite_ref-CDC2015SymP_12-1" class="reference"><a href="#cite_note-CDC2015SymP-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> The fatality rate is around 10% for healthy persons and 25% for those with underlying conditions.<sup id="cite_ref-CDC2016Tx_8-3" class="reference"><a href="#cite_note-CDC2016Tx-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>The number of cases that occur globally is not known.<sup id="cite_ref-pmid26231463_1-2" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Legionnaires' disease is the cause of an estimated 2–9% of pneumonia cases that are acquired outside of a hospital.<sup id="cite_ref-pmid26231463_1-3" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> An estimated 8,000 to 18,000 cases a year in the United States require hospitalization.<sup id="cite_ref-CDC2016Epi_9-1" class="reference"><a href="#cite_note-CDC2016Epi-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Outbreak" class="mw-redirect" title="Outbreak">Outbreaks</a> of disease account for a minority of cases.<sup id="cite_ref-pmid26231463_1-4" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> While it can occur any time of the year, it is more common in the summer and autumn.<sup id="cite_ref-CDC2016Epi_9-2" class="reference"><a href="#cite_note-CDC2016Epi-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The disease is named after <a href="/wiki/1976_Philadelphia_Legionnaires%27_disease_outbreak" title="1976 Philadelphia Legionnaires' disease outbreak">the outbreak where it was first identified</a>, at a 1976 <a href="/wiki/American_Legion" title="American Legion">American Legion</a> convention in <a href="/wiki/Philadelphia" title="Philadelphia">Philadelphia</a>.<sup id="cite_ref-Leg2016CDC_15-0" class="reference"><a href="#cite_note-Leg2016CDC-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The length of time between exposure to the bacteria and the appearance of symptoms (<a href="/wiki/Incubation_period" title="Incubation period">incubation period</a>) is generally 2–10 days, but can more rarely extend to as long as 20 days.<sup id="cite_ref-WHO_2007_16-0" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> For the general population, among those exposed, between 0.1 and 5.0% develop the disease, while among those in hospital, between 0.4 and 14% develop the disease.<sup id="cite_ref-WHO_2007_16-1" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p>Those with Legionnaires' disease usually have fever, chills, and a cough, which may be dry or may produce <a href="/wiki/Sputum" title="Sputum">sputum</a>. Almost all experience fever, while around half have cough with sputum, and one-third <a href="/wiki/Hemoptysis" title="Hemoptysis">cough up blood or bloody sputum</a>. Some also have muscle aches, <a href="/wiki/Headache" title="Headache">headache</a>, tiredness, <a href="/wiki/Loss_of_appetite" class="mw-redirect" title="Loss of appetite">loss of appetite</a>, loss of coordination (<a href="/wiki/Ataxia" title="Ataxia">ataxia</a>), chest pain, or <a href="/wiki/Diarrhea" title="Diarrhea">diarrhea</a> and <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>.<sup id="cite_ref-pmid26231463_1-5" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Up to half of those with Legionnaires' disease have gastrointestinal symptoms, and almost half have neurological symptoms,<sup id="cite_ref-WHO_2007_16-2" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> including confusion and impaired cognition.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> "Relative <a href="/wiki/Bradycardia" title="Bradycardia">bradycardia</a>" may also be present, which is low to normal heart rate despite the presence of a fever.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Laboratory tests may show that kidney functions, liver functions, and <a href="/wiki/Water-electrolyte_imbalance" class="mw-redirect" title="Water-electrolyte imbalance">electrolyte</a> levels are abnormal, which may include <a href="/wiki/Hyponatremia" title="Hyponatremia">low sodium in the blood</a>. Chest X-rays often show pneumonia with <a href="/wiki/Pulmonary_consolidation" title="Pulmonary consolidation">consolidation</a> in the bottom portion of both lungs. Distinguishing Legionnaires' disease from other types of pneumonia by symptoms or <a href="/wiki/Radiology" title="Radiology">radiologic</a> findings alone is difficult; other tests are required for definitive diagnosis.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)"><span title="Material near this tag needs references to reliable medical sources. (September 2019)">medical citation needed</span></a></i>]</sup> </p><p>People with Pontiac fever, a much milder illness caused by the same bacterium, experience fever and muscle aches without pneumonia. They generally recover in 2–5 days without treatment. For Pontiac fever, the time between exposure and symptoms is generally a few hours to two days.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)"><span title="Material near this tag needs references to reliable medical sources. (September 2019)">medical citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=2" title="Edit section: Cause"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Legionella_pneumophila_01.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Legionella_pneumophila_01.jpg/220px-Legionella_pneumophila_01.jpg" decoding="async" width="220" height="148" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Legionella_pneumophila_01.jpg/330px-Legionella_pneumophila_01.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Legionella_pneumophila_01.jpg/440px-Legionella_pneumophila_01.jpg 2x" data-file-width="3075" data-file-height="2075" /></a><figcaption><a href="/wiki/Transmission_electron_microscopy" title="Transmission electron microscopy">Transmission electron microscopy</a> image of <i>L. pneumophila</i>, responsible for over 90% of Legionnaires' disease cases<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup></figcaption></figure> <p>Over 90% of cases of Legionnaires' disease are caused by <i><a href="/wiki/Legionella_pneumophila" title="Legionella pneumophila">Legionella pneumophila</a>.</i> Other types include <i><a href="/wiki/Legionella_longbeachae" title="Legionella longbeachae">L. longbeachae</a></i>, <i><a href="/wiki/Legionella_feeleii" title="Legionella feeleii">L. feeleii</a></i>, <i><a href="/wiki/Legionella_micdadei" title="Legionella micdadei">L. micdadei</a></i>, and <i><a href="/wiki/Legionella_anisa" title="Legionella anisa">L. anisa</a></i>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (March 2024)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Transmission">Transmission</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=3" title="Edit section: Transmission"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Legionnaires' disease is usually spread by the breathing in of <a href="/wiki/Aerosolization" title="Aerosolization">aerosolized</a> water or soil contaminated with the <i>Legionella</i> bacteria.<sup id="cite_ref-pmid26231463_1-6" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Experts have stated that Legionnaires' disease is not transmitted from person to person.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> In 2014, one case of possible spread from someone sick to the caregiver occurred.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Rarely, it has been transmitted by direct contact between contaminated water and surgical wounds.<sup id="cite_ref-pmid26231463_1-7" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The bacteria grow best at warm temperatures<sup id="cite_ref-CDC2016Cau_4-6" class="reference"><a href="#cite_note-CDC2016Cau-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> and thrive at water temperatures between 25 and 45 °C (77 and 113 °F), with an optimum temperature of 35 °C (95 °F).<sup id="cite_ref-FieldsBenson2002_23-0" class="reference"><a href="#cite_note-FieldsBenson2002-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Temperatures above 60 °C (140 °F) kill the bacteria.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Sources where temperatures allow the bacteria to thrive include hot water tanks, cooling towers, and evaporative condensers of large air conditioning systems, such as those commonly found in hotels and large office buildings.<sup id="cite_ref-van_HeijnsbergenSchalk2015_25-0" class="reference"><a href="#cite_note-van_HeijnsbergenSchalk2015-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Pre-1988, <a href="/wiki/Energy_Conservation_Program_for_Consumer_Products" title="Energy Conservation Program for Consumer Products">energy conservation programs from the late 1970s and early 1980s</a> still mandated a maximum hot water generation, storage and distribution temperature of 110 °F (43 °C), unknowingly, legionella bacteria's ideal breeding temperature.<sup id="cite_ref-PHCPPros_26-0" class="reference"><a href="#cite_note-PHCPPros-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> To minimize risks of bacterial growth, the <a href="/wiki/ASHRAE" title="ASHRAE">American Society of Heating, Refrigerating and Air-Conditioning Engineers'</a> 1988 ASHRAE Standard 188 and subsequent ASHRAE Guideline 12-2000 increased recommended hot water generation and storage temperatures to 135–140 °F (57–60 °C) with minimum distribution temperatures of 124 °F (51 °C).<sup id="cite_ref-PHCPPros_26-1" class="reference"><a href="#cite_note-PHCPPros-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p><p>Though the first known outbreak was in Philadelphia, cases of legionellosis have occurred throughout the world.<sup id="cite_ref-WHO_2007_16-3" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Reservoirs">Reservoirs</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=4" title="Edit section: Reservoirs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Bellevue-Stratford_Hotel%E2%80%99s_cooling_system_water.jpg" class="mw-file-description"><img alt="A big glass jug filled with dirty yellow water in a display case" src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Bellevue-Stratford_Hotel%E2%80%99s_cooling_system_water.jpg/220px-Bellevue-Stratford_Hotel%E2%80%99s_cooling_system_water.jpg" decoding="async" width="220" height="330" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Bellevue-Stratford_Hotel%E2%80%99s_cooling_system_water.jpg/330px-Bellevue-Stratford_Hotel%E2%80%99s_cooling_system_water.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Bellevue-Stratford_Hotel%E2%80%99s_cooling_system_water.jpg/440px-Bellevue-Stratford_Hotel%E2%80%99s_cooling_system_water.jpg 2x" data-file-width="1080" data-file-height="1620" /></a><figcaption>A jug filled with chiller water taken from the Bellevue-Stratford Hotel's cooling system during the 1976 outbreak investigation on display at the <a href="/wiki/David_J._Sencer_CDC_Museum" title="David J. Sencer CDC Museum">David J. Sencer CDC Museum</a> </figcaption></figure> <p><i>L. pneumophila</i> thrives in aquatic systems, where it is established within amoebae in a <a href="/wiki/Symbiosis" title="Symbiosis">symbiotic relationship</a>.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> <i>Legionella</i> bacteria survive in water as intracellular parasites of water-dwelling protozoa, such as <a href="/wiki/Amoebae" class="mw-redirect" title="Amoebae">amoebae</a>. Amoebae are often part of <a href="/wiki/Biofilms" class="mw-redirect" title="Biofilms">biofilms</a>, and once <i>Legionella</i> and infected amoebae are protected within a biofilm, they are particularly difficult to destroy.<sup id="cite_ref-pmid26231463_1-8" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>In the built environment, <a href="/wiki/Central_air_conditioning" class="mw-redirect" title="Central air conditioning">central air conditioning</a> systems in office buildings, hotels, and hospitals are sources of contaminated water.<sup id="cite_ref-FieldsBenson2002_23-1" class="reference"><a href="#cite_note-FieldsBenson2002-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Other places the bacteria can dwell include <a href="/wiki/Cooling_towers" class="mw-redirect" title="Cooling towers">cooling towers</a> used in industrial cooling systems, <a href="/wiki/Evaporative_cooler" title="Evaporative cooler">evaporative coolers</a>, <a href="/wiki/Nebulizer" title="Nebulizer">nebulizers</a>, <a href="/wiki/Humidifiers" class="mw-redirect" title="Humidifiers">humidifiers</a>, <a href="/wiki/Jacuzzi" title="Jacuzzi">whirlpool spas</a>, hot water systems, showers, windshield washers, fountains, room-air humidifiers, ice-making machines, and misting systems typically found in grocery-store produce sections.<sup id="cite_ref-pmid26231463_1-9" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid1552203_28-0" class="reference"><a href="#cite_note-pmid1552203-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>The bacteria may also be transmitted from contaminated aerosols generated in <a href="/wiki/Hot_tub" title="Hot tub">hot tubs</a> if the disinfection and maintenance programs are not followed rigorously.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> Freshwater ponds, creeks, and ornamental fountains are potential sources of <i>Legionella</i>.<sup id="cite_ref-Winn_b_30-0" class="reference"><a href="#cite_note-Winn_b-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> The disease is particularly associated with hotels, fountains, <a href="/wiki/Cruise_ship" title="Cruise ship">cruise ships</a>, and hospitals with complex potable water systems and cooling systems. Respiratory-care devices such as humidifiers and nebulizers used with contaminated tap water may contain <i>Legionella</i> species, so using sterile water is very important.<sup id="cite_ref-Woo92_31-0" class="reference"><a href="#cite_note-Woo92-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Other sources include exposure to potting mix and compost.<sup id="cite_ref-pmid2036080_32-0" class="reference"><a href="#cite_note-pmid2036080-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=5" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><i>Legionella</i> spp. enter the lungs either by aspiration of contaminated water or inhalation of aerosolized contaminated water or soil. In the lung, the bacteria are <a href="/wiki/Phagocytosis" title="Phagocytosis">consumed</a> by <a href="/wiki/Macrophage" title="Macrophage">macrophages</a>, a type of <a href="/wiki/White_blood_cell" title="White blood cell">white blood cell</a>, inside of which the <i>Legionella</i> bacteria multiply, causing the death of the macrophage. Once the macrophage dies, the bacteria are released from the dead cell to infect other macrophages. Virulent strains of <i>Legionella</i> kill macrophages by blocking the fusion of <a href="/wiki/Phagosome" title="Phagosome">phagosomes</a> with <a href="/wiki/Lysosome" title="Lysosome">lysosomes</a> inside the host cell; normally, bacteria are contained inside the phagosome, which merges with a lysosome, allowing enzymes and other chemicals to break down the invading bacteria.<sup id="cite_ref-WHO_2007_16-4" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=6" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Severe_Pneumonia_Caused_by_Legionella_pneumophila_Serogroup_11,_Italy.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/32/Severe_Pneumonia_Caused_by_Legionella_pneumophila_Serogroup_11%2C_Italy.jpg/330px-Severe_Pneumonia_Caused_by_Legionella_pneumophila_Serogroup_11%2C_Italy.jpg" decoding="async" width="330" height="304" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/32/Severe_Pneumonia_Caused_by_Legionella_pneumophila_Serogroup_11%2C_Italy.jpg/495px-Severe_Pneumonia_Caused_by_Legionella_pneumophila_Serogroup_11%2C_Italy.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/3/32/Severe_Pneumonia_Caused_by_Legionella_pneumophila_Serogroup_11%2C_Italy.jpg 2x" data-file-width="600" data-file-height="552" /></a><figcaption>Various stages of the disease: Chest radiograph (A) and high-resolution computed tomography (B) at hospital admission, repeat high-resolution computerized tomography of the chest a week after hospital admission (C, D), shown in a 42-year-old male with severe pneumonia caused by <i>L. pneumophila</i> serogroup 11a</figcaption></figure> <p>People of any age may develop Legionnaires' disease, but the illness most often affects middle-aged and older people, particularly those who smoke cigarettes or have chronic lung disease. <a href="/wiki/Immunodeficiency" title="Immunodeficiency">Immunocompromised</a> people are also at higher risk. Pontiac fever most commonly occurs in those who are otherwise healthy.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2020)">citation needed</span></a></i>]</sup> </p><p>The most useful diagnostic tests detect the bacteria in <a href="/wiki/Sputum" title="Sputum">coughed-up mucus</a>, find <i>Legionella</i> antigens in urine samples, or allow comparison of <i>Legionella</i> antibody levels in two blood samples taken 3–6 weeks apart. A urine antigen test is simple, quick, and very reliable, but only detects <i>L. pneumophila</i> serogroup 1, which accounts for 70% of disease caused by <i>L. pneumophila</i>, which means use of the urine antigen test alone may miss as many as 30% of cases.<sup id="cite_ref-FieldsBenson2002_23-2" class="reference"><a href="#cite_note-FieldsBenson2002-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> This test was developed by Richard Kohler in 1982.<sup id="cite_ref-pmid7050258_33-0" class="reference"><a href="#cite_note-pmid7050258-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> When dealing with <i>L. pneumophila</i> serogroup 1, the urine antigen test is useful for early detection of Legionnaire's disease and initiation of treatment, and has been helpful in early detection of outbreaks. However, it does not identify the specific subtypes, so it cannot be used to match the person with the environmental source of infection. The <i>Legionella</i> bacteria can be cultured from sputum or other respiratory samples. <i>Legionella</i> spp. stain poorly with Gram stain, stain positive with silver, and are cultured on charcoal yeast extract with iron and cysteine (<a href="/wiki/CYE_agar" class="mw-redirect" title="CYE agar">CYE agar</a>).<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (March 2024)">citation needed</span></a></i>]</sup> </p><p>A significant under-reporting problem occurs with legionellosis. Even in countries with effective health services and readily available diagnostic testing, about 90% of cases of Legionnaires' disease are missed. This is partly due to the disease being a relatively rare form of pneumonia, which many clinicians may not have encountered before, thus may misdiagnose. A further issue is that people with legionellosis can present with a wide range of symptoms, some of which (such as diarrhea) may distract clinicians from making a correct diagnosis.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=7" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Although the risk of Legionnaires' disease being spread by large-scale water systems cannot be eliminated, it can be greatly reduced by writing and enforcing a highly detailed, systematic <a href="/wiki/Water_safety_plan" title="Water safety plan">water safety plan</a> appropriate for the specific facility involved (office building, hospital, hotel, spa, cruise ship, etc.)<sup id="cite_ref-WHO_2007_16-5" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Some of the elements that such a plan may include are: </p> <ul><li>Keep water temperature either below or above the 20–55 °C (68–131 °F) range in which the <i>Legionella</i> bacterium thrives.<sup id="cite_ref-WHO_2007_16-6" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-PHCPPros_26-2" class="reference"><a href="#cite_note-PHCPPros-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup></li> <li>Prevent <a href="/wiki/Water_stagnation" title="Water stagnation">stagnation</a>, for example, by removing from a network of pipes any sections that have no outlet (dead ends). Where stagnation is unavoidable, as when a wing of a hotel is closed for the off-season, remedial measures are recommended, e.g., maintaining elevated temperatures throughout the hot-water distribution system and periodic disinfection or permanent chlorination of cold-water systems.<sup id="cite_ref-WHO_2007_16-7" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></li> <li>Prevention of <a href="/wiki/Biofilms" class="mw-redirect" title="Biofilms">biofilms</a> is crucial because once established they become more difficult to remove from piping systems. The likelihood of formation is increased by pipe scale and corrosion; warm water temperatures; stagnation and the quantity of nutrients that enter the system.<sup id="cite_ref-WHO_2007_16-8" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></li> <li>Periodically disinfect the system, by high heat or a chemical <a href="/wiki/Biocide" title="Biocide">biocide</a>, and use <a href="/wiki/Water_chlorination" title="Water chlorination">chlorination</a> where appropriate. <a href="/wiki/Monochloramine" title="Monochloramine">Monochloramine</a> is likely more effective than free chlorine (<a href="/wiki/Sodium_hypochlorite" title="Sodium hypochlorite">sodium hypochlorite</a>), being more resistant with residuals likely to persist to the point of delivery. Monochloramine is also more likely to penetrate legionella biofilms.<sup id="cite_ref-WHO_2007_16-9" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Treatment of water with <a href="/wiki/Copper-silver_ionization" title="Copper-silver ionization">copper-silver ionization</a> or <a href="/wiki/Ultraviolet_light" class="mw-redirect" title="Ultraviolet light">ultraviolet light</a> may also be effective.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup></li> <li>System design (or renovation) can reduce the production of aerosols and reduce human exposure to them, by directing them well away from building air intakes.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (March 2024)">citation needed</span></a></i>]</sup></li></ul> <p>An effective water safety plan also covers such matters as training, record-keeping, communication among staff, contingency plans, and management responsibilities. The format and content of the plan may be prescribed by <a href="/wiki/Public_health" title="Public health">public health</a> laws or regulations.<sup id="cite_ref-WHO_2007_16-10" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> To inform the water safety plan, the undertaking of a site specific legionella risk assessment is often recommended in the first instance.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> The legionella risk assessment identifies the hazards, the level of risk they pose and provides recommendations of control measures to put place within the overarching <a href="/wiki/Water_safety_plan" title="Water safety plan">water safety plan</a>. </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=8" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Effective <a href="/wiki/Antibiotic" title="Antibiotic">antibiotics</a> include most <a href="/wiki/Macrolide" title="Macrolide">macrolides</a>, <a href="/wiki/Tetracycline_antibiotics" title="Tetracycline antibiotics">tetracyclines</a>, <a href="/wiki/Ketolide" title="Ketolide">ketolides</a>, and <a href="/wiki/Quinolone_antibiotic" title="Quinolone antibiotic">quinolones</a>.<sup id="cite_ref-pmid26231463_1-10" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> <i>Legionella</i> spp. multiply within the cell, so any effective treatment must have excellent intracellular penetration. Current treatments of choice are the respiratory tract quinolones (<a href="/wiki/Levofloxacin" title="Levofloxacin">levofloxacin</a>, <a href="/wiki/Moxifloxacin" title="Moxifloxacin">moxifloxacin</a>, <a href="/wiki/Gemifloxacin" title="Gemifloxacin">gemifloxacin</a>) or newer macrolides (<a href="/wiki/Azithromycin" title="Azithromycin">azithromycin</a>, <a href="/wiki/Clarithromycin" title="Clarithromycin">clarithromycin</a>, <a href="/wiki/Roxithromycin" title="Roxithromycin">roxithromycin</a>). The antibiotics used most frequently have been levofloxacin, <a href="/wiki/Doxycycline" title="Doxycycline">doxycycline</a>, and azithromycin.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (March 2023)">citation needed</span></a></i>]</sup> </p><p>Macrolides (azithromycin) are used in all age groups, while tetracyclines (doxycycline) are prescribed for children above the age of 12 and quinolones (levofloxacin) above the age of 18. <a href="/wiki/Rifampicin" title="Rifampicin">Rifampicin</a> can be used in combination with a quinolone or macrolide. Whether rifampicin is an effective antibiotic to take for treatment is uncertain. The <a href="/wiki/Infectious_Diseases_Society_of_America" title="Infectious Diseases Society of America">Infectious Diseases Society of America</a> does not recommend the use of rifampicin with added regimens. Tetracyclines and <a href="/wiki/Erythromycin" title="Erythromycin">erythromycin</a> led to improved outcomes compared to other antibiotics in the original American Legion outbreak. These antibiotics are effective because they have excellent intracellular penetration in <i>Legionella</i>-infected cells. The recommended treatment is 5–10 days of levofloxacin or 3–5 days of azithromycin, but in people who are immunocompromised, have severe disease, or other pre-existing health conditions, longer antibiotic use may be necessary.<sup id="cite_ref-pmid26231463_1-11" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> During outbreaks, prophylactic antibiotics have been used to prevent Legionnaires' disease in high-risk individuals who have possibly been exposed.<sup id="cite_ref-pmid26231463_1-12" class="reference"><a href="#cite_note-pmid26231463-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>The mortality at the original American Legion convention in 1976 was high (29 deaths in 182 infected individuals<sup id="cite_ref-Winn1988_37-0" class="reference"><a href="#cite_note-Winn1988-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup>) because the antibiotics used (including <a href="/wiki/Penicillin" title="Penicillin">penicillins</a>, <a href="/wiki/Cephalosporin" title="Cephalosporin">cephalosporins</a>, and <a href="/wiki/Aminoglycoside" title="Aminoglycoside">aminoglycosides</a>) had poor intracellular penetration. Mortality has plunged to less than 5% if therapy is started quickly. Delay in giving the appropriate antibiotic leads to higher mortality.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)"><span title="Material near this tag needs references to reliable medical sources. (October 2019)">medical citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=9" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The fatality rate of Legionnaires' disease has ranged from 5–30% during various outbreaks and approaches 50% for <a href="/wiki/Nosocomial_infections" class="mw-redirect" title="Nosocomial infections">nosocomial infections</a>, especially when treatment with antibiotics is delayed.<sup id="cite_ref-MedlinePlus_38-0" class="reference"><a href="#cite_note-MedlinePlus-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> Hospital-acquired <i>Legionella</i> pneumonia has a fatality rate of 28%, and the principal source of infection in such cases is the <a href="/wiki/Drinking-water_distribution_system" class="mw-redirect" title="Drinking-water distribution system">drinking-water distribution system</a>.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=10" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/1976_Philadelphia_Legionnaires%27_disease_outbreak" title="1976 Philadelphia Legionnaires' disease outbreak">1976 Philadelphia Legionnaires' disease outbreak</a> and <a href="/wiki/List_of_Legionnaires%27_disease_outbreaks" title="List of Legionnaires' disease outbreaks">List of Legionnaires' disease outbreaks</a></div> <p>Legionnaires' disease acquired its name in July 1976, when an outbreak of pneumonia occurred among people attending a convention of the <a href="/wiki/American_Legion" title="American Legion">American Legion</a> at the <a href="/wiki/The_Bellevue-Stratford_Hotel" title="The Bellevue-Stratford Hotel">Bellevue-Stratford Hotel</a> in Philadelphia. Of the 182 reported cases, mostly men, 29 died.<sup id="cite_ref-Legionnaire_disease_40-0" class="reference"><a href="#cite_note-Legionnaire_disease-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> On 18 January 1977, the causative agent was identified as a previously unknown strain of bacteria, subsequently named <i><a href="/wiki/Legionella" title="Legionella">Legionella</a></i>, and the species that caused the outbreak was named <i><a href="/wiki/Legionella_pneumophila" title="Legionella pneumophila">Legionella pneumophila</a></i>.<sup id="cite_ref-pmid373548_41-0" class="reference"><a href="#cite_note-pmid373548-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid335244_42-0" class="reference"><a href="#cite_note-pmid335244-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> Following this discovery, unexplained outbreaks of severe respiratory disease from the 1950s were retrospectively attributed to <i>Legionella</i>.<sup id="cite_ref-Winn1988_37-1" class="reference"><a href="#cite_note-Winn1988-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> Legionnaires' disease also became a prominent historical example of an <a href="/wiki/Emerging_infectious_disease" title="Emerging infectious disease">emerging infectious disease</a>.<sup id="cite_ref-Macfarlane2012_44-0" class="reference"><a href="#cite_note-Macfarlane2012-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>Outbreaks of Legionnaires' disease receive significant media attention, but this disease usually occurs in single, isolated cases not associated with any recognized outbreak. When outbreaks do occur, they are usually in the summer and early autumn, though cases may occur at any time of year. Most infections occur in those who are middle-aged or older.<sup id="cite_ref-MedlinePlus_38-1" class="reference"><a href="#cite_note-MedlinePlus-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> National surveillance systems and research studies were established early, and in recent years,<sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items" title="Wikipedia:Manual of Style/Dates and numbers"><span title="The time period mentioned near this tag is ambiguous. (August 2015)">when?</span></a></i>]</sup> improved ascertainment and changes in clinical methods of diagnosis have contributed to an upsurge in reported cases in many countries. Environmental studies continue to identify novel sources of infection, leading to regular revisions of guidelines and regulations. About 8,000 to 18,000 cases of Legionnaires' disease occur each year in the United States, according to the Bureau of Communicable Disease Control.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>Between 1995 and 2005, over 32,000 cases of Legionnaires' disease and more than 600 outbreaks were reported to the <a href="/wiki/European_Working_Group_for_Legionella_Infections" title="European Working Group for Legionella Infections">European Working Group for Legionella Infections</a>. The data on <i>Legionella</i> are limited in developing countries, and <i>Legionella</i>-related illnesses likely are underdiagnosed worldwide.<sup id="cite_ref-WHO_2007_16-11" class="reference"><a href="#cite_note-WHO_2007-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Improvements in diagnosis and surveillance in developing countries would be expected to reveal far higher levels of morbidity and mortality than are currently recognised. Similarly, improved diagnosis of human illness related to <i>Legionella</i> species and serogroups other than <i>Legionella pneumophila</i> would improve knowledge about their incidence and spread.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (September 2019)">citation needed</span></a></i>]</sup> </p><p>A 2011 study successfully used modeling to predict the likely number of cases during Legionnaires' outbreaks based on symptom onset dates from past outbreaks. In this way, the eventual likely size of an outbreak can be predicted, enabling efficient and effective use of public-health resources in managing an outbreak.<sup id="cite_ref-pmid21242803_46-0" class="reference"><a href="#cite_note-pmid21242803-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> </p><p>During the <a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a>, some researchers and organisations raised concerns about the impact of the <a href="/wiki/COVID-19_lockdowns" title="COVID-19 lockdowns">COVID-19 lockdowns</a> on Legionnaire's disease outbreaks.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> Additionally, at least two people in England died from a co-infection of <i>Legionella</i> and <a href="/wiki/SARS-CoV-2" title="SARS-CoV-2">SARS-CoV-2</a>.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Outbreaks">Outbreaks</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=11" title="Edit section: Outbreaks"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/List_of_Legionnaires%27_disease_outbreaks" title="List of Legionnaires' disease outbreaks">List of Legionnaires' disease outbreaks</a></div> <p>An outbreak is defined as two or more cases where the onset of illness is closely linked in time (weeks rather than months) and space, where a suspicion or evidence exists of a common source of infection, with or without microbiological support (<i>i.e.</i> common spatial location of cases from travel history).<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p> <ul><li>In April 1985, 175 people in <a href="/wiki/Stafford" title="Stafford">Stafford, England</a>, were admitted to the District or Kingsmead Stafford Hospitals with chest infection or pneumonia. A total of 28 people died. Medical diagnosis showed that Legionnaires' disease was responsible and the immediate epidemiological investigation traced the source of the infection to the air-conditioning cooling tower on the roof of Stafford District Hospital.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup></li> <li>In March 1999, a <a href="/wiki/1999_Bovenkarspel_legionellosis_outbreak" title="1999 Bovenkarspel legionellosis outbreak">large outbreak</a> in the <a href="/wiki/Netherlands" title="Netherlands">Netherlands</a> occurred during the Westfriese Flora flower exhibition in <a href="/wiki/Bovenkarspel" title="Bovenkarspel">Bovenkarspel</a>; 318 people became ill and at least 32 people died. This was the second-deadliest outbreak since the 1976 outbreak and possibly the deadliest, as several people were buried before Legionnaires' disease had been diagnosed.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup></li> <li>The world's largest outbreak of Legionnaires' disease happened in July 2001, with people appearing at the hospital on 7 July, in <a href="/wiki/Murcia" title="Murcia">Murcia, Spain</a>. More than 800 suspected cases were recorded by the time the last case was treated on 22 July; 636–696 of these cases were estimated and 449 confirmed (so, at least 16,000 people were exposed to the bacterium) and six died, a case-fatality rate around 1%.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup></li> <li>In September 2005, 127 residents of a nursing home in Canada became ill with <i>L. pneumophila</i>. Within a week, 21 of the residents had died. Culture results at first were negative, which is not unusual, as <i>L. pneumophila</i> is a "fastidious" bacterium, meaning it requires specific nutrients, living conditions, or both to grow. The source of the outbreak was traced to the air-conditioning cooling towers on the nursing home's roof.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup></li> <li>In an outbreak in lower <a href="/wiki/Quebec_City" title="Quebec City">Quebec City</a>, <a href="/wiki/Canada" title="Canada">Canada</a>, 180 people were affected with 13 resulting deaths due to contaminated water in a cooling tower.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup></li> <li>In November 2014, 302 people were hospitalized following an <a href="/wiki/2014_Legionella_outbreak_in_Portugal" class="mw-redirect" title="2014 Legionella outbreak in Portugal">outbreak of legionellosis in Portugal</a>, and seven related deaths were reported. All cases emerged in three civil parishes from the municipality of <a href="/wiki/Vila_Franca_de_Xira" title="Vila Franca de Xira">Vila Franca de Xira</a> in the northern outskirts of <a href="/wiki/Lisbon" title="Lisbon">Lisbon</a>, and were treated in hospitals of the <a href="/wiki/Grande_Lisboa" title="Grande Lisboa">greater Lisbon area</a>. The source is suspected to be located in the cooling towers of the <a href="/wiki/Fertilizer" title="Fertilizer">fertilizer</a> plant <a href="/wiki/Fertiberia" title="Fertiberia">Fertibéria</a>.<sup id="cite_ref-Expresso10112014_56-0" class="reference"><a href="#cite_note-Expresso10112014-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup></li> <li>Twelve people were diagnosed with the disease in an outbreak in <a href="/wiki/2015_Bronx_Legionnaires%27_disease_outbreaks" title="2015 Bronx Legionnaires' disease outbreaks">the Bronx, New York, in December 2014</a>; the source was traced to contaminated cooling towers at a housing development.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> In July and August 2015, another, unrelated outbreak in the Bronx killed 12 people and made about 120 people sick; the cases arose from a cooling tower on top of a hotel. At the end of September, another person died of the disease and 13 were sickened in yet another unrelated outbreak in the Bronx.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> The cooling towers from which the people were infected in the latter outbreak had been cleaned during the summer outbreak, raising concerns about how well the bacteria could be controlled.<sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup></li> <li><span class="anchor" id="2015_San_Quentin_Legionnaires'_disease_outbreaks"></span>On 28 August 2015, an outbreak of Legionnaire's disease was detected at <a href="/wiki/San_Quentin_State_Prison" class="mw-redirect" title="San Quentin State Prison">San Quentin State Prison</a> in Northern California; 81 people were sickened and the cause was sludge that had built up in cooling towers.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup></li> <li>Between June 2015, and January 2016, 87 cases of Legionnaires' disease were reported by the Michigan Department of Health and Human Services for the city of <a href="/wiki/Flint,_Michigan" title="Flint, Michigan">Flint, Michigan</a>, and surrounding areas. The outbreak may have been linked to the <a href="/wiki/Flint_water_crisis" title="Flint water crisis">Flint water crisis</a>, in which the city's water source was changed to a cheaper and inadequately treated source. Ten of those cases were fatal.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup></li> <li>In November 2017, an outbreak was detected at Hospital de São Francisco Xavier, Lisbon, Portugal, with up to 53 people being diagnosed with the disease and five of them dying from it.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup></li> <li>In <a href="/wiki/Quincy,_Illinois" title="Quincy, Illinois">Quincy, Illinois</a>, at the Illinois Veterans Home, a 2015 outbreak of the disease killed 12 people and sickened more than 50 others. It was believed to be caused by infected water supply. Three more cases were identified by November 2017.<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup></li> <li>In the autumn of 2017, 22 cases were reported in a Legionnaires' disease outbreak at <a href="/wiki/Disneyland" title="Disneyland">Disneyland</a> in <a href="/wiki/Anaheim,_California" title="Anaheim, California">Anaheim, California</a>. It was believed to have been caused by a cooling tower that releases mist for the comfort of visitors. The contaminated droplets likely spread to the people in and beyond the park.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup></li> <li>In July 2019, 11 former guests of the Sheraton Atlanta hotel were diagnosed with the disease, with 55 additional probable cases.<sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup></li> <li>In September 2019, 141 visitors to the Western North Carolina Mountain State Fair were diagnosed with Legionnaires' disease, with four reported deaths, after a hot tub exhibit is suspected to have developed and spread the bacteria. At least one additional exposure apparently occurred during the Asheville Quilt Show that took place a few weeks after the fair in the same building where the hot tub exhibit was held. The building had been sanitized after the outbreak.<sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-BUZZFEED_68-0" class="reference"><a href="#cite_note-BUZZFEED-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-CBS_69-0" class="reference"><a href="#cite_note-CBS-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ACT_70-0" class="reference"><a href="#cite_note-ACT-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup></li> <li>In December 2019, the <a href="/wiki/Government_of_Western_Australia" title="Government of Western Australia">government of Western Australia</a>'s Department of Health was notified of four cases of Legionnaires' disease. Those exposed had recently visited near Bali's Ramayana Resort and Spa in central Kuta.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup></li> <li>In February 2024, <a href="/wiki/Minnesota_Department_of_Health" title="Minnesota Department of Health">Minnesota Department of Health</a> issued a news release stating that fourteen (14) cases were identified in Grand Rapids, Minnesota since April 2023 which they attributed to the municipal water supply.<sup id="cite_ref-73" class="reference"><a href="#cite_note-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup></li> <li>In January 2024, <a href="/wiki/Ministry_of_Health_(New_South_Wales)" title="Ministry of Health (New South Wales)">NSW Health</a> issued an alert for Legionnaires' disease for <a href="/wiki/Sydney_central_business_district" title="Sydney central business district">Sydney CBD</a>. As of 3rd January 2024, 7 known cases requiring hospitalization had been reported.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=12" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-pmid26231463-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-pmid26231463_1-0"><sup><i><b>a</b></i></sup></a> <a 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.citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output 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Retrieved <span class="nowrap">21 March</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Legionella+%28Legionnaires%27+Disease+and+Pontiac+Fever%29+Diagnostic+Testing&rft.pub=Centers+for+Disease+Control+and+Prevention+%28CDC%29&rft.date=2015-11-03&rft_id=https%3A%2F%2Fwww.cdc.gov%2Flegionella%2Fclinicians%2Fdiagnostic-testing.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> <li id="cite_note-CDC2016Pre-7"><span class="mw-cite-backlink">^ <a href="#cite_ref-CDC2016Pre_7-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-CDC2016Pre_7-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-CDC2016Pre_7-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/legionella/about/prevention.html">"Legionella (Legionnaires' Disease and Pontiac Fever) Prevention"</a>. 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Retrieved <span class="nowrap">21 March</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Legionella+%28Legionnaires%27+Disease+and+Pontiac+Fever%29+Treatment+and+Complications&rft.pub=Centers+for+Disease+Control+and+Prevention+%28CDC%29&rft.date=2016-01-26&rft_id=https%3A%2F%2Fwww.cdc.gov%2Flegionella%2Fabout%2Ftreatment-complications.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> <li id="cite_note-CDC2016Epi-9"><span class="mw-cite-backlink">^ <a href="#cite_ref-CDC2016Epi_9-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-CDC2016Epi_9-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-CDC2016Epi_9-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/legionella/about/history.html">"Legionella (Legionnaires' Disease and Pontiac Fever) History and Disease Patterns"</a>. Centers for Disease Control and Prevention (CDC). 22 January 2016. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20160325152025/http://www.cdc.gov/legionella/about/history.html">Archived</a> from the original on 25 March 2016<span class="reference-accessdate">. Retrieved <span class="nowrap">21 March</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Legionella+%28Legionnaires%27+Disease+and+Pontiac+Fever%29+History+and+Disease+Patterns&rft.pub=Centers+for+Disease+Control+and+Prevention+%28CDC%29&rft.date=2016-01-22&rft_id=https%3A%2F%2Fwww.cdc.gov%2Flegionella%2Fabout%2Fhistory.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> <li id="cite_note-10"><span class="mw-cite-backlink"><b><a href="#cite_ref-10">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation book cs1"><i>Harrison's Principles of Internal Medicine</i> (21st ed.). 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Retrieved <span class="nowrap">21 March</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Legionella+%28Legionnaires%27+Disease+and+Pontiac+Fever%29+Prevention&rft.pub=Centers+for+Disease+Control+and+Prevention+%28CDC%29&rft.date=2015-10-28&rft_id=https%3A%2F%2Fwww.cdc.gov%2Flegionella%2Fclinicians%2Fprevention.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> <li id="cite_note-Leg2016CDC-15"><span class="mw-cite-backlink"><b><a href="#cite_ref-Leg2016CDC_15-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cdc.gov/legionella/index.html">"Legionella (Legionnaires' Disease and Pontiac Fever)"</a>. 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Retrieved <span class="nowrap">22 February</span> 2017</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+New+York+Times&rft.atitle=Legionnaires%27+Bacteria+Regrew+in+Bronx+Cooling+Towers+That+Were+Disinfected&rft.date=2015-10-01&rft.aulast=Mueller&rft.aufirst=Benjamin&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2015%2F10%2F02%2Fnyregion%2Flegionnaires-bacteria-regrew-in-bronx-cooling-towers-that-were-disinfected.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> <li id="cite_note-60"><span class="mw-cite-backlink"><b><a href="#cite_ref-60">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation news cs1"><a rel="nofollow" class="external text" href="https://www.cbsnews.com/news/officials-find-source-of-legionnaires-outbreak-in-california-prison/">"Officials track down source of Legionnaires' in Calif. prison"</a>. <i>CBS News</i>. 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Retrieved <span class="nowrap">17 September</span> 2019</span>. <q>Meanwhile, the official count of Legionnaires' disease deaths remains at 12, with a reported 90 residents sickened by exposure to waterborne legionella bacteria during the year and a half that the city obtained its water from the Flint River.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Salon&rft.atitle=This+is+our+%22Chernobyl%22%3A+Frontline%27s+%22Flint%27s+Deadly+Water%22+exposes+shocking+Legionnaires%27+crisis&rft.date=2019-09-10&rft.aulast=McFarland&rft.aufirst=Melanie&rft_id=https%3A%2F%2Fwww.salon.com%2F2019%2F09%2F10%2Fthis-is-our-chernobyl-frontlines-flints-deadly-water-exposes-shocking-legionnaires-crisis%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> <li id="cite_note-63"><span class="mw-cite-backlink"><b><a href="#cite_ref-63">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFRenascença2017" class="citation web cs1">Renascença (15 November 2017). <a rel="nofollow" class="external text" href="https://rr.sapo.pt/noticia/98404/legionella-numero-de-casos-sobe-para-53">"Legionella. 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Retrieved <span class="nowrap">4 January</span> 2024</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=www.abc.net.au&rft.atitle=Seven+hospitalised+after+contracting+Legionnaires%27+disease+after+visiting+Sydney+CBD&rft.date=2024-01-04&rft_id=https%3A%2F%2Fwww.abc.net.au%2Fnews%2F2024-01-04%2Fnsw-legionnaires-disease-alert-cbd%2F103283644&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> <li id="cite_note-75"><span class="mw-cite-backlink"><b><a href="#cite_ref-75">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.health.nsw.gov.au/news/Pages/20240103_01.aspx">"Legionnaires' disease alert for Sydney CBD"</a>. <i>NSW Health</i><span class="reference-accessdate">. Retrieved <span class="nowrap">4 January</span> 2024</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=NSW+Health&rft.atitle=Legionnaires%27+disease+alert+for+Sydney+CBD&rft_id=https%3A%2F%2Fwww.health.nsw.gov.au%2Fnews%2FPages%2F20240103_01.aspx&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALegionnaires%27+disease" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Legionnaires%27_disease&action=edit&section=13" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid 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/></div><div role="navigation" class="navbox" aria-label="Navbox32" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q154882" class="extiw" title="d:Q154882">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#390042715">1C19</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/A48.1">A48.1</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/A48.2">A48.2</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=482.84">482.84</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D007876">D007876</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb7366.htm">7366</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000616.htm">000616</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/1273-overview">med/1273</a></li><li><b><a href="/wiki/Orphanet" title="Orphanet">Orphanet</a></b>: <a rel="nofollow" class="external text" href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=549">549</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Pseudomonadota-associated_Gram-negative_bacterial_infections168" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><style 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style="font-size:114%;margin:0 4em"><a href="/wiki/Pseudomonadota" title="Pseudomonadota">Pseudomonadota</a>-associated <a href="/wiki/Gram-negative_bacterial_infection" class="mw-redirect" title="Gram-negative bacterial infection">Gram-negative bacterial infections</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alphaproteobacteria" title="Alphaproteobacteria">α</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Rickettsiales" title="Rickettsiales">Rickettsiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Rickettsiaceae" title="Rickettsiaceae">Rickettsiaceae</a>/<br />(<a href="/wiki/Rickettsiosis" title="Rickettsiosis">Rickettsioses</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Typhus" title="Typhus">Typhus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_typhi" title="Rickettsia typhi">Rickettsia typhi</a></i> <ul><li><a href="/wiki/Murine_typhus" title="Murine typhus">Murine typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_prowazekii" title="Rickettsia prowazekii">Rickettsia prowazekii</a></i> <ul><li><a href="/wiki/Epidemic_typhus" title="Epidemic typhus">Epidemic typhus</a>, <a href="/wiki/Brill%E2%80%93Zinsser_disease" title="Brill–Zinsser disease">Brill–Zinsser disease</a>, <a href="/wiki/Flying_squirrel_typhus" title="Flying squirrel typhus">Flying squirrel typhus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Spotted_fever" title="Spotted fever">Spotted<br />fever</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Tick-borne_disease" title="Tick-borne disease">Tick-borne</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_rickettsii" title="Rickettsia rickettsii">Rickettsia rickettsii</a></i> <ul><li><a href="/wiki/Rocky_Mountain_spotted_fever" title="Rocky Mountain spotted fever">Rocky Mountain spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_conorii" title="Rickettsia conorii">Rickettsia conorii</a></i> <ul><li><a href="/wiki/Boutonneuse_fever" title="Boutonneuse fever">Boutonneuse fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_japonica" title="Rickettsia japonica">Rickettsia japonica</a></i> <ul><li><a href="/wiki/Japanese_spotted_fever" title="Japanese spotted fever">Japanese spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_sibirica" title="Rickettsia sibirica">Rickettsia sibirica</a></i> <ul><li><a href="/wiki/North_Asian_tick_typhus" title="North Asian tick typhus">North Asian tick typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_australis" title="Rickettsia australis">Rickettsia australis</a></i> <ul><li><a href="/wiki/Queensland_tick_typhus" title="Queensland tick typhus">Queensland tick typhus</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_honei" title="Rickettsia honei">Rickettsia honei</a></i> <ul><li><a href="/wiki/Flinders_Island_spotted_fever" title="Flinders Island spotted fever">Flinders Island spotted fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_africae" title="Rickettsia africae">Rickettsia africae</a></i> <ul><li><a href="/wiki/African_tick_bite_fever" title="African tick bite fever">African tick bite fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_parkeri" title="Rickettsia parkeri">Rickettsia parkeri</a></i> <ul><li><a href="/wiki/American_tick_bite_fever" class="mw-redirect" title="American tick bite fever">American tick bite fever</a></li></ul></li> <li><i><a href="/wiki/Rickettsia_aeschlimannii" class="mw-redirect" title="Rickettsia aeschlimannii">Rickettsia aeschlimannii</a></i> <ul><li><a href="/wiki/Rickettsia_aeschlimannii_infection" title="Rickettsia aeschlimannii infection"><i>Rickettsia aeschlimannii</i> infection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Mite#Clinical_significance" title="Mite">Mite-borne</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_akari" title="Rickettsia akari">Rickettsia akari</a></i> <ul><li><a href="/wiki/Rickettsialpox" title="Rickettsialpox">Rickettsialpox</a></li></ul></li> <li><i><a href="/wiki/Orientia_tsutsugamushi" title="Orientia tsutsugamushi">Orientia tsutsugamushi</a></i> <ul><li><a href="/wiki/Scrub_typhus" title="Scrub typhus">Scrub typhus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Flea#Fleas_as_a_vector" title="Flea">Flea-borne</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Rickettsia_felis" title="Rickettsia felis">Rickettsia felis</a></i> <ul><li><a href="/wiki/Flea-borne_spotted_fever" title="Flea-borne spotted fever">Flea-borne spotted fever</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Anaplasmataceae" class="mw-redirect" title="Anaplasmataceae">Anaplasmataceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ehrlichiosis" title="Ehrlichiosis">Ehrlichiosis</a>: <i><a href="/wiki/Anaplasma_phagocytophilum" title="Anaplasma phagocytophilum">Anaplasma phagocytophilum</a></i> <ul><li><a href="/wiki/Human_granulocytic_anaplasmosis" title="Human granulocytic anaplasmosis">Human granulocytic anaplasmosis</a>, <a href="/wiki/Anaplasmosis" title="Anaplasmosis">Anaplasmosis</a></li></ul></li> <li><i><a href="/wiki/Ehrlichia_chaffeensis" title="Ehrlichia chaffeensis">Ehrlichia chaffeensis</a></i> <ul><li><a href="/wiki/Human_monocytotropic_ehrlichiosis" title="Human monocytotropic ehrlichiosis">Human monocytotropic ehrlichiosis</a></li></ul></li> <li><i><a href="/wiki/Ehrlichia_ewingii" title="Ehrlichia ewingii">Ehrlichia ewingii</a></i> <ul><li><a href="/wiki/Ehrlichiosis_ewingii_infection" title="Ehrlichiosis ewingii infection">Ehrlichiosis ewingii infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Hyphomicrobiales" title="Hyphomicrobiales">Hyphomicrobiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Brucellaceae" title="Brucellaceae">Brucellaceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Brucella_abortus" title="Brucella abortus">Brucella abortus</a></i> <ul><li><a href="/wiki/Brucellosis" title="Brucellosis">Brucellosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Bartonella" title="Bartonella">Bartonellaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bartonellosis" title="Bartonellosis">Bartonellosis</a>: <i><a href="/wiki/Bartonella_henselae" title="Bartonella henselae">Bartonella henselae</a></i> <ul><li><a href="/wiki/Cat-scratch_disease" title="Cat-scratch disease">Cat-scratch disease</a></li></ul></li> <li><i><a href="/wiki/Bartonella_quintana" title="Bartonella quintana">Bartonella quintana</a></i> <ul><li><a href="/wiki/Trench_fever" title="Trench fever">Trench fever</a></li></ul></li> <li>Either <i>B. henselae</i> or <i>B. quintana</i> <ul><li><a href="/wiki/Bacillary_angiomatosis" title="Bacillary angiomatosis">Bacillary angiomatosis</a></li></ul></li> <li><i><a href="/wiki/Bartonella_bacilliformis" title="Bartonella bacilliformis">Bartonella bacilliformis</a></i> <ul><li><a href="/wiki/Carrion%27s_disease" title="Carrion's disease">Carrion's disease</a>, <a href="/wiki/Verruga_peruana" class="mw-redirect" title="Verruga peruana">Verruga peruana</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Betaproteobacteria" title="Betaproteobacteria">β</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Neisseriaceae" title="Neisseriaceae">Neisseriales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Maltose" title="Maltose">M+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Neisseria_meningitidis" title="Neisseria meningitidis">Neisseria meningitidis/meningococcus</a></i> <ul><li><a href="/wiki/Meningococcal_disease" title="Meningococcal disease">Meningococcal disease</a>, <a href="/wiki/Waterhouse%E2%80%93Friderichsen_syndrome" title="Waterhouse–Friderichsen syndrome">Waterhouse–Friderichsen syndrome</a>, <a href="/wiki/Meningococcal_septicaemia" class="mw-redirect" title="Meningococcal septicaemia">Meningococcal septicaemia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Maltose" title="Maltose">M−</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Neisseria_gonorrhoeae" title="Neisseria gonorrhoeae">Neisseria gonorrhoeae/gonococcus</a></i> <ul><li><a href="/wiki/Gonorrhea" title="Gonorrhea">Gonorrhea</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i>ungrouped:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Eikenella_corrodens" title="Eikenella corrodens">Eikenella corrodens</a></i>/<i><a href="/wiki/Kingella_kingae" title="Kingella kingae">Kingella kingae</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li> <li><i><a href="/wiki/Chromobacterium_violaceum" title="Chromobacterium violaceum">Chromobacterium violaceum</a></i> <ul><li><a href="/wiki/Chromobacteriosis_infection" title="Chromobacteriosis infection">Chromobacteriosis infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Burkholderiales" title="Burkholderiales">Burkholderiales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Burkholderia_pseudomallei" title="Burkholderia pseudomallei">Burkholderia pseudomallei</a></i> <ul><li><a href="/wiki/Melioidosis" title="Melioidosis">Melioidosis</a></li></ul></li> <li><i><a href="/wiki/Burkholderia_mallei" title="Burkholderia mallei">Burkholderia mallei</a></i> <ul><li><a href="/wiki/Glanders" title="Glanders">Glanders</a></li></ul></li> <li><i><a href="/wiki/Burkholderia_cepacia_complex" title="Burkholderia cepacia complex">Burkholderia cepacia complex</a></i></li> <li><i><a href="/wiki/Bordetella_pertussis" title="Bordetella pertussis">Bordetella pertussis</a>/<a href="/wiki/Bordetella_parapertussis" title="Bordetella parapertussis">Bordetella parapertussis</a></i> <ul><li><a href="/wiki/Pertussis" class="mw-redirect" title="Pertussis">Pertussis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gammaproteobacteria" title="Gammaproteobacteria">γ</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Enterobacteriaceae" title="Enterobacteriaceae">Enterobacteriales</a><br />(<a href="/wiki/Oxidase_test#OX−" title="Oxidase test">OX−</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Lac+" title="MacConkey agar">Lac+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Klebsiella_pneumoniae" title="Klebsiella pneumoniae">Klebsiella pneumoniae</a></i> <ul><li><a href="/wiki/Rhinoscleroma" title="Rhinoscleroma">Rhinoscleroma</a>, <a href="/wiki/Pneumonia" title="Pneumonia">Pneumonia</a></li></ul></li> <li><i><a href="/wiki/Klebsiella_granulomatis" title="Klebsiella granulomatis">Klebsiella granulomatis</a></i> <ul><li><a href="/wiki/Granuloma_inguinale" title="Granuloma inguinale">Granuloma inguinale</a></li></ul></li> <li><i><a href="/wiki/Klebsiella_oxytoca" title="Klebsiella oxytoca">Klebsiella oxytoca</a></i></li></ul> <ul><li><i><a href="/wiki/Escherichia_coli" title="Escherichia coli">Escherichia coli</a></i>: <a href="/wiki/Enterotoxigenic_Escherichia_coli" title="Enterotoxigenic Escherichia coli">Enterotoxigenic</a></li> <li><a href="/wiki/Enteroinvasive_Escherichia_coli" title="Enteroinvasive Escherichia coli">Enteroinvasive</a></li> <li><a href="/wiki/Verotoxin-producing_Escherichia_coli" class="mw-redirect" title="Verotoxin-producing Escherichia coli">Enterohemorrhagic</a></li> <li><a href="/wiki/Escherichia_coli_O157:H7" title="Escherichia coli O157:H7">O157:H7</a></li> <li><a href="/wiki/Escherichia_coli_O104:H4" title="Escherichia coli O104:H4">O104:H4</a> <ul><li><a href="/wiki/Hemolytic-uremic_syndrome" class="mw-redirect" title="Hemolytic-uremic syndrome">Hemolytic-uremic syndrome</a></li></ul></li></ul> <ul><li><i><a href="/wiki/Enterobacter_aerogenes" class="mw-redirect" title="Enterobacter aerogenes">Enterobacter aerogenes</a>/<a href="/wiki/Enterobacter_cloacae" title="Enterobacter cloacae">Enterobacter cloacae</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Slow" title="MacConkey agar">Slow/weak</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Serratia_marcescens" title="Serratia marcescens">Serratia marcescens</a></i> <ul><li><a href="/wiki/Serratia_infection" class="mw-redirect" title="Serratia infection"><i>Serratia</i> infection</a></li></ul></li> <li><i><a href="/wiki/Citrobacter_koseri" title="Citrobacter koseri">Citrobacter koseri</a></i>/<i><a href="/wiki/Citrobacter_freundii" title="Citrobacter freundii">Citrobacter freundii</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/MacConkey_agar#Lac−" title="MacConkey agar">Lac−</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Bismuth_sulfite_agar" title="Bismuth sulfite agar">H2S+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Salmonella_enterica" title="Salmonella enterica">Salmonella enterica</a></i> <ul><li><a href="/wiki/Typhoid_fever" title="Typhoid fever">Typhoid fever</a>, <a href="/wiki/Paratyphoid_fever" title="Paratyphoid fever">Paratyphoid fever</a>, <a href="/wiki/Salmonellosis" title="Salmonellosis">Salmonellosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue">H2S−</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Shigella_dysenteriae" title="Shigella dysenteriae">Shigella dysenteriae</a>/<a href="/wiki/Shigella_sonnei" title="Shigella sonnei">sonnei</a>/<a href="/wiki/Shigella_flexneri" title="Shigella flexneri">flexneri</a>/<a href="/wiki/Shigella_boydii" title="Shigella boydii">boydii</a></i> <ul><li><a href="/wiki/Shigellosis" title="Shigellosis">Shigellosis</a>, <a href="/wiki/Bacillary_dysentery" title="Bacillary dysentery">Bacillary dysentery</a></li></ul></li> <li><i><a href="/wiki/Proteus_mirabilis" title="Proteus mirabilis">Proteus mirabilis</a></i>/<i><a href="/wiki/Proteus_vulgaris" title="Proteus vulgaris">Proteus vulgaris</a></i></li> <li><i><a href="/wiki/Yersinia_pestis" title="Yersinia pestis">Yersinia pestis</a></i> <ul><li><a href="/wiki/Plague_(disease)" title="Plague (disease)">Plague</a>/<a href="/wiki/Bubonic_plague" title="Bubonic plague">Bubonic plague</a></li></ul></li> <li><i><a href="/wiki/Yersinia_enterocolitica" title="Yersinia enterocolitica">Yersinia enterocolitica</a></i> <ul><li><a href="/wiki/Yersiniosis" title="Yersiniosis">Yersiniosis</a></li></ul></li> <li><i><a href="/wiki/Yersinia_pseudotuberculosis" title="Yersinia pseudotuberculosis">Yersinia pseudotuberculosis</a></i> <ul><li><a href="/wiki/Far_East_scarlet-like_fever" title="Far East scarlet-like fever">Far East scarlet-like fever</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Pasteurellaceae" title="Pasteurellaceae">Pasteurellales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Haemophilus" title="Haemophilus">Haemophilus</a>:</i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Haemophilus_influenzae" title="Haemophilus influenzae">H. influenzae</a></i> <ul><li><a href="/wiki/Haemophilus_meningitis" title="Haemophilus meningitis"><i>Haemophilus</i> meningitis</a></li> <li><a href="/wiki/Brazilian_purpuric_fever" title="Brazilian purpuric fever">Brazilian purpuric fever</a></li></ul></li> <li><i><a href="/wiki/Haemophilus_ducreyi" title="Haemophilus ducreyi">H. ducreyi</a></i> <ul><li><a href="/wiki/Chancroid" title="Chancroid">Chancroid</a></li></ul></li> <li><i><a href="/wiki/Haemophilus_parainfluenzae" title="Haemophilus parainfluenzae">H. parainfluenzae</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Pasteurella_multocida" title="Pasteurella multocida">Pasteurella multocida</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pasteurellosis" title="Pasteurellosis">Pasteurellosis</a></li> <li><i><a href="/wiki/Actinobacillus" title="Actinobacillus">Actinobacillus</a></i> <ul><li><a href="/wiki/Actinobacillosis" title="Actinobacillosis">Actinobacillosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><span class="nobold"><i><a href="/wiki/Aggregatibacter_actinomycetemcomitans" title="Aggregatibacter actinomycetemcomitans">Aggregatibacter actinomycetemcomitans</a></i></span></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Legionellales" title="Legionellales">Legionellales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Legionella_pneumophila" title="Legionella pneumophila">Legionella pneumophila</a>/<a href="/wiki/Legionella_longbeachae" title="Legionella longbeachae">Legionella longbeachae</a></i> <ul><li><a class="mw-selflink selflink">Legionnaires' disease</a></li></ul></li> <li><i><a href="/wiki/Coxiella_burnetii" title="Coxiella burnetii">Coxiella burnetii</a></i> <ul><li><a href="/wiki/Q_fever" title="Q fever">Q fever</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Thiotrichales" title="Thiotrichales">Thiotrichales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Francisella_tularensis" title="Francisella tularensis">Francisella tularensis</a></i> <ul><li><a href="/wiki/Tularemia" title="Tularemia">Tularemia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Vibrionaceae" title="Vibrionaceae">Vibrionaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Vibrio_cholerae" title="Vibrio cholerae">Vibrio cholerae</a></i> <ul><li><a href="/wiki/Cholera" title="Cholera">Cholera</a></li></ul></li> <li><i><a href="/wiki/Vibrio_vulnificus" title="Vibrio vulnificus">Vibrio vulnificus</a></i></li> <li><i><a href="/wiki/Vibrio_parahaemolyticus" title="Vibrio parahaemolyticus">Vibrio parahaemolyticus</a></i></li> <li><i><a href="/wiki/Vibrio_alginolyticus" title="Vibrio alginolyticus">Vibrio alginolyticus</a></i></li> <li><i><a href="/wiki/Plesiomonas_shigelloides" title="Plesiomonas shigelloides">Plesiomonas shigelloides</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Pseudomonadales" title="Pseudomonadales">Pseudomonadales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Pseudomonas_aeruginosa" title="Pseudomonas aeruginosa">Pseudomonas aeruginosa</a></i> <ul><li><a href="/wiki/Pseudomonas_infection" title="Pseudomonas infection"><i>Pseudomonas</i> infection</a></li></ul></li> <li><i><a href="/wiki/Moraxella_catarrhalis" title="Moraxella catarrhalis">Moraxella catarrhalis</a></i></li> <li><i><a href="/wiki/Acinetobacter_baumannii" title="Acinetobacter baumannii">Acinetobacter baumannii</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Xanthomonadaceae" title="Xanthomonadaceae">Xanthomonadaceae</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Stenotrophomonas_maltophilia" title="Stenotrophomonas maltophilia">Stenotrophomonas maltophilia</a></i></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Cardiobacteriaceae" title="Cardiobacteriaceae">Cardiobacteriaceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Cardiobacterium_hominis" title="Cardiobacterium hominis">Cardiobacterium hominis</a></i> <ul><li><a href="/wiki/HACEK_organisms" title="HACEK organisms">HACEK</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Aeromonadales" title="Aeromonadales">Aeromonadales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Aeromonas_hydrophila" title="Aeromonas hydrophila">Aeromonas hydrophila</a>/<a href="/wiki/Aeromonas_veronii" title="Aeromonas veronii">Aeromonas veronii</a></i> <ul><li><a href="/wiki/Aeromonas_infection" title="Aeromonas infection"><i>Aeromonas</i> infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Campylobacterota" title="Campylobacterota">ε</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Campylobacterales21" scope="row" class="navbox-group" style="width:1%;background-color: PowderBlue"><a href="/wiki/Campylobacterales" title="Campylobacterales">Campylobacterales</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Campylobacter_jejuni" title="Campylobacter jejuni">Campylobacter jejuni</a></i> <ul><li><a href="/wiki/Campylobacteriosis" title="Campylobacteriosis">Campylobacteriosis</a>, <a href="/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome" title="Guillain–Barré syndrome">Guillain–Barré syndrome</a></li></ul></li> <li><i><a href="/wiki/Helicobacter_pylori" title="Helicobacter pylori">Helicobacter pylori</a></i> <ul><li><a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">Peptic ulcer</a>, <a href="/wiki/MALT_lymphoma" title="MALT lymphoma">MALT lymphoma</a>, <a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">Gastric cancer</a></li></ul></li> <li><i><a href="/wiki/Helicobacter_cinaedi" title="Helicobacter cinaedi">Helicobacter cinaedi</a></i> <ul><li><a href="/wiki/Helicobacter_cellulitis" title="Helicobacter cellulitis"><i>Helicobacter</i> cellulitis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Legionnaires&#039;_disease93" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231" /><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Legionnaires%27_disease" title="Template:Legionnaires' disease"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Legionnaires%27_disease" title="Template talk:Legionnaires' disease"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Legionnaires%27_disease" title="Special:EditPage/Template:Legionnaires' disease"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Legionnaires&#039;_disease93" style="font-size:114%;margin:0 4em"><a class="mw-selflink selflink">Legionnaires' disease</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/List_of_Legionnaires%27_disease_outbreaks" title="List of Legionnaires' disease outbreaks">List of outbreaks</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/1976_Philadelphia_Legionnaires%27_disease_outbreak" title="1976 Philadelphia Legionnaires' disease outbreak">1976 Philadelphia Legionnaires' disease outbreak</a></li> <li><a href="/wiki/1999_Bovenkarspel_legionellosis_outbreak" title="1999 Bovenkarspel legionellosis outbreak">1999 Bovenkarspel legionellosis outbreak</a></li> <li><a href="/wiki/2002_Barrow-in-Furness_legionellosis_outbreak" title="2002 Barrow-in-Furness legionellosis outbreak">2002 Barrow-in-Furness legionellosis outbreak</a></li> <li><a href="/wiki/2014_Portugal_legionellosis_outbreak" title="2014 Portugal legionellosis outbreak">2014 Portugal legionellosis outbreak</a></li> <li><a href="/wiki/2015_Bronx_Legionnaires%27_disease_outbreaks" title="2015 Bronx Legionnaires' disease outbreaks">2015 Bronx Legionnaires' disease outbreaks</a></li> <li><a href="/wiki/2022_Tucum%C3%A1n_legionellosis_outbreak" title="2022 Tucumán legionellosis outbreak">2022 Tucumán legionellosis outbreak</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pontiac_fever" title="Pontiac fever">Pontiac fever</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_the_respiratory_system378" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231" /><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Respiratory_pathology" title="Template:Respiratory pathology"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Respiratory_pathology" title="Template talk:Respiratory pathology"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Respiratory_pathology" title="Special:EditPage/Template:Respiratory pathology"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_the_respiratory_system378" style="font-size:114%;margin:0 4em"><a href="/wiki/Respiratory_disease" title="Respiratory disease">Diseases of the respiratory system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Upper_respiratory_tract_infection" title="Upper respiratory tract infection">Upper RT</a><br />(including <a href="/wiki/Upper_respiratory_tract_infection" title="Upper respiratory tract infection">URTIs</a>,<br /><a href="/wiki/Common_cold" title="Common cold">common cold</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_head" title="Human head">Head</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dt><i><a href="/wiki/Paranasal_sinuses" title="Paranasal sinuses">sinuses</a></i></dt> <dd></dd> <dd><a href="/wiki/Sinusitis" title="Sinusitis">Sinusitis</a></dd></dl> <dl><dt><i><a href="/wiki/Human_nose" title="Human nose">nose</a></i></dt> <dd></dd> <dd><a href="/wiki/Rhinitis" title="Rhinitis">Rhinitis</a> <dl><dd><a href="/wiki/Nonallergic_rhinitis" title="Nonallergic rhinitis">Vasomotor rhinitis</a></dd> <dd><a href="/wiki/Chronic_atrophic_rhinitis" title="Chronic atrophic rhinitis">Atrophic rhinitis</a></dd> <dd><a href="/wiki/Allergic_rhinitis" title="Allergic rhinitis">Hay fever</a></dd></dl></dd> <dd><a href="/wiki/Nasal_polyp" title="Nasal polyp">Nasal polyp</a></dd> <dd><a href="/wiki/Rhinorrhea" title="Rhinorrhea">Rhinorrhea</a></dd> <dd><i><a href="/wiki/Nasal_septum" title="Nasal septum">nasal septum</a></i> <dl><dd><a href="/wiki/Nasal_septum_deviation" title="Nasal septum deviation">Nasal septum deviation</a></dd> <dd><a href="/wiki/Nasal_septum_perforation" title="Nasal septum perforation">Nasal septum perforation</a></dd> <dd><a href="/wiki/Nasal_septal_hematoma" title="Nasal septal hematoma">Nasal septal hematoma</a></dd></dl></dd></dl> <dl><dt><i><a href="/wiki/Tonsil" title="Tonsil">tonsil</a></i></dt> <dd></dd> <dd><a href="/wiki/Tonsillitis" title="Tonsillitis">Tonsillitis</a></dd> <dd><a href="/wiki/Adenoid_hypertrophy" title="Adenoid hypertrophy">Adenoid hypertrophy</a></dd> <dd><a href="/wiki/Peritonsillar_abscess" title="Peritonsillar abscess">Peritonsillar abscess</a></dd></dl> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neck" title="Neck">Neck</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dt><i><a href="/wiki/Pharynx" title="Pharynx">pharynx</a></i></dt> <dd></dd> <dd><a href="/wiki/Pharyngitis" title="Pharyngitis">Pharyngitis</a> <dl><dd><a href="/wiki/Streptococcal_pharyngitis" title="Streptococcal pharyngitis">Strep throat</a></dd></dl></dd> <dd><a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">Laryngopharyngeal reflux</a> (LPR)</dd> <dd><a href="/wiki/Retropharyngeal_abscess" title="Retropharyngeal abscess">Retropharyngeal abscess</a></dd></dl> <dl><dt><i><a href="/wiki/Larynx" title="Larynx">larynx</a></i></dt> <dd></dd> <dd><a href="/wiki/Croup" title="Croup">Croup</a></dd> <dd><a href="/wiki/Laryngomalacia" title="Laryngomalacia">Laryngomalacia</a></dd> <dd><a href="/wiki/Laryngeal_cyst" title="Laryngeal cyst">Laryngeal cyst</a></dd> <dd><a href="/wiki/Laryngitis" title="Laryngitis">Laryngitis</a></dd> <dd><a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">Laryngopharyngeal reflux</a> (LPR)</dd> <dd><a href="/wiki/Laryngospasm" title="Laryngospasm">Laryngospasm</a></dd></dl> <dl><dt><i><a href="/wiki/Vocal_cords" title="Vocal cords">vocal cords</a></i></dt> <dd></dd> <dd><a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">Laryngopharyngeal reflux</a> (LPR)</dd> <dd><a href="/wiki/Vocal_cord_nodule" title="Vocal cord nodule">Vocal fold nodule</a></dd> <dd><a href="/wiki/Vocal_cord_paresis" title="Vocal cord paresis">Vocal fold paresis</a></dd> <dd><a href="/wiki/Vocal_cord_dysfunction" title="Vocal cord dysfunction">Vocal cord dysfunction</a></dd></dl> <dl><dt><i><a href="/wiki/Epiglottis" title="Epiglottis">epiglottis</a></i></dt> <dd></dd> <dd><a href="/wiki/Epiglottitis" title="Epiglottitis">Epiglottitis</a></dd></dl> <dl><dt><i><a href="/wiki/Trachea" title="Trachea">trachea</a></i></dt> <dd></dd> <dd><a href="/wiki/Tracheitis" title="Tracheitis">Tracheitis</a></dd> <dd><a href="/wiki/Laryngotracheal_stenosis" title="Laryngotracheal stenosis">Laryngotracheal stenosis</a></dd></dl> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Lower_respiratory_tract" class="mw-redirect" title="Lower respiratory tract">Lower RT</a>/<br /><a href="/wiki/Respiratory_disease" title="Respiratory disease">lung disease</a><br />(including <a href="/wiki/Lower_respiratory_tract_infection" title="Lower respiratory tract infection">LRTIs</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bronchus" title="Bronchus">Bronchial</a>/<br /><a href="/wiki/Obstructive_lung_disease" title="Obstructive lung disease">obstructive</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dt><i>acute</i></dt> <dd></dd> <dd><a href="/wiki/Acute_bronchitis" title="Acute bronchitis">Acute bronchitis</a></dd></dl> <dl><dt><i>chronic</i></dt> <dd></dd> <dd><a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">COPD</a> <dl><dd><a href="/wiki/Bronchitis#Chronic_bronchitis" title="Bronchitis">Chronic bronchitis</a></dd> <dd><a href="/wiki/Acute_exacerbation_of_chronic_obstructive_pulmonary_disease" title="Acute exacerbation of chronic obstructive pulmonary disease">Acute exacerbation of COPD</a>)</dd> <dd><a href="/wiki/Asthma" title="Asthma">Asthma</a> (<a href="/wiki/Status_asthmaticus" class="mw-redirect" title="Status asthmaticus">Status asthmaticus</a></dd> <dd><a href="/wiki/Aspirin-exacerbated_respiratory_disease" title="Aspirin-exacerbated respiratory disease">AERD</a></dd> <dd><a href="/wiki/Exercise-induced_asthma" class="mw-redirect" title="Exercise-induced asthma">Exercise-induced</a></dd></dl></dd> <dd><a href="/wiki/Bronchiectasis" title="Bronchiectasis">Bronchiectasis</a></dd> <dd><a href="/wiki/Cystic_fibrosis" title="Cystic fibrosis">Cystic fibrosis</a></dd></dl> <dl><dt><i>unspecified</i></dt> <dd></dd> <dd><a href="/wiki/Bronchitis" title="Bronchitis">Bronchitis</a></dd> <dd><a href="/wiki/Bronchiolitis" title="Bronchiolitis">Bronchiolitis</a> <dl><dd><a href="/wiki/Bronchiolitis_obliterans" title="Bronchiolitis obliterans">Bronchiolitis obliterans</a></dd></dl></dd> <dd><a href="/wiki/Diffuse_panbronchiolitis" title="Diffuse panbronchiolitis">Diffuse panbronchiolitis</a></dd></dl> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Interstitial_lung_disease" title="Interstitial lung disease">Interstitial</a>/<br /><a href="/wiki/Restrictive_lung_disease" title="Restrictive lung disease">restrictive</a><br />(<a href="/wiki/Pulmonary_fibrosis" title="Pulmonary fibrosis">fibrosis</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">External agents/<br /><a href="/wiki/Occupational_disease" title="Occupational disease">occupational</a><br /><a href="/wiki/Occupational_lung_disease" title="Occupational lung disease">lung disease</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <dl><dd><a href="/wiki/Pneumoconiosis" title="Pneumoconiosis">Pneumoconiosis</a> <dl><dd><a href="/wiki/Aluminosis" title="Aluminosis">Aluminosis</a></dd> <dd><a href="/wiki/Asbestosis" title="Asbestosis">Asbestosis</a></dd> <dd><a href="/wiki/Baritosis" title="Baritosis">Baritosis</a></dd> <dd><a href="/wiki/Bauxite_fibrosis" title="Bauxite fibrosis">Bauxite fibrosis</a></dd> <dd><a href="/wiki/Berylliosis" title="Berylliosis">Berylliosis</a></dd> <dd><a href="/wiki/Caplan%27s_syndrome" title="Caplan's syndrome">Caplan's syndrome</a></dd> <dd><a href="/wiki/Chalicosis" title="Chalicosis">Chalicosis</a></dd> <dd><a href="/wiki/Coalworker%27s_pneumoconiosis" class="mw-redirect" title="Coalworker's pneumoconiosis">Coalworker's pneumoconiosis</a></dd> <dd><a href="/wiki/Siderosis" title="Siderosis">Siderosis</a></dd> <dd><a href="/wiki/Silicosis" title="Silicosis">Silicosis</a></dd> <dd><a href="/wiki/Pulmonary_talcosis" title="Pulmonary talcosis">Talcosis</a></dd> <dd><a href="/wiki/Byssinosis" title="Byssinosis">Byssinosis</a></dd></dl></dd></dl> <dl><dd><a href="/wiki/Hypersensitivity_pneumonitis" title="Hypersensitivity pneumonitis">Hypersensitivity pneumonitis</a> <dl><dd><a href="/wiki/Bagassosis" title="Bagassosis">Bagassosis</a></dd> <dd><a href="/wiki/Bird_fancier%27s_lung" title="Bird fancier's lung">Bird fancier's lung</a></dd> <dd><a href="/wiki/Farmer%27s_lung" title="Farmer's lung">Farmer's lung</a></dd> <dd><a href="/wiki/Lycoperdonosis" title="Lycoperdonosis">Lycoperdonosis</a></dd></dl></dd></dl> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acute_respiratory_distress_syndrome" title="Acute respiratory distress syndrome">ARDS</a></li> <li><a href="/wiki/Combined_pulmonary_fibrosis_and_emphysema" title="Combined pulmonary fibrosis and emphysema">Combined pulmonary fibrosis and emphysema</a></li> <li><a href="/wiki/Pulmonary_edema" title="Pulmonary edema">Pulmonary edema</a></li> <li><a href="/wiki/L%C3%B6ffler%27s_syndrome" title="Löffler's syndrome">Löffler's syndrome</a>/<a href="/wiki/Eosinophilic_pneumonia" title="Eosinophilic pneumonia">Eosinophilic pneumonia</a></li> <li><a href="/wiki/Respiratory_hypersensitivity" class="mw-redirect" title="Respiratory hypersensitivity">Respiratory hypersensitivity</a> <ul><li><a href="/wiki/Allergic_bronchopulmonary_aspergillosis" title="Allergic bronchopulmonary aspergillosis">Allergic bronchopulmonary aspergillosis</a></li></ul></li> <li><a href="/wiki/Hamman%E2%80%93Rich_syndrome" class="mw-redirect" title="Hamman–Rich syndrome">Hamman–Rich syndrome</a></li> <li><a href="/wiki/Idiopathic_pulmonary_fibrosis" title="Idiopathic pulmonary fibrosis">Idiopathic pulmonary fibrosis</a></li> <li><a href="/wiki/Sarcoidosis" title="Sarcoidosis">Sarcoidosis</a></li> <li><a href="/wiki/Vaping-associated_pulmonary_injury" title="Vaping-associated pulmonary injury">Vaping-associated pulmonary injury</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Obstructive /<br /> Restrictive</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pneumonia" title="Pneumonia">Pneumonia</a>/<br /><a href="/wiki/Pneumonitis" title="Pneumonitis">pneumonitis</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">By pathogen</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Viral_pneumonia" title="Viral pneumonia">Viral</a></li> <li><a href="/wiki/Bacterial_pneumonia" title="Bacterial pneumonia">Bacterial</a> <ul><li><a href="/wiki/Pneumococcal_infection" title="Pneumococcal infection">Pneumococcal</a></li> <li><a href="/wiki/Klebsiella_pneumoniae#Klebsiella_pneumonia" title="Klebsiella pneumoniae">Klebsiella</a></li></ul></li> <li><a href="/wiki/Atypical_pneumonia" title="Atypical pneumonia">Atypical bacterial</a> <ul><li><a href="/wiki/Mycoplasma_pneumonia" title="Mycoplasma pneumonia">Mycoplasma</a></li> <li><a href="/wiki/Legionellosis" class="mw-redirect" title="Legionellosis">Legionnaires' disease</a></li> <li><a href="/wiki/Chlamydiota" title="Chlamydiota">Chlamydiae</a></li></ul></li> <li><a href="/wiki/Fungal_pneumonia" title="Fungal pneumonia">Fungal</a> <ul><li><a href="/wiki/Pneumocystis_pneumonia" title="Pneumocystis pneumonia">Pneumocystis</a></li></ul></li> <li><a href="/wiki/Parasitic_pneumonia" title="Parasitic pneumonia">Parasitic</a></li> <li><i>noninfectious</i> <ul><li><a href="/wiki/Chemical_pneumonia" class="mw-redirect" title="Chemical pneumonia">Chemical</a>/<a href="/wiki/Mendelson%27s_syndrome" title="Mendelson's syndrome">Mendelson's syndrome</a></li> <li><a href="/wiki/Aspiration_pneumonia" title="Aspiration pneumonia">Aspiration</a>/<a href="/wiki/Lipid_pneumonia" title="Lipid pneumonia">Lipid</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">By vector/route</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Community-acquired_pneumonia" title="Community-acquired pneumonia">Community-acquired</a></li> <li><a href="/wiki/Healthcare-associated_pneumonia" class="mw-redirect" title="Healthcare-associated pneumonia">Healthcare-associated</a></li> <li><a href="/wiki/Hospital-acquired_pneumonia" title="Hospital-acquired pneumonia">Hospital-acquired</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">By distribution</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bronchopneumonia" title="Bronchopneumonia">Broncho-</a></li> <li><a href="/wiki/Lobar_pneumonia" title="Lobar pneumonia">Lobar</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Idiopathic_interstitial_pneumonia" title="Idiopathic interstitial pneumonia">IIP</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Usual_interstitial_pneumonia" title="Usual interstitial pneumonia">UIP</a></li> <li><a href="/wiki/Desquamative_interstitial_pneumonia" title="Desquamative interstitial pneumonia">DIP</a></li> <li><a href="/wiki/Bronchiolitis_obliterans_organizing_pneumonia" class="mw-redirect" title="Bronchiolitis obliterans organizing pneumonia">BOOP-COP</a></li> <li><a href="/wiki/Nonspecific_interstitial_pneumonia" class="mw-redirect" title="Nonspecific interstitial pneumonia">NSIP</a></li> <li><a href="/wiki/Respiratory_bronchiolitis" title="Respiratory bronchiolitis">RB</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Atelectasis" title="Atelectasis">Atelectasis</a></li> <li><i>circulatory</i> <ul><li><a href="/wiki/Pulmonary_hypertension" title="Pulmonary hypertension">Pulmonary hypertension</a></li> <li><a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">Pulmonary embolism</a></li></ul></li> <li><a href="/wiki/Lung_abscess" title="Lung abscess">Lung abscess</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pleural_cavity" title="Pleural cavity">Pleural cavity</a>/<br /><a href="/wiki/Mediastinum" title="Mediastinum">mediastinum</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pleural_disease" title="Pleural disease">Pleural disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pleurisy" title="Pleurisy">Pleuritis/pleurisy</a></li></ul> <ul><li><a href="/wiki/Pneumothorax" title="Pneumothorax">Pneumothorax</a>/<a href="/wiki/Hemopneumothorax" title="Hemopneumothorax">Hemopneumothorax</a></li></ul> <dl><dt><a href="/wiki/Pleural_effusion" title="Pleural effusion">Pleural effusion</a></dt> <dd></dd> <dd><a href="/wiki/Hemothorax" title="Hemothorax">Hemothorax</a></dd> <dd><a href="/wiki/Hydrothorax" title="Hydrothorax">Hydrothorax</a></dd> <dd><a href="/wiki/Chylothorax" title="Chylothorax">Chylothorax</a></dd> <dd><a href="/wiki/Pleural_empyema" title="Pleural empyema">Empyema/pyothorax</a></dd> <dd><a href="/wiki/Malignant_pleural_effusion" title="Malignant pleural effusion">Malignant</a></dd></dl> <dl><dd><a href="/wiki/Fibrothorax" title="Fibrothorax">Fibrothorax</a></dd></dl> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mediastinal_disease" class="mw-redirect" title="Mediastinal disease">Mediastinal disease</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Mediastinitis" title="Mediastinitis">Mediastinitis</a></li> <li><a href="/wiki/Pneumomediastinum" title="Pneumomediastinum">Mediastinal emphysema</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other/general</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Respiratory_failure" title="Respiratory failure">Respiratory failure</a></li> <li><a href="/wiki/Influenza" title="Influenza">Influenza</a></li> <li><a href="/wiki/Common_cold" title="Common cold">Common cold</a></li> <li><a href="/wiki/Severe_acute_respiratory_syndrome" class="mw-redirect" title="Severe acute respiratory syndrome">SARS</a></li> <li><a href="/wiki/COVID-19" title="COVID-19">COVID-19</a></li> <li><a href="/wiki/Idiopathic_pulmonary_haemosiderosis" title="Idiopathic pulmonary haemosiderosis">Idiopathic pulmonary haemosiderosis</a></li> <li><a href="/wiki/Pulmonary_alveolar_proteinosis" title="Pulmonary alveolar proteinosis">Pulmonary alveolar proteinosis</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Biological_warfare_and_bioterrorism296" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231" /><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Bioterrorism" title="Template:Bioterrorism"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Bioterrorism" title="Template talk:Bioterrorism"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Bioterrorism" title="Special:EditPage/Template:Bioterrorism"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Biological_warfare_and_bioterrorism296" style="font-size:114%;margin:0 4em"><a href="/wiki/Biological_warfare" title="Biological warfare">Biological warfare</a> and <a href="/wiki/Bioterrorism" title="Bioterrorism">bioterrorism</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Modern incidents</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Unit_731#Biological_warfare" title="Unit 731">Unit 731</a></li> <li><a href="/wiki/1984_Rajneeshee_bioterror_attack" title="1984 Rajneeshee bioterror attack">1984 Rajneeshee bioterror attack</a></li> <li><a href="/wiki/1989_California_medfly_attack" title="1989 California medfly attack">1989 California medfly attack</a></li> <li><a href="/wiki/2001_anthrax_attacks" title="2001 anthrax attacks">2001 anthrax attacks</a></li> <li><a href="/wiki/Wood_Green_ricin_plot" title="Wood Green ricin plot">Wood Green ricin plot</a></li> <li><a href="/wiki/2003_ricin_letters" title="2003 ricin letters">2003 ricin letters</a></li> <li><a href="/wiki/April_2013_ricin_letters" title="April 2013 ricin letters">2013 ricin letters</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Prevention<br />and response</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Australia_Group" title="Australia Group">Australia Group</a></li> <li><a href="/wiki/Caribbean_Public_Health_Agency" title="Caribbean Public Health Agency">Caribbean Public Health Agency</a></li> <li><a href="/wiki/Center_for_Health_Security" class="mw-redirect" title="Center for Health Security">Center for Health Security</a></li> <li><a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a></li> <li><a href="/wiki/Chinese_Center_for_Disease_Control_and_Prevention" title="Chinese Center for Disease Control and Prevention">Chinese Center for Disease Control and Prevention</a></li> <li><a href="/wiki/Council_of_Europe_Convention_on_the_Prevention_of_Terrorism" title="Council of Europe Convention on the Prevention of Terrorism">Council of Europe Convention on the Prevention of Terrorism</a></li> <li><a href="/wiki/DARPA" title="DARPA">Defense Advanced Research Projects Agency</a></li> <li><a href="/wiki/Defense_Threat_Reduction_Agency" title="Defense Threat Reduction Agency">Defense Threat Reduction Agency</a></li> <li><a href="/wiki/European_Centre_for_Disease_Prevention_and_Control" title="European Centre for Disease Prevention and Control">European Centre for Disease Prevention and Control</a></li> <li><a href="/wiki/Global_Health_Security_Initiative" title="Global Health Security Initiative">Global Health Security Initiative</a></li> <li><a href="/wiki/Health_Threat_Unit_(European_Commission)" class="mw-redirect" title="Health Threat Unit (European Commission)">Health Threat Unit</a></li> <li><a href="/wiki/Laboratory_Response_Network" title="Laboratory Response Network">Laboratory Response Network</a></li> <li><a href="/wiki/Ministry_of_Health_and_Family_Welfare" title="Ministry of Health and Family Welfare">India's Ministry of Health and Family Welfare</a></li> <li><a href="/wiki/National_Biodefense_Analysis_and_Countermeasures_Center" title="National Biodefense Analysis and Countermeasures Center">National Biodefense Analysis and Countermeasures Center</a></li> <li><a href="/wiki/National_Science_Advisory_Board_for_Biosecurity" title="National Science Advisory Board for Biosecurity">National Science Advisory Board for Biosecurity</a></li> <li><a href="/wiki/United_Nations_Office_for_Disarmament_Affairs" title="United Nations Office for Disarmament Affairs">United Nations Office for Disarmament Affairs</a></li> <li><a href="/wiki/United_States_Army_Medical_Research_Institute_of_Infectious_Diseases" title="United States Army Medical Research Institute of Infectious Diseases">United States Army Medical Research Institute of Infectious Diseases</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Biological_agent" title="Biological agent">Biological agents</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anthrax" title="Anthrax">Anthrax</a></li> <li><a href="/wiki/Avian_influenza" title="Avian influenza">Avian influenza</a></li> <li><a href="/wiki/Botulinum_toxin" title="Botulinum toxin">Botulinum toxin</a></li> <li><a href="/wiki/Brucellosis" title="Brucellosis">Brucellosis</a></li> <li><a href="/wiki/Burkholderia_pseudomallei" title="Burkholderia pseudomallei">Burkholderia pseudomallei</a></li> <li><a href="/wiki/Chlamydophila_psittaci" class="mw-redirect" title="Chlamydophila psittaci">Chlamydophila psittaci</a></li> <li><a href="/wiki/Coxiella_burnetii" title="Coxiella burnetii">Coxiella burnetii</a></li> <li><a href="/wiki/Ebola" title="Ebola">Ebola</a></li> <li>Equine encephalitis <small>(<a href="/wiki/Eastern_equine_encephalitis_virus" class="mw-redirect" title="Eastern equine encephalitis virus">Eastern</a></small></li> <li><small><a href="/wiki/Western_equine_encephalitis_virus" title="Western equine encephalitis virus">Western</a></small></li> <li><small><a href="/wiki/Venezuelan_equine_encephalitis_virus" title="Venezuelan equine encephalitis virus">Venezuelan</a>)</small></li> <li><a href="/wiki/Foodborne_illness" title="Foodborne illness">Foodborne illness</a></li> <li><a href="/wiki/Fungus" title="Fungus">Fungi</a></li> <li><a href="/wiki/Glanders" title="Glanders">Glanders</a></li> <li><a href="/wiki/Hantavirus" class="mw-redirect" title="Hantavirus">Hantavirus</a></li> <li><a href="/wiki/Henipavirus" title="Henipavirus">Henipavirus</a></li> <li><a class="mw-selflink selflink">Legionnaires' disease</a></li> <li><a href="/wiki/Marburg_virus" title="Marburg virus">Marburg virus</a></li> <li><a href="/wiki/Mold_(fungus)" class="mw-redirect" title="Mold (fungus)">Mold</a></li> <li><a href="/wiki/Bubonic_plague" title="Bubonic plague">Plague</a></li> <li><a href="/wiki/Ricin" title="Ricin">Ricin</a></li> <li><a href="/wiki/Salmonella_enterica" title="Salmonella enterica">Salmonella enterica</a></li> <li><a href="/wiki/Salmonellosis" title="Salmonellosis">Salmonellosis</a></li> <li><a href="/wiki/Typhoid_fever" title="Typhoid fever">Salmonella typhi</a></li> <li><a href="/wiki/Smallpox" title="Smallpox">Smallpox</a></li> <li><a href="/wiki/Staphylococcus" title="Staphylococcus">Staphylococcus</a></li> <li><a href="/wiki/Tularemia" title="Tularemia">Tularemia</a></li> <li><a href="/wiki/Typhus" title="Typhus">Typhus</a></li> <li><a href="/wiki/Viral_hemorrhagic_fever" title="Viral hemorrhagic fever">Viral hemorrhagic fever</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related concepts</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Agro-terrorism" title="Agro-terrorism">Agro-terrorism</a></li> <li><a href="/wiki/Anthrax_hoaxes" title="Anthrax hoaxes">Anthrax hoaxes</a></li> <li><a href="/wiki/Psychochemical_weapon" class="mw-redirect" title="Psychochemical weapon">Psychochemical weapons</a></li> <li><a href="/wiki/Bacteria" title="Bacteria">Bacteria</a></li> <li><a href="/wiki/Biocontainment" title="Biocontainment">Biocontainment</a></li> <li><a href="/wiki/Biological_hazard" title="Biological hazard">Biological hazard</a></li> <li><a href="/wiki/Biological_warfare_in_popular_culture" title="Biological warfare in popular culture">Biological warfare in popular culture</a></li> <li><a href="/wiki/Ethnic_bioweapon" title="Ethnic bioweapon">Ethnic bioweapon</a></li> <li><a href="/wiki/Human_decontamination" title="Human decontamination">Decontamination</a></li> <li><a href="/wiki/Entomological_warfare" title="Entomological warfare">Entomological warfare</a></li> <li><a href="/wiki/Infection" title="Infection">Infectious disease</a></li> <li><a href="/wiki/Virus" title="Virus">Virus</a></li> <li><a href="/wiki/Toxin" title="Toxin">Toxin</a></li> <li><a href="/wiki/Terrorism" title="Terrorism">Terrorism</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">International law</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Geneva_Protocol" title="Geneva Protocol">Geneva Protocol</a></li> <li><a href="/wiki/Biological_Weapons_Convention" title="Biological Weapons Convention">Biological Weapons Convention</a></li> <li><a href="/wiki/United_Nations_Security_Council_Resolution_1540" title="United Nations Security Council Resolution 1540">United Nations Security Council Resolution 1540</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><a href="https://en.wiktionary.org/wiki/Bioterrorism" class="extiw" title="wiktionary:Bioterrorism">Wiktionary definition</a></li> <li><a href="https://commons.wikimedia.org/wiki/Category:Bioterrorism" class="extiw" title="commons:Category:Bioterrorism">Wikimedia Commons</a></li> <li><a href="https://en.wikisource.org/wiki/Category:Bioterrorism" class="extiw" title="wikisource:Category:Bioterrorism">Wikisource</a></li></ul> </div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1130092004">.mw-parser-output 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