臺灣博碩士論文加值系統

在近期許多的研究報告中指出，退伍軍人症主要的感染來源是存在於飲用水供水系統當中的退伍軍人菌，特別是旅途當中所感染到退伍軍人症。許多的報告和國際指標建議需要長期監控和控制郵輪、旅館、飯店、或是一些公共建築物的退伍軍人菌的菌數。鑑於之前的研究指出，退伍軍人菌出現於高雄的各大醫院和社區。本篇研究是為了提醒大眾和媒體在2009年夏天的高雄世運期間，能夠注意和提前防治退伍軍人菌的存在。而本篇研究的目的是調查高雄和世運相關的公共場所公所供水系統當中是否有退伍軍人菌移生情況。本研究採樣了30個遍布於高雄的相關地點，包含大型建築物(如:運動場館、捷運站、旅館)和戶外場所。每一個地點至少採集三個水樣，每一個水樣至少有250ml，將水樣以標準程序檢測退伍軍人菌移生情況。乳膠凝結試驗和螢光抗體染色來區分嗜肺性退伍軍人菌分型。總共107個水樣30個採樣點當中，嗜肺性退伍軍人菌地點的陽性率為13.3%(4/30)，而大型建築和戶外遊憩區的退伍軍人菌陽性率分別為11.1%(3/27)和33.3%(1/3)。而鳳山和左營區的陽性率較高分別為50%(2/4)和33.3%(2/6)，然而在30個樣點中有一座剛啟用的體育館的陽性率為100%(3/3)。雖然本篇研究的陽性率和先前的研究相較之下低很多，但退伍軍人菌確實存在於高雄的供水系統當中。平時長期監控可有助於退伍軍人症社區感染和因旅遊感染退伍軍人症的風險評估。

Many recent studies suggested that Legionella present in drinking water systems may be the major source for outbreaks of community-acquired Legionnaires disease (LD), especially in travel-associated LDs. Numerous reports and national guidelines have recommended routine environmental cultures for Legionella in cruises, hotels, convention centers, and public buildings. The World Game held in Kaohsiung during summer 2009 drew attention of the public and media whether the water supply in Kaohsiung was contaminated by Legionella given the previously detected hospital- and community-acquired LDs in Kaohsiung. The objective is to determine the presence of Legionella in Kaohsiung public water systems associated with World Game facilities. Thirty sampling locations were selected in Kaohsiung including large buildings (i.e. gymnasium, subway stations, and sports facilities) and outdoor recreational area. At least 3 water samples (250mL ea) were withdrawn from each sampling location. Sample concentration by filtration of 250 mL water sample was used to increase the yield of Legionella. A standardized procedure was followed for sample processing and enumeration. Latex agglutination test and direct fluorescent antibody technique were used for sero-typing of L. pneumophila. Total of 107 water samples were collected from 30 sampling locations. L. pneumophila was isolated from 13.3% (4/30) of the sampling locations. The Legionella positive rate for large buildings and outdoor recreational area was 11.1% (3/27) and 33.3% (1/3), respectively. Sampling locations in Fengshan and Tsoying districts have significantly higher positive rates of 50% (2/4) and 33.3% (2/6), respectively. The water samples from a newly opened gymnasium were 100% (3/3) positive for Legionella. Legionella was found in the public water supply in Kaohsiung; however, the Legionella positive rate is lower than the previously published data from hospital surveillance. Routine environmental surveillance for Legionella in public water supplies can be a good practice for evaluating risk of community-acquired and travel-associated LDs.

Table of Contents
Abstract II
Chinese Abstract IV
Table of Content V
List of Table VII
List of Figures VIII
1.0 Introduction 1
2.0 Literature Review 2
2.1 Legionella Epidemiology 2
2.2 Travel-associated Legionnaire’s Disease 3
2.2.1 Cases of Legionnaires’ disease in hotel 3
2.2.2 Cases of Legionnaires’ disease in Bathtub and Whirlpool 4
2.2.3 The Guideline of Travel-Association 4
2.3 Case of Legionella in Taiwan 5
2.4 Legionella in our Environments 7
2.5 The Practice of WHO in Olympics Game 9
3.0 Materials and Methods 10
3.1 Sampling Locations Selection 10
3.2 Collection of Water Sample 10
3.3 Sample Process 10
3.4 Legionella identification 11
3.4.1 Subculture 11
3.4.2 Sero-typing 11
4.0 Results 12
5.0 Discussion 14
6.0 Conclusions 17
7.0 Reference 18

List of Table
Table. 1 21
Table. 2 21
Table. 3 21
Table. 4 21
Table. 5 22

List of Figure
Figure 1 23
Figure 2 24

Alary, M., & Joly, J. R. (1992). Factors contributing to the contamination of hospital water distribution systems by legionellae. J Infect Dis, 165(3), 565-569.
Anonymous. (2005a). European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease. London: European Working Group for Legionella Infections.
Anonymous. (2005b). Legionnaire's Disease (Legionellosis).
Benin, A. L., Benson, R. F., Arnold, K. E., Fiore, A. E., Cook, P. G., Williams, L. K., et al. (2002). An outbreak of travel-associated Legionnaires' disease and Pontiac fever and the need for enhanced surveillance for travel-associated legionellosis in the United States. J.Infect.Dis., -.
Blackburn, B. G., Craun, G. F., Yoder, J. S., Hill, V., Calderon, R. L., Chen, N., et al. (2004). Surveillance for waterborne-disease outbreaks associated with drinking water--United States, 2001-2002. MMWR Surveill Summ, 53(8), 23-45.
Chang, J. H., Tseng, L. R., Zeng, S. J., Chen, Y. Y., Hwang, C. H., Mu, J. J., et al. (2007). Laboratory diagnosis and analysis of a Legionella infection event in a public swimming pool in Nantou County. Department of Health Republic of China Epimiology bulletin, 23(8), 396-405.
Chen, W.-H. (2008). The Surveillance of Legionella and Total Bathtub and Whirlpool Water in Taipei. Type, National Kaohsiung Normal University, Kaohsiung.
Erdogan, H., & Arslan, H. (2007). Colonization of Legionella species in hotel water systems in Turkey. J Travel Med, 14(6), 369-373.
Fields, B. S., Benson, R. F., & Besser, R. E. (2002a). Legionella and Legionnaires' disease: 25 years of investigation. Clinical Microbiology Reviews, 15(3), 506-526.
Fields, B. S., Benson, R. F., & Besser, R. E. (2002b). Legionella and Legionnaires' disease: 25 years of investigation. Clin Microbiol Rev, 15(3), 506-526.
Franzin, L., Scolfaro, C., Cabodi, D., Valera, M., & Tovo, P. A. (2001). Legionella pneumophila pneumonia in a newborn after water birth: a new mode of transmission. Clinical Infectious Diseases, 33(9), e103-104.
Fraser, D. W., Tsai, T. R., Orenstein, W., Parkin, W. E., Beecham, H. J., Sharrar, R. G., et al. (1977). Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med, 297(22), 1189-1197.
Ito, I., Naito, J., Kadowaki, S., Mishima, M., Ishida, T., Hongo, T., et al. (2002). Hot spring bath and Legionella pneumonia: an association confirmed by genomic identification. Intern Med, 41(10), 859-863.
Joseph, C. A., Yadav, R., & Ricketts, K. D. (2009). Travel-associated Legionnaires disease in Europe in 2007. Euro Surveill, 14(18).
Koziol-Montewka, M., Magrys, A., Stojek, N., Palusinska-Szysz, M., Danielak, M., Wojtowicz, M., et al. (2008). Monitoring Legionella species in hospital water systems. Link with disease and evaluation of different detection methods. Ann Agric Environ Med, 15(1), 143-147.
Leoni, E., De Luca, G., Legnani, P. P., Sacchetti, R., Stampi, S., & Zanetti, F. (2005a). Legionella waterline colonization: detection of Legionella species in domestic, hotel and hospital hot water systems. Journal of Applied Microbiology, 98(2), 373-379.
Leoni, E., De Luca, G., Legnani, P. P., Sacchetti, R., Stampi, S., & Zanetti, F. (2005b). Legionella waterline colonization: detection of Legionella species in domestic, hotel and hospital hot water systems. Journal of Applied Microbiology, 98(2), 373-379.
Lin, Y. E., Lu, W. M., Huang, H. I., & Huang, W. K. (2007). Environmental survey of Legionella pneumophila in hot springs in Taiwan. J Toxicol Environ Health A, 70(1), 84-87.
McDade, J. E., Shepard, C. C., Fraser, D. W., Tsai, T. R., Redus, M. A., & Dowdle, W. R. (1977). Legionnaires' disease: isolation of a bacterium and demonstration of its role in other respiratory disease. N Engl J Med, 297(22), 1197-1203.
Muder, R. R., & Yu, V. L. (2002). Infection due to Legionella species other than L. pneumophila. Clinical Infectious Diseases, 35(8), 990-998.
Olle Goig, J. E., Martin Casabona, N., & Gonzalez Fuente, T. (1987). [Legionella pneumophila infection in hotel guests: showers as a probable source of infection]. Med Clin (Barc), 88(7), 261-263.
Pan, T. M., Yeh, H. L., & Horng, C. B. (1996). Testings for Legionellosis in the Taiwan Area - A Preliminaryy Report- Department of Health Republic of China Epidemiology Bulletin, 12(8), 123-136.
Ricketts, K. D., McNaught, B., & Joseph, C. A. (2006). Travel-associated legionnaires' disease in Europe: 2004. Euro Surveill, 11(4), 107-110.
Schlech, W. F., 3rd, Gorman, G. W., Payne, M. C., & Broome, C. V. (1985). Legionnaires' disease in the Caribbean. An outbreak associated with a resort hotel. Arch Intern Med, 145(11), 2076-2079.
Stout, J. E., Brennen, C., & Muder, R. R. (2000). Legionnaires' disease in a newly constructed long-term care facility. J Am Geriatr Soc, 48(12), 1589-1592.
Su, H. P., Tseng, L. R., Chou, C. Y., Chung, T. C., & Pan, T. M. (2005). Legionella pneumophila infection in the Taiwan area. J Infect Chemother, 11(5), 244-249.
Su, H. P., Tseng, L. R., Tzeng, S. C., Chou, C. P., & Chung, T. C. (2006). A Legionellosis Case Due to Contaminated Spa Water and Confirmed by Genomic Identification in Taiwan. . Microbiology and Immunology 50(5), 371-377.
Ta, A. C., Stout, J. E., Yu, V. L., & Wagener, M. M. (1995). Comparison of culture methods for monitoring Legionella species in hospital potable water systems and recommendations for standardization of such methods. J Clin Microbiol, 33(8), 2118-2123.
Tsouros, A. D., & Efstathoou, P. A. (2004). Mass Gatherings and Public Health - The Experience of the Athens 2004 Olympic Games. Denmark: Ministry of Health and Social Solidarity.
Vickers, R. M., Yu, V. L., Hanna, S. S., Muraca, P., Diven, W., Carmen, N., et al. (1987). Determinants of Legionella pneumophila contamination of water distribution systems: 15-hospital prospective study. Infect Control, 8(9), 357-363.
Waterer, G. W., Baselski, V. S., & Wunderink, R. G. (2001). Legionella and community-acquired pneumonia: a review of current diagnostic tests from a clinician's viewpoint. American Journal of Medicine, 110(1), 41-48.
Yu, P. Y., Lin, Y. E., Lin, W. R., Shih, H. Y., Chuang, Y. C., Ben, R. J., et al. (2008). The high prevalence of Legionella pneumophila contamination in hospital potable water systems in Taiwan: implications for hospital infection control in Asia. International Journal of Infectious Diseases, 12(4), 416-420.
Yu, V. L. (2002). Legionella surveillance: political and social implications--a little knowledge is a dangerous thing. Journal of Infectious Diseases, 185(2), 259-261.
Yu, V. L., Plouffe, J. F., Pastoris, M. C., Stout, J. E., Schousboe, M., Widmer, A., et al. (2002). Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. Journal of Infectious Diseases, 186(1), 127-128.