576
Legionella and fountains
SEROLOGICAL AND PCR ANALYSES OF HTLV-IAND HTLV-II
I
I
I
I
I
I
I
*Results on sera already tested for H IV-1 by enzyme immunoassay and western blot. tSera with antibody to the p19/p24 gag and the gp46 env encoded proteins were considered positive for HTLV-I by WB; sera with antibody to p19/p24 but not gp46 were labelled mdeterminate (I).
Only 1 case was confirmed positive for HTLV-1 by PCR (table); this sample was HIV-1 seronegative and was HTLV-1 seropositive by IFA only. 7 cases were positive for anti-HTLV-II by IFA and PCR; and 5 of these were co-infected by HIV-1but none with HTLV-I. The study indicates that the higher frequency of HTLV-11 over HTLV-I infection, already reported for IVDU populations in the United States, is seen in Europe too. The usefulness of PCR analysis to discriminate HTLV-1 and II is confirmed, and there was a good correlation between PCR and IFA-antibody assays for HTLV-II.4 We thank Dr A. Gessain for comments. Superiore di Sanita, Progetto AIDS 1990.
Supported in part by Istituto
CNR Institute of Biochemical and Evolutionary Genetics, Pavia
DAVIDE ZELLA LUIGI MORI MONICA SALA
Don Gnocchi Multiple Sclerosis Centre and Institute of Medical Microbiology, University of Milan
PASQUALE FERRANTE
Institute of Medical Pathology, University of Parma
CLAUDIO CASOLI
Department of Infectious Diseases, University of Parma
GIACOMO MAGNANI
Institute of Infectious Diseases, Policlinico S. Matteo, Pavia
GIORGIO ACHILLI ERCOLE CATTANEO
Laboratory of Tumor Cell Biology, National Cancer Institute, Bethesda, Maryland, USA
FRANCO LORI
CNR Institute of Biochemical and Evolutionary Genetics, 27100 Pavia, Italy
UMBERTO BERTAZZONI
Cann AJ, Chen ISY. Human T-cell leukemia virus types I and II. In: Field BN, et al, eds. Virology. New York: Raven Press, 1990: 1501-26. 2. Lee H, Swanson P, Shorty VS, et al. High rate of HTLV-II infection in seropositive IV drug abusers m New Orleans. Science 1989; 244: 471-75. 3. Ehrlich GD, Glaser JB, LaVigne K, et al. Prevalence of human T-cell leukemia/ lymphoma virus (HTLV) type II infection among high-nsk individuals type-specific identification of HTLVs by polymerase chain reaction. Blood 1989; 1.
74: 1658-64. 4. Kwok S, Gallo D, Hanson C, et al. High prevalence of HTLV-IIamong intravenous drug abusers: PCR confirmation and typing. AIDS Res Hum Retrov 1990, 6: 561-65. 5. Manzari V, Gradilone A, Barillari G, et al. HTLV-I is endemic in Southern Italy: detection of the first infectious cluster m a white population. Int J Cancer 1985; 36: 557—59. 6. Gradilone A, Zani M, Banllan G, et al. HTLV-I and HIV infection in drug addicts in Italy. Lancet 1986; ii: 753-54.
SIR,-Dr Fenstersheib and colleagues (July 7, p 35) describe an outbreak of Pontiac fever due to Legionella anisa which supports the possibility that Legionella species are transmitted by inhalation of aerosols generated by decorative fountains. Aerosolisation of a similar nature was implicated in an outbreak of legionnaires’ disease caused by L pneumophila subgroup 1, at a hotel in St Croix, US Virgin Islands in 1981-82.’ The only common source of exposure to aerosolised water was a multitiered waterfall outside the hotel lobby which grew L pneumophila serogroups 1 and 3. Fresh water samples from the hotel also grew L anisa and L steigerwalti, and samples from cisterns around St Croix grew many Legionella species, including a new species, L santicrucis. Fenstersheib et al noted serological evidence in hotel employees of exposure to the causative microorganism in the absence of clinical disease. Serological surveys in St Croix showed immunofluorescence antibody titres to L pneumophila of > 256 in 22% of hotel employees. 51 % of an unselected population of clinic patients without respiratory disease in St Croix also had titres > 256. I agree with Fenstersheib et al that control of Legionella species in man-made decorative fountains and waterfalls should be encouraged in the hotel industry. Respiratory morbidity and mortality attributable to this type of exposure may go unreported, and the association with fountains or waterfalls may be unrecognised because hotel visits tend to be brief. National surveillance systems for legionellosis are essential for detecting disease in travellers and allowing identification of dangerous environmental sources of infection in the absence of clearcut outbreaks as was demonstrated in St Croix. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada B3H 2K4
WALTER F. SCHLECH III
1. Schlech WF, German GW, Payne MC, Broome CV. Legionnaires’ disease in the Caribbean: an outbreak associated with a resort hotel. Arch Intern Med 1985; 145: 2076-79.
Benzodiazepines and fantasy SIR,-We read with interest Mrs Brahams’ article (Jan 20, p 157) on benzodiazepines and sexual fantasies, and report a somewhat different, but equally embarrassing, experience with benzodiazepine adverse effects involving one of our doctors. A 30-year-old man, being investigated for epigastric pain, received a slow intravenous bolus of diazepam 10 mg and then had an uneventful upper endoscopy which disclosed no abnormalities. A few minutes later, while still lying on the procedure table the patient asked when he would have the endoscopy. When told he had already had it, he said he would not be lied to and insulted. He then became abusive, broke into a tantrum, assaulted his physician, and had to be restrained by several members of staff. He was calmed down only by a second endoscopy. The patient had complete amnesia about the first endoscopy and the following incident. He was very embarrassed and apologised repeatedly. Two facts merit comment. First, the patient was a gentle, calm man, with no previous violent tendencies. Second, this has been the only incident of its kind since our unit was established in 1972. This is an example of a very rare side-effect, where a drug given to the patient can be harmful to the doctor. Division of
Gastroenterology, Kaplan Hospital, Rehovot, Israel
Y. LURIE F. GOTTESFELD D. D. BASS
CORRECTION Antenatal screening for toxoplasmosis in the UK In this editorial (Aug 11, 1, p 346), in lines two and eight of the second full paragraph on page 347 "symptomless" should have read "symptomatic".
Legionella and fountains
SEROLOGICAL AND PCR ANALYSES OF HTLV-IAND HTLV-II
I
I
I
I
I
I
I
*Results on sera already tested for H IV-1 by enzyme immunoassay and western blot. tSera with antibody to the p19/p24 gag and the gp46 env encoded proteins were considered positive for HTLV-I by WB; sera with antibody to p19/p24 but not gp46 were labelled mdeterminate (I).
Only 1 case was confirmed positive for HTLV-1 by PCR (table); this sample was HIV-1 seronegative and was HTLV-1 seropositive by IFA only. 7 cases were positive for anti-HTLV-II by IFA and PCR; and 5 of these were co-infected by HIV-1but none with HTLV-I. The study indicates that the higher frequency of HTLV-11 over HTLV-I infection, already reported for IVDU populations in the United States, is seen in Europe too. The usefulness of PCR analysis to discriminate HTLV-1 and II is confirmed, and there was a good correlation between PCR and IFA-antibody assays for HTLV-II.4 We thank Dr A. Gessain for comments. Superiore di Sanita, Progetto AIDS 1990.
Supported in part by Istituto
CNR Institute of Biochemical and Evolutionary Genetics, Pavia
DAVIDE ZELLA LUIGI MORI MONICA SALA
Don Gnocchi Multiple Sclerosis Centre and Institute of Medical Microbiology, University of Milan
PASQUALE FERRANTE
Institute of Medical Pathology, University of Parma
CLAUDIO CASOLI
Department of Infectious Diseases, University of Parma
GIACOMO MAGNANI
Institute of Infectious Diseases, Policlinico S. Matteo, Pavia
GIORGIO ACHILLI ERCOLE CATTANEO
Laboratory of Tumor Cell Biology, National Cancer Institute, Bethesda, Maryland, USA
FRANCO LORI
CNR Institute of Biochemical and Evolutionary Genetics, 27100 Pavia, Italy
UMBERTO BERTAZZONI
Cann AJ, Chen ISY. Human T-cell leukemia virus types I and II. In: Field BN, et al, eds. Virology. New York: Raven Press, 1990: 1501-26. 2. Lee H, Swanson P, Shorty VS, et al. High rate of HTLV-II infection in seropositive IV drug abusers m New Orleans. Science 1989; 244: 471-75. 3. Ehrlich GD, Glaser JB, LaVigne K, et al. Prevalence of human T-cell leukemia/ lymphoma virus (HTLV) type II infection among high-nsk individuals type-specific identification of HTLVs by polymerase chain reaction. Blood 1989; 1.
74: 1658-64. 4. Kwok S, Gallo D, Hanson C, et al. High prevalence of HTLV-IIamong intravenous drug abusers: PCR confirmation and typing. AIDS Res Hum Retrov 1990, 6: 561-65. 5. Manzari V, Gradilone A, Barillari G, et al. HTLV-I is endemic in Southern Italy: detection of the first infectious cluster m a white population. Int J Cancer 1985; 36: 557—59. 6. Gradilone A, Zani M, Banllan G, et al. HTLV-I and HIV infection in drug addicts in Italy. Lancet 1986; ii: 753-54.
SIR,-Dr Fenstersheib and colleagues (July 7, p 35) describe an outbreak of Pontiac fever due to Legionella anisa which supports the possibility that Legionella species are transmitted by inhalation of aerosols generated by decorative fountains. Aerosolisation of a similar nature was implicated in an outbreak of legionnaires’ disease caused by L pneumophila subgroup 1, at a hotel in St Croix, US Virgin Islands in 1981-82.’ The only common source of exposure to aerosolised water was a multitiered waterfall outside the hotel lobby which grew L pneumophila serogroups 1 and 3. Fresh water samples from the hotel also grew L anisa and L steigerwalti, and samples from cisterns around St Croix grew many Legionella species, including a new species, L santicrucis. Fenstersheib et al noted serological evidence in hotel employees of exposure to the causative microorganism in the absence of clinical disease. Serological surveys in St Croix showed immunofluorescence antibody titres to L pneumophila of > 256 in 22% of hotel employees. 51 % of an unselected population of clinic patients without respiratory disease in St Croix also had titres > 256. I agree with Fenstersheib et al that control of Legionella species in man-made decorative fountains and waterfalls should be encouraged in the hotel industry. Respiratory morbidity and mortality attributable to this type of exposure may go unreported, and the association with fountains or waterfalls may be unrecognised because hotel visits tend to be brief. National surveillance systems for legionellosis are essential for detecting disease in travellers and allowing identification of dangerous environmental sources of infection in the absence of clearcut outbreaks as was demonstrated in St Croix. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada B3H 2K4
WALTER F. SCHLECH III
1. Schlech WF, German GW, Payne MC, Broome CV. Legionnaires’ disease in the Caribbean: an outbreak associated with a resort hotel. Arch Intern Med 1985; 145: 2076-79.
Benzodiazepines and fantasy SIR,-We read with interest Mrs Brahams’ article (Jan 20, p 157) on benzodiazepines and sexual fantasies, and report a somewhat different, but equally embarrassing, experience with benzodiazepine adverse effects involving one of our doctors. A 30-year-old man, being investigated for epigastric pain, received a slow intravenous bolus of diazepam 10 mg and then had an uneventful upper endoscopy which disclosed no abnormalities. A few minutes later, while still lying on the procedure table the patient asked when he would have the endoscopy. When told he had already had it, he said he would not be lied to and insulted. He then became abusive, broke into a tantrum, assaulted his physician, and had to be restrained by several members of staff. He was calmed down only by a second endoscopy. The patient had complete amnesia about the first endoscopy and the following incident. He was very embarrassed and apologised repeatedly. Two facts merit comment. First, the patient was a gentle, calm man, with no previous violent tendencies. Second, this has been the only incident of its kind since our unit was established in 1972. This is an example of a very rare side-effect, where a drug given to the patient can be harmful to the doctor. Division of
Gastroenterology, Kaplan Hospital, Rehovot, Israel
Y. LURIE F. GOTTESFELD D. D. BASS
CORRECTION Antenatal screening for toxoplasmosis in the UK In this editorial (Aug 11, 1, p 346), in lines two and eight of the second full paragraph on page 347 "symptomless" should have read "symptomatic".
