Table Of ContentLegionellosis
Volume II
Editor
Sheila Moriber Katz, M.D.
Professor
Department of Pathology and Laboratory Medicine
Hahnemann University School of Medicine
Philadelphia, Pennsylvania
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Library of Congress Cataloging in Publication Data
Main entry under title:
Legionellosis.
Includes bibliographies and index.
1. Legionnaires'disease. 2. Legionella pneumophila
I. Katz, Sheila Moriber, 1943- . [DNLM:
1. Legionnaires'Disease. WC200L5135]
RC152.7.L43 1985 616.9'2 85-416
ISBN 0-8493-5233-9 (v. 1)
ISBN 0-8493-5234-7 (v. 2)
A Library of Congress record exists under LC control number: 85000416
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ISBN 13:978-1-315-89488-1 (hbk)
ISBN 13:978-1-351-07398-1 (ebk)
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PREFACE
Let's keep our watch. No matter what, we are never done discovering new agents or new
ailments. Enter Legionella, bicentennial ruffian: it was Philadelphia, 1976, and bacteriology
was presumed stagnant. Now the saga of a new microbe and a new disease unwrapped like
a bandage, erupted like a full-scale battle, attesting that to be unseen is not to be unreal.
Unfocused by lenses of modern science, Legionella had remained camouflaged before 1976
primarily by virtue of two iconoclastic traits: (1) it rejected conventional stains that visualize
microbes and (2) its culture required a hitherto unconcocted medium. So, prior to its isolation
in January, 1977' the elusive microbe hid in infected tissues and it died on conventional
bacteriologic media. (No matter that someone had spied it in the lung of an ill Legionnaire
in August, 1976).2
In the summer-fall of 1976, all tests confirmed the absence of a microbe. The medical
community surmized that an infectious agent could not be there and nickle, paraquat, or
freon were presumed the likely culprits of the Philadelphia outbreak. The scientists who
finally cracked the mystery, particularly those diligent and dedicated workers at the Federal
Centers for Disease Control, are, indeed, modern heros and heroines. They kept the circuitry
open and they kept their watch. I am one eyewitness to their stamina, perserverance, and
logic. The book in your grasp began with their collective efforts.
Legionellosis is a text in two volumes that presents the modern viewpoint of the agent
and the disease. It also chronicles the history of the discovery of Legionella pneumophila.
You will, for instance, meet Dr. Joseph McDade, the scientist who isolated Legionella, and
you will read an account of the epidemic of Philadelphia, 1976. Volume I discusses current
aspects of the microbe including taxonomy, morphology, biochemistry, and physiology. It
also discusses the illness including clinical features, pathology, and therapy. Volume II
details the laboratory diagnosis, epidemiology, and pathobiology. The contributors are amongst
the most eminent scientists in their respective fields. To that end, thanks go to Dr. Albert
Balows, Assistant Director, Laboratory Service Center for Infection Disease Federal Centers
for Disease Control, for his efforts. Thanks are also offered to Dr. Jay M. Hammel, Associate
Professor of Microbiology and Immunology, Hahnemann University, for his editorial
assistance.
Please remember that even as you read this gospel, new data ebbs and flows. It is all so
fluid, the unraveling of natural law.
Sheila Moriber Katz
REFERENCES
1. McDade, J. E., Shepard, C. C., Eraser, D. W., et al., Legionnaires' disease: isolation of a bacterium
and demonstration of its role in other respiratory disease, N. Engl. J. Med., 297, 1197, 1977.
2. Katz, S. M., Brodsky, I., and Kahn, S. B., Legionnaires' disease: ultrastructural appearance of the agent
in a lung biopsy specimen, Arch. Pathol. Lab. Med., 103, 261, 1979.
Legionella
Fin
below billows.
Strange vibrations,
Low, disharmonious.
But it is nothing, no one.
Only a hungry gull
Or a hull hauling ripples
To shore.
Still and sterile
The water is febrile,
Airless.
It is a lung fit for drowning.
Waves contuse blue to mauve to red,
And lips blench colorless.
Something below grinds alveoli.
Alien smells prickle the snout or the palate.
Hell of cries,
Hill of eyes,
They plunk like coral or legs
Into mud. Mauled:
The skulls and organs
Fix or float, cluttered in formalin.
Still no clarity, no cleaver.
?Are they slitted gills or lateral cuts,
These neck marks
Predict them.
All teeth, it is a man-eater,
Jaws of tiny grindstones or enzymes,
Each tooth is white, triangular.
No repellent
As the profile clarifies
To placoid scales or jellied membranes.
Part microbe, part Pisces,
A killer pure as atoms or love.
Be it fish or cell
The portrait develops
until
Fin and all,
It is netted —
Legionella.
Sheila Moriber Katz
THE EDITOR
Sheila Moriber Katz, M.D. is professor of Pathology and Laboratory Medicine at
Hahnemann University School of Medicine and Director of the Division of Renal Pathology
and Electron Microscopy. Dr. Katz received her B.A. from Cornell University College of
Arts and Sciences and her M.D. degree from Duke University School of Medicine. Her
postdoctoral training in pathology took place at Yale, Harvard, Jefferson, and the University
of Pennsylvania. From 1974 to the present she has been on the faculty at Hahnemann, rising
from the rank of assistant professor to full professor in 1981. Dr. Katz is a member of more
than 20 professional societies and the author of more than 100 scientific publications. Her
research interests include Legionellosis, renal diseases, and diagnostic electron microscopy.
CONTRIBUTORS
Charles E. Benson, Ph.D. Carl B. Fliermans, Ph.D.
Associate Professor of Microbiology Staff Microbial Ecologist
Head, Large Animal Diagnostic Savannah River Laboratory
Microbiology E.I. duPont deNemours and Company
School of Veterinary Medicine Aiken, South Carolina
New Bolton Center
University of Pennsylvania Herman Friedman
Kennett Square, Pennsylvania Chairman and Professor
Department of Medical Microbiology and
Immunology
Baruch S. Blumberg, M.D.
University of South Florida
Institute for Cancer Research
School of Medicine
Fox Chase Cancer Center
Tampa, Florida
Philadelphia, Pennsylvania
Richard W. Gilpin, Ph.D.
Amedo Bondi, Ph.D. Associate Professor
Professor Department of Microbiology and
Department of Microbiology and Immunology
Immunology Medical College of Pennsylvania
Hahnemann University School of Philadelphia, Pennsylvania
Medicine
Marcus A. Horwitz, M.D.
Philadelphia, Pennsylvania
Professor
Department of Medicine and
Claire V. Broome, M.D. Microbiology and Immunology
Chief, Special Pathogens Branch Chief
Bacterial Diseases Division Division of Infectious Diseases
Center for Infectious Diseases UCLA School of Medicine
Centers for Disease Control Center for the Health Sciences
Atlanta, Georgia Los Angeles, California
Ellen J. Mangione, M.D.
Donald C. Drake
Epidemic Intelligence Service
Staff Writer
Bacterial Diseases Division
Philadelphia Inquire
Center for Infectious Diseases
Philadelphia, Pennsylvania
Centers for Disease Control
Atlanta, Georgia
Toby K. Eisenstein
Roger M. McKinney, Ph.D.
Associate Professor
Supervisory Research Chemist
Department of Microbiology and
Biotechnology Branch
Immunology
Centers for Disease Control
Temple University School of Medicine
Atlanta, Georgia
Philadelphia, Pennsylvania
Sheila Moriber Katz, M.D.
James C. Feeley, Ph.D. Professor
Chief Department of Pathology and Laboratory
Field Investigations Section Medicine
Respiratory and Special Pathogens Branch Hahnemann University School of
Centers for Disease Control Medicine
Atlanta, Georgia Philadelphia, Pennsylvania
Burton J. Landau, Ph.D. Joseph P. Matus
Associate Professor of Microbiology and Department of Pathology
Immunology Hahnemann Medical College and Hospital
Department of Microbiology and Philadelphia, Pennsylvania
Immunology
Hahnemann University School of
Medicine
Philadelphia, Pennsylvania
Hazel W. Wilkinson, Ph.D.
Chief
Immunology Section
Centers for Disease Control
Atlanta, Georgia
ACKNOWLEDGMENT
To Sara, Jonathan, and Julian.
TABLE OF CONTENTS
Volume I
Part I: History of Legionellosis
Chapter 1
Isolation of a New Microbe 3
Sheila M. Katz
Chapter 2
Prior Outbreaks of Legionellosis 11
Robert G. Sharrar
Part II: The Microbe
Chapter 3
Taxonomy of the Family Legionellaceae 21
Don J. Brenner
Chapter 4
Morphology of Legionella 39
Frank G. Rodgers
Chapter 5
Biochemistry and Physiology of Legionella 83
Richard D. Miller and Jay M. Hamniel
Part III: The Illness
Chapter 6
Clinical Features of Legionnaires Disease Ill
Charles C. Bailey, Patricia R. Murray, and Sydney M. Finegold
Chapter 7
Clinical Features of Disease due to Legionella Species 151
John N. Dowling
Chapter 8
The Pathology of Legionellosis 161
Part I: Pulmonary Pathology 161
Jeffrey D. Goldstein
Part II: Extrapulmonary Pathology of Legionaire's Disease 181
Shahab Hashemi
Part III: Visualization of Legionella Pneumophila in Exudates and Tissues by
Histochemical Techniques 189
Sheila M. Katz
