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Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers. Streptococcus pneumoniae is the causative microorganism responsible for community-acquired pneumonia (CAP) most frequently associated with smoking, particularly in invasive pneumococcal disease and septic shock. It is not clear how it acts on the progress of pneumonia, but there is evidence to suggest that the prognosis for pneumococcal pneumonia is worse. In CAP caused by Legionella pneumophila, it has also been observed that smoking is the most important risk factor, with the risk rising 121% for each pack of cigarettes smoked a day. Tobacco use may also favor diseases that are also known risk factors for CAP, such as periodontal disease and upper respiratory viral infections. By way of prevention, while giving up smoking should always be proposed, the use of the pneumococcal vaccine is also recommended, regardless of the presence of other comorbidities., (Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.)

Objective: Description of an outbreak of legionnaires' disease originating in one of the cooling towers of a hospital., Patients and Methods: This study included patients with confirmed pneumonia caused by Legionella pneumophila serogroup 1 and related to the Vallcarca neighborhood of Barcelona (Spain) in August 2004. Exposure was determined by a standardized questionnaire. An environmental investigation was carried out to identify the source of the outbreak. A descriptive analysis including incidence rates estimation was performed, as well as molecular study to document the genetic identity among human and environmental strains., Results: Thirty-three cases of L. pneumophila pneumonia were detected. Median age was 68 years and 70% of the affected patients were men. Incidence rate among residents in less than 200 meters of the source and older than 65 was 888.9 cases/100,000 inhabitants. Lethality rate was 6%. Four seasonal cooling towers that were not registered with the authorities were identified in a health care center. L. pneumophila was isolated from all four and at least one colony in each tower had the same genetic profile as the strains isolated from patients., Conclusions: An association was demonstrated between a community outbreak of legionellosis and unregistered seasonal cooling towers located in a hospital. All risk facilities should be registered and inspected to ensure that they fulfill current legislation requirements.

Background and Objective: Superheat-and-flush is one of the methods of disinfection used against Legionella in hospital water distribution systems. An outbreak of nosocomial legionellosis (NL) was detected in the hospital Germans Trias i Pujol in January 1996. The aim of this study was to evaluate the impact of this disinfection technique at an environmental and clinical level., Material and Method: Water samples were collected daily from central and tap water points 3 days prior to 15 days after superheating and flushing. Clinical surveillance of NL was performed 30 consecutive days following disinfection., Results: After superheat-and-flush, the inoculum of Legionella pneumophila decreased in the central points but increased after day 11, achieving maximum values at 15 days. On the other hand, L. pneumophila was not detected in tap water points after 4 days but recolonization was observed after day 7, achieving 66% at day 9. No clinical cases of NL were detected during the study period., Conclusions: Superheat-and-flush is an effective albeit transitory method of rapid disinfection in outbreaks of NL.

Background: A community outbreak of atypical pneumonia occurred in summer 1994 in L'Espluga de Francolí, Tarragona, Spain, affecting 20 people., Patients and Methods: The clinical and epidemiologic description of the outbreak are performed, as well as the sanitary actions leading to the discovery of the original focus (an hotel refrigerating tower). Through case-control studies (among the 17 in-home contagions according to their nearness) and using the causality criteria of Evans and Bradford-Hill., Results: Although the symptomatical description brings forth new symptoms such as hyperglycemia or livedo reticularis, the comparative clinical-therapeutical study bears no significant differences with other series, and the radiological data as well as the response to the treatment are wholly overlapping, with results less coincident in those coming from the lab, very specially due to the small sensibility the indirect immuno-fluorescence showed., Conclusions: The epidemiologic study demonstrates the etiology of the outbreak (Legionella), their source in the refrigerating tower, in so much sterilization coincided with the end of the epidemy.

Four cases of hospital acquired pneumonia are reported in children aged from 10 days to 7 years, in whom L. pneumophila serogroup 6 was isolated. All patients were sporadic cases occurring during a two year period (1987-1988) in the Pediatric Hospital of our institution. L. pneumophila was isolated in samples of pleural fluid, lung biopsy, tracheal aspirate, bronchial brushing and bronchoalveolar lavage. All our patients were immunologically depressed and three died. Only in two cases of erythromycin therapy was administered, as the etiology of their pneumonia was not suspected. The literature on other reported cases of infantile legionellosis is discussed.

The investigation of the outbreak of legionellosis which developed in Barcelona in February 1988 included: 1) a case-control study, with the patients with Legionella pneumophila pneumonia (n = 56) and those with pneumonia by other organisms (n = 109) in the Hospital Clínic i Provincial (HCP); 2) a review of refrigeration towers and the water supply system; 3) a meteorological study, and 4) a survey of the construction works being carried out in the HCP area. The cases lived in the urban district 2 more often than the controls (odds ratio = 3.73, 95% confidence intervals 1.8-7.6), and were not associated with hospitals of hotels. L. pneumophila was not recovered from the environmental samples. The temperatures were unusually high, with a low air humidity. In the area near the HCP demolition materials were frequently removed. A causative focus was not detected; it cannot be ruled out, however, that the source of the outbreak was the removal of demolition materials in the affected area on the days preceding the epidemic outbreak.