[Human parasites and amoeba: lower warm-water temperature is favourable to Legionella bacteria]

Our knowledge of Legionella bacteria has increased since their discovery in 1977. Legionnaires' disease is an underestimated diagnosis in Sweden. Most cases are community acquired and probably due to the presence of legionella bacteria in the water distribution systems of buildings, though the precise source of infection often remains unknown. Although a number of putative virulence factors have been identified, to date few of them have been shown to be significant. The replication of legionella in human macrophages is similar to that in protozoa. Their interaction with protozoa might explain certain features of their ecology and virulence, and shed light on peculiarities in the transmission of infection. The urinary antigen assay has greatly facilitated the diagnosis of legionellosis, and methods based on the amplification of specific DNA sequences will probably become increasingly important, but isolation of the organism will still be justified. Traditional erythromycin therapy is likely to be replaced by treatment with new antimicrobials.