101
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Evaluation of GVPC and BCYE Media for Legionella Detection and Enumeration in Water Samples by ISO 11731: Does Plating on BCYE Medium Really Improve Yield? Pathogens 2020; 9:pathogens9090757. [PMID: 32948082 PMCID: PMC7559527 DOI: 10.3390/pathogens9090757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
Legionella spp are the causative agents of Legionnaires’ diseases, which is a pneumonia of important public health concern. Ubiquitous freshwater and soil inhabitants can reach man-made water systems and cause illness. Legionella enumeration and quantification in water systems is crucial for risk assessment and culture examination is the gold standard method. In this study, Legionella recovery from potable water samples, at presumably a low concentration of interfering microorganisms, was compared by plating on buffered charcoal yeast extract (BCYE) and glycine, vancomycin, polymyxin B, cycloheximide (GVPC) Legionella agar media, according to the International Standard Organization (ISO) 11731: 2017. Overall, 556 potable water samples were analyzed and 151 (27.1%) were positive for Legionella. Legionella grew on both BCYE and GVPC agar plates in 85/151 (56.3%) water samples, in 65/151 (43%) on only GVPC agar plates, and in 1/151 (0.7%) on only BCYE agar plates. In addition, GVPC medium identified Legionella species other than pneumophila in six more samples as compared with the culture on BCYE. Although the medians of colony forming units per liter (CFU/L) detected on the BCYE and GVPC agar plates were 2500 and 1350, respectively (p-value < 0.0001), the difference did not exceed one logarithm, and therefore is not relevant for Legionella risk assessment. These results make questionable the need to utilize BCYE agar plates to analyze potable water samples.
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102
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Performance of Legiolert Test vs. ISO 11731 to Confirm Legionella pneumophila Contamination in Potable Water Samples. Pathogens 2020; 9:pathogens9090690. [PMID: 32842454 PMCID: PMC7560050 DOI: 10.3390/pathogens9090690] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022] Open
Abstract
Detection and enumeration of Legionella in water samples is of great importance for risk assessment analysis. The plate culture method is the gold standard, but has received several well-known criticisms, which have induced researchers to develop alternative methods. The purpose of this study was to compare Legionella counts obtained by the analysis of potable water samples through the plate culture method and through the IDEXX liquid culture Legiolert method. Legionella plate culture, according to ISO 11731:1998, was performed using 1 L of water. Legiolert was performed using both the 10 mL and 100 mL Legiolert protocols. Overall, 123 potable water samples were analyzed. Thirty-seven (30%) of them, positive for L. pneumophila, serogroups 1 or 2–14 by plate culture, were used for comparison with the Legiolert results. The Legiolert 10 mL test detected 34 positive samples (27.6%) and the Legiolert 100 mL test detected 37 positive samples, 27.6% and 30% respectively, out of the total samples analyzed. No significant difference was found between either the Legiolert 10 mL and Legiolert 100 mL vs. the plate culture (p = 0.9 and p = 0.3, respectively) or between the Legiolert 10 mL and Legiolert 100 mL tests (p = 0.83). This study confirms the reliability of the IDEXX Legiolert test for Legionella pneumophila detection and enumeration, as already shown in similar studies. Like the plate culture method, the Legiolert assay is also suitable for obtaining isolates for typing purposes, relevant for epidemiological investigations.
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103
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Effects of Data Aggregation on Time Series Analysis of Seasonal Infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165887. [PMID: 32823719 PMCID: PMC7460497 DOI: 10.3390/ijerph17165887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/03/2023]
Abstract
Time series analysis in epidemiological studies is typically conducted on aggregated counts, although data tend to be collected at finer temporal resolutions. The decision to aggregate data is rarely discussed in epidemiological literature although it has been shown to impact model results. We present a critical thinking process for making decisions about data aggregation in time series analysis of seasonal infections. We systematically build a harmonic regression model to characterize peak timing and amplitude of three respiratory and enteric infections that have different seasonal patterns and incidence. We show that irregularities introduced when aggregating data must be controlled during modeling to prevent erroneous results. Aggregation irregularities had a minimal impact on the estimates of trend, amplitude, and peak timing for daily and weekly data regardless of the disease. However, estimates of peak timing of the more common infections changed by as much as 2.5 months when controlling for monthly data irregularities. Building a systematic model that controls for data irregularities is essential to accurately characterize temporal patterns of infections. With the urgent need to characterize temporal patterns of novel infections, such as COVID-19, this tutorial is timely and highly valuable for experts in many disciplines.
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104
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Rota MC, Scaturro M, Ricci ML. Letter to the editor: importance of a careful investigation to avoid attributing Legionnaires' disease cases to an incorrect source of infection. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2020; 25. [PMID: 32856585 PMCID: PMC7453685 DOI: 10.2807/1560-7917.es.2020.25.34.2001484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Maria Scaturro
- Department Infectious Diseases, National Institute of Health, Rome, Italy
| | - Maria Luisa Ricci
- Department Infectious Diseases, National Institute of Health, Rome, Italy
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105
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Loh CH, Soni R. Exposure to potting soils and compost material as potential sources of Legionella pneumophilia in Australia. Respir Med Case Rep 2020; 31:101156. [PMID: 32793411 PMCID: PMC7406913 DOI: 10.1016/j.rmcr.2020.101156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022] Open
Abstract
Legionnaires' disease is a form of atypical community-acquired pneumonia usually caused by Legionella pneumophilia, which is typically associated with exposure to tower cooling or water systems. In Australia, Legionnaires’ disease is more commonly caused by Legionella longbaechae, which is typically associated with exposure to soil or compost materials, and the presence of Legionellapneumophilia is less recognized. We report a sporadic case of Legionnaires' disease caused by Legionellapneumophilia serogroup 1 that was contracted following exposure to potting mix and topsoil.
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Affiliation(s)
- Chee H Loh
- Department of Respiratory Medicine, Gosford Hospital, Gosford, New South Wales, Australia
| | - Rajeev Soni
- Department of Respiratory Medicine, Gosford Hospital, Gosford, New South Wales, Australia
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106
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Leung YH, Lam CK, Cheung YY, Chan CW, Chuang SK. Epidemiology of Legionnaires' Disease, Hong Kong, China, 2005-2015. Emerg Infect Dis 2020; 26:1695-1702. [PMID: 32687025 PMCID: PMC7392469 DOI: 10.3201/eid2608.191244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We reviewed findings of clinical, epidemiologic, and environmental investigations for 288 confirmed case-patients with Legionnaires’ disease reported in Hong Kong, China, during January 2005−December 2015. We found that chronic renal failure/impairment (adjusted odds ratio [aOR] 4.09), chronic pulmonary diseases (aOR 3.22), malignancy (aOR 3.04), and heart diseases (aOR 2.15) were independently associated with a higher risk for severe Legionnaires’ disease. However, patients with hyperlipidemia had a lower risk for severe outcome (aOR 0.17). Legionella positivity rate was 22% for 1,904 water samples collected. We found a higher positivity rate in summer months (28%−30%), which corroborated with months of highest rainfalls. Our novel finding that Legionnaires’ disease patients with hyperlipidemia had a lower risk for severe outcome deserves further study to confirm the observation and ascertain the underlying reason.
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107
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Zemouri C, Awad SF, Volgenant CMC, Crielaard W, Laheij AMGA, de Soet JJ. Modeling of the Transmission of Coronaviruses, Measles Virus, Influenza Virus, Mycobacterium tuberculosis, and Legionella pneumophila in Dental Clinics. J Dent Res 2020; 99:1192-1198. [PMID: 32614681 PMCID: PMC7444020 DOI: 10.1177/0022034520940288] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Dental health care workers are in close contact to their patients and are therefore at higher risk for contracting airborne infectious diseases. The transmission rates of airborne pathogens from patient to dental health care workers are unknown. With the outbreaks of infectious diseases, such as seasonal influenza, occasional outbreaks of measles and tuberculosis, and the current pandemic of the coronavirus disease COVID-19, it is important to estimate the risks for dental health care workers. Therefore, the transmission probability of these airborne infectious diseases was estimated via mathematical modeling. The transmission probability was modeled for Mycobacterium tuberculosis, Legionella pneumophila, measles virus, influenza virus, and coronaviruses per a modified version of the Wells-Riley equation. This equation incorporated the indoor air quality by using carbon dioxide as a proxy and added the respiratory protection rate from medical face masks and N95 respirators. Scenario-specific analyses, uncertainty analyses, and sensitivity analyses were run to produce probability rates. A high transmission probability was characterized by high patient infectiousness, the absence of respiratory protection, and poor indoor air quality. The highest transmission probabilities were estimated for measles virus (100%), coronaviruses (99.4%), influenza virus (89.4%), and M. tuberculosis (84.0%). The low-risk scenario leads to transmission probabilities of 4.5% for measles virus and 0% for the other pathogens. From the sensitivity analysis, it shows that the transmission probability is strongly driven by indoor air quality, followed by patient infectiousness, and the least by respiratory protection from medical face mask use. Airborne infection transmission of pathogens such as measles virus and coronaviruses is likely to occur in the dental practice. The risk magnitude, however, is highly dependent on specific conditions in each dental clinic. Improved indoor air quality by ventilation, which reduces carbon dioxide, is the most important factor that will either strongly increase or decrease the probability of the transmission of a pathogen.
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Affiliation(s)
- C Zemouri
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation, Doha, Qatar
| | - C M C Volgenant
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - W Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - A M G A Laheij
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J J de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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108
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Chowdhury A, Khan SA, Haugh S. Diffuse alveolar hemorrhage due to Legionella pneumophila serogroup 3. J Community Hosp Intern Med Perspect 2020; 10:262-264. [PMID: 32850075 PMCID: PMC7426976 DOI: 10.1080/20009666.2020.1767274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Legionella pneumophilia remains an important cause of pneumonia that can cause substantial clinical morbidity and mortality. We describe a case involving a 67-year-old woman with legionella pneumonia who developed diffuse alveolar hemorrhage. We also highlight the pitfalls of commonly used legionella urine antigen testing. Furthermore, we explore the role of high-dose steroid therapy as a treatment option for patients with diffuse alveolar hemorrhage secondary to legionella pneumonia who continue to deteriorate in spite of adequate antimicrobial therapy.
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Affiliation(s)
- Arnab Chowdhury
- Department of Hospital Medicine , Mayo Clinic Health System, Mankato, MN, USA
| | - Syed Anjum Khan
- Department of Critical Care, Mayo Clinic Health System, Mankato, MN, USA
| | - Susan Haugh
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Mankato, MN, USA
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109
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Yakunin E, Kostyal E, Agmon V, Grotto I, Valinsky L, Moran-Gilad J. A Snapshot of the Prevalence and Molecular Diversity of Legionella pneumophila in the Water Systems of Israeli Hotels. Pathogens 2020; 9:pathogens9060414. [PMID: 32471136 PMCID: PMC7350324 DOI: 10.3390/pathogens9060414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 11/16/2022] Open
Abstract
Exposure to Legionella spp. contaminated aerosols in hotel settings confers risk for travel-associated Legionnaire’s disease (TALD). In this study, we investigated the prevalence of Legionella contamination and its molecular diversity in hotels and resorts across Israel. The study was comprised of a convenience sample of water systems from 168 hotels and resorts countrywide, routinely inspected between March 2015 and February 2017. Isolation and quantitation of Legionella were performed in a water laboratory using the ISO 11731 method. The distribution of Legionella isolates was analyzed according to geography and source. The genetic diversity of a subset of isolates was analyzed by sequence-based typing (SBT) at the National Reference Laboratory for Legionella and compared to the national database. Out of 2830 samples tested, 470 (17%) obtained from 102 different premises (60% of hotels) were positive for Legionella spp. In 230 samples (49% of all positive, 8% of total samples), accounting for 37% of hotels, Legionella spp. counts exceeded the regulatory threshold of 1000 CFU/L. The most frequently contaminated water sources were cooling towers (38%), followed by faucets, hot tubs, water lines, and storage tanks (14–17% each). Furthermore, 32% and 17% of samples obtained from cooling towers and hot tubs, respectively, exceeded the regulatory thresholds. SBT was performed on 78 strains and revealed 27 different sequence types (STs), including two novel STs. The most prevalent STs found were ST1 (26%), ST87 (10%), ST93 (6%), and ST461 and ST1516 (5% each). Several L. pneumophila STs were found to be limited to certain geographical regions. This is the first study to investigate the prevalence and diversity of Legionella in hotels and resorts in Israel during non-outbreak environmental inspections. These findings will inform risk assessment, surveillance, and control measures of TALD.
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Affiliation(s)
- Eugenia Yakunin
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
| | - Eszter Kostyal
- Department of Water Microbiology, Biolab Ltd., Jerusalem 9134001, Israel;
| | - Vered Agmon
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
| | - Itamar Grotto
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Lea Valinsky
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
| | - Jacob Moran-Gilad
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Correspondence:
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110
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Coulon P, Cordier C, Saint-Léger P, Lambiotte F, Loridant S, Mazars E. Invasive pulmonary aspergillosis in an ICU patient with Legionnaires' disease: A diagnostic challenge. J Mycol Med 2020; 30:100985. [PMID: 32418638 DOI: 10.1016/j.mycmed.2020.100985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/20/2020] [Indexed: 02/06/2023]
Abstract
Aspergillus fumigatus can cause a wide range of diseases, from hypersensitivity to invasive infection. Invasive disease usually occurs in severely immunocompromised patients with deep and prolonged neutropenia. It is a less well-recognized complication in critically ill patients without traditional risk factors. We describe a case of early invasive pulmonary aspergillosis (IPA) secondary to Legionella pneumophila serogroup 1 pneumonia in a patient on an intensive care unit (ICU). In addition to commonly accepted risk factors for IPA in ICU patients, we hypothesis that L. pneumophilia pneumonia could enhance this type of infection. We also reviewed all published cases of coinfection with L. pneumophila and A. fumigatus to assess whether Legionnaires' disease could be a risk factor for IPA.
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Affiliation(s)
- P Coulon
- Inserm U995-LIRIC (Lille Inflammation Research International Centre), laboratoire de parasitologie mycologie, université Lille, CHU Lille, 1, place Verdun, 59000 Lille, France
| | - C Cordier
- Laboratoire de microbiologie, pôle de biologie-hygiène, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes, France
| | - P Saint-Léger
- Service de réanimation polyvalente, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes, France
| | - F Lambiotte
- Service de réanimation polyvalente, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes, France
| | - S Loridant
- Inserm U995-LIRIC (Lille Inflammation Research International Centre), laboratoire de parasitologie mycologie, université Lille, CHU Lille, 1, place Verdun, 59000 Lille, France
| | - E Mazars
- Laboratoire de microbiologie, pôle de biologie-hygiène, centre hospitalier de Valenciennes, avenue Désandrouin, 59322 Valenciennes, France.
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111
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Rafiei N, Shaw B, Dendle C, Opat S, Williamson D, Graham M. Persistently positive culture of antimicrobial-susceptible Legionella pneumophila despite appropriate therapy. Access Microbiol 2020; 2:acmi000113. [PMID: 32974578 PMCID: PMC7494184 DOI: 10.1099/acmi.0.000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/12/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nastaran Rafiei
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
- *Correspondence: Nastaran Rafiei,
| | - Briony Shaw
- Department of Haematology, Monash Health, Clayton, Victoria, Australia
| | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Stephen Opat
- Department of Haematology, Monash Health, Clayton, Victoria, Australia
| | - Deborah Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity, Australia
| | - Maryza Graham
- Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
- Department of Microbiology, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
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112
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Review Global seroprevalence of legionellosis - a systematic review and meta-analysis. Sci Rep 2020; 10:7337. [PMID: 32355282 PMCID: PMC7193644 DOI: 10.1038/s41598-020-63740-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/11/2020] [Indexed: 01/31/2023] Open
Abstract
Legionella is a ubiquitous pathogen yet the global occurrence of legionellosis is poorly understood. To address this deficit, this paper summarises the available evidence on the seroprevalence of Legionella antibodies and explores factors that may influence seroprevalence estimates. Through a systematic review, a total of 3979 studies were identified with seroprevalence results published after 1 January 1990. We tabulated findings by World Health Organization (WHO) region, location, study period and design, composition of study population(s) for all ages in terms of exposure, sex, detection methods, IFA titre, Legionella species measured, and present seroprevalence point estimates and 95% confidence intervals. Sampled populations were classified according to income, WHO region, gender, age, occupation and publication date. We conducted a meta-analysis on these subgroups using Comprehensive Meta-Analysis 3.0 software. Heterogeneity across studies was evaluated by the Q test in conjunction with I2 statistics. Publication bias was evaluated via funnel plot and Egger's test. Fifty-seven studies met our inclusion criteria, giving an overall estimate of seroprevalence for Legionella of 13.7% (95% CI 11.3-16.5), but with substantial heterogeneity across studies.
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113
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Short-term associations between Legionnaires' disease incidence and meteorological variables in Belgium, 2011-2019. Epidemiol Infect 2020; 148:e150. [PMID: 32345387 PMCID: PMC7374801 DOI: 10.1017/s0950268820000886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The number of reported cases with Legionnaires' disease (LD) is increasing in Belgium. Previous studies have investigated the associations between LD incidence and meteorological factors, but the Belgian data remained unexplored. We investigated data collected between 2011 and 2019. Daily exposure data on temperature, relative humidity, precipitation and wind speed was obtained from the Royal Meteorological Institute for 29 weather stations. Case data were collected from the national reference centre and through mandatory notification. Daily case and exposure data were aggregated by province. We conducted a time-stratified case-crossover study. The 'at risk' period was defined as 10 to 2 days prior to disease onset. The corresponding days in the other study years were selected as referents. We fitted separate conditional Poisson models for each day in the 'at risk' period and a distributed lag non-linear model (DLNM) which fitted all data in one model. LD incidence showed a yearly peak in August and September. A total of 614 cases were included. Given seasonality, a sequence of precipitation, followed by high relative humidity and low wind speed showed a statistically significant association with the number of cases 6 to 4 days later. We discussed the advantages of DLNM in this context.
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114
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Differential Seasonality of Legionnaires' Disease by Exposure Category. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093049. [PMID: 32353925 PMCID: PMC7246710 DOI: 10.3390/ijerph17093049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022]
Abstract
Legionnaires’ disease (LD) shows a seasonal pattern with most cases occurring in summer. We investigate if seasonality can be observed for all three exposure categories (community-acquired (CALD), travel-associated (TALD) and healthcare-associated (HCA)). Methods: LD cases (2005–2015) were classified by exposure categories and we calculated the relative case ratio for each month from February to December using January as reference. The TALD relative case ratio was compared with flight frequencies. Results: Overall case numbers in Germany (N = 7351) peaked in August. CALD had a curve similar to all cases. TALD displayed a bimodal curve with peaks in June/July and October. The latter was attributable to LD cases aged 60+. The relative case ratio of TALD surpassed clearly that of CALD. The curve was similar to that of the relative flight frequencies, but was shifted by about one month. HCA showed no apparent seasonality. Conclusions: Although the overall seasonality in LD is heavily influenced by CALD, seasonal differences are more pronounced for TALD which may reflect travel behavior. The bimodal pattern of TALD is attributable to the curve among those aged 60+ and may reflect their preference to travel outside school holiday periods. Heightened vigilance for HCA cases is necessary throughout the entire year.
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115
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Toberna CP, William HM, Kram JJF, Heslin K, Baumgardner DJ. Epidemiologic Survey of Legionella Urine Antigen Testing Within a Large Wisconsin-Based Health Care System. J Patient Cent Res Rev 2020; 7:165-175. [PMID: 32377550 DOI: 10.17294/2330-0698.1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Legionella pneumophila pneumonia is a life-threatening, environmentally acquired infection identifiable via Legionella urine antigen tests (LUAT). We aimed to identify cumulative incidence, demographic distribution, and undetected disease outbreaks of Legionella pneumonia via positive LUAT in a single eastern Wisconsin health system, with a focus on urban Milwaukee County. Methods A multilevel descriptive ecologic study was conducted utilizing electronic medical record data from a large integrated health care system of patients who underwent LUAT from 2013 to 2017. A random sample inclusive of all positive tests was reviewed to investigate geodemographic differences among patients testing positive versus negative. Statistical comparisons used chi-squared or 2-sample t-tests; stepwise regression followed by binary logistic regression was used for multivariable analysis. Positive cases identified by LUAT were mapped to locate hotspots; positive cases versus total tests performed also were mapped by zip code. Results Of all LUAT performed (n=21,599), 0.68% were positive. Among those in the random sample (n=11,652), positive cases by LUAT were more prevalent in the June-November time period (86.2%) and younger patients (59.4 vs 67.7 years) and were disproportionately male (70.3% vs 29.7%) (P<0.0001 for each). Cumulative incidence was higher among nonwhite race/ethnicity (1.91% vs 1.01%, P<0.0001) but did not remain significant on multivariable analysis. Overall, 5507 tests were performed in Milwaukee County zip codes, yielding 82 positive cases by LUAT (60.7% of all positive cases in the random sample). A potential small 2016 outbreak was identified. Conclusions Cumulative incidence of a positive LUAT was less than 1%. LUAT testing, if done in real time by cooperative health systems, may complement public health detection of Legionella pneumonia outbreaks.
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Affiliation(s)
- Caroline P Toberna
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Hannah M William
- Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Jessica J F Kram
- Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kayla Heslin
- Aurora Research Institute, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI
| | - Dennis J Baumgardner
- Center for Urban Population Health, Milwaukee, WI.,Aurora UW Medical Group, Aurora Health Care, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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116
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Nisar MA, Ross KE, Brown MH, Bentham R, Whiley H. Legionella pneumophila and Protozoan Hosts: Implications for the Control of Hospital and Potable Water Systems. Pathogens 2020; 9:pathogens9040286. [PMID: 32326561 PMCID: PMC7238060 DOI: 10.3390/pathogens9040286] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
Legionella pneumophila is an opportunistic waterborne pathogen of public health concern. It is the causative agent of Legionnaires’ disease (LD) and Pontiac fever and is ubiquitous in manufactured water systems, where protozoan hosts and complex microbial communities provide protection from disinfection procedures. This review collates the literature describing interactions between L. pneumophila and protozoan hosts in hospital and municipal potable water distribution systems. The effectiveness of currently available water disinfection protocols to control L. pneumophila and its protozoan hosts is explored. The studies identified in this systematic literature review demonstrated the failure of common disinfection procedures to achieve long term elimination of L. pneumophila and protozoan hosts from potable water. It has been demonstrated that protozoan hosts facilitate the intracellular replication and packaging of viable L. pneumophila in infectious vesicles; whereas, cyst-forming protozoans provide protection from prolonged environmental stress. Disinfection procedures and protozoan hosts also facilitate biogenesis of viable but non-culturable (VBNC) L. pneumophila which have been shown to be highly resistant to many water disinfection protocols. In conclusion, a better understanding of L. pneumophila-protozoan interactions and the structure of complex microbial biofilms is required for the improved management of L. pneumophila and the prevention of LD.
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Garner E, Brown CL, Schwake DO, Rhoads WJ, Arango-Argoty G, Zhang L, Jospin G, Coil DA, Eisen JA, Edwards MA, Pruden A. Comparison of Whole-Genome Sequences of Legionella pneumophila in Tap Water and in Clinical Strains, Flint, Michigan, USA, 2016. Emerg Infect Dis 2020; 25:2013-2020. [PMID: 31625848 PMCID: PMC6810188 DOI: 10.3201/eid2511.181032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During the water crisis in Flint, Michigan, USA (2014-2015), 2 outbreaks of Legionnaires' disease occurred in Genesee County, Michigan. We compared whole-genome sequences of 10 clinical Legionella pneumophila isolates submitted to a laboratory in Genesee County during the second outbreak with 103 water isolates collected the following year. We documented a genetically diverse range of L. pneumophila strains across clinical and water isolates. Isolates belonging to 1 clade (3 clinical isolates, 3 water isolates from a Flint hospital, 1 water isolate from a Flint residence, and the reference Paris strain) had a high degree of similarity (2-1,062 single-nucleotide polymorphisms), all L. pneumophila sequence type 1, serogroup 1. Serogroup 6 isolates belonging to sequence type 2518 were widespread in Flint hospital water samples but bore no resemblance to available clinical isolates. L. pneumophila strains in Flint tap water after the outbreaks were diverse and similar to some disease-causing strains.
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Carlson KM, Boczek LA, Chae S, Ryu H. Legionellosis and Recent Advances in Technologies for Legionella Control in Premise Plumbing Systems: A Review. WATER 2020; 12:1-676. [PMID: 32704396 PMCID: PMC7377215 DOI: 10.3390/w12030676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review discusses Legionella, among the most prolific and publicly well-known waterborne pathogens, and advances in potential treatment technologies. The number of cases associated with Legionella continues to rise, as does its public awareness. Currently, cases associated with premise plumbing account for the largest number of legionellosis cases in the United States. So, while it is important to understand Legionella as such, it is also important to investigate how to treat drinking water in premise plumbing for Legionella and other waterborne pathogens. While there are currently several methods recognized as potential means of inactivating waterborne pathogens, several shortcomings continue to plague its implementation. These methods are generally of two types. Firstly, there are chemical treatments such as chlorine, chlorine dioxide, monochloramine, ozone, and copper-silver ionization. Secondly, there are physical treatments such as thermal inactivation and media filtration. Their shortcomings range from being labor-intensive and costly to having negative health effects if not properly operated. Recently developed technologies including ultraviolet (UV) irradiation using light emitting diodes (LEDs) and innovative carbon nanotube (CNT) filters can better control waterborne pathogens by allowing for the simultaneous use of different treatment measures in plumbing systems.
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Affiliation(s)
- Kelsie M. Carlson
- United States Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA
- Department of Chemical and Environmental Engineering, University of Cincinnati, Cincinnati, OH 45268, USA
| | - Laura A. Boczek
- United States Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA
| | - Soryong Chae
- Department of Chemical and Environmental Engineering, University of Cincinnati, Cincinnati, OH 45268, USA
| | - Hodon Ryu
- United States Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA
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Abstract
The early detection of Legionella in water reservoirs, and the prevention of their often fatal diseases, requires the development of rapid and reliable detection processes. A method for the magnetic separation (MS) of Legionella pneumophila by superparamagnetic iron oxide nanoparticles is developed, which represents the basis for future bacteria detection kits. The focus lies on the separation process and the simplicity of using magnetic nanomaterials. Iron oxide nanoparticles are functionalized with epoxy groups and Legionella-specific antibodies are immobilized. The resulting complexes are characterized with infrared spectroscopy and tested for the specific separation and enrichment of the selected microorganisms. The cell-particle complexes can be isolated in a magnetic field and detected with conventional methods such as fluorescence detection. A nonspecific enrichment of bacteria is also possible by using bare iron oxide nanoparticles (BIONs), which we used as a reference to the nanoparticles with immobilized antibodies. Furthermore, the immunomagnetic separation can be applied for the detection of multiple other microorganisms and thus might pave the way for simpler bacterial diagnosis.
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Method Comparison of the ImmuView L. pneumophila and L. longbeachae Urinary Antigen Test with the BinaxNOW Legionella Urinary Antigen Card for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine. J Clin Microbiol 2020; 58:JCM.01429-19. [PMID: 31826962 DOI: 10.1128/jcm.01429-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022] Open
Abstract
We compared the clinical performance of the ImmuView L. pneumophila and L. longbeachae urinary antigen test (SSI Diagnostica A/S, Hillerød, Denmark) to that of the BinaxNOW Legionella urinary antigen card (Binax; Abbott, Lake Buff, IL) using urine specimens from patients suspected of having pneumonia. In total, 100 frozen urine samples (derived from 50 Legionella cases and 50 noncases) were analyzed with both tests, as were 200 nonfrozen prospectively collected samples. For urine samples from five Legionella cases and two non-Legionella cases, analytical sensitivity (limit of detection) and repeatability were examined. The urine samples from the five Legionella cases were diluted with urine samples that tested Legionella urinary antigen negative with both tests. The analyses of the 100 frozen samples resulted in a sensitivity and specificity of both ImmuView and the BinaxNOW of 96.0% (48/50) and 100% (50/50), respectively. Of the 200 nonfrozen samples, there were three samples that showed a positive result for L. pneumophila by both tests. The analyses of reproducibility showed that for the 34 (diluted) samples that were tested at two consecutive times, 33 samples showed a consistent result for both the ImmuView and the BinaxNOW tests (Cohen's kappa values of 0.916 and 0.928). In addition, the ImmuView test may have detected two L. longbeachae-positive urine samples, although other diagnostic tests could not confirm this. Both ImmuView and BinaxNOW showed high sensitivity and specificity for the detection of L. pneumophila serogroup 1 antigen in urine samples from clinical patients with a suspected lower respiratory tract infection.
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Miyashita N, Higa F, Aoki Y, Kikuchi T, Seki M, Tateda K, Maki N, Uchino K, Ogasawara K, Kiyota H, Watanabe A. Distribution of Legionella species and serogroups in patients with culture-confirmed Legionella pneumonia. J Infect Chemother 2020; 26:411-417. [PMID: 32081644 DOI: 10.1016/j.jiac.2019.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/04/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Legionella species are consistently identified as some of the most common causative agents of severe community-acquired pneumonia (CAP) or nosocomial pneumonia. Although the number of reported Legionella infection cases is gradually increasing in Japan, most cases are diagnosed by a urinary antigen test, which identifies only L. pneumophila serogroup 1. Therefore, assessment of pneumonia-causing Legionella species and serogroups would be important. The Japan Society for Chemotherapy Legionella committee has collected the isolates and clinical information on cases of sporadic community-acquired Legionella pneumonia throughout Japan. Between December 2006 and March 2019, totally 140 sporadic cases were identified, in which L. pneumophila was the most frequently isolated species (90.7%) followed by L. bozemanae (3.6%), L. dumofii (3.6%), L. micdadei (1.4%), and L. longbeachae (0.7%). Among 127 isolates of L. pneumophila, 111 isolates were of serogroup 1, two of serogroup 2, four of serogroup 3, one of serogroup 4, one of serogroup 5, seven of serogroup 6, and one was of serogroup 10. We also assessed in vitro activity of antibiotics against these isolates and showed that quinolones and macrolides have potent anti-Legionella activity. Our study showed that pneumonia-causing Legionella species and serogroup distribution was comparable to that reported in former surveillances. L. pneumophila was the most common etiologic agent in patients with community-acquired Legionella pneumonia, and L. pneumophila serogroup 1 was the predominant serogroup.
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Affiliation(s)
- Naoyuki Miyashita
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan.
| | - Futoshi Higa
- National Hospital Organization Okinawa National Hospital, Japan
| | - Yosuke Aoki
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Masafumi Seki
- Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan
| | - Nobuko Maki
- Taisho Toyama Pharmaceutical Co., Ltd, Japan
| | | | | | - Hiroshi Kiyota
- Department of Urology, The Jikei University Katsushika Medical Center, Japan
| | - Akira Watanabe
- Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Japan
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Hasni I, Jarry A, Quelard B, Carlino A, Eberst JB, Abbe O, Demanèche S. Intracellular Behaviour of Three Legionella pneumophila Strains within Three Amoeba Strains, Including Willaertia magna C2c Maky. Pathogens 2020; 9:pathogens9020105. [PMID: 32041369 PMCID: PMC7168187 DOI: 10.3390/pathogens9020105] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/12/2022] Open
Abstract
Legionella pneumophila is a facultative intracellular pathogen found in aquatic environments as planktonic cells within biofilms and as intracellular parasites of free-living amoebae such as Acanthamoeba castellanii. This pathogen bypasses the elimination mechanism to replicate within amoebae; however, not all amoeba species support the growth of L. pneumophila. Willaertia magna C2c Maky, a non-pathogenic amoeba, was previously demonstrated to possess the ability to eliminate the L. pneumophila strain Paris. Here, we study the intracellular behaviour of three L. pneumophila strains (Paris, Philadelphia, and Lens) within W. magna C2c Maky and compare this strain to A. castellanii and W. magna Z503, which are used as controls. We observe the intracellular growth of strain Lens within W. magna Z503 and A. castellanii at 22 °C and 37 °C. Strain Paris grows within A. castellanii at any temperature, while it only grows at 22 °C within W. magna Z503. Strain Philadelphia proliferates only within A. castellanii at 37 °C. Within W. magna C2c Maky, none of the three legionella strains exhibit intracellular growth. Additionally, the ability of W. magna C2c Maky to decrease the number of internalized L. pneumophila is confirmed. These results support the idea that W. magna C2c Maky possesses unique behaviour in regard to L. pneumophila strains.
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Affiliation(s)
- Issam Hasni
- Microbes, Evolution, Phylogeny and Infection Department, Institut de Recherche pour le Développement IRD 198, Institut Hospitalo-Universitaire (IHU), Aix-Marseille Université, 13007 Marseille, France;
- R&D Department, Amoéba, 38 Avenue des Frères Montgolfier, 69680 Chassieu, France; (A.J.); (B.Q.); (A.C.); (J.-B.E.); (O.A.)
| | - Antoine Jarry
- R&D Department, Amoéba, 38 Avenue des Frères Montgolfier, 69680 Chassieu, France; (A.J.); (B.Q.); (A.C.); (J.-B.E.); (O.A.)
| | - Benjamin Quelard
- R&D Department, Amoéba, 38 Avenue des Frères Montgolfier, 69680 Chassieu, France; (A.J.); (B.Q.); (A.C.); (J.-B.E.); (O.A.)
| | - Antoine Carlino
- R&D Department, Amoéba, 38 Avenue des Frères Montgolfier, 69680 Chassieu, France; (A.J.); (B.Q.); (A.C.); (J.-B.E.); (O.A.)
| | - Jean-Baptiste Eberst
- R&D Department, Amoéba, 38 Avenue des Frères Montgolfier, 69680 Chassieu, France; (A.J.); (B.Q.); (A.C.); (J.-B.E.); (O.A.)
| | - Olivier Abbe
- R&D Department, Amoéba, 38 Avenue des Frères Montgolfier, 69680 Chassieu, France; (A.J.); (B.Q.); (A.C.); (J.-B.E.); (O.A.)
| | - Sandrine Demanèche
- R&D Department, Amoéba, 38 Avenue des Frères Montgolfier, 69680 Chassieu, France; (A.J.); (B.Q.); (A.C.); (J.-B.E.); (O.A.)
- Correspondence:
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Paranjape K, Bédard É, Whyte LG, Ronholm J, Prévost M, Faucher SP. Presence of Legionella spp. in cooling towers: the role of microbial diversity, Pseudomonas, and continuous chlorine application. WATER RESEARCH 2020; 169:115252. [PMID: 31726393 DOI: 10.1016/j.watres.2019.115252] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/23/2019] [Accepted: 10/27/2019] [Indexed: 05/25/2023]
Abstract
Legionnaires' disease (LD) is a severe pneumonia caused by several species of the genus Legionella, most frequently by Legionella pneumophila. Cooling towers are the most common source for large community-associated outbreaks. Colonization, survival, and proliferation of L. pneumophila in cooling towers are necessary for outbreaks to occur. These steps are affected by the chemical and physical parameters of the cooling tower environment. We hypothesize that the bacterial community residing in the cooling tower could also affect the presence of L. pneumophila. A 16S rRNA gene targeted amplicon sequencing approach was used to study the bacterial community of cooling towers and its relationship with the Legionella spp. and L. pneumophila communities. The results indicated that the water source shaped the bacterial community of cooling towers. Several taxa were enriched and positively correlated with Legionella spp. and L. pneumophila. In contrast, Pseudomonas showed a strong negative correlation with Legionella spp. and several other genera. Most importantly, continuous chlorine application reduced microbial diversity and promoted the presence of Pseudomonas creating a non-permissive environment for Legionella spp. This suggests that disinfection strategies as well as the resident microbial population influences the ability of Legionella spp. to colonize cooling towers.
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Affiliation(s)
- Kiran Paranjape
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Émilie Bédard
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada; Department of Civil Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Lyle G Whyte
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Jennifer Ronholm
- Department of Food Science and Agricultural Chemistry, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada; Department of Animal Science, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Sébastien P Faucher
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada.
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Complete Genome Sequence of a Legionella longbeachae Serogroup 2 Isolate Derived from a Patient with Legionnaires' Disease. Microbiol Resour Announc 2020; 9:9/5/e01563-19. [PMID: 32001572 PMCID: PMC6992876 DOI: 10.1128/mra.01563-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Legionella longbeachae is the predominant cause of Legionnaires’ disease (LD) in New Zealand. Although serogroup 2 (sg2) does not contain the most clinically significant strain, it is an important cause of disease. Here, we report the complete genome sequence of an sg2 isolate from a patient who was hospitalized with LD. Legionella longbeachae is the predominant cause of Legionnaires’ disease (LD) in New Zealand. Although serogroup 2 (sg2) does not contain the most clinically significant strain, it is an important cause of disease. Here, we report the complete genome sequence of an sg2 isolate from a patient who was hospitalized with LD.
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125
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Wolff C, Lange H, Feruglio S, Vold L, MacDonald E. Evaluation of the national surveillance of Legionnaires' disease in Norway, 2008-2017. BMC Public Health 2019; 19:1624. [PMID: 31795996 PMCID: PMC6889696 DOI: 10.1186/s12889-019-7981-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background In Norway, Legionnaires’ disease is reportable upon clinical suspicion to public health authorities and mandatorily notifiable through the Norwegian surveillance system for communicable diseases (MSIS) for both clinicians and laboratories. In the summer of 2017, several European countries reported high notification rates for Legionnaires’ disease, which was not observed in Norway. We evaluated MSIS to assess if it meets its objectives of detecting cases and trends in incidence of Legionnaires’ disease. Methods We retrieved MSIS data from 2008 to 2017 and calculated timeliness as days from sampling to notification, and internal completeness for key variables as the proportion of observations with a value. Where possible, we assessed internal validity on the presence of a plausible value. To estimate external completeness and validity we linked MSIS with hospital reimbursement claims in the Norwegian Patient Registry. To assess acceptability and representativeness, we surveyed doctors in 39 hospitals on their units’ diagnostic and notification procedures, and their use of MSIS. Results There were 438 notified cases. Internal completeness and internal validity were high for key variables (≥95%). The median delay from sampling to notification was 4 days. There were 73 patients in MSIS only, 70 in the Norwegian Patient Registry only, and 351 in both registers. The external completeness of MSIS was 83% (95% CI 80–86%). For external validity, the positive predictive value of MSIS was 83% (95% CI 79–86%). Forty-seven respondents from 28 hospitals described testing procedures. These were inconsistent: 29 (62%) reported no systematic application of criteria for requesting legionella testing. Eighteen (38%) reported testing all patients with suspected pneumonia and a travel history. Thirty-one (66%) found the notification criteria clear. Conclusions Our results suggest that the surveillance in MSIS can detect incidence changes for Legionnaires’ disease over time, by place and person, but likely does not detect every case diagnosed in Norway. We recommend wider investigation of diagnostic procedures in order to improve representativeness and awareness of MSIS notification criteria among clinicians in order to improve acceptability of the surveillance. We also recommend a more comprehensive assessment of whether patients only registered in the Norwegian Patient Registry were true Legionnaires’ disease cases.
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Affiliation(s)
- Cecilia Wolff
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway. .,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Heidi Lange
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
| | - Siri Feruglio
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
| | - Line Vold
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
| | - Emily MacDonald
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
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126
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Actualités sur les infections à Legionella. Rev Med Interne 2019; 40:791-798. [DOI: 10.1016/j.revmed.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/25/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022]
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127
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Smith AF, Huss A, Dorevitch S, Heijnen L, Arntzen VH, Davies M, Robert-Du Ry van Beest Holle M, Fujita Y, Verschoor AM, Raterman B, Oesterholt F, Heederik D, Medema G. Multiple Sources of the Outbreak of Legionnaires' Disease in Genesee County, Michigan, in 2014 and 2015. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:127001. [PMID: 31799878 PMCID: PMC6957290 DOI: 10.1289/ehp5663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND A community-wide outbreak of Legionnaires' disease (LD) occurred in Genesee County, Michigan, in 2014 and 2015. Previous reports about the outbreak are conflicting and have associated the outbreak with a change of water source in the city of Flint and, alternatively, to a Flint hospital. OBJECTIVE The objective of this investigation was to independently identify relevant sources of Legionella pneumophila that likely resulted in the outbreak. METHODS An independent, retrospective investigation of the outbreak was conducted, making use of public health, health care, and environmental data and whole-genome multilocus sequence typing (wgMLST) of clinical and environmental isolates. RESULTS Strong evidence was found for a hospital-associated outbreak in both 2014 and 2015: a) 49% of cases had prior exposure to Flint hospital A, significantly higher than expected from Medicare admissions; b) hospital plumbing contained high levels of L. pneumophila; c) Legionella control measures in hospital plumbing aligned with subsidence of hospital A-associated cases; and d) wgMLST showed Legionella isolates from cases exposed to hospital A and from hospital plumbing to be highly similar. Multivariate analysis showed an increased risk of LD in 2014 for people residing in a home that received Flint water or was located in proximity to several Flint cooling towers. DISCUSSION This is the first LD outbreak in the United States with evidence for three sources (in 2014): a) exposure to hospital A, b) receiving Flint water at home, and c) residential proximity to cooling towers; however, for 2015, evidence points to hospital A only. Each source could be associated with only a proportion of cases. A focus on a single source may have delayed recognition and remediation of other significant sources of L. pneumophila. https://doi.org/10.1289/EHP5663.
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Affiliation(s)
- Anya F. Smith
- KWR Water Research Institute, Nieuwegein, Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Samuel Dorevitch
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Leo Heijnen
- KWR Water Research Institute, Nieuwegein, Netherlands
| | | | - Megan Davies
- Davies Public Health Consulting, LLC, Raleigh, North Carolina, USA
| | | | - Yuki Fujita
- KWR Water Research Institute, Nieuwegein, Netherlands
| | | | | | | | - Dick Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
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De Giglio O, Fasano F, Diella G, Lopuzzo M, Napoli C, Apollonio F, Brigida S, Calia C, Campanale C, Marzella A, Pousis C, Rutigliano S, Triggiano F, Caggiano G, Montagna MT. Legionella and legionellosis in touristic-recreational facilities: Influence of climate factors and geostatistical analysis in Southern Italy (2001-2017). ENVIRONMENTAL RESEARCH 2019; 178:108721. [PMID: 31541805 DOI: 10.1016/j.envres.2019.108721] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
Legionella is the causative agent of Legionnaires' disease, a flu-like illness normally acquired following inhalation or aspiration of contaminated water aerosols. Our recent studies revealed that climatic parameters can increase the number of reported cases of community-acquired Legionnaires' disease. Here, we evaluated the presence of Legionella in water networks and the distribution of Legionnaires' disease cases associated with touristic-recreational facilities in the Apulia region (southern Italy) during the period 2001-2017 using geostatistical and climatic analyses. Geostatistical analysis data revealed that the area with the highest concentration of Legionella in water systems also had the greatest number of cases of Legionnaires' disease associated with touristic-recreational facilities. Climatic analysis showed that higher daily temperature excursion (difference between maximum and minimum temperature) on the day of sampling was more often associated with Legionella-positive samples than Legionella-negative samples. In addition, our data highlighted an increased risk of Legionnaires' disease with increases in precipitation and average temperature and with decreases in daily temperature excursion (difference between maximum and minimum temperature over the course of 24 h in the days of incubation period of disease) and minimum temperature. Healthcare professionals should be aware of this phenomenon and be particularly vigilant for cases of community-acquired pneumonia during such climatic conditions and among the tourist population. The innovative geo-statistical approach used in this study could be applied in other contexts when evaluating the effects of climatic conditions on the incidence of Legionella infections.
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Affiliation(s)
- Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Fabrizio Fasano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Marco Lopuzzo
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Christian Napoli
- Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189, Rome, Italy.
| | - Francesca Apollonio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Silvia Brigida
- Water Research Institute-Italian National Research Council, Bari, Italy.
| | - Carla Calia
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Carmen Campanale
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Angelo Marzella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Chrysovalentinos Pousis
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Francesco Triggiano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
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Shah JA, Emery R, Lee B, Venkatasubramanian S, Simmons JD, Brown M, Hung CF, Prins JM, Verbon A, Hawn TR, Skerrett SJ. TOLLIP deficiency is associated with increased resistance to Legionella pneumophila pneumonia. Mucosal Immunol 2019; 12:1382-1390. [PMID: 31462698 PMCID: PMC6824992 DOI: 10.1038/s41385-019-0196-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/08/2019] [Accepted: 08/02/2019] [Indexed: 02/04/2023]
Abstract
Legionella pneumophila (Lp) is a flagellated, intracellular bacterium that can cause Legionnaires' disease (LD). Lp activates multiple innate immune receptors, and TOLLIP dampens MyD88-dependent signaling and may influence susceptibility to LD. We evaluated the effect of TOLLIP on innate immunity, pneumonia severity, and LD susceptibility in mouse lungs and human populations. To accomplish this, we evaluated the effect of TOLLIP on lung-specific Lp control and immune response and associated a common functional TOLLIP variant with Lp-induced innate immune responses and LD susceptibility in humans. After aerosol Lp infection, Tollip-/- mice demonstrated significantly fewer bacterial colony-forming unit and increased cytokine responses from BAL fluid. Tollip-/- macrophages also suppressed intracellular Lp replication in a flagellin-independent manner. The presence of a previously characterized, functionally active SNP associated with decreased TOLLIP mRNA transcript in monocytes was associated with increased TNF and IL-6 secretion after Lp stimulation of PBMC ex vivo. This genotype was separately associated with decreased LD susceptibility (309 controls, 88 cases, p = 0.008, OR 0.36, 95% CI 0.16-0.76) in a candidate gene association study. These results suggest that TOLLIP decreases lung-specific TLR responses to increase LD susceptibility in human populations. Better understanding of TOLLIP may lead to novel immunomodulatory therapies.
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Affiliation(s)
- Javeed A. Shah
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Robyn Emery
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Brian Lee
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Jason D. Simmons
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Melanie Brown
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Chi F. Hung
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jan M. Prins
- University of Amsterdam, Amsterdam, the Netherlands
| | | | - Thomas R. Hawn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Shawn J. Skerrett
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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130
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Ginevra C, Chastang J, David S, Mentasti M, Yakunin E, Chalker VJ, Chalifa-Caspi V, Valinsky L, Jarraud S, Moran-Gilad J. A real-time PCR for specific detection of the Legionella pneumophila serogroup 1 ST1 complex. Clin Microbiol Infect 2019; 26:514.e1-514.e6. [PMID: 31525518 DOI: 10.1016/j.cmi.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Legionella pneumophila serogroup 1 (Lp1) sequence type (ST) 1 is globally widespread in the environment and accounts for a significant proportion of Legionella infections, including nosocomial Legionnaires' disease (LD). This study aimed to design a sensitive and specific detection method for Lp ST1 that will underpin epidemiological investigations and risk assessment. METHODS A total of 628 Lp genomes (126 ST1s) were analyzed by comparative genomics. Interrogation of more than 900 accessory genes revealed seven candidate targets for specific ST1 detection and specific primers and hydrolysis probes were designed and evaluated. The analytical sensitivity and specificity of the seven primer and probe sets were evaluated on serially diluted DNA extracted from the reference strain CIP107629 and via qPCR applied on 200 characterized isolates. The diagnostic performance of the assay was evaluated on 142 culture-proven clinical samples from LD cases and a real-life investigation of a case cluster. RESULTS Of seven qPCR assays that underwent analytical validation, one PCR target (lpp1868) showed higher sensitivity and specificity for ST1 and ST1-like strains. The diagnostic performance of the assay using respiratory samples corresponded to a sensitivity of 95% (19/20) (95% CI (75.1-99.9)) and specificity of 100% (122/122) (95% CI (97-100)). The ST1 PCR assay could link two out of three culture-negative hospitalized LD cases to ST1 during a real-time investigation. CONCLUSION Using whole genome sequencing (WGS) data, we developed and validated a sensitive and specific qPCR assay for the detection of Lp1 belonging to the ST1 clonal complex by amplification of the lpp1868 gene. The ST1 qPCR is expected to deliver an added value for Lp control and prevention, in conjunction with other recently developed molecular assays.
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Affiliation(s)
- C Ginevra
- CIRI, Centre International de Recherche en Infectiologie, Legionella Pathogenesis Team, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; National Reference Centre of Legionella, Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France; ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - J Chastang
- National Reference Centre of Legionella, Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France
| | - S David
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Pathogen Genomics, Welcome Trust Sanger Institute, Cambridge, UK; Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, UK
| | - M Mentasti
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, UK
| | - E Yakunin
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - V J Chalker
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, UK
| | - V Chalifa-Caspi
- National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - L Valinsky
- Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - S Jarraud
- CIRI, Centre International de Recherche en Infectiologie, Legionella Pathogenesis Team, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; National Reference Centre of Legionella, Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France; ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - J Moran-Gilad
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev. Beer-Sheva, Israel; Public Health Services, Ministry of Health, Jerusalem, Israel.
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131
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Valciņa O, Pūle D, Mališevs A, Trofimova J, Makarova S, Konvisers G, Bērziņš A, Krūmiņa A. Co-Occurrence of Free-Living Amoeba and Legionella in Drinking Water Supply Systems. MEDICINA-LITHUANIA 2019; 55:medicina55080492. [PMID: 31443316 PMCID: PMC6723719 DOI: 10.3390/medicina55080492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 12/15/2022]
Abstract
Background and Objectives:Legionella is one of the most important water-related pathogens. Inside the water supply systems and the biofilms, Legionella interact with other bacteria and free-living amoeba (FLA). Several amoebas may serve as hosts for bacteria in aquatic systems. This study aimed to investigate the co-occurrence of Legionella spp. and FLA in drinking water supply systems. Materials and Methods: A total of 268 water samples were collected from apartment buildings, hotels, and public buildings. Detection of Legionella spp. was performed in accordance with ISO 11731:2017 standard. Three different polymerase chain reaction (PCR) protocols were used to identify FLA. Results: Occurrence of Legionella varied from an average of 12.5% in cold water samples with the most frequent occurrence observed in hot water, in areas receiving untreated groundwater, where 54.0% of the samples were Legionella positive. The occurrence of FLA was significantly higher. On average, 77.2% of samples contained at least one genus of FLA and, depending on the type of sample, the occurrence of FLA could reach 95%. In the samples collected during the study, Legionella was always isolated along with FLA, no samples containing Legionella in the absence of FLA were observed. Conclusions: The data obtained in our study can help to focus on the extensive distribution, close interaction, and long-term persistence of Legionella and FLA. Lack of Legionella risk management plans and control procedures may promote further spread of Legionella in water supply systems. In addition, the high incidence of Legionella-related FLA suggests that traditional monitoring methods may not be sufficient for Legionella control.
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Affiliation(s)
- Olga Valciņa
- Institute of Food Safety, Animal Health and Environment "BIOR", LV-1076 Rīga, Latvia.
| | - Daina Pūle
- Institute of Food Safety, Animal Health and Environment "BIOR", LV-1076 Rīga, Latvia
- Department of Water Engineering and Technology, Riga Technical University, LV-1658 Rīga, Latvia
| | - Artjoms Mališevs
- Institute of Food Safety, Animal Health and Environment "BIOR", LV-1076 Rīga, Latvia
| | - Jūlija Trofimova
- Institute of Food Safety, Animal Health and Environment "BIOR", LV-1076 Rīga, Latvia
| | - Svetlana Makarova
- Institute of Food Safety, Animal Health and Environment "BIOR", LV-1076 Rīga, Latvia
| | - Genadijs Konvisers
- Institute of Food Safety, Animal Health and Environment "BIOR", LV-1076 Rīga, Latvia
| | - Aivars Bērziņš
- Institute of Food Safety, Animal Health and Environment "BIOR", LV-1076 Rīga, Latvia
| | - Angelika Krūmiņa
- Department of Infectology and Dermatology, Riga Stradiņš University, LV-1007 Rīga, Latvia
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133
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Congestrì F, Morotti M, Vicari R, Pedna MF, Sparacino M, Torri A, Bertini S, Sambri V. Comparison of the Novel Immunocatch Legionella Test with Sofia Legionella FIA Assay and with BinaxNOW Legionella Card Assay for Detection of Legionella pneumophila (Serogroup 1) Antigen in Urine Samples. J Clin Microbiol 2019; 57:e00305-19. [PMID: 31092595 PMCID: PMC6663892 DOI: 10.1128/jcm.00305-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 11/20/2022] Open
Abstract
Legionnaires' disease (LD) refers to a serious form of acute pneumonia caused by Legionella species. LD can be difficult to diagnose because the signs and symptoms are nonspecific, and therefore a rapid laboratory diagnosis is of paramount importance. In this study, a recently introduced immunochromatographic test (Immunocatch Legionella; Eiken Chemical Co., Ltd.) for Legionella pneumophila (serogroup 1) urinary antigen detection was compared with the Sofia Legionella fluorescent immunoassay (FIA) (Quidel) (routinely used in our laboratory) and with the widely used BinaxNOW Legionella assay (Alere). A total of 248 urine samples (60 frozen and 188 fresh) were evaluated. All of the samples were collected from patients with high clinical suspicion of Legionnaires' disease. The three assays were performed simultaneously according to the manufacturers' instructions. A total of 180 concordant negative and 66 concordant positive results were obtained. Only 2 discrepant results were registered. The sensitivity and specificity of Immunocatch compared with Sofia were, respectively, 98.5% and 99.4%. Cohen's kappa coefficient and overall percent agreement between Immunocatch and Sofia were also calculated and resulted in, respectively, 0.97 and 99.2%. These performances suggest that the Immunocatch test is a useful tool for Legionella pneumophila (serogroup 1) urinary antigen detection.
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Affiliation(s)
- F Congestrì
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - M Morotti
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - R Vicari
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - M F Pedna
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - M Sparacino
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - A Torri
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - S Bertini
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
| | - V Sambri
- Unit of Microbiology, Greater Romagna Hub Laboratory, Pievesestina di Cesena, Italy
- DIMES, University of Bologna, Bologna, Italy
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134
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Viewing Legionella pneumophila Pathogenesis through an Immunological Lens. J Mol Biol 2019; 431:4321-4344. [PMID: 31351897 DOI: 10.1016/j.jmb.2019.07.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/25/2019] [Accepted: 07/13/2019] [Indexed: 12/14/2022]
Abstract
Legionella pneumophila is the causative agent of the severe pneumonia Legionnaires' disease. L. pneumophila is ubiquitously found in freshwater environments, where it replicates within free-living protozoa. Aerosolization of contaminated water supplies allows the bacteria to be inhaled into the human lung, where L. pneumophila can be phagocytosed by alveolar macrophages and replicate intracellularly. The Dot/Icm type IV secretion system (T4SS) is one of the key virulence factors required for intracellular bacterial replication and subsequent disease. The Dot/Icm apparatus translocates more than 300 effector proteins into the host cell cytosol. These effectors interfere with a variety of cellular processes, thus enabling the bacterium to evade phagosome-lysosome fusion and establish an endoplasmic reticulum-derived Legionella-containing vacuole, which facilitates bacterial replication. In turn, the immune system has evolved numerous strategies to recognize intracellular bacteria such as L. pneumophila, leading to potent inflammatory responses that aid in eliminating infection. This review aims to provide an overview of L. pneumophila pathogenesis in the context of the host immune response.
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135
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Environmental surveillance and spatio-temporal analysis of Legionella spp. in a region of northeastern Italy (2002-2017). PLoS One 2019; 14:e0218687. [PMID: 31287819 PMCID: PMC6615612 DOI: 10.1371/journal.pone.0218687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023] Open
Abstract
Legionella spp. are considered an important cause of potentially preventable morbidity and mortality, making environmental surveillance a crucial component of risk assessment plans. In this work, 20,319 water samples were collected in 3,983 environmental surveys during a 16-year period by ARPA, the Regional Agency for Environmental Protection, Friuli Venezia Giulia, and the results were studied to better understand the diffusion mechanisms of Legionella. The data showed a strong seasonal signal, a prevalence of L. pneumophila serogroup 2–15 in most environments (63% of positive samples), a prevalence of L. pneumophila serogroup 1 in swimming pool-associated environments (82% of positive samples), a persistent presence of Legionella in hospitals and a recurrent presence of Legionella in other facilities such as hotels, possibly years after interventions, highlighting the difficulty of eradicating the bacteria. Retrospective spatio-temporal analyses on geocoded historical data were carried out with SaTScan using an ordinal model with risk as a covariate to identify potential clusters with an excess of cases in the higher-risk categories. Although no outbreaks occurred during the period of study, such analyses identified spatially restricted zones with unusual contamination, which sometimes were also areas in which several surveys triggered by notifications of clinical cases were performed. Simulations of periodic prospective analyses permitted the assessment of the efficacy of the method in early detection of such clusters. The proposed method may be a useful tool in environmental surveillance, prevention and control of Legionella.
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136
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The burden of Legionnaires' disease in New Zealand (LegiNZ): a national surveillance study. THE LANCET. INFECTIOUS DISEASES 2019; 19:770-777. [DOI: 10.1016/s1473-3099(19)30113-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 11/22/2022]
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137
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Cervero-Aragó S, Schrammel B, Dietersdorfer E, Sommer R, Lück C, Walochnik J, Kirschner A. Viability and infectivity of viable but nonculturable Legionella pneumophila strains induced at high temperatures. WATER RESEARCH 2019; 158:268-279. [PMID: 31048196 PMCID: PMC6520252 DOI: 10.1016/j.watres.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 06/09/2023]
Abstract
Thermal disinfection is commonly used to prevent the proliferation of culturable Legionella in engineered water systems (EWS). In response to such stress, culturable Legionella populations can switch into a viable but nonculturable (VBNC) state. The importance of such VBNC Legionella cells is currently hotly debated. Here, we investigated the stress response patterns and transitions of the bacteria to the VBNC state at 55 °C, 60 °C and 70 °C on two L. pneumophila strains for >80 days using a combination of cell-based viability indicators. Complete loss of culturability at 55 °C, 60 °C and 70 °C occurred after 3-8 h, 60 min and <2 min, respectively. In contrast, L. pneumophila strains required 9 days at 55 °C, 8 h at 60 °C and 20 min at 70 °C to achieve a 2 log reduction in cells with intact membranes and high esterase activity; a 4 log reduction was achieved only after 150, 8-15 and 1-4 days, respectively. In parallel, the presence of diagnostic outer-membrane epitopes (OMEs) and changes in the infectivity patterns of the two strains towards amoebae and THP-1 cells were assessed. OMEs were more persistent than viability indicators, showing their potential as targets for VBNC Legionella detection. L. pneumophila strains infected amoebae and THP-1 cells for at least 85 days at 55 °C and 60 °C and for up to 8 days at 70 °C. However, they did so with reduced efficiency, requiring prolonged co-incubation times with the hosts and higher Legionella cell numbers in comparison to culturable cells. Consequently, infection of amoebae by thermally induced VBNC L. pneumophila with lowered virulence can be expected in EWS. Although the gold standard method cannot detect VBNC Legionella, it provides important information about the most virulent bacterial subpopulations. Our results indicate that a prolonged thermal regime ≥60 °C at the central parts of warm water systems is not only effective against culturable L. pneumophila but in the long run even against VBNC cells.
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Affiliation(s)
- Sílvia Cervero-Aragó
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria.
| | - Barbara Schrammel
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Elisabeth Dietersdorfer
- Medical University of Vienna, Institute of Specific Prophylaxis and Tropical Medicine, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Regina Sommer
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria
| | - Christian Lück
- Technical University Dresden, Institute for Medical Microbiology and Hygiene, Medical Faculty "Carl Gustav Carus", Helmholtzstr. 10, D 01069, Dresden, Germany
| | - Julia Walochnik
- Medical University of Vienna, Institute of Specific Prophylaxis and Tropical Medicine, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Alexander Kirschner
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria; Karl Landsteiner University of Health Sciences, Division Water Quality and Health, Dr. Karl Dorrekstraße 30, A-3400, Krems, Austria
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138
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Sharaby Y, Rodríguez-Martínez S, Höfle MG, Brettar I, Halpern M. Quantitative microbial risk assessment of Legionella pneumophila in a drinking water supply system in Israel. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 671:404-410. [PMID: 30933796 DOI: 10.1016/j.scitotenv.2019.03.287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
Legionella pneumophila cause human infections via inhalation of contaminated water aerosols, resulting in severe pneumonia. Legionella spp. prevalence was monitored in a drinking-water distribution system (DWDS) in Northern Israel. Five points (toilet faucets and showers) were sampled seasonally along a three years period. Toilet faucets and shower use, both generating aerosols, are known transmission routes for this pathogen and thus, present a potential health risk. Quantitative Microbial Risk Assessment (QMRA) was applied in order to assess the health risks posed by Legionella for these two exposure scenarios, while considering Legionella seasonality. The obtained results were compared with estimated tolerable risk levels of infection and of disease set by the USEPA and WHO. Both limits were expressed as Disability-Adjusted Life Years index (DALY) being 1 × 10-4 and 1 × 10-6, respectively. The QMRA revealed that the annual risk levels for both faucets and showers use exceeded the acceptable risk of infection with an average of 5.52 × 10-4 and 2.37 × 10-3 DALY'S per person per year, respectively. Annual risk levels were stable with no significant differences between the three years. Risk levels varied significantly between seasons by up to three orders of magnitude. Risk levels were highest during summer, autumn, and lowest during winter. The highest seasonal infection risk values were found in summer for both faucets and showers, which corresponded to 8.09 × 10-4 and 2.75 × 10-3 DALY'S per person per year, respectively. In conclusion, during summer and autumn there is a significant increase of the infection risk associated with exposure to Legionella-contaminated aerosols, in the studied water system. Public health assessment and prevention measures should focus on these seasons.
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Affiliation(s)
- Y Sharaby
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel.
| | - S Rodríguez-Martínez
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - M G Höfle
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - I Brettar
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - M Halpern
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel; Department of Biology and Environment, Faculty of Natural Sciences, University of Haifa, Oranim, Tivon, Israel
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139
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Sutarjono B, Alexis J, Sachidanandam JC. Legionella pneumonia complicated by rhabdomyolysis. BMJ Case Rep 2019; 12:12/6/e229243. [PMID: 31227570 DOI: 10.1136/bcr-2019-229243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Legionnaires' disease is a recognised but rare cause of rhabdomyolysis. It can be further complicated with renal impairment. In this case report, we describe a previously healthy, semiactive 50-year-old man who within days was reduced to having periods of dyspnea after minutes of walking in addition to near fatal acute renal failure. He was found to have the rare triad of Legionella pneumonia, renal failure and rhabdomyolysis, which is associated with high morbidity and mortality. He was treated according to guidelines with azithromycin monotherapy and aggressive fluid hydration. 20 days after admission, the patient was walking independently and discharged home.
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Affiliation(s)
- Bayu Sutarjono
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, New York, USA.,Saba University School of Medicine, Devens, Massachusetts, USA
| | - Janeah Alexis
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, New York, USA.,New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
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Crooke SN, Schimer J, Raji I, Wu B, Oyelere AK, Finn MG. Lung Tissue Delivery of Virus-Like Particles Mediated by Macrolide Antibiotics. Mol Pharm 2019; 16:2947-2955. [DOI: 10.1021/acs.molpharmaceut.9b00180] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Stephen N. Crooke
- School of Chemistry and Biochemistry, ∥School of Biological Sciences, and §Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Jiri Schimer
- School of Chemistry and Biochemistry, ∥School of Biological Sciences, and §Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
- Institute of Organic Chemistry and Biochemistry of the CAS, 16610 Prague, Czech Republic
| | - Idris Raji
- School of Chemistry and Biochemistry, ∥School of Biological Sciences, and §Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Bocheng Wu
- School of Chemistry and Biochemistry, ∥School of Biological Sciences, and §Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Adegboyega K. Oyelere
- School of Chemistry and Biochemistry, ∥School of Biological Sciences, and §Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - M. G. Finn
- School of Chemistry and Biochemistry, ∥School of Biological Sciences, and §Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
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141
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Sreenath K, Chaudhry R, Vinayaraj EV, Thakur B. Antibiotic susceptibility of environmental Legionella pneumophila isolated in India. Future Microbiol 2019; 14:661-669. [PMID: 31148475 DOI: 10.2217/fmb-2019-0049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Data are limited regarding the antibiotic susceptibility of Legionella pneumophila in India. The aim of this study was to determine the drug susceptibility of environmental L. pneumophila isolates in India for antibiotics commonly used in clinical practice for Legionnaires' disease treatment. Materials & methods: The activities of seven antibiotics against 46 environmental isolates of L. pneumophila were evaluated by using E-test on buffered charcoal yeast extract-α agar. Results: Among the L. pneumophila isolates tested, no tendency toward drug resistance was observed. Rifampicin was the most potent drug followed by levofloxacin, while doxycycline and tetracycline were found to be the less active agents. Conclusion: Susceptibility testing of Legionella environmental isolates could be beneficial to notify resistance to antibiotics in the environment before it becomes evident in clinical strains.
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Affiliation(s)
- K Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - E V Vinayaraj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Thakur
- Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
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Abstract
Bacterial pathogens are generally investigated in the context of disease. To prevent outbreaks, it is essential to understand their lifestyle and interactions with other microbes in their natural environment. Legionella pneumophila is an important human respiratory pathogen that survives and multiplies in biofilms or intracellularly within protists, such as amoebae. Importantly, transmission to humans occurs from these environmental sources. Legionella infection generally leads to rapid host cell lysis. It was therefore surprising to observe that amoebae, including fresh environmental isolates, were well protected during Legionella infection when the bacterial symbiont Protochlamydia amoebophila was also present. Legionella was not prevented from invading amoebae but was impeded in its ability to develop fully virulent progeny and were ultimately cleared in the presence of the symbiont. This study highlights how ecology and virulence of an important human pathogen is affected by a defensive amoeba symbiont, with possibly major consequences for public health. Legionella pneumophila is an important opportunistic pathogen for which environmental reservoirs are crucial for the infection of humans. In the environment, free-living amoebae represent key hosts providing nutrients and shelter for highly efficient intracellular proliferation of L. pneumophila, which eventually leads to lysis of the protist. However, the significance of other bacterial players for L. pneumophila ecology is poorly understood. In this study, we used a ubiquitous amoeba and bacterial endosymbiont to investigate the impact of this common association on L. pneumophila infection. We demonstrate that L. pneumophila proliferation was severely suppressed in Acanthamoeba castellanii harboring the chlamydial symbiont Protochlamydia amoebophila. The amoebae survived the infection and were able to resume growth. Different environmental amoeba isolates containing the symbiont were equally well protected as different L. pneumophila isolates were diminished, suggesting ecological relevance of this symbiont-mediated defense. Furthermore, protection was not mediated by impaired L. pneumophila uptake. Instead, we observed reduced virulence of L. pneumophila released from symbiont-containing amoebae. Pronounced gene expression changes in the presence of the symbiont indicate that interference with the transition to the transmissive phase impedes the L. pneumophila infection. Finally, our data show that the defensive response of amoebae harboring P. amoebophila leaves the amoebae with superior fitness reminiscent of immunological memory. Given that mutualistic associations between bacteria and amoebae are widely distributed, P. amoebophila and potentially other amoeba endosymbionts could be key in shaping environmental survival, abundance, and virulence of this important pathogen, thereby affecting the frequency of human infection.
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143
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Mojtahedi SY, Rahbarimanesh A, Noorbakhsh S, Shokri H, Jamali-Moghadam-Siyahkali S, Izadi A. Urinary antigene and PCR can both be used to detect Legionella pneumophila in children's hospital-acquired pneumonia. Eur J Transl Myol 2019; 29:8120. [PMID: 31354920 PMCID: PMC6615363 DOI: 10.4081/ejtm.2019.8120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022] Open
Abstract
Legionella pneumophila is the causative agent of more than 95% cases of severe Legionella pneumonia. Nosocomial pneumonias in different hospital wards is an important medical and pharmaceutical concern. This study aimed to detect Legionella with two methods: polymerase chain reaction (PCR) and detection of urine antigenic test (UAT) in patients suffering from nosocomial pneumonia admitted to pediatric intensive care unit (PICU) of children hospitals. This study was conducted in PICU wards of Rasool Akram and Bahrami children hospitals, Tehran, Iran during 2013-2014. In patients diagnosed with hospital-acquired pneumonia, intratracheal secretion samples for PCR and urine sample for UAT were taken. Simultaneously, PCR and urinary antigen test were conducted using commercial kits. The results of urinary antigen test and PCR were analyzed by SPSS v.19 for statistical comparison. In this study, 96 patients aging 2.77 years on average with two age peaks of less than 1 year and 7-8 year were enrolled. More than half of the patients were under 1 year old. The most common underlying diseases were seizure, Acute Lymphoblastic Lymphoma, Down syndrome and metabolic syndromes. The positivity rate of Legionella urinary antigen test was 16.7% and positivity rate of PCR test was 19.8%. There were no significant associations between the results obtained by both assays with age, gender or underlying diseases. In conclusion, PCR is a better detection method for Legionella infection than urinary antigen test, but the difference between the two methods was not significant.
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Affiliation(s)
- Sayed-Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Rahbarimanesh
- Department of Pediatric Infectious Disease, Bahrami Hospital, Tehran University of Medical sciences, Tehran, Iran
| | - Samileh Noorbakhsh
- Research Center of Pediatric Infectious Disease, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Shokri
- Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Anahita Izadi
- Department of Pediatric Infectious disease, Tehran University of Medical science, Tehran, Iran
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144
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Draft Genome Sequences of Seven Legionella pneumophila Isolates from a Hot Water System of a Large Building. Microbiol Resour Announc 2019; 8:8/18/e00384-19. [PMID: 31048385 PMCID: PMC6498240 DOI: 10.1128/mra.00384-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Public health data show that a significant fraction of the nation's waterborne disease outbreaks are attributable to premise plumbing. We report the draft genome sequences of seven Legionella pneumophila serogroup 1 isolates from hot water lines of a large building. Genomic analysis identified the isolates as belonging to sequence type 1.
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145
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Beauté J, Sandin S, de Jong B, Hallström LP, Robesyn E, Giesecke J, Sparén P. Factors associated with Legionnaires' disease recurrence in hotel and holiday rental accommodation sites. Euro Surveill 2019; 24:1800295. [PMID: 31115313 PMCID: PMC6530253 DOI: 10.2807/1560-7917.es.2019.24.20.1800295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/16/2019] [Indexed: 11/20/2022] Open
Abstract
BackgroundThe detection of a cluster of travel-associated Legionnaires' disease (TALD) cases in any European Union/European Economic Area (EU/EEA) country prompts action at the accommodation, follow-up by health authorities and reporting of measures taken. Some accommodations incur further cases despite presumed implementation of adequate control measures.AimTo identify factors associated with the occurrence of a further TALD case after the implementation of control measures.MethodsWe conducted a retrospective cohort study of hotel and holiday rental accommodations in the EU/EEA associated with two or more TALD cases with onset dates less than 2 years apart (a 'cluster') and notification between 1 June 2011-31 December 2016. We fitted Cox regression models to estimate the association between accommodation characteristics and the occurrence of a further case, defined as any case with onset date after the report on measures taken.ResultsOf the 357 accommodations in the analysis, 90 (25%) were associated with at least one further case after the report on measures taken (12.4/100 accommodation-years). Accommodations associated with two or more cases before the cluster notification were more likely to be associated with a further case, compared with those not previously associated with any case (adjusted hazard ratio 1.85; 95% confidence interval: 1.14-3.02). Neither the detection of Legionella in the water system nor the type of disinfection were found to be associated with the risk of a further case.ConclusionAccommodation size and previous TALD cases were predictive of further Legionnaires' disease cases after implementation of control measures.
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Affiliation(s)
- Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, United States
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Birgitta de Jong
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Emmanuel Robesyn
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Sweden
| | - Johan Giesecke
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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146
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Ahmed F, Hossain S, Hossain S, Fakhruddin ANM, Abdullah ATM, Chowdhury MAZ, Gan SH. Impact of household air pollution on human health: source identification and systematic management approach. SN APPLIED SCIENCES 2019. [DOI: 10.1007/s42452-019-0405-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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147
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Extreme Rhabdomyolysis, Acute Renal Failure, and Protracted Ileus in a Case of Legionella Pneumonia. Case Rep Crit Care 2019; 2019:3472627. [PMID: 30838138 PMCID: PMC6374832 DOI: 10.1155/2019/3472627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/30/2018] [Indexed: 11/17/2022] Open
Abstract
A 53-year-old man developed a Legionella pneumophila pneumonia complicated by rhabdomyolysis, acute kidney injury, and protracted ileus. Risk factors were smoking and chronic alcoholism, but the patient had no history of previous abdominal surgery. Hemodialysis was required for a period of 5 weeks with a full renal recovery. Pneumonia required respiratory support but for a limited period of 6 days. The protracted course of the ileus led to explorative laparotomy despite negative computed tomography findings. No cause of mechanical obstruction was found at surgery and common etiologies of intestinal obstruction were excluded. Parenteral nutrition was needed for a total of 4 weeks, before recovery of intestinal motility. This case illustrates the apparent discrepancy between the pulmonary symptoms and the extrapulmonary manifestations that could be seen as a consequence of an exaggerated immune response.
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148
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Moosavian M, Seyed-Mohammadi S, Saki M, Shahi F, Khoshkholgh Sima M, Afshar D, Barati S. Loop-mediated isothermal amplification for detection of Legionella pneumophila in respiratory specimens of hospitalized patients in Ahvaz, southwest Iran. Infect Drug Resist 2019; 12:529-534. [PMID: 30881058 PMCID: PMC6402708 DOI: 10.2147/idr.s198099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Legionnaires’ disease is an important public health problem that can cause substantial mortality and morbidity. Legionnaires’ disease-risk estimation may be compromised by uncertainties in Legionella-detection methods. The aim of this study was the detection of L. pneumophila in respiratory specimens of hospitalized patients with respiratory symptoms by culture, PCR, and loop-mediated isothermal amplification (LAMP) methods. Methods Sputum and bronchoalveolar lavage samples were obtained from patients with pneumonia admitted to teaching hospitals in Ahvaz, Iran from June 2016 to March 2017. Isolation of Legionella spp. was done by culturing the samples directly onto buffered charcoal–yeast extract and modified Wadowsky–Yee agar medium. Then, PCR and LAMP assays were performed for detection of L. pneumophila via its mip gene in respiratory specimens. Results A total of 100 respiratory specimens were collected. Our results showed that 1% of the samples were culture positive for Legionella spp., and 3% and 7% of samples were positive for L. pneumophila using the mip gene on PCR and LAMP assays, respectively. Conclusion Legionnaires’ disease should be considered in the diagnosis of pulmonary infectious diseases. Also, the LAMP assay is a faster method with higher sensitivity and specificity than conventional methods, such as PCR and culture, for laboratory diagnosis of Legionnaires’ disease.
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Affiliation(s)
- Mojtaba Moosavian
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
| | - Sakineh Seyed-Mohammadi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, .,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
| | - Morteza Saki
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, .,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
| | - Fatemeh Shahi
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, .,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
| | - Mahtab Khoshkholgh Sima
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
| | - Davoud Afshar
- Department of Microbiology and Virology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Sara Barati
- Department of Pathobiology, School of Veterinary, University of Shahid Chamran, Ahvaz, Iran
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149
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De Giglio O, Napoli C, Apollonio F, Brigida S, Marzella A, Diella G, Calia C, Scrascia M, Pacifico C, Pazzani C, Uricchio VF, Montagna MT. Occurrence of Legionella in groundwater used for sprinkler irrigation in Southern Italy. ENVIRONMENTAL RESEARCH 2019; 170:215-221. [PMID: 30594053 DOI: 10.1016/j.envres.2018.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Legionellae are opportunistic bacteria that cause various conditions after exposure to contaminated aerosols, ranging from a serious type of pneumonia to a mild case of an influenza-like illness. Despite the risks of exposure, little is known about the occurrence of Legionella in natural environments and, even though studies have shown that there is a potential risk of transmission via inhalation, it does not have to be detected in groundwater that is used for irrigation. The culture methods traditionally used to detect Legionella have several limits that can be partly solved by applying molecular techniques. Samples from 177 wells in Apulia, Southern Italy, were collected twice, in winter and in summer, and analyzed. When compared with the guidelines, 145 (81.9%) of the sampled wells were suitable for irrigation use. The culture-based method highlighted the presence of different species and serogroups of Legionella in 31 (21.2%) of the 145 wells that were shown to be suitable for irrigation use. A greater number of wells returned positive results for Legionella in summer than in winter (p = 0.023), and the median concentrations were mostly higher in summer (500 CFU/L) than in winter (300 CFU/L). The median temperature in the Legionella positive well waters was significantly higher than that in the negative ones, both in winter and in summer (p < 0.001). Using molecular techniques, Legionella non-pneumophila was found in 37 of the 114 wells earlier detected as suitable for irrigation use but negative for Legionella by the culture-based methods. The distribution of Legionella differ significantly in porous aquifers compared to the karst-fissured ones both with quantitative polymerase chain reaction (qPCR) (p = 0.0004) and viable cells by propidium monoazide (PMA-qPCR) (p = 0.0000). Legionella concentrations were weakly correlated with temperature of water both with qPCR (ρ = 0.47, p = 0.0033) and PMA-qPCR (ρ = 0.41, p = 0.0126). Our data suggest that water that aerosolizes when sprinkled on plants represents a potential source of Legionellosis, with a higher risk from exposure in summer. On a practical level, this finding is important for workers (farmers and gardeners) who are in contact with waters used for irrigation.
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Affiliation(s)
- Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Christian Napoli
- Department of Medical and Surgical sciences and translational Medicine, Sapienza University of Rome, Italy.
| | - Francesca Apollonio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Silvia Brigida
- Water Research Institute, National Research Council, Bari, Italy.
| | - Angelo Marzella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Carla Calia
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Maria Scrascia
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy.
| | - Claudia Pacifico
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Carlo Pazzani
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy.
| | | | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
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Chaudhry R, Sreenath K, Agrawal SK, Valavane A. Legionella and Legionnaires' disease: Time to explore in India. Indian J Med Microbiol 2019; 36:324-333. [PMID: 30429383 DOI: 10.4103/ijmm.ijmm_18_298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Legionella pneumophila was first recognised as a fatal cause of pneumonia more than four decades ago, during the 1976-American Legion convention in Philadelphia, USA. Legionella spp. continue to cause disease outbreaks of public health significance, and at present, Legionnaires' disease (LD) has emerged as an important cause of community and hospital-acquired pneumonia. Parallel to this, the understanding of LD has also increased exponentially. However, the disease is likely to be underreported in many countries because of the dearth of common definitions, diagnostic tests and active surveillance systems. In this review, we outline the basic concepts of Legionella including clinical presentations, epidemiology, laboratory diagnosis and the status of LD in India. This article also summarises the progress of research related to Legionella in this country, identifying the research gaps and discussing priorities to explore this unexplored pathogen in India.
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Affiliation(s)
- Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - K Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Kumari Agrawal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Valavane
- Department of Microbiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
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