1
|
Buse HY, Morris BJ, Gomez-Alvarez V, Szabo JG, Hall JS. Legionella Diversity and Spatiotemporal Variation in The Occurrence of Opportunistic Pathogens within a Large Building Water System. Pathogens 2020; 9:E567. [PMID: 32668779 PMCID: PMC7400177 DOI: 10.3390/pathogens9070567] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/22/2023] Open
Abstract
Understanding Legionella survival mechanisms within building water systems (BWSs) is challenging due to varying engineering, operational, and water quality characteristics unique to each system. This study aimed to evaluate Legionella, mycobacteria, and free-living amoebae occurrence within a BWS over 18-28 months at six locations differing in plumbing material and potable water age, quality, and usage. A total of 114 bulk water and 57 biofilm samples were analyzed. Legionella culturability fluctuated seasonally with most culture-positive samples being collected during the winter compared to the spring, summer, and fall months. Positive and negative correlations between Legionella and L. pneumophila occurrence and other physiochemical and microbial water quality parameters varied between location and sample types. Whole genome sequencing of 19 presumptive Legionella isolates, from four locations across three time points, identified nine isolates as L. pneumophila serogroup (sg) 1 sequence-type (ST) 1; three as L. pneumophila sg5 ST1950 and ST2037; six as L. feeleii; and one as Ochrobactrum. Results showed the presence of a diverse Legionella population with consistent and sporadic occurrence at four and two locations, respectively. Viewed collectively with similar studies, this information will enable a better understanding of the engineering, operational, and water quality parameters supporting Legionella growth within BWSs.
Collapse
Affiliation(s)
- Helen Y. Buse
- Homeland Security and Materials Management Division, Center for Environmental Solutions & Emergency Response (CESER), Office of Research and Development (ORD), US Environmental Protection Agency (USEPA), Cincinnati, OH 45268, USA; (J.G.S.); (J.S.H.)
| | - Brian J. Morris
- Pegasus Technical Services, Inc c/o US EPA, Cincinnati, OH 45268, USA;
| | - Vicente Gomez-Alvarez
- Water Infrastructure Division, Center for Environmental Solutions & Emergency Response (CESER), US Environmental Protection Agency (USEPA), Office of Research and Development (ORD), Cincinnati, OH 45268, USA;
| | - Jeffrey G. Szabo
- Homeland Security and Materials Management Division, Center for Environmental Solutions & Emergency Response (CESER), Office of Research and Development (ORD), US Environmental Protection Agency (USEPA), Cincinnati, OH 45268, USA; (J.G.S.); (J.S.H.)
| | - John S. Hall
- Homeland Security and Materials Management Division, Center for Environmental Solutions & Emergency Response (CESER), Office of Research and Development (ORD), US Environmental Protection Agency (USEPA), Cincinnati, OH 45268, USA; (J.G.S.); (J.S.H.)
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Hamilton KA, Prussin AJ, Ahmed W, Haas CN. Outbreaks of Legionnaires’ Disease and Pontiac Fever 2006–2017. Curr Environ Health Rep 2018; 5:263-271. [DOI: 10.1007/s40572-018-0201-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
4
|
del Castillo M, Lucca A, Plodkowski A, Huang YT, Kaplan J, Gilhuley K, Babady NE, Seo SK, Kamboj M. Atypical presentation of Legionella pneumonia among patients with underlying cancer: A fifteen-year review. J Infect 2016; 72:45-51. [PMID: 26496794 PMCID: PMC4938150 DOI: 10.1016/j.jinf.2015.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Immunocompromised patients, especially those receiving treatment with corticosteroids and cytotoxic chemotherapy are at increased risk for developing Legionella pneumonia. OBJECTIVE The aim of this study was to determine clinical and radiographic characteristics of pulmonary infection due to Legionella in persons undergoing treatment for cancer and stem cell transplant (SCT) recipients. METHODS Retrospective review of Legionella cases at MSKCC over a fifteen-year study period from January 1999 and December 2013. Cases were identified by review of microbiology records. RESULTS During the study period, 40 cases of Legionella infection were identified; nine among these were due to non-pneumophila species. Most cases occurred during the summer. The majority [8/9, (89%)] of patients with non-pneumophila infection had underlying hematologic malignancy, compared to 18/31 (58%) with Legionella pneumophila infections. Radiographic findings were varied-nodular infiltrates mimicking invasive fungal infection were seen only among patients with hematologic malignancy and hematopoietic stem cell transplant (SCT) recipients and were frequently associated with non-pneumophila infections (50% vs 16%; P = 0.0594). All cases of nodular Legionella pneumonia were found incidentally or had an indolent clinical course. CONCLUSIONS Legionella should be considered in the differential diagnosis of nodular lung lesions in immunocompromised patients, especially those with hematologic malignancy and SCT recipients. Most cases of nodular disease due to Legionella are associated with non-pneumophila infections.
Collapse
Affiliation(s)
- Maria del Castillo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA.
| | - Anabella Lucca
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Andrew Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Yao-Ting Huang
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Janice Kaplan
- Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Kathleen Gilhuley
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - N Esther Babady
- Clinical Microbiology Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Susan K Seo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; Infection Control, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| |
Collapse
|
5
|
Conza L, Casati S, Limoni C, Gaia V. Meteorological factors and risk of community-acquired Legionnaires' disease in Switzerland: an epidemiological study. BMJ Open 2013; 3:e002428. [PMID: 23468470 PMCID: PMC3612760 DOI: 10.1136/bmjopen-2012-002428] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/17/2013] [Accepted: 01/31/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify meteorological factors that could be associated with an increased risk of community-acquired Legionnaires' disease (LD) in two Swiss regions. DESIGN Retrospective epidemiological study using discriminant analysis and multivariable Poisson regression. SETTING We analysed legionellosis cases notified between January 2003 and December 2007 and we looked for a possible relationship between incidence rate and meteorological factors. PARTICIPANTS Community-acquired LD cases in two Swiss regions, the Canton Ticino and the Basle region, with climatically different conditions were investigated. PRIMARY OUTCOME MEASURES Vapour pressure, temperature, relative humidity, wind, precipitation and radiation recorded in weather stations of the two Swiss regions during the period January 2003 and December 2007. RESULTS Discriminant analysis showed that the two regions are characterised by different meteorological conditions. A multiple Poisson regression analysis identified region, temperature and vapour pressure during the month of infection as significant risk factors for legionellosis. The risk of developing LD was 129.5% (or 136.4% when considering vapour pressure instead of temperature in the model) higher in the Canton Ticino as compared to the Basle region. There was an increased relative risk of LD by 11.4% (95% CI 7.70% to 15.30%) for each 1 hPa rise of vapour pressure or by 6.7% (95% CI 4.22% to 9.22%) for 1°C increase of temperature. CONCLUSIONS In this study, higher water vapour pressure and heat were associated with a higher risk of community-acquired LD in two regions of Switzerland.
Collapse
Affiliation(s)
- Lisa Conza
- Swiss National Reference Centre for Legionella, Cantonal Institute of Microbiology, Bellinzona, Switzerland
| | - Simona Casati
- Swiss National Reference Centre for Legionella, Cantonal Institute of Microbiology, Bellinzona, Switzerland
| | - Costanzo Limoni
- Alpha5, Biometrics & Data Management, Riva San Vitale, Switzerland
| | - Valeria Gaia
- Swiss National Reference Centre for Legionella, Cantonal Institute of Microbiology, Bellinzona, Switzerland
| |
Collapse
|
6
|
Meteorological conditions and incidence of Legionnaires' disease in Glasgow, Scotland: application of statistical modelling. Epidemiol Infect 2012; 141:687-96. [PMID: 22687530 DOI: 10.1017/s095026881200101x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This study investigated the relationships between Legionnaires' disease (LD) incidence and weather in Glasgow, UK, by using advanced statistical methods. Using daily meteorological data and 78 LD cases with known exact date of onset, we fitted a series of Poisson log-linear regression models with explanatory variables for air temperature, relative humidity, wind speed and year, and sine-cosine terms for within-year seasonal variation. Our initial model showed an association between LD incidence and 2-day lagged humidity (positive, P = 0·0236) and wind speed (negative, P = 0·033). However, after adjusting for year-by-year and seasonal variation in cases there were no significant associations with weather. We also used normal linear models to assess the importance of short-term, unseasonable weather values. The most significant association was between LD incidence and air temperature residual lagged by 1 day prior to onset (P = 0·0014). The contextual role of unseasonably high air temperatures is worthy of further investigation. Our methods and results have further advanced understanding of the role which weather plays in risk of LD infection.
Collapse
|
7
|
Ng V, Tang P, Jamieson F, Guyard C, Low DE, Fisman DN. Laboratory-based evaluation of legionellosis epidemiology in Ontario, Canada, 1978 to 2006. BMC Infect Dis 2009; 9:68. [PMID: 19460152 PMCID: PMC2695468 DOI: 10.1186/1471-2334-9-68] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 05/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Legionellosis is a common cause of severe community acquired pneumonia and respiratory disease outbreaks. The Ontario Public Health Laboratory (OPHL) has conducted most testing for Legionella species in the Canadian province of Ontario since 1978, and represents a multi-decade repository of population-based data on legionellosis epidemiology. We sought to provide a laboratory-based review of the epidemiology of legionellosis in Ontario over the past 3 decades, with a focus on changing rates of disease and species associated with legionellosis during that time period. METHODS We analyzed cases that were submitted and tested positive for legionellosis from 1978 to 2006 using Poisson regression models incorporating temporal, spatial, and demographic covariates. Predictors of infection with culture-confirmed L. pneumophila serogroup 1 (LP1) were evaluated with logistic regression models. RESULTS 1,401 cases of legionellosis tested positive from 1978 to 2006. As in other studies, we found a late summer to early autumn seasonality in disease occurrence with disease risk increasing with age and in males. In contrast to other studies, we found a decreasing trend in cases in the recent decade (IRR 0.93, 95% CI 0.91 to 0.95, P-value = 0.001); only 66% of culture-confirmed isolates were found to be LP1. CONCLUSION Despite similarities with disease epidemiology in other regions, legionellosis appears to have declined in the past decade in Ontario, in contrast to trends observed in the United States and parts of Europe. Furthermore, a different range of Legionella species is responsible for illness, suggesting a distinctive legionellosis epidemiology in this North American region.
Collapse
Affiliation(s)
- Victoria Ng
- Child Health Evaluative Sciences, Research Institute of the Hospital for Sick Children, Toronto, Canada
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Patrick Tang
- Ontario Agency for Health Protection and Promotion, Toronto, Canada
| | - Frances Jamieson
- Ontario Agency for Health Protection and Promotion, Toronto, Canada
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Canada
| | - Cyril Guyard
- Ontario Agency for Health Protection and Promotion, Toronto, Canada
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Canada
| | - Donald E Low
- Ontario Agency for Health Protection and Promotion, Toronto, Canada
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Canada
- Department of Microbiology, Mount Sinai Hospital, Toronto, Canada
| | - David N Fisman
- Child Health Evaluative Sciences, Research Institute of the Hospital for Sick Children, Toronto, Canada
- Ontario Agency for Health Protection and Promotion, Toronto, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Ng V, Tang P, Jamieson F, Drews SJ, Brown S, Low DE, Johnson CC, Fisman DN. Going with the flow: legionellosis risk in Toronto, Canada is strongly associated with local watershed hydrology. ECOHEALTH 2008; 5:482-490. [PMID: 19370300 DOI: 10.1007/s10393-009-0218-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 08/18/2008] [Accepted: 09/11/2008] [Indexed: 05/27/2023]
Abstract
Legionella species are increasingly recognized as a cause of both healthcare- and community-acquired pneumonia (so-called "Legionnaire's disease"). These pathogens are ubiquitous in the environment, but environmental factors in the occurrence of sporadic legionellosis remain poorly understood. We analyzed all legionellosis cases identified in the Greater Toronto Area of Ontario from 1978 to 2006, and evaluated seasonal and environmental patterns in legionellosis case occurrence by using both negative binomial models and case-crossover analysis. A total of 837 cases were reported during the study period. After adjusting for seasonal effects, changes in the local watershed, rather than weather, were the strongest contributors to legionellosis risk. A 3.6-fold increase (95% confidence interval (CI), 2.4-5.3) in odds of disease was identified with decreasing watershed levels approximately 4 weeks before case-occurrence. We also found a 33% increase (95% CI, 8-64%) in odds of disease with decreasing lake temperature during the same period and a 34% increase (95% CI, 14-57%) with increasing humidity 5 weeks before case-occurrence. We conclude that local watershed ecology influences the risk of legionellosis, notwithstanding the availability of advanced water treatment capacity in Toronto. Enhancement of risk might occur through direct contamination of water sources or via introduction of micronutrients or commensal organisms into residential and hospital water supplies. These observations suggest testable hypotheses for future empiric studies.
Collapse
Affiliation(s)
- Victoria Ng
- Research Institute of the Hospital for Sick Children, Toronto, Canada
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Dynamics of Legionella spp. and bacterial populations during the proliferation of L. pneumophila in a cooling tower facility. Appl Environ Microbiol 2008; 74:3030-7. [PMID: 18390683 DOI: 10.1128/aem.02760-07] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The dynamics of Legionella spp. and of dominant bacteria were investigated in water from a cooling tower plant over a 9-month period which included several weeks when Legionella pneumophila proliferated. The structural diversity of both the bacteria and the Legionella spp. was monitored by a fingerprint technique, single-strand conformation polymorphism, and Legionella spp. and L. pneumophila were quantified by real-time quantitative PCR. The structure of the bacterial community did not change over time, but it was perturbed periodically by chemical treatment or biofilm detachment. In contrast, the structure of the Legionella sp. population changed in different periods, its dynamics at times showing stability but also a rapid major shift during the proliferation of L. pneumophila in July. The dynamics of the Legionella spp. and of dominant bacteria were not correlated. In particular, no change in the bacterial community structure was observed during the proliferation of L. pneumophila. Legionella spp. present in the cooling tower system were identified by cloning and sequencing of 16S rRNA genes. A high diversity of Legionella spp. was observed before proliferation, including L. lytica, L. fallonii, and other Legionella-like amoebal pathogen types, along with as-yet-undescribed species. During the proliferation of L. pneumophila, Legionella sp. diversity decreased significantly, L. fallonii and L. pneumophila being the main species recovered.
Collapse
|
10
|
Den Boer JW, Verhoef L, Bencini MA, Bruin JP, Jansen R, Yzerman EPF. Outbreak detection and secondary prevention of Legionnaires’ disease: A national approach. Int J Hyg Environ Health 2007; 210:1-7. [PMID: 16956792 DOI: 10.1016/j.ijheh.2006.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 07/03/2006] [Accepted: 07/03/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND To stop a possible outbreak of Legionnaires' disease (LD) at an early stage an outbreak detection programme was installed in The Netherlands. METHODS The programme consisted of sampling and controlling of potential sources to which LD patients had been exposed during their incubation period. Potential sources were considered to be true sources of infection if two or more LD patients (cluster) had visited them, or if available patients' isolates and environmental Legionella spp. were indistinguishable by amplified fragment length polymorphism genotyping. RESULTS Rapid sampling and genotyping as well as cluster recognition helped to target control measures. Despite these measures, two small outbreaks were only stopped after renewal of the water system. The combination of genotyping and cluster recognition lead to 29 of 190 (15%) patient-source associations. CONCLUSION Systematic sampling and cluster recognition can contribute to outbreak detection and lead to cost-effective secondary prevention of Legionnaires' disease.
Collapse
Affiliation(s)
- Jeroen W Den Boer
- Municipal Health Service Kennemerland, P.O. Box 5514, 2000 GM Haarlem, The Netherlands.
| | | | | | | | | | | |
Collapse
|
11
|
Gjenero-Margan I, Vidovic R, Drazenovic V. Pityriasis rosea Gibert: detection of Legionella micdadei antibodies in patients. Eur J Epidemiol 1995; 11:459-62. [PMID: 8549715 DOI: 10.1007/bf01721233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Some epidemiological and clinical characteristics of Pityriasis rosea Gibert has led us to hypothesize that this disease may be the clinical manifestation of an infection caused by legionellas. We have thus tested the sera of 36 patients ill with Pityriasis rosea and 19 controls for Legionella pneumophila serogroup 1-6 and Legionella micdadei antibodies. These, who had the same age and sex distribution as study patients, were receiving treatment for other diseases in the same ward. Also tested were 200 sera from the voluntary blood donors from the same region as study patients. Legionella micdadei antibodies were detected in 12 (33.3%) Pityriasis rosea cases and in one (5.2%) control. They were significantly more common in Pityriasis rosea cases than in either controls or voluntary blood donor population. The findings to date encourage continued research into the causative relationship between the Legionella micddadei infection and the onset of Pityriasis rosea Gibert.
Collapse
Affiliation(s)
- I Gjenero-Margan
- Epidemiology Service, Croatian National Institute of Public Health, Zagreb, Croatia
| | | | | |
Collapse
|
12
|
Levy M, Westley-Wise V, Blumer C, Frommer M, Rubin G, Lyle D, Brown J, Stewart G. Legionnaires' disease outbreak, Fairfield 1992: public health aspects. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1994; 18:137-43. [PMID: 7948328 DOI: 10.1111/j.1753-6405.1994.tb00214.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
An investigation of an outbreak of Legionnaires' disease in 1992 in Fairfield, a municipality of Sydney, was carried out to determine the source of the outbreak. Cases of Legionnaires' disease with onset of symptoms between 11 and 20 April 1992 were included. Definite cases were individuals with a history consistent with Legionnaires' disease, confirmed by direct fluorescent antibody testing plus serology or culture. There were two control groups: patients admitted to the same hospital as the cases, matched for age and sex, and patients admitted to hospital with a presumptive diagnosis of legionnaires' disease, in whom the diagnosis was subsequently excluded. There were 26 definite cases with onset of symptoms between 11 and 20 April 1992. Six (23 per cent) died. Twenty-two cases (85 per cent) reported visiting the Fairfield business district during the ten days prior to the onset of symptoms. They were 20 times more likely to have visited Fairfield than were matched controls. Matching of Legionella pneumophila serogroup 1 from environmental and clinical samples was achieved by cytogenetic fingerprinting. Fourteen cases were linked to a single environmental sample. The epidemiological findings were consistent with a point source of Legionella in the Fairfield business district. It is most likely that the exposure occurred on 10 April 1992.
Collapse
Affiliation(s)
- M Levy
- Epidemiology and Health Services Evaluation Branch, New South Wales Health Department
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Joseph CA, Watson JM, Harrison TG, Bartlett CL. Nosocomial Legionnaires' disease in England and Wales, 1980-92. Epidemiol Infect 1994; 112:329-45. [PMID: 8150007 PMCID: PMC2271466 DOI: 10.1017/s0950268800057745] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Two hundred and eighteen nosocomial cases of Legionnaires' disease with 68 deaths were reported to the National Surveillance Scheme for Legionnaires Disease between 1980 and 1992, representing 15% of the reported infections acquired in England and Wales. Twenty-two nosocomial outbreaks accounted for 135 (62%) of these cases, the remainder occurring as single cases either in hospitals where other single cases or outbreaks had been reported in different years or as 'sporadic' cases in hospitals from which no other cases were reported. A clinical history prior to onset of Legionnaires' disease was available for 124 patients, 61 of whom had undergone recent transplant therapy or were immunosuppressed for other reasons. Sixty cases (27%) were diagnosed by culture of the organism and isolates from 56 patients were typed; 25 (42%) were non L. pneumophila serogroup 1 infections. Methods for prevention and control of nosocomial outbreaks are discussed, in particular the susceptibility to Legionnaires' disease of certain groups of hospital patients.
Collapse
Affiliation(s)
- C A Joseph
- PHLS Communicable Disease Surveillance Centre, Central Public Health Laboratory, London, UK
| | | | | | | |
Collapse
|
14
|
Bentham RH, Broadbent CR. A model for autumn outbreaks of Legionnaires' disease associated with cooling towers, linked to system operation and size. Epidemiol Infect 1993; 111:287-95. [PMID: 8405155 PMCID: PMC2271390 DOI: 10.1017/s0950268800056995] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Cooling towers have been demonstrated to be amplifiers and disseminators of legionella, the causative organism of Legionnaires' disease. Community outbreaks associated with cooling towers have been reported with several common factors. Small towers (< 300 kW) have predominantly been implicated in outbreaks. Cooling tower-associated outbreaks are most frequent in autumn, and frequently implicated systems have been operated after a period of shutdown. This paper reports field study data relating system operation to legionella colonization of systems. Operating systems have been shown to be more frequently colonized by legionella than shutdown systems. In some cases operation of systems after periods of shutdown raised legionella concentrations from below detection limits to between 50 and 950 c.f.u./ml within 10 min. These data and previously reported data relating to biofilm and sediment colonization of the systems, and community outbreaks of Legionnaires' disease, have been used to develop a model explaining the seasonal nature of outbreaks associated with irregularly operated, small cooling tower systems.
Collapse
Affiliation(s)
- R H Bentham
- Repatriation General Hospital, Daw Park, South Australia
| | | |
Collapse
|
15
|
Bhopal RS, Diggle P, Rowlingson B. Pinpointing clusters of apparently sporadic cases of Legionnaires' disease. BMJ (CLINICAL RESEARCH ED.) 1992; 304:1022-7. [PMID: 1586784 PMCID: PMC1881722 DOI: 10.1136/bmj.304.6833.1022] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To test the hypothesis that many non-outbreak cases of legionnaires' disease are not sporadic and to attempt to pinpoint cases clustering in space and time. DESIGN Descriptive study of a case series, 1978-86. SETTING 15 health boards in Scotland. PATIENTS 203 probable cases of non-outbreak, non-travel, community acquired legionnaires' disease in patients resident in Scotland. MAIN MEASURES Date of onset of disease and postcode and health board of residence of cases. RESULTS Space-time clustering was present and numerous groups of cases were identified, all but two being newly recognised. Nine cases occurred during three months within two postcodes in Edinburgh, and an outbreak was probably missed. In several places cases occurred in one area over a prolonged period--for example, nine cases in postcode districts G11.5 and G12.8 in Glasgow during five years (estimated mean annual incidence of community acquired, non-outbreak, non-travel legionnaires' disease of 146 per million residents v 4.8 per million for Scotland). Statistical analysis showed that the space time clustering of cases in the Glasgow and Edinburgh areas was unusual (p = 0.036, p = 0.068 respectively). CONCLUSION Future surveillance requires greater awareness that clusters can be overlooked; case searching whenever a case is identified; collection of complete information particularly of date of onset of the disease and address or postcode; ongoing analysis for space-time clustering; and an accurate yet workable definition of sporadic cases. Other researchers should re-examine their data on apparently sporadic infection.
Collapse
Affiliation(s)
- R S Bhopal
- Division of Epidemiology and Public Health, School of Health Care Sciences, Newcastle upon Tyne
| | | | | |
Collapse
|
16
|
Johansen HK, Høiby N. Seasonal onset of initial colonisation and chronic infection with Pseudomonas aeruginosa in patients with cystic fibrosis in Denmark. Thorax 1992; 47:109-11. [PMID: 1549817 PMCID: PMC463585 DOI: 10.1136/thx.47.2.109] [Citation(s) in RCA: 142] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND METHODS To assess the relation between seasonal variation and the onset of initial and chronic Pseudomonas aeruginosa infection, 300 Danish patients with cystic fibrosis were investigated. A retrospective analysis based on case reports was performed to identify the date and year of initial and chronic P aeruginosa infection from 1965 to 1990. RESULTS Sixty six per cent of the patients contracted their initial P aeruginosa colonisation and 68% contracted chronic infection during the winter months (October to March). Despite major changes in treatment, including improved and intensified antibiotic treatment, during the investigation period in our cystic fibrosis centre, the seasonal difference in P aeruginosa infection persisted. CONCLUSIONS As respiratory virus infections have the same seasonal distribution in Denmark such infections may pave the way for P aeruginosa and thus explain the parallel seasonal occurrence of this pathogen in patients with cystic fibrosis.
Collapse
Affiliation(s)
- H K Johansen
- Danish Cystic Fibrosis Centre, Department of Clinical Microbiology, Rigshospitalet, Copenhagen
| | | |
Collapse
|