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Nisar MA, Ross KE, Brown MH, Bentham R, Best G, Whiley H. Detection and quantification of viable but non-culturable Legionella pneumophila from water samples using flow cytometry-cell sorting and quantitative PCR. Front Microbiol 2023; 14:1094877. [PMID: 36793878 PMCID: PMC9922708 DOI: 10.3389/fmicb.2023.1094877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023] Open
Abstract
Legionella pneumophila is a waterborne pathogen and, as the causative agent of Legionnaires' disease, a significant public health concern. Exposure to environmental stresses, and disinfection treatments, promotes the formation of resistant and potentially infectious viable but non-culturable (VBNC) Legionella. The management of engineered water systems to prevent Legionnaires' disease is hindered by the presence of VBNC Legionella that cannot be detected using the standard culture (ISO11731:2017-05) and quantitative polymerase reaction (ISO/TS12869:2019) methods. This study describes a novel method to quantify VBNC Legionella from environmental water samples using a "viability based flow cytometry-cell sorting and qPCR" (VFC + qPCR) assay. This protocol was then validated by quantifying the VBNC Legionella genomic load from hospital water samples. The VBNC cells were unable to be cultured on Buffered Charcoal Yeast Extract (BCYE) agar; however, their viability was confirmed through their ATP activity and ability to infect amoeba hosts. Subsequently, an assessment of the ISO11731:2017-05 pre-treatment procedure demonstrated that acid or heat treatment cause underestimation of alive Legionella population. Our results showed that these pre-treatment procedures induce culturable cells to enter a VBNC state. This may explain the observed insensitivity and lack of reproducibility often observed with the Legionella culture method. This study represents the first time that flow cytometry-cell sorting in conjunction with a qPCR assay has been used as a rapid and direct method to quantify VBNC Legionella from environmental sources. This will significantly improve future research evaluating Legionella risk management approaches for the control of Legionnaires' disease.
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Affiliation(s)
- Muhammad Atif Nisar
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - Kirstin E. Ross
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - Melissa H. Brown
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - Richard Bentham
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - Giles Best
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia,Flow Cytometry Facility, Flinders University, Bedford Park, SA, Australia
| | - Harriet Whiley
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia,*Correspondence: Harriet Whiley, ✉
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Wang X, Xu H, Chu P, Zeng Y, Tian J, Song F, Guo Y, Xu X, Ni X, Feng G. Effects of COVID-19-targeted nonpharmaceutical interventions on children's respiratory admissions in China: a national multicenter time series study. Int J Infect Dis 2022; 124:174-180. [PMID: 36241166 PMCID: PMC9554008 DOI: 10.1016/j.ijid.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To estimate the impact of nonpharmaceutical interventions (NPIs) targeted at the COVID-19 pandemic on the admission number of respiratory diseases, including pneumonia, acute bronchitis & bronchiolitis, and acute upper respiratory infections (AURIs) for children in China. METHODS Continuous hospitalization records aged 0-18 years from January 1, 2016, to December 31, 2020, were collected from 26 tertiary children's hospitals. Interrupted time series analysis with a quasi-Poisson model was conducted with the start time of the COVID-19 pandemic as the interrupted timepoint and the weekly admission numbers of all-cause respiratory disease, pneumonia, acute bronchitis & bronchiolitis, and AURI as the outcome measures. Hospitalizations of childhood neoplasms were analyzed as the reference group. RESULTS The reduction in admission numbers following NPIs was -55.0% (-57.9 to -51.9%) for all-cause respiratory diseases, -62.7% (-65.7 to -59.5%) for pneumonia, -48.1% (-53.3 to -42.3%) for bronchitis & bronchiolitis, and -24.3% (-28.6 to -19.8%) for AURI. The effect estimates of NPIs on childhood neoplasms was -29.1% (-33.6 to -24.4%). Stratification analysis showed the reduction was most drastic for children at 4-6 and 7-12 years. CONCLUSION The admission number for respiratory diseases among children in China decreased drastically after the implementation of NPIs. NPIs with low socio-economic burdens should be suggested even outside the COVID-19 pandemic.
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Affiliation(s)
- Xinyu Wang
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hui Xu
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ping Chu
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yueping Zeng
- Medical Record Management Office, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jian Tian
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fei Song
- Medical Record Management Office, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, MOE Key Laboratory of Major Diseases in Children, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Xu
- Information Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Iliadi V, Staykova J, Iliadis S, Konstantinidou I, Sivykh P, Romanidou G, Vardikov DF, Cassimos D, Konstantinidis TG. Legionella pneumophila: The Journey from the Environment to the Blood. J Clin Med 2022; 11:jcm11206126. [PMID: 36294446 PMCID: PMC9605555 DOI: 10.3390/jcm11206126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/26/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022] Open
Abstract
An outbreak of a potentially fatal form of pneumonia in 1976 and in the annual convention of the American Legion was the first time that Legionella spp. was identified. Thereafter, the term Legionnaires’ disease (LD) was established. The infection in humans is transmitted by the inhalation of aerosols that contain the microorganisms that belong to the Legionellaceae family and the genus Legionella. The genus Legionella contains genetically heterogeneous species and serogroups. The Legionella pneumophila serogroup 1 (Lp1) is the most often detected strain in outbreaks of LD. The pathogenesis of LD infection initiates with the attachment of the bacterial cells to the host cells, and subsequent intracellular replication. Following invasion, Legionella spp. activates its virulence mechanisms: generation of specific compartments of Legionella-containing vacuole (LCV), and expression of genes that encode a type IV secretion system (T4SS) for the translocation of proteins. The ability of L. pneumophila to transmigrate across the lung’s epithelium barrier leads to bacteremia, spread, and invasion of many organs with subsequent manifestations, complications, and septic shock. The clinical manifestations of LD depend on the bacterial load in the aerosol, the virulence factors, and the immune status of the patient. The infection has two distinct forms: the non- pneumatic form or Pontiac fever, which is a milder febrile flu-like illness, and LD, a more severe form, which includes pneumonia. In addition, the extrapulmonary involvement of LD can include heart, brain, abdomen, and joints.
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Affiliation(s)
- Valeria Iliadi
- Izhevsk State Medical Academy, Kommunarov Street 281, 426034 Izhevsk, Russia
| | - Jeni Staykova
- Faculty of Public Health, Medical University of Sofia, Byalo More Str. 8, 1527 Sofia, Bulgaria
| | - Sergios Iliadis
- Izhevsk State Medical Academy, Kommunarov Street 281, 426034 Izhevsk, Russia
| | | | - Polina Sivykh
- State Budgetary Health City Polyclinic No 2 (GBUZ GB2) of Krasnodar, Seleznev Street 4/10, 350059 Krasnodar, Russia
| | - Gioulia Romanidou
- Nephrology Department, General Hospital “Sismanogleio”, 69100 Komotini, Greece
| | - Daniil F. Vardikov
- Russian Research Center for Radiology and Surgical Technologies of the Ministry of Health of the Russian Federation, Tkachey Str. 70-16, 192029 St. Petersburg, Russia
| | - Dimitrios Cassimos
- Pediatric Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Theocharis G. Konstantinidis
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
- Correspondence: ; Tel.: +30-2551-352005
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Ghaznavi C, Ishikane M, Yoneoka D, Tanoue Y, Kawashima T, Eguchi A, Nomura S. Effect of the COVID-19 pandemic and state of emergency declarations on the relative incidence of legionellosis and invasive pneumococcal disease in Japan. J Infect Chemother 2022; 29:90-94. [PMID: 36116719 PMCID: PMC9477788 DOI: 10.1016/j.jiac.2022.08.016] [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] [Received: 05/12/2022] [Revised: 08/03/2022] [Accepted: 08/20/2022] [Indexed: 11/27/2022]
Abstract
Introduction During the COVID-19 pandemic, the incidence of many droplet-transmitted infections decreased due to increased mask-wearing and social distancing. Contrastingly, there has been concern that COVID-19 countermeasures, such as lockdowns, may increase legionellosis incidence via water stagnation. During the pandemic in Japan, four state of emergency declarations were imposed between 2020 and 2021, which makes it particularly suitable to test this hypothesis. Methods We use country-level surveillance data from the National Institute of Infectious Diseases to track the relative incidence of legionellosis compared to invasive pneumococcal disease (IPD) during the COVID-19 pandemic in Japan, with a focus on the periods just after state of emergency declarations were lifted. Results The absolute number of legionellosis and IPD cases decreased in 2020 and 2021 compared to previous years. The average relative incidence of legionellosis as well as the variance of the relative incidence significantly increased during the pandemic compared to previous years. There were no increases in the relative incidence of legionellosis during the periods immediately following emergency declaration liftings, but the relative incidence did increase considerably during the first two states of emergency. Conclusions COVID-19 countermeasures appear more effective at decreasing the incidence of human-to-human transmitted infections, such as IPD, compared to environmentally-transmitted infections, such as legionellosis. Though no evidence was found to suggest that legionellosis cases increased after state of emergency declarations, public health efforts should continue to emphasize the importance of routine sanitation and water system maintenance to prevent water stagnation and Legionella spp. contamination.
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Affiliation(s)
- Cyrus Ghaznavi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Medical Education Program, Washington University School of Medicine in St Louis, Saint Louis, USA.
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Yoneoka
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tokyo Foundation for Policy Research, Tokyo, Japan; Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuta Tanoue
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Institute for Business and Finance, Waseda University, Tokyo, Japan
| | - Takayuki Kawashima
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Mathematical and Computing Science, Tokyo Institute of Technology, Tokyo, Japan
| | - Akifumi Eguchi
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Tokyo Foundation for Policy Research, Tokyo, Japan
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Gattuso G, Rizzo R, Lavoro A, Spoto V, Porciello G, Montagnese C, Cinà D, Cosentino A, Lombardo C, Mezzatesta ML, Salmeri M. Overview of the Clinical and Molecular Features of Legionella Pneumophila: Focus on Novel Surveillance and Diagnostic Strategies. Antibiotics (Basel) 2022; 11:antibiotics11030370. [PMID: 35326833 PMCID: PMC8944609 DOI: 10.3390/antibiotics11030370] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
Legionella pneumophila (L. pneumophila) is one of the most threatening nosocomial pathogens. The implementation of novel and more effective surveillance and diagnostic strategies is mandatory to prevent the occurrence of legionellosis outbreaks in hospital environments. On these bases, the present review is aimed to describe the main clinical and molecular features of L. pneumophila focusing attention on the latest findings on drug resistance mechanisms. In addition, a detailed description of the current guidelines for the disinfection and surveillance of the water systems is also provided. Finally, the diagnostic strategies available for the detection of Legionella spp. were critically reviewed, paying the attention to the description of the culture, serological and molecular methods as well as on the novel high-sensitive nucleic acid amplification systems, such as droplet digital PCR.
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Affiliation(s)
- Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Roberta Rizzo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Alessandro Lavoro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Vincenzoleo Spoto
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, National Cancer Institute IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (G.P.); (C.M.)
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, National Cancer Institute IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (G.P.); (C.M.)
| | - Diana Cinà
- Health Management of the “Cannizzaro” Emergency Hospital of Catania, 95126 Catania, Italy;
- Clinical Pathology and Clinical Molecular Biology Unit, “Garibaldi Centro” Hospital, ARNAS Garibaldi, 95123 Catania, Italy
| | - Alessia Cosentino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Cinzia Lombardo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Maria Lina Mezzatesta
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
| | - Mario Salmeri
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (G.G.); (R.R.); (A.L.); (V.S.); (A.C.); (C.L.); (M.L.M.)
- Correspondence: ; Tel.: +39-095-478-1244
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Tang HJ, Lai CC, Chao CM. Changing Epidemiology of Respiratory Tract Infection during COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11030315. [PMID: 35326778 PMCID: PMC8944752 DOI: 10.3390/antibiotics11030315] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
The outbreak of COVID-19 has significantly changed the epidemiology of respiratory tract infection in several ways. The implementation of non-pharmaceutical interventions (NPIs) including universal masking, hand hygiene, and social distancing not only resulted in a decline in reported SARS-CoV-2 cases but also contributed to the decline in the non-COVID-19 respiratory tract infection-related hospital utilization. Moreover, it also led to the decreased incidence of previous commonly encountered respiratory pathogens, such as influenza and Streptococcus pneumoniae. Although antimicrobial agents are essential for treating patients with COVID-19 co-infection, the prescribing of antibiotics was significantly higher than the estimated prevalence of bacterial co-infection, which indicated the overuse of antibiotics or unnecessary antibiotic use during the COVID-19 pandemic. Furthermore, inappropriate antimicrobial exposure may drive the selection of drug-resistant microorganisms, and the disruption of infection control in COVID-19 setting measures may result in the spread of multidrug-resistant organisms (MDROs). In conclusion, NPIs could be effective in preventing respiratory tract infection and changing the microbiologic distribution of respiratory pathogens; however, we should continue with epidemiological surveillance to establish updated information, antimicrobial stewardship programs for appropriate use of antibiotic, and infection control prevention interventions to prevent the spread of MDROs during the COVID-19 pandemic.
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Affiliation(s)
- Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 710, Taiwan;
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan
- Correspondence:
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