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Hershkovitz D, Chen EJ, Ensminger AW, Dugan AS, Conway KT, Joyce AC, Segal G, Isberg RR. Genetic evidence for a regulated cysteine protease catalytic triad in LegA7, a Legionella pneumophila protein that impinges on a stress response pathway. mSphere 2024:e0022224. [PMID: 39166849 DOI: 10.1128/msphere.00222-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/30/2024] [Indexed: 08/23/2024] Open
Abstract
Legionella pneumophila grows within membrane-bound vacuoles in phylogenetically diverse hosts. Intracellular growth requires the function of the Icm/Dot type-IVb secretion system, which translocates more than 300 proteins into host cells. A screen was performed to identify L. pneumophila proteins that stimulate mitogen-activated protein kinase (MAPK) activation, using Icm/Dot translocated proteins ectopically expressed in mammalian cells. In parallel, a second screen was performed to identify L. pneumophila proteins expressed in yeast that cause growth inhibition in MAPK pathway-stimulatory high-osmolarity medium. LegA7 was shared in both screens, a protein predicted to be a member of the bacterial cysteine protease family that has five carboxyl-terminal ankyrin repeats. Three conserved residues in the predicted catalytic triad of LegA7 were mutated. These mutations abolished the ability of LegA7 to inhibit yeast growth. To identify other residues important for LegA7 function, a generalizable selection strategy in yeast was devised to isolate mutants that have lost function and no longer cause growth inhibition on a high-osmolarity medium. Mutations were isolated in the two carboxyl-terminal ankyrin repeats, as well as an inter-domain region located between the cysteine protease domain and the ankyrin repeats. These mutations were predicted by AlphaFold modeling to localize to the face opposite from the catalytic site, arguing that they interfere with the positive regulation of the catalytic activity. Based on our data, we present a model in which LegA7 harbors a cysteine protease domain with an inter-domain and two carboxyl-terminal ankyrin repeat regions that modulate the function of the catalytic domain. IMPORTANCE Legionella pneumophila grows in a membrane-bound compartment in macrophages during disease. Construction of the compartment requires a dedicated secretion system that translocates virulence proteins into host cells. One of these proteins, LegA7, is shown to activate a stress response pathway in host cells called the mitogen-activated protein kinase (MAPK) pathway. The effects on the mammalian MAPK pathway were reconstructed in yeast, allowing the development of a strategy to identify the role of individual domains of LegA7. A domain similar to cysteine proteases is demonstrated to be critical for impinging on the MAPK pathway, and the catalytic activity of this domain is required for targeting this path. In addition, a conserved series of repeats, called ankyrin repeats, controls this activity. Data are provided that argue the interaction of the ankyrin repeats with unknown targets probably results in activation of the cysteine protease domain.
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Affiliation(s)
- Dar Hershkovitz
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Emy J Chen
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- Program in Genetics, Molecular and Cellular Biology, Graduate School of Biomedical Sciences Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Alexander W Ensminger
- Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Aisling S Dugan
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kaleigh T Conway
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
- Program in Genetics, Molecular and Cellular Biology, Graduate School of Biomedical Sciences Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Alex C Joyce
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Gil Segal
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ralph R Isberg
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts, USA
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2
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Hershkovitz D, Chen EJ, Ensminger AW, Dugan AS, Conway KT, Joyce AC, Segal G, Isberg RR. Genetic evidence for a regulated cysteine protease catalytic triad in LegA7, a Legionella pneumophila protein that impinges on a stress response pathway. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.17.585421. [PMID: 38562771 PMCID: PMC10983931 DOI: 10.1101/2024.03.17.585421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Legionella pneumophila grows within membrane-bound vacuoles in phylogenetically diverse hosts. Intracellular growth requires the function of the Icm/Dot type-IVb secretion system, which translocates more than 300 proteins into host cells. A screen was performed to identify L. pneumophila proteins that stimulate MAPK activation, using Icm/Dot translocated proteins ectopically expressed in mammalian cells. In parallel, a second screen was performed to identify L. pneumophila proteins expressed in yeast that cause growth inhibition in MAPK pathway-stimulatory high osmolarity medium. LegA7 was shared in both screens, a protein predicted to be a member of the bacterial cysteine protease family that has five carboxyl-terminal ankyrin repeats. Three conserved residues in the predicted catalytic triad of LegA7 were mutated. These mutations abolished the ability of LegA7 to inhibit yeast growth. To identify other residues important for LegA7 function, a generalizable selection strategy in yeast was devised to isolate mutants that have lost function and no longer cause growth inhibition on high osmolarity medium. Mutations were isolated in the two carboxyl-terminal ankyrin repeats, as well as an inter-domain region located between the cysteine protease domain and the ankyrin repeats. These mutations were predicted by AlphaFold modeling to localize to the face opposite from the catalytic site, arguing that they interfere with the positive regulation of the catalytic activity. Based on our data, we present a model in which LegA7 harbors a cysteine protease domain with an inter-domain and two carboxyl-terminal ankyrin repeat regions that modulate the function of the catalytic domain.
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Affiliation(s)
- Dar Hershkovitz
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, 6997801, Israel
| | - Emy J. Chen
- Department of Molecular Biology and Microbiology
- Program in Genetics, Molecular and Cellular Biology, Graduate School of Biomedical Sciences, Tufts University School of Medicine,150 Harrison Ave., Boston, MA 02115, USA
| | | | - Aisling S. Dugan
- Department of Molecular Biology and Microbiology
- Current Address: Dept. of Biology, Brown University, Providence, RI 02912
| | - Kaleigh T. Conway
- Department of Molecular Biology and Microbiology
- Program in Genetics, Molecular and Cellular Biology, Graduate School of Biomedical Sciences, Tufts University School of Medicine,150 Harrison Ave., Boston, MA 02115, USA
| | | | - Gil Segal
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, 6997801, Israel
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Pan Y, Xing Y, Lai Y, Dong H, Sheng H, Xu W. Metagenomic next-generation sequencing reveals co-infection with Legionella pneumophila and Fusobacterium necrophorum in a patient with severe pneumonia: a case report. BMC Pulm Med 2024; 24:279. [PMID: 38867173 PMCID: PMC11170816 DOI: 10.1186/s12890-024-03097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/11/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Legionella pneumonia is one of the most severe types of atypical pneumonia, impairing multiple organ systems, posing a threat to life. Diagnosing Legionella pneumonia is challenging due to difficulties in culturing the bacteria and limitations in immunoassay sensitivity and specificity. CASE PRESENTATION This paper reports a rare case of sepsis caused by combined infection with Legionella pneumophila and Fusobacterium necrophorum, leading to respiratory failure, acute kidney injury, acute liver injury, myocardial damage, and electrolyte disorders. In addition, we systematically reviewed literature on patients with combined Legionella infections, analyzing their clinical features, laboratory results and diagnosis. CONCLUSIONS For pathogens that require prolonged incubation periods and are less sensitive to conventional culturing methods, metagenomic next-generation sequencing (mNGS) can be a powerful supplement to pathogen screening and plays a significant role in the auxiliary diagnosis of complex infectious diseases.
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Affiliation(s)
- Yunqi Pan
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yi Xing
- Department of Hospital Infection Management, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Yanan Lai
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huixing Dong
- Department of Respiratory and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Huiming Sheng
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Weihong Xu
- Department of Laboratory Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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Ferrari DDDM, Lima SC, Teixeira RLF, Lopes MQP, Vaconcellos SEG, Machado ES, Suffys PN, Gomes HM. Genetic Diversity of Legionella pneumophila Isolates from Artificial Water Sources in Brazil. Curr Microbiol 2024; 81:165. [PMID: 38714565 PMCID: PMC11076386 DOI: 10.1007/s00284-024-03645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/19/2024] [Indexed: 05/10/2024]
Abstract
Legionella pneumophila (Lp) is a Gram-negative bacterium found in natural and artificial aquatic environments and inhalation of contaminated aerosols can cause severe pneumonia known as Legionnaires' Disease (LD). In Brazil there is hardly any information about this pathogen, so we studied the genetic variation of forty Legionella spp. isolates obtained from hotels, malls, laboratories, retail centers, and companies after culturing in BCYE medium. These isolates were collected from various sources in nine Brazilian states. Molecular identification of the samples was carried out using Sequence-Based Typing (SBT), which consists of sequencing and analysis of seven genes (flaA, pilE, asd, mip, mompS, proA, and neuA) to define a Sequence Type (ST). Eleven STs were identified among 34/40 isolates, of which eight have been previously described (ST1, ST80, ST152, ST242, ST664, ST1185, ST1464, ST1642) and three were new STs (ST2960, ST2962, and ST2963), the former identified in five different cooling towers in the city of São Paulo. The ST1 that is widely distributed in many countries was also the most prevalent in this study. In addition, other STs that we observed have also been associated with legionellosis in other countries, reinforcing the potential of these isolates to cause LD in Brazil. Unfortunately, no human isolates could be characterized until presently, but our observations strongly suggest the need of surveillance implementation system and control measures of Legionella spp. in Brazil, including the use of more sensitive genotyping procedures besides ST.
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Affiliation(s)
- Dândrea Driely de Melo Ferrari
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil.
| | | | - Raquel Lima Figueiredo Teixeira
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil
| | - Marcia Quinhones Pires Lopes
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil
| | | | - Edson Silva Machado
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil
| | - Philip Noel Suffys
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil.
| | - Harrison Magdinier Gomes
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil.
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Zhou X, Liu X, Zhao H, Guo G, Jiang X, Liu S, Sun X, Yang H. Research advances in microfluidic collection and detection of virus, bacterial, and fungal bioaerosols. Mikrochim Acta 2024; 191:132. [PMID: 38351367 DOI: 10.1007/s00604-024-06213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/14/2024] [Indexed: 02/16/2024]
Abstract
Bioaerosols are airborne suspensions of fine solid or liquid particles containing biological substances such as viruses, bacteria, cellular debris, fungal spores, mycelium, and byproducts of microbial metabolism. The global Coronavirus disease 2019 (COVID-19) pandemic and the previous emergence of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and influenza have increased the need for reliable and effective monitoring tools for bioaerosols. Bioaerosol collection and detection have aroused considerable attention. Current bioaerosol sampling and detection techniques suffer from long response time, low sensitivity, and high costs, and these drawbacks have forced the development of novel monitoring strategies. Microfluidic technique is considered a breakthrough for high performance analysis of bioaerosols. In recent years, several emerging methods based on microfluidics have been developed and reported for collection and detection of bioaerosols. The unique advantages of microfluidic technique have enabled the integration of bioaerosol collection and detection, which has a higher efficiency over conventional methods. This review focused on the research progress of bioaerosol collection and detection methods based on microfluidic techniques, with special attention on virus aerosols and bacterial aerosols. Different from the existing reviews, this work took a unique perspective of the targets to be collected and detected in bioaerosols, which would provide a direct index of bioaerosol categories readers may be interested in. We also discussed integrated microfluidic monitoring system for bioaerosols. Additionally, the application of bioaerosol detection in biomedicine was presented. Finally, the current challenges in the field of bioaerosol monitoring are presented and an outlook given of future developments.
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Affiliation(s)
- Xinyue Zhou
- Department of Respiratory Medicine, The Fourth Hospital of China Medical University, No. 4, Chongshan East Road, Huanggu District, Shenyang, 110032, Liaoning, China
| | - Xin Liu
- Department of Respiratory Medicine, The Fourth Hospital of China Medical University, No. 4, Chongshan East Road, Huanggu District, Shenyang, 110032, Liaoning, China
| | - Haiyang Zhao
- Teaching Center for Basic Medical Experiment, China Medical University, No.77, Puhe Road, Shenyang, 110122, Liaoning Province, China
| | - Guanqi Guo
- Teaching Center for Basic Medical Experiment, China Medical University, No.77, Puhe Road, Shenyang, 110122, Liaoning Province, China
| | - Xiran Jiang
- School of Intelligent Medicine, China Medical University, No.77, Puhe Road, Shenyang, 110122, Liaoning Province, China.
| | - Shuo Liu
- Department of Respiratory Medicine, The Fourth Hospital of China Medical University, No. 4, Chongshan East Road, Huanggu District, Shenyang, 110032, Liaoning, China.
| | - Xiaoting Sun
- School of Forensic Medicine, China Medical University, No.77, Puhe Road, Shenyang, 110122, Liaoning Province, China.
| | - Huazhe Yang
- School of Intelligent Medicine, China Medical University, No.77, Puhe Road, Shenyang, 110122, Liaoning Province, China.
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Shapira N, Zusman T, Segal G. The LysR-type transcriptional regulator LelA co-regulates various effectors in different Legionella species. Mol Microbiol 2024; 121:243-259. [PMID: 38153189 DOI: 10.1111/mmi.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/29/2023]
Abstract
The intracellular pathogen Legionella pneumophila translocates more than 300 effector proteins into its host cells. The expression levels of the genes encoding these effectors are orchestrated by an intricate regulatory network. Here, we introduce LelA, the first L. pneumophila LysR-type transcriptional regulator of effectors. Through bioinformatic and experimental analyses, we identified the LelA target regulatory element and demonstrated that it directly activates the expression of three L. pneumophila effectors (legL7, legL6, and legU1). We further found that the gene encoding LelA is positively regulated by the RpoS sigma factor, thus linking it to the known effector regulatory network. Examination of other species throughout the Legionella genus revealed that this regulatory element is found upstream of 34 genes encoding validated effectors, putative effectors, and hypothetical proteins. Moreover, ten of these genes were examined and found to be activated by the L. pneumophila LelA as well as by their orthologs in the corresponding species. LelA represents a novel type of Legionella effector regulator, which coordinates the expression of both adjacently and distantly located effector-encoding genes, thus forming small groups of co-regulated effectors.
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Affiliation(s)
- Naomi Shapira
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Zusman
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Segal
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
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7
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Fang Z, Zhou X, Liao H, Xu H. A meta-analysis of Legionella pneumophila contamination in hospital water systems. Am J Infect Control 2023; 51:1250-1262. [PMID: 37054892 DOI: 10.1016/j.ajic.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Legionella pneumophila is a common cause of community-acquired pneumonia. We aimed to determine the pooled rates of L pneumophila contamination in the water environment of the hospital. METHODS We searched PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure, WangFang and Science Direct, The Cochrane Library, and Science Finder, for relevant studies published until December 2022. Stata 16.0 software was used to determine pooled contamination rates, publication bias, and subgroup analysis. RESULTS Forty-eight eligible articles with a total of 23,640 samples of water were evaluated, and the prevalence of L pneumophila was 41.6%. The results of the subgroup analysis showed that the pollution rate of L pneumophila in hot water (47.6%) was higher than that in other water bodies. The rates of L pneumophila contamination were higher in developed countries (45.2%), culture methods (42.3%), published between 1985 and 2015 (42.9%), and studies with a sample size of less than 100 (53.0%). CONCLUSIONS L pneumophila contamination in medical institutions is still very serious and should be paid attention to, especially in developed countries and hot water tanks.
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Affiliation(s)
- Zisi Fang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaocong Zhou
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hui Liao
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hong Xu
- Department of Environmental Health, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.
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Motokura Y, Ito A, Ishida T. Severe Legionella Pneumonia in Which Serial Testing by Ribotest ® Legionella was Useful for the Diagnosis. Intern Med 2023; 62:2989-2993. [PMID: 36889700 PMCID: PMC10641205 DOI: 10.2169/internalmedicine.0766-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/19/2022] [Indexed: 03/09/2023] Open
Abstract
A 79-year-old man presented with chest pain, and urinary antigen tests for Legionella pneumophila (ImmunoCatch® Legionella and Ribotest® Legionella) were negative on admission. The next day, rapid respiratory failure suggested Legionella pneumonia, and levofloxacin was added. Since a lung infiltration shadow appeared on the other side as well on day 4, non-infectious diseases were considered, and steroid therapy was started. Urinary antigen tests for Legionella pneumophila became positive on day 5. In the present case, retesting with Ribotest® Legionella, which could be negative early after the disease onset, was useful for diagnosing Legionella pneumonia, which led to the discontinuation of unnecessary steroid treatment.
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Affiliation(s)
- Yumi Motokura
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
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Fischer FB, Bigler M, Mäusezahl D, Hattendorf J, Egli A, Julian TR, Rölli F, Gaia V, Wymann M, Fridez F, Bertschi S. Legionnaires' disease in Switzerland: rationale and study protocol of a prospective national case-control and molecular source attribution study (SwissLEGIO). Infection 2023; 51:1467-1479. [PMID: 36905400 PMCID: PMC10545568 DOI: 10.1007/s15010-023-02014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/23/2023] [Indexed: 03/12/2023]
Abstract
Switzerland has one of the highest annual Legionnaires' disease (LD) notification rates in Europe (7.8 cases/100,000 population in 2021). The main sources of infection and the cause for this high rate remain largely unknown. This hampers the implementation of targeted Legionella spp. control efforts. The SwissLEGIO national case-control and molecular source attribution study investigates risk factors and infection sources for community-acquired LD in Switzerland. Over the duration of one year, the study is recruiting 205 newly diagnosed LD patients through a network of 20 university and cantonal hospitals. Healthy controls matched for age, sex, and residence at district level are recruited from the general population. Risk factors for LD are assessed in questionnaire-based interviews. Clinical and environmental Legionella spp. isolates are compared using whole genome sequencing (WGS). Direct comparison of sero- and sequence types (ST), core genome multilocus sequencing types (cgMLST), and single nucleotide polymorphisms (SNPs) between clinical and environmental isolates are used to investigate the infection sources and the prevalence and virulence of different Legionella spp. strains detected across Switzerland. The SwissLEGIO study innovates in combining case-control and molecular typing approaches for source attribution on a national level outside an outbreak setting. The study provides a unique platform for national Legionellosis and Legionella research and is conducted in an inter- and transdisciplinary, co-production approach involving various national governmental and national research stakeholders.
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Affiliation(s)
- Fabienne B Fischer
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Melina Bigler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Jan Hattendorf
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Adrian Egli
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Timothy R Julian
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Franziska Rölli
- Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Valeria Gaia
- Service of Microbiology, Institute of Laboratory Medicine, National Reference Centre for Legionella, EOC, Bellinzona, Switzerland
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Marras L, Bertolino G, Sanna A, Carraro V, Coroneo V. Legionella spp. Monitoring in the Water Supply Systems of Accommodation Facilities in Sardinia, Italy: A Two-Year Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6722. [PMID: 37754582 PMCID: PMC10530320 DOI: 10.3390/ijerph20186722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Abstract
Travel-associated Legionnaires' disease is a significant public health concern worldwide. A high number of cases are reported every year among travellers who stay at guest houses, hotels, and spas. Indeed, hot water systems, showers, and air-conditioning systems can be contaminated by Legionella, which grows at 25-42 °C. Studies have shown that in Sardinia, especially during the summer months, the water circulation in the hotels' pipes is exposed to extremely high temperatures. As a result, this study was conducted to assess the colonization of hotel water systems by Legionella in Sardinia, concerning a recent EU directive 2020/2184 for drinking water with a limit of 1000 CFU /L. Methods. A total of 112 accommodation facilities were analyzed, of which 61.3% were found to be colonized with Legionella, and out of a total of 807 samples, 32.5% were positive for Legionella presence. The results showed a higher number of positive samples in the summer season. This was also associated with the higher concentration presence of >1000 CFU/L in the samples. Consequently, this study confirms that local hotel operators should improve their water safety and prevention plans, especially in spring and summer.
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Affiliation(s)
- Luisa Marras
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Giacomo Bertolino
- Pharmaceutical Department, Azienda Ospedaliero, Universitaria di Cagliari, 09123 Cagliari, Italy;
| | - Adriana Sanna
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Valentina Carraro
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Valentina Coroneo
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Park J, Bae JM. Trends of legionellosis reported in Jeju Province, Republic of Korea, 2015-2022. Osong Public Health Res Perspect 2023; 14:321-327. [PMID: 37652687 PMCID: PMC10493698 DOI: 10.24171/j.phrp.2023.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The number of reported cases of Legionnaires' disease (LD) in the Republic of Korea surged nationally in 2016; however, in 2022, this number was higher in Jeju Province than the previous national peak. A descriptive epidemiological study was conducted to analyze trends in the incidence of reported LD cases in Jeju Island from 2015 to 2022. METHODS The data for this study were obtained from case reports submitted to the Korea Disease Control and Prevention Agency through its Disease and Health Integrated Management System. The selection criteria were cases or suspected cases of LD reported among Jeju residents between 2015 and 2022. The 95% confidence interval of the crude incidence rate was calculated using the Poisson distribution. RESULTS Since 2020, the incidence rate of LD in Jeju has risen sharply, showing a statistically significant difference from the national incidence rate. A particular medical institution in Jeju reported a significant number of LD cases. Screening with the urine antigen test (UAT) also increased significantly. CONCLUSION Our findings indicate that the rapid increase in cases of LD in Jeju Province since 2020 was due to the characteristics of medical-care use among Jeju residents, which were focused on a specific medical institution. According to their clinical practice guidelines, this medical institution conducted UATs to screen patients suspected of pneumonia.
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Affiliation(s)
- Juyoung Park
- Department of Medicine, Graduate School, Jeju National University, Jeju, Republic of Korea
- Jeju Center for Infectious Disease Control and Prevention, Jeju, Republic of Korea
| | - Jong-Myon Bae
- Jeju Center for Infectious Disease Control and Prevention, Jeju, Republic of Korea
- Department of Preventive Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
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Riccò M, Ferraro P, Ranzieri S, Boldini G, Zanella I, Marchesi F. Legionnaires' Disease in Occupational Settings: A Cross-Sectional Study from Northeastern Italy (2019). Trop Med Infect Dis 2023; 8:364. [PMID: 37505660 PMCID: PMC10384770 DOI: 10.3390/tropicalmed8070364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/09/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
In Italy, Legionnaires' Disease (LD) causes >1000 hospital admissions per year, with a lethality rate of 5 to 10%. Occupational exposures could reasonably explain a substantial share of total cases, but the role of Occupational Physicians (OPs) in management and prevention of LD has been scarcely investigated. The present survey therefore evaluates the knowledge, attitudes and practices (KAP) regarding LD from a convenience sample of Italian OPs, focusing on their participation in preventive interventions. A total of 165 OPs were recruited through a training event (Parma, Northeastern Italy, 2019), and completed a specifically designed structured questionnaire. The association between reported participation in preventive interventions and individual factors was analyzed using a binary logistic regression model, calculating corresponding multivariable Odds Ratio (aOR). Overall, participants exhibited satisfactory knowledge of the clinical and diagnostic aspects of LD, while substantial uncertainties were associated epidemiological factors (i.e., notification rate and lethality). Although the majority of participating OPs reportedly assisted at least one hospital (26.7%) and/or a nursing home (42.4%) and/or a wastewater treatment plant, only 41.8% reportedly contributed to the risk assessment for LD and 18.8% promoted specifically designed preventive measures. Working as OPs in nursing homes (aOR 8.732; 95% Confidence Intervals [95%CI] 2.991 to 25.487) and wastewater treatment plants (aOR 8.710; 95%CI 2.844 to 26.668) was associated with participation in the risk assessment for LD, while the promotion of preventive practice was associated with working as an OP in hospitals (aOR 6.792; 95%CI 2.026 to 22.764) and wastewater treatment plants (aOR 4.464, 95%CI 1.363 to 14.619). In other words, the effective participation of the OP in the implementation of preventive measures appears uncommon and is limited to certain occupational settings. Collectively, these results highlight the importance of tailoring specifically designed information campaigns aimed to raise the involvement of OPs in the prevention of LD in occupational settings other than healthcare.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Via Amendola n.2, I-42122 Reggio Emilia, Italy
| | - Pietro Ferraro
- Occupational Medicine Unit, Direzione Sanità, Italian Railways' Infrastructure Division, RFI SpA, I-00161 Rome, Italy
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
| | - Giorgia Boldini
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
- Servizio di Igiene Pubblica, AUSL di Parma, Via Vasari n.13/a, I-43123 Parma, Italy
| | - Ilaria Zanella
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy
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Farina C, Cacciabue E, Averara F, Ferri N, Vailati F, Del Castillo G, Serafini A, Fermi B, Doniselli N, Pezzoli F. Water Safety Plan, Monochloramine Disinfection and Extensive Environmental Sampling Effectively Control Legionella and Other Waterborne Pathogens in Nosocomial Settings: The Ten-Year Experience of an Italian Hospital. Microorganisms 2023; 11:1794. [PMID: 37512966 PMCID: PMC10384652 DOI: 10.3390/microorganisms11071794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Legionella contamination control is crucial in healthcare settings where patients suffer an increased risk of disease and fatal outcome. To ensure an effective management of this health hazard, the accurate application of a hospital-specific Water Safety Plan (WSP), the choice of a suitable water disinfection system and an extensive monitoring program are required. Here, the ten-year experience of an Italian hospital is reported: since its commissioning, Legionellosis risk management has been entrusted to a multi-disciplinary Working Group, applying the principles of the World Health Organization's WSP. The disinfection strategy to prevent Legionella and other waterborne pathogens relies on the treatment of domestic hot water with a system ensuring the in situ production and dosage of monochloramine. An average of 250 samples/year were collected and analyzed to allow an accurate assessment of the microbiological status of water network. With the aim of increasing the monitoring sensitivity, in addition to the standard culture method, an optimized MALDI-ToF MS-based strategy was applied, allowing the identification of Legionella species and other relevant opportunistic pathogens. Data collected so far confirmed the effectiveness of this multidisciplinary approach: the fraction of positive samples never overcame 1% on a yearly basis and Legionnaires' Disease cases never occurred.
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Affiliation(s)
- Claudio Farina
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Eleonora Cacciabue
- Health Care Coordination Offices, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Franca Averara
- Department of Health Care Professions, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Nadia Ferri
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | - Francesca Vailati
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
| | | | | | - Beatrice Fermi
- Sanipur S.p.A., 25020 Flero, Italy
- ESCMID Study Group for Legionella Infections (ESGLI), 4001 Basel, Switzerland
| | - Nicola Doniselli
- Sanipur S.p.A., 25020 Flero, Italy
- ESCMID Study Group for Legionella Infections (ESGLI), 4001 Basel, Switzerland
| | - Fabio Pezzoli
- Health Care Coordination Offices, ASST "Papa Giovanni XXIII", 24127 Bergamo, Italy
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Ashbolt NJ. Conceptual model to inform Legionella-amoebae control, including the roles of extracellular vesicles in engineered water system infections. Front Cell Infect Microbiol 2023; 13:1200478. [PMID: 37274310 PMCID: PMC10232903 DOI: 10.3389/fcimb.2023.1200478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023] Open
Abstract
Extracellular vesicles (EVs or exosomes) are well described for bacterial pathogens associated with our gastrointestinal system, and more recently as a novel mechanism for environmental persistence, dissemination and infection for human enteric viruses. However, the roles played by EVs in the ancient arms race that continues between amoebae and one of their prey, Legionella pneumophila, is poorly understood. At best we know of intracellular vesicles of amoebae containing a mix of bacterial prey species, which also provides an enhanced niche for bacteriophage infection/spread. Free-living amoeba-associated pathogens have recently been recognized to have enhanced resistance to disinfection and environmental stressors, adding to previously understood (but for relatively few species of) bacteria sequestered within amoebal cysts. However, the focus of the current work is to review the likely impacts of large numbers of respiratory-sized EVs containing numerous L. pneumophila cells studied in pure and biofilm systems with mixed prey species. These encapsulated pathogens are orders of magnitude more resistant to disinfection than free cells, and our engineered systems with residual disinfectants could promote evolution of resistance (including AMR), enhanced virulence and EV release. All these are key features for evolution within a dead-end human pathogen post lung infection. Traditional single-hit pathogen infection models used to estimate the probability of infection/disease and critical environmental concentrations via quantitative microbial risk assessments may also need to change. In short, recognizing that EV-packaged cells are highly virulent units for transmission of legionellae, which may also modulate/avoid human host immune responses. Key data gaps are raised and a previous conceptual model expanded upon to clarify where biofilm EVs could play a role promoting risk as well as inform a more wholistic management program to proactively control legionellosis.
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Du R, Feng Y, Wang Y, Huang J, Tao Y, Mao H. Metagenomic next-generation sequencing confirms the diagnosis of Legionella pneumonia with rhabdomyolysis and acute kidney injury in a limited resource area: a case report and review. Front Public Health 2023; 11:1145733. [PMID: 37228720 PMCID: PMC10205016 DOI: 10.3389/fpubh.2023.1145733] [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: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Background Legionella pneumonia, rhabdomyolysis, and acute kidney injury are called the Legionella triad, which is rare and associated with a poor outcome and even death. Early diagnosis and timely treatment are essential for these patients. Case presentation A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first Legionella antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of Legionella pneumophila by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy. Conclusion Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires' disease, who manifested with the triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires' disease in limited resource areas where urine antigen tests are not available.
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Affiliation(s)
- Rao Du
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yinhe Feng
- Department of Respiratory and Critical Care Medicine, Deyang People's Hospital, Affiliated Hospital of Chengdu College of Medicine, Deyang, China
| | - Yubin Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jifeng Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yuhan Tao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Mao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Kanarek P, Bogiel T, Breza-Boruta B. Legionellosis risk-an overview of Legionella spp. habitats in Europe. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:76532-76542. [PMID: 36161570 PMCID: PMC9511453 DOI: 10.1007/s11356-022-22950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/05/2022] [Indexed: 05/28/2023]
Abstract
An increase in the number of reports of legionellosis in the European Union and the European Economic Area have been recorded in recent years. The increase in cases is significant: from 6947 reports in 2015 to 11,298 in 2019. This is alarming as genus Legionella, which comprises a large group of bacteria inhabiting various aquatic systems, poses a serious threat to human health and life, since more than 20 species can cause legionellosis, with L. pneumophila being responsible for the majority of cases. The ability to colonize diverse ecosystems makes the eradication of these microorganisms difficult. A detailed understanding of the Legionella habitat may be helpful in the effective control of this pathogen. This paper provides an overview of Legionella environments in Europe: natural (lakes, groundwater, rivers, compost, soil) and anthropogenic (fountains, air humidifiers, water supply systems), and the role of Legionella spp. in nosocomial infections, which are potentially fatal for children, the elderly and immunocompromised patients.
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Affiliation(s)
- Piotr Kanarek
- Department of Microbiology and Food Technology, Faculty of Agriculture and Biotechnology, Bydgoszcz University of Science and Technology, 6 Bernardyńska Street, 85-029, Bydgoszcz, Poland
| | - Tomasz Bogiel
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 9 Skłodowska-Curie Street, 85-094, Bydgoszcz, Poland
| | - Barbara Breza-Boruta
- Department of Microbiology and Food Technology, Faculty of Agriculture and Biotechnology, Bydgoszcz University of Science and Technology, 6 Bernardyńska Street, 85-029, Bydgoszcz, Poland.
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Ortí-Lucas RM, Luciano E. New immunomagnetic separation method to analyze risk factors for Legionella colonization in health care centres. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:744-750. [PMID: 35264765 PMCID: PMC8906530 DOI: 10.1038/s41370-022-00421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND It's pivotal to control the presence of legionella in sanitary structures. So, it's important to determine the risk factors associated with Legionella colonization in health care centres. In recent years that is why new diagnostic techniques have been developed. OBJECTIVE To evaluate risks factors for Legionella colonization using a novel and more sensitive Legionella positivity index. METHODS A total of 204 one-litre water samples (102 cold water samples and 102 hot water samples), were collected from 68 different sampling sites of the hospital water system and tested for Legionella spp. by two laboratories using culture, polymerase chain reaction and a method based on immunomagnetic separation (IMS). A Legionella positivity index was defined to evaluate Legionella colonization and associated risk factors in the 68 water samples sites. We performed bivariate analyses and then logistic regression analysis with adjustment of potentially confounding variables. We compared the performance of culture and IMS methods using this index as a new gold standard to determine if rapid IMS method is an acceptable alternative to the use of slower culture method. RESULTS Based on the new Legionella positivity index, no statistically significant differences were found neither between laboratories nor between methods (culture, IMS). Positivity was significantly correlated with ambulatory health assistance (p = 0.05) and frequency of use of the terminal points. The logistic regression model revealed that chlorine (p = 0.009) and the frequency of use of the terminal points (p = 0.001) are predictors of Legionella colonization. Regarding this index, the IMS method proved more sensitive (69%) than culture method (65.4%) in hot water samples. SIGNIFICANCE We showed that the frequency of use of terminal points should be considered when examining environmental Legionella colonization, which can be better evaluated using the provided Legionella positivity index. This study has implications for the prevention of Legionnaires' disease in hospital settings.
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Affiliation(s)
- Rafael Manuel Ortí-Lucas
- Research group on Public Health and Patient Safety, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
- Department of Preventive Medicine, Hospital Clínico Universitario de Valencia, Valencia, Spain.
| | - Eugenio Luciano
- Department of Preventive Medicine, Hospital Clínico Universitario de Valencia, Valencia, Spain.
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
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18
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Legionnaires' Disease: Update on Diagnosis and Treatment. Infect Dis Ther 2022; 11:973-986. [PMID: 35505000 PMCID: PMC9124264 DOI: 10.1007/s40121-022-00635-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Legionellosis is the infection caused by bacteria of the genus Legionella, including a non-pneumonic influenza-like syndrome, and Legionnaires’ disease is a more serious illness characterized by pneumonia. Legionellosis is becoming increasingly important as a public health problem throughout the world; although it is an underreported disease, studies have consistently documented a high incidence. In addition, health costs associated with the disease are high. Diagnosis of Legionnaires’ disease is based mainly on the detection of Legionella pneumophila serogroup 1 antigen in urine. However, there have been advances in detection tests for patients with legionellosis. New methodologies show greater sensitivity and specificity, detect more species and serogroups of Legionella spp., and have the potential for use in epidemiological studies. Testing for Legionella spp. is recommended at hospital admission for severe community-acquired pneumonia, and antibiotics directed against Legionella spp. should be included early as empirical therapy. Inadequate or delayed antibiotic treatment in Legionella pneumonia has been associated with a worse prognosis. Either a fluoroquinolone (levofloxacin or moxifloxacin) or a macrolide (azithromycin preferred) is the recommended first-line therapy for Legionnaires’ disease; however, little information is available regarding adverse events or complications, or about the duration of antibiotic therapy and its association with clinical outcomes. Most published studies evaluating antibiotic treatment for Legionnaires’ disease are observational and consequently susceptible to bias and confounding. Well-designed studies are needed to assess the usefulness of diagnostic tests regarding clinical outcomes, as well as randomized trials comparing fluoroquinolones and macrolides or combination therapy that evaluate outcomes and adverse events.
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Yin X, Chen YZ, Ye QQ, Liao LJ, Cai ZR, Lin M, Li JN, Zhang GB, Peng XL, Shi WF, Guo XG. Detection performance of PCR for Legionella pneumophila in environmental samples: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2022; 21:12. [PMID: 35303873 PMCID: PMC8934000 DOI: 10.1186/s12941-022-00503-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Legionellosis remains a public health problem. The most common diagnostic method to detect Legionella pneumophila (L. pneumophila) is culture. Polymerase chain reaction (PCR) is a fast and accurate method for this detection in environmental samples. Methods Four databases were searched for studies that evaluated the detection efficiency of PCR in L. pneumophila. The quality evaluation was conducted using Review Manager 5.3. We used Meta-DiSc 1.4 software and the Stata 15.0 software to create forest plots, a meta-regression, a bivariate boxplot and a Deeks’ funnel plot. Results A total of 18 four-fold tables from 16 studies were analysed. The overall pooled sensitivity and specificity of PCR was 94% and 72%, respectively. The positive likelihood ratio (RLR) and negative likelihood ratio (NLR) was 2.73 and 0.12, respectively. The result of the diagnostic odds ratio (DOR) was 22.85 and the area under the curve (AUC) was 0.7884. Conclusion Establishing a laboratory diagnostic tool for L. pneumophila detection is important for epidemiological studies. In this work, PCR demonstrated a promising diagnostic accuracy for L. pneumophila. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-022-00503-9.
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Affiliation(s)
- Xin Yin
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.,Department of Pediatrics, The Pediatrics School of Guangzhou Medical University, Guangzhou, 510182, China
| | - Ying-Zhou Chen
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.,Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | - Qi-Qing Ye
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.,Department of Pediatrics, The Pediatrics School of Guangzhou Medical University, Guangzhou, 510182, China
| | - Li-Juan Liao
- Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | - Zhuo-Rui Cai
- Department of Preventive Medicine, The School of Public Health of Guangzhou Medical University, Guangzhou, 511436, China
| | - Min Lin
- Department of Traditional Chinese and Western Medicine in Clinical Medicine, The Clinical School of Traditional Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, 511436, China
| | - Jia-Na Li
- Department of Medical Imaging, The Second Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | - Geng-Biao Zhang
- Department of Medical Imaging, The Second Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | - Xiao-Li Peng
- Department of Traditional Chinese and Western Medicine in Clinical Medicine, The Clinical School of Traditional Chinese and Western Medicine of Guangzhou Medical University, Guangzhou, 511436, China
| | - Wen-Fang Shi
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, 511436, China
| | - Xu-Guang Guo
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China. .,Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, 511436, China. .,Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China. .,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
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Riccò M, Ferraro P, Peruzzi S, Zaniboni A, Ranzieri S. SARS-CoV-2-Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020-2021). Microorganisms 2022; 10:499. [PMID: 35336074 PMCID: PMC8951730 DOI: 10.3390/microorganisms10030499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
Legionnaires' Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila. Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129-0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2-Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Pietro Ferraro
- Servizio di Medicina del Lavoro, ASL di Foggia, 71121 Foggia, Italy;
| | - Simona Peruzzi
- AUSL–IRCCS di Reggio Emilia, Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, 42016 Guastalla, Italy;
| | - Alessandro Zaniboni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.Z.); (S.R.)
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.Z.); (S.R.)
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ÖZİŞ M, KAYA H, BOZOK T, TEZCAN ÜLGER S, ASLAN G. Investigation of Legionella bacteria in water and cooling systems of a university in Turkey. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1033028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives: Colonization of Legionella in water systems is among the factors affecting the incidence of community and hospital-acquired pneumonia. In this study, it was aimed to investigate the presence of Legionella in the water and cooling systems of the inpatient services of the faculty of medicine hospital and the faculties of the university.
Material and Methods: The presence of Legionella was investigated in 418 water and swab samples were taken from the water and cooling systems of the inpatient services of X University Faculty of Medicine Research and Practice Hospital and 11 faculties of the university between February-October 2020. Collected water and swab samples were inoculated into BCYE medium and identification at the species and serogroups by latex agglutination test. In addition, rpoB sequencing was used to confirm these isolates.
Results: Legionella were isolated in four (4.1%) of the samples collected from the inpatient services of the hospital and in three (0.9%) of the samples collected from the faculties (n=321), in total seven (1.67%) samples. One of these isolates (14.3%) was grouped as L.pneumophila serogroup 2-14 and six (85.7%) as L.pneumophila serogroup 1 by latex agglutination test. Species identifications were consistent with sequence analysis results.
Conclusion: The isolation of L.pneumophila in samples taken from inpatient services at a higher rate than in faculties poses a great risk. Although the detection rate of Legionella in our study was low, we think that regular disinfection, follow-up and inspection of water and cooling systems may be effective in reducing Legionella-related pneumonias.
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Affiliation(s)
- Merve ÖZİŞ
- MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, TEMEL TIP BİLİMLERİ BÖLÜMÜ, TIBBİ MİKROBİYOLOJİ ANABİLİM DALI
| | - Hamide KAYA
- MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, TEMEL TIP BİLİMLERİ BÖLÜMÜ, TIBBİ MİKROBİYOLOJİ ANABİLİM DALI
| | - Taylan BOZOK
- MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, TEMEL TIP BİLİMLERİ BÖLÜMÜ, TIBBİ MİKROBİYOLOJİ ANABİLİM DALI
| | - Seda TEZCAN ÜLGER
- MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, TEMEL TIP BİLİMLERİ BÖLÜMÜ, TIBBİ MİKROBİYOLOJİ ANABİLİM DALI
| | - Gönül ASLAN
- MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, TEMEL TIP BİLİMLERİ BÖLÜMÜ, TIBBİ MİKROBİYOLOJİ ANABİLİM DALI
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The Legionella genus core effectors display functional conservation among orthologs by themselves or combined with an accessory protein. CURRENT RESEARCH IN MICROBIAL SCIENCES 2022; 3:100105. [PMID: 35059677 PMCID: PMC8760000 DOI: 10.1016/j.crmicr.2022.100105] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/03/2022] Open
Abstract
The Legionella genus contains nine core effectors. Three Legionella pneumophila core effectors are required for intracellular growth. The Legionella genus core effectors display functional conservation among orthologs. One Legionella core effector requires an accessory protein to perform its function.
The intracellular pathogen Legionella pneumophila, as well as other Legionella species, utilize the Icm/Dot type-IV secretion system to translocate an exceptionally large and diverse repertoire of effectors into their host cells. However, only nine core effectors were found to be present in all analyzed Legionella species. In this study, we investigated the core effectors, and used intracellular growth complementation to determine whether orthologs of core effectors perform the same function in different Legionella species. We found that three out of the nine L. pneumophila core effectors are required for maximal intracellular growth. Examination of orthologous core effectors from four Legionella species spread over the Legionella phylogenetic tree revealed that most of them perform the same function. Nevertheless, some of the orthologs of the core effector LegA3 did not complement the L. pneumophila legA3 deletion mutant for intracellular growth. LegA3 is encoded as part of an operon together with another gene, which we named legA3C, encoding a non-translocated protein. We found that LegA3 and LegA3C physically interact with each other, are both required for maximal intracellular growth, and the LegA3-LegA3C orthologous pairs from all the Legionella species examined fully complement the L. pneumophila legA3 deletion mutant for intracellular growth. Our results indicate that the Legionella core effectors orthologs generally perform the same function and establish that LegA3 requires LegA3C to fulfill its conserved function.
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National survey of physicians in Japan regarding their use of diagnostic tests for legionellosis. J Infect Chemother 2021; 28:129-134. [PMID: 34933785 DOI: 10.1016/j.jiac.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/20/2021] [Accepted: 12/10/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Bacterial culture remains the gold standard for the diagnosis of legionellosis. However, past reports indicate that most physicians use the urinary antigen test (UAT) alone. Combining it with other tests is important, especially in patients with negative UAT results. The aim of this study was to investigate the current situation of legionellosis diagnostics and clarify the issues that need to be addressed. METHODS Between March 1, 2021 and April 30, 2021, a questionnaire survey was conducted in an anonymous manner among physicians working in Japan. Questionnaires were generated on a website and asked questions in a multiple-choice format. RESULTS Valid responses were received from 309 physicians during the study period. Most (92.9%) physicians reported using UAT as the initial test for patients suspected of having legionellosis, and <10% reported using other tests (e.g., culture, nucleic acid amplification test [NAAT], Gimenez staining, and serum antibody titer measurement [ATM]). When the initial test result was negative, 63% of physicians reported not conducting additional tests. Even when they chose to run additional tests, at most 27.8%, 23.6%, 12.3%, and 10.4% of all physicians used NAAT, culture, Gimenez staining, and serum ATM, respectively. The major reasons for not using tests other than UAT were "unavailability in the medical facility," "long turn-around time," and "difficult to collect sputum." CONCLUSIONS The present survey revealed that most physicians in Japan used UAT alone for diagnosing legionellosis. Eliminating barriers to creating a reasonable environment and edification of physicians are needed to improve the current situation.
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Riccò M, Peruzzi S, Ranzieri S, Giuri PG. Epidemiology of Legionnaires' Disease in Italy, 2004-2019: A Summary of Available Evidence. Microorganisms 2021; 9:microorganisms9112180. [PMID: 34835307 PMCID: PMC8624895 DOI: 10.3390/microorganisms9112180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 01/11/2023] Open
Abstract
Legionnaires’ disease (LD) incidence has been increasing in several European countries since 2011. Currently, Italy is experiencing high notification rates for LD, whose cause still remains scarcely understood. We sought to summarize the available evidence on the epidemiology of LD in Italy (2004–2019), characterizing the risk of LD by region, sex, age group, and settings of the case (i.e., community, healthcare, or travel-associated cases). Environmental factors (e.g., average air temperatures and relative humidity) were also included in a Poisson regression model in order to assess their potential role on the annual incidence of new LD cases. National surveillance data included a total of 23,554 LD cases occurring between 2004 and 2019 (70.4% of them were of male gender, 94.1% were aged 40 years and older), with age-adjusted incidence rates increasing from 1.053 cases per 100,000 in 2004 to 4.559 per 100,000 in 2019. The majority of incident cases came from northern Italy (43.2% from northwestern Italy, 25.6% from northeastern Italy). Of these, 5.9% were healthcare-related, and 21.1% were travel-associated. A case-fatality ratio of 5.2% was calculated for the whole of the assessed timeframe, with a pooled estimate for mortality of 0.122 events per 100,000 population per year. Poisson regression analysis was associated with conflicting results, as any increase in average air temperature resulted in reduced risk for LD cases (Incidence Rate Ratio [IRR] 0.807, 95% Confidence Interval [95% CI] 0.744–0.874), while higher annual income in older individuals was associated with an increased IRR (1.238, 95% CI 1.134–1.351). The relative differences in incidence between Italian regions could not be explained by demographic factors (i.e., age and sex distribution of the population), and also a critical reappraisal of environmental factors failed to substantiate both the varying incidence across the country and the decennial trend we were able to identify.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL—IRCCS di Reggio Emilia, Via Amendola n.2, I-42022 Reggio Emilia, Italy
- Correspondence: or ; Tel.: +39-3392-994-343 or +39-522-837-587
| | - Simona Peruzzi
- Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, AUSL—IRCCS di Reggio Emilia, I-42016 Guastalla, Italy;
| | - Silvia Ranzieri
- Department of Medicine and Surgery, School of Occupational Medicine, University of Parma, Via Gramsci n.14, I-43123 Parma, Italy;
| | - Pasquale Gianluca Giuri
- Dipartimento Internistico Interaziendale, Struttura Operativa Semplice Dipartimentale “Medicina Infettivologica”, AUSL—IRCCS di Reggio Emilia, Ospedale “Sant’Anna”, I-42035 Castelnovo ne’ Monti, Italy;
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Croze A, Carlino A, Quélard B, Saha A, Convert T, Eberst JB, Demanèche S. Intracellular Behaviour of Legionella Non- pneumophila Strains within Three Amoeba Strains, Including Willaertia magna C2c Maky. Pathogens 2021; 10:pathogens10101350. [PMID: 34684299 PMCID: PMC8538512 DOI: 10.3390/pathogens10101350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 01/05/2023] Open
Abstract
Legionellosis, an often-lethal pneumonia, is generally associated with contamination by Legionella pneumophila. This bacterium can persist in the environment and resist chemical treatment when it is internalized by amoebae. In addition, there is increasing medical proof that other Legionella species can be causative agents of Legionellosis. The objective of this study was to evaluate whether Legionella non-pneumophila (Lnp) strains were able to use the machinery of amoeba to multiply, or whether amoebae were able to limit their proliferation. Seven strains belonging to the species L. longbeachae, L. anisa, L. bozemanae, L. taurinensis, and L. dumoffii were cocultured with three amoebae, Acanthamoeba castellanii, Willaertia magna T5(S)44, and Willaertia magna C2c Maky, at two temperatures, 22 and 37 °C. We found that at 22 °C, all amoebae were able to phagocytose the seven Lnp strains and to avoid intracellular development, except for L. longbeachae, which was able to multiply inside W. magna T5(S)44. At 37 °C, four Lnp strains were able to hijack the machinery of one or two amoebae and to use it to proliferate, but none were able to multiply inside W. magna C2c Maky.
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Tata A, Marzoli F, Massaro A, Passabì E, Bragolusi M, Negro A, Cristaudo I, Piro R, Belluco S. Assessing direct analysis in real-time mass spectrometry for the identification and serotyping of Legionella pneumophila. J Appl Microbiol 2021; 132:1479-1488. [PMID: 34543502 DOI: 10.1111/jam.15301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 12/11/2022]
Abstract
AIMS The efficacy of ambient mass spectrometry to identify and serotype Legionella pneumophila was assessed. To this aim, isolated waterborne colonies were submitted to a rapid extraction method and analysed by direct analysis in real-time mass spectrometry (DART-HRMS). METHODS AND RESULTS The DART-HRMS profiles, coupled with partial least squares discriminant analysis (PLS-DA), were first evaluated for their ability to differentiate Legionella spp. from other bacteria. The resultant classification model achieved an accuracy of 98.1% on validation. Capitalising on these encouraging results, DART-HRMS profiling was explored as an alternative approach for the identification of L. pneumophila sg. 1, L. pneumophila sg. 2-15 and L. non-pneumophila; therefore, a different PLS-DA classifier was built. When tested on a validation set, this second classifier reached an overall accuracy of 95.93%. It identified the harmful L. pneumophila sg. 1 with an impressive specificity (100%) and slightly lower sensitivity (91.7%), and similar performances were reached in the classification of L. pneumophila sg. 2-15 and L. non-pneumophila. CONCLUSIONS The results of this study show the DART-HMRS method has good accuracy, and it is an effective method for Legionella serogroup profiling. SIGNIFICANCE AND IMPACT OF THE STUDY These preliminary findings could open a new avenue for the rapid identification and quick epidemiologic tracing of L. pneumophila, with a consequent improvement to risk assessment.
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Affiliation(s)
- Alessandra Tata
- Istituto Zooprofilattico Sperimentale delle Venezie, Laboratorio di Chimica Sperimentale, Vicenza, Italy
| | - Filippo Marzoli
- Department of Food Safety, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Andrea Massaro
- Istituto Zooprofilattico Sperimentale delle Venezie, Laboratorio di Chimica Sperimentale, Vicenza, Italy
| | - Eleonora Passabì
- Department of Food Safety, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Marco Bragolusi
- Istituto Zooprofilattico Sperimentale delle Venezie, Laboratorio di Chimica Sperimentale, Vicenza, Italy
| | - Alessandro Negro
- Istituto Zooprofilattico Sperimentale delle Venezie, Laboratorio di Chimica Sperimentale, Vicenza, Italy
| | - Ilaria Cristaudo
- Department of Food Safety, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Roberto Piro
- Istituto Zooprofilattico Sperimentale delle Venezie, Laboratorio di Chimica Sperimentale, Vicenza, Italy
| | - Simone Belluco
- Department of Food Safety, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
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Walker JT, McDermott PJ. Confirming the Presence of Legionella pneumophila in Your Water System: A Review of Current Legionella Testing Methods. J AOAC Int 2021; 104:1135-1147. [PMID: 33484265 PMCID: PMC8378878 DOI: 10.1093/jaoacint/qsab003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022]
Abstract
Legionnaires' disease has been recognized since 1976 and Legionella pneumophila still accounts for more than 95% of cases. Approaches in countries, including France, suggest that focusing risk reduction specifically on L. pneumophila is an effective strategy, as detecting L. pneumophila has advantages over targeting multiple species of Legionella. In terms of assays, the historically accepted plate culture method takes 10 days for confirmed Legionella spp. results, has variabilities which affect trending and comparisons, requires highly trained personnel to identify colonies on a plate in specialist laboratories, and does not recover viable-but-non-culturable bacteria. PCR is sensitive, specific, provides results in less than 24 h, and determines the presence/absence of Legionella spp. and/or L. pneumophila DNA. Whilst specialist personnel and laboratories are generally required, there are now on-site PCR options, but there is no agreement on comparing genome units to colony forming units and action limits. Immunomagnetic separation assays are culture-independent, detect multiple Legionella species, and results are available in 24 h, with automated processing options. Field-use lateral flow devices provide presence/absence determination of L. pneumophila serogroup 1 where sufficient cells are present, but testing potable waters is problematic. Liquid culture most probable number (MPN) assays provide confirmed L. pneumophila results in 7 days that are equivalent to or exceed plate culture, are robust and reproducible, and can be performed in a variety of laboratory settings. MPN isolates can be obtained for epidemiological investigations. This accessible, non-technical review will be of particular interest to building owners, operators, risk managers, and water safety groups and will enable them to make informed decisions to reduce the risk of L. pneumophila.
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Abstract
OBJECTIVES: Few studies have reported the complications and outcomes of patients with Legionella pneumonia requiring ICU admission. The objective of our study is to report the clinical course, complications, and 30-day mortality of patients with Legionella pneumonia admitted to the critical care units at our medical center over a 10-year period. DESIGN: Retrospective observational study. SETTING: Tertiary care teaching hospital. PATIENTS: All adult (≥ 18 yr old) patients with Legionella pneumonia admitted to the ICUs from January 1, 2010, to December 31, 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 88 patients with Legionella pneumonia were admitted to ICUs over the 10-year period. The majority of infections (n = 80; 90.9%) were community acquired. The median (interquartile range) age of patients was 60 years (51.5–71.0 yr); 58 (66%) were male, and 41 (46.6%) identified their race as Black. The median (interquartile range) Sequential Organ Failure Assessment score at ICU admission was 6 (3–9). The distribution of infections showed seasonal dominance with most cases (86%) occurring in the summer to early fall (May to October). Invasive mechanical ventilation was required in 62 patients (70.5%), septic shock developed in 57 patients (64.8%), and acute respiratory distress syndrome developed in 42 patients (47.7%). A majority of patients developed acute kidney injury (n = 69; 78.4%), with 15 (21.7%) receiving only intermittent hemodialysis and 15 (21.7%) requiring continuous renal replacement therapy. Ten patients required venovenous extracorporeal membrane oxygenation support; eight (80%) survived and were successfully decannulated. Overall 30-day mortality was 26.1% (n = 23). Advanced age, higher Sequential Organ Failure Assessment score at admission, and not receiving Legionella-specific antimicrobial therapy within 24 hours of hospital admission were predictors of 30-day mortality. CONCLUSIONS: Patients with Legionella pneumonia may require ICU admission and major organ support. Legionella-targeted antibiotics should be included in the empiric regimen for any patient with severe pneumonia. Outcomes of extracorporeal membrane oxygenation therapy in this population are encouraging.
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Vittal R, Raj JRM, Kumar BK, Karunasagar I. Advances in Environmental Detection and Clinical Diagnostic Tests for Legionella Species. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1731863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Legionella is a fastidious organism that is difficult to culture in the lab but is widely distributed in environmental, domestic, and hospital settings. The clinical manifestations due to Legionella infections range from mild fever to fatal pneumonia and multiorgan pathologies. Legionella outbreaks though prevalent globally are not reported in developing countries due to difficulties in isolating this organism and the lack of simple diagnostic protocols. Here, we review the literature from across countries to present various methods used to detect Legionella from environmental and clinical samples. We compare the sensitivity and the specificity of the conventional culture-based assays with the recent methods and discuss approaches to develop better detection and diagnostic tests. With better cost-effective detection techniques and regular monitoring of the susceptible sites, which may harbor Legionella colonies, most of the Legionella infections can be prevented. As a result, considerable burden, caused by Legionella infections, on the healthcare system, in especially economically weaker countries, can be mitigated.
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Affiliation(s)
- Rajeshwari Vittal
- Division of Infectious Diseases, Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
| | - Juliet Roshini Mohan Raj
- Division of Infectious Diseases, Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
| | - Ballamoole Krishna Kumar
- Division of Infectious Diseases, Nitte University Centre for Science Education and Research, Deralakatte, Mangaluru, Karnataka, India
| | - Indrani Karunasagar
- Nitte University Centre for Science Education and Research, Mangaluru, Karnataka, India
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Yue R, Wu X, Li T, Chang L, Huang X, Pan L. Early Detection of Legionella pneumophila and Aspergillus by mNGS in a Critically Ill Patient With Legionella Pneumonia After Extracorporeal Membrane Oxygenation Treatment: Case Report and Literature Review. Front Med (Lausanne) 2021; 8:686512. [PMID: 34277662 PMCID: PMC8277993 DOI: 10.3389/fmed.2021.686512] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/31/2021] [Indexed: 01/07/2023] Open
Abstract
Legionella pneumophila can cause pneumonia, leading to severe acute respiratory distress syndrome (ARDS). Because of its harsh growth requirements, limited detection methods, and non-specific clinical manifestations, diagnosing Legionella pneumonia remains still challenging. Metagenomic next-generation sequencing (mNGS) technology has increased the rate of detection of Legionella. This study describes a patient who rapidly progressed to severe ARDS during the early stage of infection and was treated with extracorporeal membrane oxygenation (ECMO). Although his bronchoalveolar lavage fluid (BALF) was negative for infection and his serum was negative for anti-Legionella antibody, mNGS of his BALF and blood showed only the presence of Legionella pneumophila (blood mNGS reads 229, BALF reads 656). After antibiotic treatment and weaning from ECMO, however, he developed a secondary Aspergillus and Klebsiella pneumoniae infection as shown by mNGS. Mechanical ventilation and antibiotic treatment were effective. A search of PubMed showed few reports of secondary Aspergillus infections after Legionella infection. Severe pneumonia caused by any type of pathogenic bacteria may be followed by Aspergillus infection, sometimes during extremely early stages of infection. Patients with severe pneumonia caused by Legionella infection should undergo early screening for secondary infections using methods such as mNGS, enabling early and precise treatment, thereby simplifying the use of antibiotics and improving patient prognosis.
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Affiliation(s)
- Ruiming Yue
- Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xiaoxiao Wu
- Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Tianlong Li
- Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Li Chang
- Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xiaobo Huang
- Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Lingai Pan
- Department of Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Linsky M, Segal G. A horizontally acquired Legionella genomic island encoding a LuxR type regulator and effector proteins displays variation in gene content and regulation. Mol Microbiol 2021; 116:766-782. [PMID: 34120381 DOI: 10.1111/mmi.14770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022]
Abstract
The intracellular pathogen Legionella pneumophila translocates >300 effector proteins into host cells, many of which are regulated at the transcriptional level. Here, we describe a novel L. pneumophila genomic island, which undergoes horizontal gene transfer within the Legionella genus. This island encodes two Icm/Dot effectors: LegK3 and a previously uncharacterized effector which we named CegK3, as well as a LuxR type regulator, which we named RegK3. Analysis of this island in different Legionella species revealed a conserved regulatory element located upstream to the effector-encoding genes in the island. Further analyses, including gene expression analysis, mutagenesis of the RegK3 regulatory element, controlled expression studies, and gel-mobility shift assays, all demonstrate that RegK3 directly activates the expression levels of legK3 and cegK3 effector-encoding genes. Additionally, the expression of all the components of the island is silenced by the Fis repressors. Comparison of expression profiles of these three genes among different Legionella species revealed variability in the activation levels mediated by RegK3, which were positively correlated with the Fis-mediated repression. Furthermore, LegK3 and CegK3 effectors moderately inhibit yeast growth, and importantly, they have a strong synergistic inhibitory effect on yeast growth, suggesting these two effectors are not only co-regulated but also might function together.
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Affiliation(s)
- Marika Linsky
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Segal
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Nakamura A, Fukuda S, Kusuki M, Watari H, Shimura S, Kimura K, Nishi I, Komatsu M. Evaluation of five Legionella urinary antigen detection kits including new Ribotest Legionella for simultaneous detection of ribosomal protein L7/L12. J Infect Chemother 2021; 27:1533-1535. [PMID: 34088604 DOI: 10.1016/j.jiac.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/10/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
Urinary antigen tests are a widely used rapid diagnostic method for Legionella pneumonia. However, conventional urinary antigen tests are unable to detect anything other than Legionella pneumophila serogroup 1. The Ribotest Legionella (Ribotest) can detect all serogroups by using antibodies recognizing L. pneumophila ribosomal protein L7/L12 in addition to the conventional L. pneumophila serogroup 1 lipopolysaccharide. The aim of this study was to evaluate the performance of Ribotest against conventional urinary antigen tests, including the detection of Legionellaceae other than L. pneumophila. We investigated the detection sensitivity of various kits using in-vitro culture-soluble antigen extracts of ATCC strains and 22 clinical isolates collected from multiple medical facilities in the Kinki region of Japan. For L. pneumophila serogroup 1, four kits, including Ribotest, had a detection sensitivity of 105 CFU/mL, with only Check Legionella having a sensitivity of 106 CFU/mL. L. pneumophila non-serogroup 1 and Legionellaceae of other species were undetectable by the four conventional kits, whereas Ribotest could detect them with a sensitivity of 105-108 CFU/mL. The Ribotest was also able to detect other species such as Legionella hackeliae, Legionella feeleii, Legionella anisa, Fluoribacter bozemanae, and Fluoribacter dumoffii, but the detection sensitivity of L. hackeliae and L. feeleii was 108 CFU/mL, which was much lower than that of the other strains. The Ribotest has high potential to be applied as a rapid diagnostic method for pneumonia caused by other species of Legionella and Fluoribacter.
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Affiliation(s)
- Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan.
| | - Saori Fukuda
- Department of Clinical Laboratory, Tenri Hospital, Tenri, Japan
| | - Mari Kusuki
- Department of Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Hideo Watari
- Department of Clinical Laboratory, Otemae Hospital, Osaka, Japan
| | - Satoshi Shimura
- Department of Clinical Laboratory, Otemae Hospital, Osaka, Japan
| | - Keigo Kimura
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka, Japan
| | - Isao Nishi
- Laboratory for Clinical Investigation, Osaka University Hospital, Osaka, Japan
| | - Masaru Komatsu
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
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Checa J, Carbonell I, Manero N, Martí I. Comparative study of Legiolert with ISO 11731-1998 standard method-conclusions from a Public Health Laboratory. J Microbiol Methods 2021; 186:106242. [PMID: 34019935 DOI: 10.1016/j.mimet.2021.106242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Legionella pneumophila (L. pneumophila) is responsible for 96% of Legionnaires' disease (LD) and 10% of all worldwide pneumonia cases. Legiolert™, a liquid culture method for most probable number (MPN) enumeration of L. pneumophila, was developed by IDEXX Laboratories. The method detects all serogroups of L. pneumophila in potable and non-potable water samples. OBJECTIVE The goal of this study is to establish that Legiolert is a suitable alternative method to meet testing requirements in Spain for the enumeration of Legionella in water samples. METHODOLOGY The laboratory analyzed 118 environmental water samples from the Barcelona region (56 potable and 62 non-potable) in parallel by the Standard method for detection and enumeration of Legionella (ISO 11731:1998) and by Legiolert. Comparison of the recovery of the alternative method (Legiolert) and the Standard was made using ISO 17994:2014 and McNemar's binomial test statistical methods. RESULTS 44 samples were positive for Legionella (36 potable and 8 non-potable). Legiolert and the Standard method detected a similar percentage of positive samples, with Legiolert being slightly higher (31 vs 30%) and detecting higher concentrations of Legionella within the samples. ISO 17994:2014 analysis of the potable water samples found Legiolert was more sensitive than the Standard at detecting Legionella, even when complete Legionella species (L. spp.) results were considered for both methods. The two methods also demonstrated equivalent detection of L. spp. according to the McNemar's test. The comparison is significantly more in favor of Legiolert when only L. pneumophila results are considered. Each confirmation run with material extracted from positive Legiolert wells contained L. pneumophila, giving the method a specificity of 100%. Although statistical results for non-potable waters are not included because of the low number of samples, the two methods trended towards equivalence. CONCLUSIONS Relative to the Standard method, Legiolert has a greater sensitivity and selectivity, and appears to have higher recovery for L. pneumophila, and equivalent recovery when L. spp. is included in the comparison. Legiolert also has high specificity. The procedural advantages of Legiolert allow laboratories to save on resources, costs, and time and consequently to test more frequently. In conclusion, the study finds IDEXX Legiolert a suitable alternative to ISO 11731:1998.
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Affiliation(s)
- Javier Checa
- Public Health Laboratory of L'Hospitalet. Health Service, L'Hospitalet City Council, Cobalt Building. Cobalt street, 57-59, 2nd floor, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Iago Carbonell
- Public Health Laboratory of L'Hospitalet. Health Service, L'Hospitalet City Council, Cobalt Building. Cobalt street, 57-59, 2nd floor, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Neus Manero
- Public Health Laboratory of L'Hospitalet. Health Service, L'Hospitalet City Council, Cobalt Building. Cobalt street, 57-59, 2nd floor, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Inés Martí
- Public Health Laboratory of L'Hospitalet. Health Service, L'Hospitalet City Council, Cobalt Building. Cobalt street, 57-59, 2nd floor, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
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Gonçalves IG, Simões LC, Simões M. Legionella pneumophila. Trends Microbiol 2021; 29:860-861. [PMID: 33994277 DOI: 10.1016/j.tim.2021.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Inês G Gonçalves
- LEPABE, Faculty of Engineering, Department of Chemical Engineering, University of Porto, Porto, Portugal; M2BE, Aragon Institute of Engineering Research, Mechanical Engineering Department, University of Zaragoza, Zaragoza, Spain
| | - Lúcia C Simões
- CEB, Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga, Portugal.
| | - Manuel Simões
- LEPABE, Faculty of Engineering, Department of Chemical Engineering, University of Porto, Porto, Portugal.
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Mazzotta M, Salaris S, Pascale MR, Girolamini L, Cristino S. Occurrence of Legionella spp. in Man-Made Water Sources: Isolates Distribution and Phylogenetic Characterization in the Emilia-Romagna Region. Pathogens 2021; 10:552. [PMID: 34063633 PMCID: PMC8147600 DOI: 10.3390/pathogens10050552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
Legionella species distribution in the Emilia-Romagna region, involving hospital (H) and community (C) environments, was conducted. Legionella culture, agglutination test, and mip-gene sequencing were applied on 240 isolates. The analysis showed a higher prevalence of non-Legionellapneumophila (n-Lp) species (84.1%) compared with L. pneumophila (Lp) (15.9%), with a higher frequency of n-Lp with respect to Lp species in both environments (77.6% and 96.4%, in H and C, respectively). The Shannon index showed a significant difference in Legionella distribution (p = 0.00017), with a significant abundance of Lp in the H compared with C environment (p = 0.00028). The continuous disinfection treatment in H could contribute to adaptive survival of the Lp species. Phylogenetic analysis revealed a conservative clade distribution between H and C: L. feeleii clade with three subclades in C and the Lp clade with five subclades in H and two in C, respectively. Our findings suggest the importance of Legionella surveillance both in H and C, with a focus on n-Lp species less connected to human disease. The Legionella prevalence and diversity found here indicate that geographical and temporal isolate evolution should be considered during surveillance, particularly in the light of global warming and changes in population risk factors.
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Affiliation(s)
| | | | | | | | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (S.S.); (M.R.P.); (L.G.)
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Evaluation of Four Lateral Flow Assays for the Detection of Legionella Urinary Antigen. Microorganisms 2021; 9:microorganisms9030493. [PMID: 33652772 PMCID: PMC7996842 DOI: 10.3390/microorganisms9030493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/29/2022] Open
Abstract
Urinary antigen tests (UATs) are often used to diagnose Legionnaires’ disease as they are rapid and easy to perform on readily obtainable urine samples without the need for specialized skills compared to conventional methods. Recently developed automated readers for UATs may provide objective results interpretation, especially in cases of weak result bands. Using 53 defined patient urine samples, we evaluated the performance of the BinaxNOW Legionella Antigen Card (Abbott), ImmuView S. pneumoniae and Legionella (SSI Diagnostica), STANDARD F Legionella Ag FIA (SD Biosensor), and Sofia Legionella FIA (Quidel) simultaneously with their respective automated readers. Automatic and visual interpretation of result bands were also compared for the immunochromatography-based BinaxNOW and ImmuView UATs. Overall sensitivity and specificity of Legionella UATs were 53.9–61.5% and 90.0–94.9%, respectively. All four UATs successfully detected all samples from L. pneumophila serogroup 1-positive patients, but most failed to detect samples for Legionella spp., or other serogroups. Automatic results interpretation of results was found to be mostly concordant with visual results reading. In conclusion, the performance of the four UATs were similar to each other in the detection of Legionella urinary antigen with no major difference between automated or visual results reading.
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How Molecular Typing Can Support Legionella Environmental Surveillance in Hot Water Distribution Systems: A Hospital Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228662. [PMID: 33233464 PMCID: PMC7700474 DOI: 10.3390/ijerph17228662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
In this study, we aimed to associate the molecular typing of Legionella isolates with a culture technique during routine Legionella hospital environmental surveillance in hot water distribution systems (HWDSs) to develop a risk map able to be used to prevent nosocomial infections and formulate appropriate preventive measures. Hot water samples were cultured according to ISO 11731:2017. The isolates were serotyped using an agglutination test and genotyped by sequence-based typing (SBT) for Legionella pneumophila or macrophage infectivity potentiator (mip) gene sequencing for non-pneumophila Legionella species. The isolates' relationship was phylogenetically analyzed. The Legionella distribution and level of contamination were studied in relation to temperature and disinfectant residues. The culture technique detected 62.21% of Legionella positive samples, characterized by L. pneumophila serogroup 1, Legionella non-pneumophila, or both simultaneously. The SBT assigned two sequence types (STs): ST1, the most prevalent in Italy, and ST104, which had never been isolated before. The mip gene sequencing detected L. anisa and L. rubrilucens. The phylogenetic analysis showed distinct clusters for each species. The distribution of Legionella isolates showed significant differences between buildings, with a negative correlation between the measured level of contamination, disinfectant, and temperature. The Legionella molecular approach introduced in HWDSs environmental surveillance permits (i) a risk map to be outlined that can help formulate appropriate disinfection strategies and (ii) rapid epidemiological investigations to quickly identify the source of Legionella infections.
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Ito A, Yamamoto Y, Ishii Y, Okazaki A, Ishiura Y, Kawagishi Y, Takiguchi Y, Kishi K, Taguchi Y, Shinzato T, Okochi Y, Hayashi R, Nakamori Y, Kichikawa Y, Murata K, Takeda H, Higa F, Miyara T, Saito K, Ishikawa T, Ishida T, Tateda K. Evaluation of a novel urinary antigen test kit for diagnosing Legionella pneumonia. Int J Infect Dis 2020; 103:42-47. [PMID: 33176204 DOI: 10.1016/j.ijid.2020.10.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic utility of a novel test kit that could theoretically detect all serogroups of Legionella pneumophila for diagnosing Legionella pneumonia, in comparison with existing kits. METHODS This study was conducted in 16 hospitals in Japan from April 2016 to December 2018. Three urinary antigen test kits were used: the novel kit (LAC-116), BinaxNOW Legionella (Binax), and Q-line Kyokutou Legionella (Q-line). In addition, sputum culture and nucleic acid detection tests and serum antibody tests were performed where possible. The diagnostic accuracy and correlations of the novel kit with the two existing kits were analyzed. RESULTS In total, 56 patients were diagnosed with Legionella pneumonia. The sensitivities of LAC-116, Binax, and Q-line were 79%, 84%, and 71%, respectively. The overall match rate between LAC-116 and Binax was 96.8% and between LAC-116 and Q-line was 96.4%. One patient had L. pneumophila serogroup 2, and only LAC-116 showed a positive result, whereas Binax and Q-line did not. CONCLUSIONS The novel Legionella urinary antigen test kit was useful for diagnosing Legionella pneumonia. In addition, it could detect Legionella pneumonia caused by non-L. pneumophila serogroup 1.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.
| | - Yoshikazu Ishii
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan.
| | - Akihito Okazaki
- Department of Respiratory Medicine, Koseiren Takaoka Hospital, 5-10 Eirakumachi, Takaoka, Toyama 933-8555, Japan.
| | - Yoshihisa Ishiura
- First Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Yukio Kawagishi
- Department of Internal Medicine, Kurobe City Hospital, 1108-1 Mikkaichi, Kurobe, Toyama 938-8502, Japan.
| | - Yasuo Takiguchi
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, 1273-2 Aoba-chou, Chuo-ku, Chiba, Chiba 260-0852, Japan.
| | - Kazuma Kishi
- Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan.
| | - Takashi Shinzato
- Department of Infectious Diseases and Internal Medicine, Nakagami General Hospital, 610 Noborikawa, Okinawa, Okinawa 904-2195, Japan.
| | - Yasumi Okochi
- Department of Respiratory Medicine, Japan Community Health Care Organization, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0073, Japan.
| | - Ryuji Hayashi
- Clinical Oncology, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.
| | - Yoshitaka Nakamori
- Division of Respiratory Medicine, Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
| | - Yoshiko Kichikawa
- Division of Respiratory Medicine, Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
| | - Kengo Murata
- Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan.
| | - Hiroaki Takeda
- Department of Respiratory Medicine, Yamagata Saisei Hospital, 79-1 Okimachi, Yamagata, Yamagata 990-8545, Japan.
| | - Futoshi Higa
- Department of Internal Medicine, National Hospital Organization Okinawa Hospital, 3-20-14 Ganeko, Ginowan, Okinawa 901-2214, Japan.
| | - Takayuki Miyara
- Department of Infection Prevention and Control, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
| | - Keisuke Saito
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan.
| | - Takeo Ishikawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo 201-8601, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan.
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Palazzolo C, Maffongelli G, D'Abramo A, Lepore L, Mariano A, Vulcano A, Bartoli TA, Bevilacqua N, Giancola ML, Di Rosa E, Nicastri E. Legionella pneumonia: increased risk after COVID-19 lockdown? Italy, May to June 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32734857 PMCID: PMC7393852 DOI: 10.2807/1560-7917.es.2020.25.30.2001372] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of Legionella pneumonia in a dishwasher of a restaurant in Rome, Italy, just after the end of the lockdown that was in place to control the SARS-CoV-2 epidemic. The case highlights the importance of strict monitoring of water and air systems immediately before reopening business or public sector buildings, and the need to consider Legionella infections among the differential diagnosis of respiratory infections after lockdown due to the ongoing COVID-19 pandemic.
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Affiliation(s)
- Claudia Palazzolo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Gaetano Maffongelli
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Alessandra D'Abramo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Luciana Lepore
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Andrea Mariano
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Antonella Vulcano
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | | - Nazario Bevilacqua
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | | | | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
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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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Serrano L, Ruiz LA, Martinez-Indart L, España PP, Gómez A, Uranga A, García M, Santos B, Artaraz A, Zalacain R. Non-bacteremic pneumococcal pneumonia: general characteristics and early predictive factors for poor outcome. Infect Dis (Lond) 2020; 52:603-611. [PMID: 32552142 DOI: 10.1080/23744235.2020.1772991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: Nowadays, most cases of pneumococcal community-acquired pneumonia (PCAP) are diagnosed by positive urinary antigen. Our aims were to analyse process of care in patients hospitalised with non-bacteremic PCAP (NB-PCAP) and identify factors associated with poor outcome (PO) in this population.Methods: We conducted a prospective study, including patients hospitalised for NB-PCAP (positive urinary antigen and negative blood culture) over a 15 year period. We performed multivariate analysis of predisposing factors for PO, defined as need for mechanical ventilation and/or shock and/or in-hospital death.Results: Of the 638 patients included, 4.1% died in hospital and 12.8% had PO. Host-related factors were similar in patients with and without PO, but patients with PO had higher illness severity on admission. Adjusted analysis revealed the following independent factors associated with PO: being a nursing home resident (OR: 6.156; 95% CI: 1.827-20.750; p = .003), respiratory rate ≥30 breaths/min (OR: 3.030; 95% CI: 1.554-5.910; p = .001), systolic blood pressure <90 mmHg (OR: 4.789; 95% CI: 1.967-11.660; p = .001), diastolic blood pressure <60 mmHg (OR: 2.820; 95% CI: 1.329-5.986; p = .007), pulse rate ≥125 beats/min (OR: 3.476; 95% CI: 1.607-7.518; p = .002), pH <7.35 (OR: 9.323; 95% CI: 3.680-23.622; p < .001), leukocytes <4000/µL (OR: 10.007; 95% CI: 2.960-33.835; p < .001), and severe inflammation (OR: 2.364; 95% CI 1.234-4.526; p = .009). The area under the curve for predicting PO was 0.890 (95% CI: 0.851-0.929).Conclusions: Since patients with PO seem different and had worse in-hospital course, we identified eight independent risk factors for PO measurable on admission.
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Affiliation(s)
- Leyre Serrano
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Luis A Ruiz
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Lorea Martinez-Indart
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Pedro P España
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Ainhoa Gómez
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Ane Uranga
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Marta García
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Borja Santos
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Amaia Artaraz
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Rafael Zalacain
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
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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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In Vitro and Intracellular Activities of Omadacycline against Legionella pneumophila. Antimicrob Agents Chemother 2020; 64:AAC.01972-19. [PMID: 32094130 PMCID: PMC7179622 DOI: 10.1128/aac.01972-19] [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: 10/03/2019] [Accepted: 02/14/2020] [Indexed: 11/20/2022] Open
Abstract
Omadacycline is an aminomethylcycline antibiotic with in vitro activity against pathogens causing community-acquired bacterial pneumonia (CABP). This study investigated the activity of omadacycline against Legionella pneumophila strains isolated between 1995 and 2014 from nosocomial or community-acquired respiratory infections. Omadacycline exhibited extracellular activity similar to comparator antibiotics; intracellular penetrance was found by day 3 of omadacycline exposure. These results support the utility of omadacycline as an effective antibiotic for the treatment of CABP caused by L. pneumophila.
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A Novel Legionella Genomic Island Encodes a Copper-Responsive Regulatory System and a Single Icm/Dot Effector Protein Transcriptionally Activated by Copper. mBio 2020; 11:mBio.03232-19. [PMID: 31992628 PMCID: PMC6989116 DOI: 10.1128/mbio.03232-19] [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] [Indexed: 12/31/2022] Open
Abstract
Legionella pneumophila is an intracellular human pathogen that utilizes amoebae as its environmental host. The adaptation of L. pneumophila to the intracellular environment requires coordination of expression of its multicomponent pathogenesis system, which is composed of a secretion system and effector proteins. However, the regulatory factors controlling the expression of this pathogenesis system are only partially uncovered. Here, we discovered a novel regulatory system that is activated by copper and controls the expression of a single effector protein. The genes encoding both the regulatory system and the effector protein are located on a genomic island that undergoes horizontal gene transfer within the Legionella genus. This regulator-effector genomic island represents the first reported case of local regulation of effectors in Legionella. The discovery of this regulatory mechanism is an important step forward in the understanding of how the regulatory network of effectors functions and evolves in the Legionella genus. The intracellular pathogen Legionella pneumophila utilizes the Icm/Dot type IV secretion system to translocate >300 effector proteins into host cells during infection. The regulation of some of these effector-encoding genes was previously shown to be coordinated by several global regulators, including three two-component systems (TCSs) found in all the Legionella species examined. Here, we describe the first Legionella genomic island encoding a single Icm/Dot effector and a dedicated TCS, which regulates its expression. This genomic island, which we named Lci, undergoes horizontal gene transfer in the Legionella genus, and the TCS encoded from this island (LciRS) is homologous to TCSs that control the expression of various metal resistance systems found in other bacteria. We found that the L. pneumophila sensor histidine kinase LciS is specifically activated by copper via a unique, small periplasmic sensing domain. Upon activation by LciS, the response regulator LciR directly binds to a conserved regulatory element and activates the expression of the adjacently located lciE effector-encoding gene. Thus, LciR represents the first local regulator of effectors identified in L. pneumophila. Moreover, we found that the expression of the lciRS operon is repressed by the Fis1 and Fis3 regulators, leading to Fis-mediated effects on copper induction of LciE and silencing of the expression of this genomic island in the absence of copper. This island represents a novel type of effector regulation in Legionella, shedding new light on the ways by which the Legionella pathogenesis system evolves its effector repertoire and expands its activating signals.
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Reuter C, Slesiona N, Hentschel S, Aehlig O, Breitenstein A, Csáki A, Henkel T, Fritzsche W. Loop-mediated amplification as promising on-site detection approach for Legionella pneumophila and Legionella spp. Appl Microbiol Biotechnol 2019; 104:405-415. [PMID: 31832709 DOI: 10.1007/s00253-019-10286-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/08/2019] [Accepted: 11/28/2019] [Indexed: 12/16/2022]
Abstract
Recently Legionella pneumophila is the main causative waterborne organism of severe respiratory infections. Additionally, other Legionella species are documented as human pathogens. In our work, we describe a rapid detection method which combines two advantages for sensitive and specific detection of the genus Legionella: the fast isothermal amplification method "Loop-mediated isothermal AMPlification" (LAMP), and a colorimetric detection method using the metal indicator hydroxynaphtol blue (HBN) which allows to determine an optical signal with a simple readout (with the naked eye). Moreover, we present two approaches for minimizing the assay volume using a stationary microchip LAMP and droplet digital-based LAMP (ddLAMP) as promising highly sensitive setups.
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Affiliation(s)
- Cornelia Reuter
- Leibniz Institute of Photonic Technology (Leibniz IPHT) Jena, Member of the Leibniz Research Alliance-Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany.
| | - Nicole Slesiona
- Leibniz Institute of Photonic Technology (Leibniz IPHT) Jena, Member of the Leibniz Research Alliance-Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Stefanie Hentschel
- Leibniz Institute of Photonic Technology (Leibniz IPHT) Jena, Member of the Leibniz Research Alliance-Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Oliver Aehlig
- Leibniz Institute of Photonic Technology (Leibniz IPHT) Jena, Member of the Leibniz Research Alliance-Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | | | - Andrea Csáki
- Leibniz Institute of Photonic Technology (Leibniz IPHT) Jena, Member of the Leibniz Research Alliance-Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Thomas Henkel
- Leibniz Institute of Photonic Technology (Leibniz IPHT) Jena, Member of the Leibniz Research Alliance-Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
| | - Wolfgang Fritzsche
- Leibniz Institute of Photonic Technology (Leibniz IPHT) Jena, Member of the Leibniz Research Alliance-Leibniz Health Technologies, Albert-Einstein-Straße 9, 07745, Jena, Germany
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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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Maillet F, Bonnet N, Billard-Pomares T, El Alaoui Magdoud F, Tandjaoui-Lambiotte Y. Fatal Legionella pneumophila serogroup 1 pleural empyema: A case report. World J Crit Care Med 2019; 8:99-105. [PMID: 31750087 PMCID: PMC6854392 DOI: 10.5492/wjccm.v8.i6.99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Legionella pneumophila (L. pneumophila) is a gram-negative intracellular bacillus composed of sixteen different serogroups. It is mostly known to cause pneumonia in individuals with known risk factors as immunocompromised status, tobacco use, chronic organ failure or age older than 50 years. Although parapneumonic pleural effusion is frequent in legionellosis, pleural empyema is very uncommon. In this study, we report a case of fatal pleural empyema caused by L. pneumophila serogroup 1 in an 81-year-old man with multiple risk factors.
CASE SUMMARY An 81-year-old man presented to the emergency with a 3 wk dyspnea, fever and left chest pain. His previous medical conditions were chronic lymphocytic leukemia, diabetes mellitus, chronic kidney failure, hypertension and hyperlipidemia, without tobacco use. Chest X-ray and comouted tomography-scan confirmed a large left pleural effusion, which puncture showed a citrine exudate with negative standard bacterial cultures. Despite intravenous cefotaxime antibiotherapy, patient’s worsening condition after 10 d led to thoracocentesis and evacuation of 2 liters of pus. The patient progressively developed severe hypoxemia and multiorgan failure occurred. The patient was treated by antibiotherapy with cefepime and amikacin and with adequate symptomatic shock treatment, but died of uncontrolled sepsis. The next day, cultures of the surgical pleural liquid samples yielded L. pneumophila serogroup 1, consistent with the diagnosis of pleural legionellosis.
CONCLUSION L. pneumophila should be considered in patients with multiple risk factors and undiagnosed pleural empyema unresponsive to conventional antibiotherapy.
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Affiliation(s)
- François Maillet
- Intensive Care Unit, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
| | - Nicolas Bonnet
- Intensive Care Unit, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
- Paris XIII University, Bobigny 93000, France
| | - Typhaine Billard-Pomares
- Microbiology Department, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
| | - Fatma El Alaoui Magdoud
- Microbiology Department, Jean Verdier Hospital, Assistance Publique–Hôpitaux de Paris, Bondy 93140, France
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Community Acquired Legionnaire's Disease in a Kidney Transplant Patient. ACTA ACUST UNITED AC 2019; 39:45-49. [PMID: 30864362 DOI: 10.2478/prilozi-2018-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This case report details the clinical picture of a renal transplant recipient infected with community acquired Legionella pneumonia. While it is more commonly associated as a nosocomial infection due to pathogenic organisms in a hospital's water supply, this case serves as a reminder to consider the patient's impaired cellular immune function when trying to diagnose community acquired pneumonia.
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Moosavian M, Moradzadeh M, Ghadiri A, Saki M. Isolation and Identification of Legionella spp. in environmental water sources based on macrophage infectivity potentiator ( mip) gene sequencing in southwest Iran. AIMS Microbiol 2019; 5:223-231. [PMID: 31663058 PMCID: PMC6787354 DOI: 10.3934/microbiol.2019.3.223] [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: 06/04/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022] Open
Abstract
Legionella species are widespread in natural water sources and man-made aqueous environments, as well as fresh-water. The present study was conducted owing to the lack of research regarding the prevalence of Legionella spp in the water sources of Ahvaz city in southwest Iran. In this study the macrophage infectivity potentiator (mip) gene sequencing was used for identification of various Legionella species isolated from different water sources. In this study, 144 water samples were collected and inoculated on the buffered charcoal-yeast extract (BCYE) agar and modified Wadowsky-Yee (MWY) medium. The DNA was extracted from positive cultures. The Legionella species were confirmed by amplifying a 654 bp fragment of the 16S rRNA gene. The mip gene of all isolates were amplified by PCR and purified for sequencing. The mip gene sequences were analyzed by jPHYDIT software version 1. The results showed a 13.9% (20/144) prevalence of Legionella spp. in water sources of Ahvaz city, southwest Iran. Analyzing of the mip gene sequences showed, out of 20 Legionella isolates, 13 isolates (54.1%) were positive for L. pneumophila, 5 isolates (20.8%) were positive for L. worsleinsis, one isolates for each one of L. dumoffi and L. fairfieldensis, (4.1%). According to our research, the occurrence of Legionella spp in water sources could be a hazard for the health systems especially in the hospitals. The regular monitoring of these water sources by health planners may therefore be useful for decreasing the risk for Legionella spp. infections.
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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
| | - Mina Moradzadeh
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ataollah Ghadiri
- Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Saki
- 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
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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50
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Legionella infection associated with dimethyl fumarate used for treatment of multiple sclerosis. J Neurol 2019; 266:2867-2868. [DOI: 10.1007/s00415-019-09483-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 01/25/2023]
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