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Kim P, Deshpande A, Rothberg MB. Urinary Antigen Testing for Respiratory Infections: Current Perspectives on Utility and Limitations. Infect Drug Resist 2022; 15:2219-2228. [PMID: 35510157 PMCID: PMC9058651 DOI: 10.2147/idr.s321168] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
Pneumonia is a leading cause of hospitalization and death due to infection worldwide. Streptococcus pneumoniae and Legionella pneumophila remain among the most commonly identified bacterial pathogens. Unfortunately, more than half of all pneumonia cases today lack an etiologic diagnosis due to limitations in traditional microbiological methods like blood and sputum cultures, which are affected by poor sample collection, prior antibiotic administration, and delayed processing. Urinary antigen tests (UATs) for S. pneumoniae and L. pneumophila have emerged as powerful tools for improving the diagnosis of bacterial respiratory infections, enabling physicians to administer early directed therapy and improve antimicrobial stewardship. UATs are simple, rapid, and non-invasive diagnostic tests with high specificity (>90%) and moderate sensitivity (<80%). The potential impact of urinary antigen testing is especially significant for respiratory infections caused by Legionella. While all recommended community-acquired pneumonia (CAP) therapies are adequate for treating pneumococcal pneumonia, only certain antibiotics are effective against Legionella. Delayed therapy for Legionella is associated with worse clinical outcomes, which underscores the importance of rapid diagnostic methods like UATs. Despite their potential impact, current American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) guidelines argue against the routine use of urinary antigen testing for S. pneumoniae and L. pneumophila, except in patients with severe CAP and those with epidemiological risk factors for Legionella. Further research is necessary to evaluate the impact of early targeted treatment due to positive UAT results, as well as optimal strategies for UAT utilization. The purpose of this review is to summarize the UATs available for bacterial respiratory infections, describe current guidelines on their usage, and assess their impact on clinical outcomes and targeted therapy.
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Affiliation(s)
- Priscilla Kim
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Abhishek Deshpande
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
- Correspondence: Michael B Rothberg, Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Ave, Mail Code G10, Cleveland, OH, 44195, USA, Tel +1 216-445-5556, Email
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Pascale MR, Salaris S, Mazzotta M, Girolamini L, Fregni Serpini G, Manni L, Grottola A, Cristino S. New Insight regarding Legionella Non- Pneumophila Species Identification: Comparison between the Traditional mip Gene Classification Scheme and a Newly Proposed Scheme Targeting the rpoB Gene. Microbiol Spectr 2021; 9:e0116121. [PMID: 34908503 PMCID: PMC8672888 DOI: 10.1128/spectrum.01161-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
The identification of Legionella non-pneumophila species (non-Lp) in clinical and environmental samples is based on the mip gene, although several studies suggest its limitations and the need to expand the classification scheme to include other genes. In this study, the development of a new classification scheme targeting the rpoB gene is proposed to obtain a more reliable identification of 135 Legionella environmental isolates. All isolates were sequenced for the mip and rpoB genes, and the results were compared to study the discriminatory power of the proposed rpoB scheme. Complete concordance between the mip and rpoB results based on genomic percent identity was found for 121/135 (89.6%) isolates; in contrast, discordance was found for 14/135 (10.4%) isolates. Additionally, due to the lack of reference values for the rpoB gene, inter- and intraspecies variation intervals were calculated based on a pairwise identity matrix that was built using the entire rpoB gene (∼4,107 bp) and a partial region (329 bp) to better evaluate the genomic identity obtained. The interspecies variation interval found here (4.9% to 26.7%) was then proposed as a useful sequence-based classification scheme for the identification of unknown non-Lp isolates. The results suggest that using both the mip and rpoB genes makes it possible to correctly discriminate between several species, allowing possible new species to be identified, as confirmed by preliminary whole-genome sequencing analyses performed on our isolates. Therefore, starting from a valid and reliable identification approach, the simultaneous use of mip and rpoB associated with other genes, as it occurs with the sequence-based typing (SBT) scheme developed for Legionella pneumophila, could support the development of multilocus sequence typing to improve the knowledge and discovery of Legionella species subtypes. IMPORTANCELegionella spp. are a widely spread bacteria that cause a fatal form of pneumonia. While traditional laboratory techniques have provided valuable systems for Legionella pneumophila identification, the amplification of the mip gene has been recognized as the only useful tool for Legionella non-pneumophila species identification both in clinical and environmental samples. Several studies focused on the mip gene classification scheme showed its limitations and the need to improve the classification scheme, including other genes. Our study provides significant advantages on Legionella identification, providing a reproducible new rpoB gene classification scheme that seems to be more accurate than mip gene sequencing, bringing out greater genetic variation on Legionella species. In addition, the combined use of both the mip and rpoB genes allowed us to identify presumed new Legionella species, improving epidemiological investigations and acquiring new understanding on Legionella fields.
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Affiliation(s)
- Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Giulia Fregni Serpini
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Laura Manni
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Antonella Grottola
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
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Bagheri H, Khaledi A, Ghanizadeh G, Esmaeili D. Efficacy of PCR Analysis of Mip, Doth and Gspd Genes with Culture in Detection of Legionella pneumophila. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1079-1081. [PMID: 34183971 PMCID: PMC8223580 DOI: 10.18502/ijph.v50i5.6130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hamid Bagheri
- Department of Microbiology and Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azad Khaledi
- Infectious Diseases Research Center, Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Ghader Ghanizadeh
- Health School, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Davoud Esmaeili
- Department of Microbiology and Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Falcone M, Russo A, Tiseo G, Cesaretti M, Guarracino F, Menichetti F. Predictors of intensive care unit admission in patients with Legionella pneumonia: role of the time to appropriate antibiotic therapy. Infection 2020; 49:321-325. [PMID: 33315182 PMCID: PMC7734452 DOI: 10.1007/s15010-020-01565-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 01/11/2023]
Abstract
Purpose Legionella spp. pneumonia (LP) is a cause of community-acquired pneumonia (CAP) that requires early intervention. The median mortality rate varies from 4 to 11%, but it is higher in patients admitted to intensive care unit (ICU). The objective of this study is to identify predictors of ICU admission in patients with LP. Methods A single-center, retrospective, observational study conducted in an academic tertiary-care hospital in Pisa, Italy. Adult patients with LP consecutively admitted to study center from October 2012 to October 2019. Results During the study period, 116 cases of LP were observed. The rate of ICU admission was 20.7% and the overall 30-day mortality rate was 12.1%. Mortality was 4.3% in patients hospitalized in medical wards versus 41.7% in patients transferred to ICU (p < 0.001). The majority of patients (74.1%) received levofloxacin as definitive therapy, followed by macrolides (16.4%), and combination of levofloxacin plus a macrolide (9.5%). In the multivariate analysis, diabetes (OR 8.28, CI 95% 2.11–35.52, p = 0.002), bilateral pneumonia (OR 10.1, CI 95% 2.74–37.27, p = 0.001), and cardiovascular events (OR 10.91, CI 95% 2.83–42.01, p = 0.001), were independently associated with ICU admission, while the receipt of macrolides/levofloxacin therapy within 24 h from admission was protective (OR 0.20, CI 95% 0.05–0.73, p = 0.01). Patients who received a late anti-Legionella antibiotic (> 24 h from admission) underwent urinary antigen test later compared to those who received early active antibiotic therapy (2 [2–4] vs. 1 [1–2] days, p < 0.001). Conclusions Admission to ICU carries significantly increased mortality in patients with diagnosis of LP. Initial therapy with an antibiotic active against Legionella (levofloxacin or macrolides) reduces the probability to be transferred to ICU and should be provided in all cases until Legionella etiology is excluded.
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Affiliation(s)
- Marco Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Alessandro Russo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Cesaretti
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care, Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Menichetti
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Fischer FB, Schmutz C, Gaia V, Mäusezahl D. Legionnaires' Disease on the Rise in Switzerland: A Denominator-Based Analysis of National Diagnostic Data, 2007-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197343. [PMID: 33050023 PMCID: PMC7579383 DOI: 10.3390/ijerph17197343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 12/17/2022]
Abstract
The risk of falling ill with Legionnaires' disease (LD) is suggested to increase, but the global burden of disease is unknown due to a lack of appropriate diagnosis and surveillance systems. In Switzerland, the number of LD cases, captured by the National Notification System for Infectious Diseases, has more than doubled since 2008. This study aims to investigate this increase, contextualizing disease surveillance data with denominator data, which is not routinely available, i.e., the number of tests performed for Legionella spp. We collected the testing data for Legionella spp. of 14 Swiss diagnostic laboratories and calculated the positivity, defined as the proportion of the number of positive tests to the number of tests performed. The number of positive tests increased proportionally to the number of tests performed; hence, the positivity remained stable. However, the cause of the increase in test volume is unclear and has a large impact on the interpretation of the positivity curve. Further, the test outcome was found to be dependent on regional determinants, and the diagnostic method applied. The lack of understanding if and at which stage LD is considered in current case management of pneumonia patients limits the interpretation of observed heterogeneities in incidence or underestimation of LD in Switzerland. The absence of (or non-adherence to) existing guidelines and the heterogeneity in diagnostic testing hampers the comparison of data in the Swiss public health context. Therefore, diagnostic procedures should be harmonised across Switzerland and adherence to national LD management guidelines supported.
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Affiliation(s)
- Fabienne B. Fischer
- Swiss Tropical and Public Health Institute, 4001 Basel, Switzerland; (F.B.F.); (C.S.)
- Faculty of Science, University of Basel, 4002 Basel, Switzerland
| | - Claudia Schmutz
- Swiss Tropical and Public Health Institute, 4001 Basel, Switzerland; (F.B.F.); (C.S.)
- Faculty of Science, University of Basel, 4002 Basel, Switzerland
| | - Valeria Gaia
- National Reference Center for Legionella, Service of Microbiology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Daniel Mäusezahl
- Swiss Tropical and Public Health Institute, 4001 Basel, Switzerland; (F.B.F.); (C.S.)
- Faculty of Science, University of Basel, 4002 Basel, Switzerland
- Correspondence: ; Tel.: +41-61-284-8178
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Sims AN, Lewis BS, Prabhakaran P. Legionnaire's Disease in an Immunocompetent Host: An Unlikely Diagnosis. Clin Pediatr (Phila) 2018; 57:1696-1698. [PMID: 30261746 DOI: 10.1177/0009922818803402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea N Sims
- 1 University of Alabama at Birmingham, AL, USA.,2 Children's of Alabama, Birmingham, AL, USA
| | - Bryauna S Lewis
- 1 University of Alabama at Birmingham, AL, USA.,2 Children's of Alabama, Birmingham, AL, USA
| | - Priya Prabhakaran
- 1 University of Alabama at Birmingham, AL, USA.,2 Children's of Alabama, Birmingham, AL, USA
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Aston SJ. Pneumonia in the developing world: Characteristic features and approach to management. Respirology 2017; 22:1276-1287. [PMID: 28681972 DOI: 10.1111/resp.13112] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/22/2023]
Abstract
Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in adults worldwide, but its epidemiology varies markedly by region. Whilst in high-income countries, the predominant burden of CAP is in the elderly and those with chronic cardiovascular and pulmonary co-morbidity, CAP patients in low-income settings are often of working age and, in sub-Saharan Africa, frequently HIV-positive. Although region-specific aetiological data are limited, they are sufficient to highlight major trends: in high-burden settings, tuberculosis (TB) is a common cause of acute CAP; Gram-negative pathogens such as Klebsiella pneumoniae are regionally important; and HIV-associated opportunistic infections are common but difficult to diagnose. These differences in epidemiology and aetiological profile suggest that modified approaches to diagnosis, severity assessment and empirical antimicrobial therapy of CAP are necessary, but tailored individualized management approaches are constrained by limitations in the availability of radiological and laboratory diagnostic services, as well as medical expertise. The widespread introduction of the Xpert MTB/RIF platform represents a major advance for TB diagnosis, but innovations in rapid diagnostics for other opportunistic pathogens are urgently needed. Severity assessment tools (e.g. CURB65) that are used to guide early management decisions in CAP have not been widely validated in low-income settings and locally adapted tools are required. The optimal approach to initial antimicrobial therapy choices such as the need to provide early empirical cover for atypical bacteria and TB remain poorly defined. Improvements in supportive care such as correcting hypoxaemia and intravenous fluid management represent opportunities for substantial reductions in mortality.
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Affiliation(s)
- Stephen J Aston
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
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9
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Catherinot E, Rivaud E, Bron C, Couderc LJ. Neumonía aguda extrahospitalaria. EMC - TRATADO DE MEDICINA 2016. [PMCID: PMC7147127 DOI: 10.1016/s1636-5410(16)79472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
La neumonía aguda extrahospitalaria sigue estando asociada a una elevada morbimortalidad. Durante estos últimos años, y gracias al desarrollo de técnicas de biología molecular, se han realizado importantes progresos en los métodos diagnósticos. Estas técnicas permiten mejorar la detección de bacterias atípicas y de virus respiratorios estacionales. Han permitido asimismo subrayar el lugar de los virus respiratorios en su aparición. El protocolo terapéutico se basa siempre en la instauración precoz de una antibioticoterapia que casi siempre es empírica. Las recomendaciones europeas para el tratamiento de las neumonías extrahospitalarias han sido puestas al día en 2011, como también lo han sido recientemente las pautas vacunales frente al neumococo. En este artículo, se resumen las etiologías de las neumonías, su diagnóstico, las escalas que permiten evaluar su gravedad y orientar el tratamiento del paciente, los datos sobre la sensibilidad a los antibióticos y las recomendaciones terapéuticas resultantes, así como las estrategias de prevención.
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Affiliation(s)
- E. Catherinot
- Service de pneumologie, Pôle des maladies des voies respiratoires, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
- Laboratoire de pharmacologie respiratoire UPRES EA220, Hôpital Foch, 11, rue Guillaume-Lenoir, 92150 Suresnes, France
| | - E. Rivaud
- Service de pneumologie, Pôle des maladies des voies respiratoires, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - C. Bron
- Service de pneumologie, Pôle des maladies des voies respiratoires, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
- Unité de formation et de recherches Sciences de la santé Simone-Veil, Université Versailles Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France
| | - L.-J. Couderc
- Service de pneumologie, Pôle des maladies des voies respiratoires, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
- Laboratoire de pharmacologie respiratoire UPRES EA220, Hôpital Foch, 11, rue Guillaume-Lenoir, 92150 Suresnes, France
- Unité de formation et de recherches Sciences de la santé Simone-Veil, Université Versailles Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France
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Cross KE, Mercante JW, Benitez AJ, Brown EW, Diaz MH, Winchell JM. Simultaneous detection of Legionella species and L. anisa, L. bozemanii, L. longbeachae and L. micdadei using conserved primers and multiple probes in a multiplex real-time PCR assay. Diagn Microbiol Infect Dis 2016; 85:295-301. [PMID: 27107536 PMCID: PMC5505572 DOI: 10.1016/j.diagmicrobio.2016.03.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/03/2016] [Accepted: 03/29/2016] [Indexed: 10/27/2022]
Abstract
Legionnaires' disease is a severe respiratory disease that is estimated to cause between 8,000 and 18,000 hospitalizations each year, though the exact burden is unknown due to under-utilization of diagnostic testing. Although Legionella pneumophila is the most common species detected in clinical cases (80-90%), other species have also been reported to cause disease. However, little is known about Legionnaires' disease caused by these non-pneumophila species. We designed a multiplex real-time PCR assay for detection of all Legionella spp. and simultaneous specific identification of four clinically-relevant Legionella species, L. anisa, L. bozemanii, L. longbeachae, and L. micdadei, using 5'-hydrolysis probe real-time PCR. The analytical sensitivity for detection of nucleic acid from each target species was ≤50fg per reaction. We demonstrated the utility of this assay in spiked human sputum specimens. This assay could serve as a tool for understanding the scope and impact of non-pneumophila Legionella species in human disease.
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Affiliation(s)
- Kristen E Cross
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Jeffrey W Mercante
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Alvaro J Benitez
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Ellen W Brown
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Maureen H Diaz
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Jonas M Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA, 30329, USA.
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Dooling KL, Toews KA, Hicks LA, Garrison LE, Bachaus B, Zansky S, Carpenter LR, Schaffner B, Parker E, Petit S, Thomas A, Thomas S, Mansmann R, Morin C, White B, Langley GE. Active Bacterial Core Surveillance for Legionellosis — United States, 2011–2013. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2015; 64:1190-3. [DOI: 10.15585/mmwr.mm6442a2] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Contamination of Hospital Water Supplies in Gilan, Iran, with Legionella pneumophila, Escherichia coli, and Pseudomonas aeruginosa. Interdiscip Perspect Infect Dis 2015; 2015:809842. [PMID: 26448745 PMCID: PMC4576014 DOI: 10.1155/2015/809842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/23/2015] [Accepted: 08/26/2015] [Indexed: 11/17/2022] Open
Abstract
This study is designed to determine the contamination degree of hospital water supplies with Pseudomonas aeruginosa, Legionella pneumophila, and E. coli in Gilan, Iran. Samples were collected directly into sterile containers and concentrated by centrifuge. Half part of any sample transferred to yeast extract broth and the second part transferred to Trypticase Soy Broth and incubated for 3 days. DNA was extracted by using commercial kit. Four rounds of PCR were performed as follows: multiplex PCR for detecting Pseudomonas aeruginosa, Integron 1, and Metallo-β-lactamases gene; PCR for detecting Legionella pneumophila and mip gene separately; PCR for detecting E. coli; and another PCR for detecting whole bacterial presence. Contamination rates of cold, warm, and incubator water samples with P. aeruginosa, were 16.6%, 37.5%, and 6.8% consequently. Degrees of contamination with L. pneumophila were 3.3%, 9.3%, and 10.9% and with E. coli were zero, 6.2%, and zero. Total bacterial contamination of cold, warm, and incubator water samples was 93.3%, 84.4%, and 89.0% consequently. Metallo-β-lactamases gene was found in 20.0% of all samples. Contamination degree with P. aeruginosa was considerable and with L. pneumophila was moderate. Metallo-β-lactamases gene was found frequently indicating widespread multiple drug resistance bacteria. We suggest using new decontamination method based on nanotechnology.
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Janczarek M, Palusińska-Szysz M. PCR method for the rapid detection and discrimination of Legionella spp. based on the amplification of pcs, pmtA, and 16S rRNA genes. J Appl Genet 2015; 57:251-61. [PMID: 26423783 DOI: 10.1007/s13353-015-0317-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/18/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
Legionella bacteria are organisms of public health interest due to their ability to cause pneumonia (Legionnaires' disease) in susceptible humans and their ubiquitous presence in water supply systems. Rapid diagnosis of Legionnaires' disease allows the use of therapy specific for the disease. L. pneumophila serogroup 1 is the most common cause of infection acquired in community and hospital environments. The non-L. pneumophila infections are likely under-detected because of a lack of effective diagnosis. In this work, simplex and duplex PCR assays with the use of new molecular markers pcs and pmtA involved in phosphatidylcholine synthesis were specified for rapid and cost-efficient identification and distinguishing Legionella species. The sets of primers developed were found to be sensitive and specific for reliable detection of Legionella belonging to the eight most clinically relevant species. Among these, four primer sets I, II, VI, and VII used for duplex-PCRs proved to have the highest identification power and reliability in the detection of the bacteria. Application of this PCR-based method should improve detection of Legionella spp. in both clinical and environmental settings and facilitate molecular typing of these organisms.
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Affiliation(s)
- Monika Janczarek
- Department of Genetics and Microbiology, Institute of Microbiology and Biotechnology, Maria Curie-Sklodowska University, Akademicka St. 19, 20-033, Lublin, Poland
| | - Marta Palusińska-Szysz
- Department of Genetics and Microbiology, Institute of Microbiology and Biotechnology, Maria Curie-Sklodowska University, Akademicka St. 19, 20-033, Lublin, Poland.
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Dirou S, Cazanave C. [Urine antigen testing: Indication and contribution to the treatment of community-acquired pneumonia]. Rev Mal Respir 2015. [PMID: 26204800 DOI: 10.1016/j.rmr.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Urinary antigen tests are quick and simple tests helping to provide an etiological diagnosis in community-acquired pneumonia. However, their prescription is sometimes excessive and performed in unjustified situations. The therapeutic benefit is limited. Indeed, studies show that appropriate antibiotic therapy based on the result of urinary antigen tests does not improve the cost and the patient survival compared to empirical antibiotic therapy. One must be careful before antibiotic therapy reduction based on the sole negative result of urinary antigen test. Legionella urinary antigen test is the most commonly method used for the diagnosis of legionellosis but must be prescribed in a specific clinical context. Streptococcus pneumoniae urinary antigen test is especially interesting in the epidemiological surveillance of pneumococcal community-acquired pneumonia.
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Affiliation(s)
- S Dirou
- Service de pneumologie, l'institut du thorax, hôpital G.- et R.- Laënnec, CHU de Nantes, boulevard J.-Monod, 44093 Nantes cedex 1, France.
| | - C Cazanave
- Service de maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
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15
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Legionellosis in Patients With Cancer. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mercante JW, Winchell JM. Current and emerging Legionella diagnostics for laboratory and outbreak investigations. Clin Microbiol Rev 2015; 28:95-133. [PMID: 25567224 PMCID: PMC4284297 DOI: 10.1128/cmr.00029-14] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic "blind spot" for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.
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Affiliation(s)
- Jeffrey W Mercante
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Thellier D, Georges H, Leroy O. [Which samples to obtain in the emergency department for the microbiological diagnosis of community-acquired pneumonia in the immunocompetent patient?]. MEDECINE INTENSIVE REANIMATION 2014; 23:490-497. [PMID: 32288739 PMCID: PMC7117809 DOI: 10.1007/s13546-014-0923-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/08/2014] [Indexed: 11/01/2022]
Abstract
Current diagnostic methods allow microbial identification in 50% of patients admitted with severe community-acquired pneumonia (CAP). Guidelines derived from epidemiological data help physicians to start empirical antimicrobial therapy. Definitive microbial diagnosis is useful to guide further pathogen-directed therapy. Blood cultures, cultures of respiratory specimens and urine antigen tests are recommended to determine the causative bacterial pathogen. Positive blood cultures range from 15 to 25% of CAP patients according to severity. Whether sputum specimens represent or not lower respiratory secretions determines its accuracy in CAP microbial diagnosis. In intubated patients, endotracheal aspirates are often of interest. Detection of positive pneumococcal or legionella urinary antigen is often associated with CAP severity. The sensitivity of this test is not decreased in patients who have received antibiotics prior to sampling. Viral pneumonia account for 10 to 40% of severe CAP. Nasal swabs are recommended for influenza identification using polymerase chain reaction (PCR) in order to deliver oseltamivir treatment. In the emergency department, atypical pneumonia serology is less useful than respiratory specimens obtained using fiberoptic bronchoscopy. Serum PCR to diagnose bacterial CAP is not superior to the other usual methods.
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Affiliation(s)
- D. Thellier
- Service de réanimation médicale et maladies infectieuses, centre hospitalier Chatilliez, 135 rue du Président Coty, F-59208 Tourcoing, France
| | - H. Georges
- Service de réanimation médicale et maladies infectieuses, centre hospitalier Chatilliez, 135 rue du Président Coty, F-59208 Tourcoing, France
| | - O. Leroy
- Service de réanimation médicale et maladies infectieuses, centre hospitalier Chatilliez, 135 rue du Président Coty, F-59208 Tourcoing, France
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Aston SJ. The role of rapid diagnostic tests in managing adults with pneumonia in low-resource settings. Pneumonia (Nathan) 2014; 5:8-17. [PMID: 26290807 PMCID: PMC4538792 DOI: 10.15172/pneu.2014.5/444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In well-resourced settings the systematic use of rapid diagnostics tests (e.g. pneumococcal urinary antigen test) that define the causal pathogen to direct therapy has not resulted in significantly improved outcomes in adults withpneumonia. The management of pneumonia in many low-resource settings is complicated by a substantial burden of tuberculosis and HIV-associated opportunistic infections, in addition to the usual spectrum of pathogens seenin well-resourced settings. Clinical features alone do not reliably distinguish between these different aetiologiesand physicians often have to treat empirically. Given the limitations in diagnostic laboratory capability present inmost low-resource settings, rapid and point-of-care diagnostic tests could become valuable tools to guide treatment decisions. Pneumococcal and Legionella urinary antigen tests are specific and moderately sensitive, but their utilityin low-resource settings is uncertain. The Xpert MTB/RIF (Cepheid, USA) platform and rapid assays for urinary lipoarabinomannan can substantially speed up tuberculosis diagnosis; the current challenge is to translate this intoearlier treatment and hopefully improve patient outcome. In HIV-infected patients, 1-3-β-D-glucan is a serum marker of Pneumocystis jirovecii infection with excellent sensitivity. Further studies are needed to assess the clinical utilityand cost-effectiveness of these rapid diagnostic assays when they are incorporated into treatment algorithms.
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Affiliation(s)
- Stephen J Aston
- Malawi Liverpool Wellcome Trust Clinical Research Facility, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Development of an indirect sandwich ELISA for detection of urinary antigen, using Legionella pneumophila PAL protein. World J Microbiol Biotechnol 2013; 30:1463-71. [PMID: 24293241 DOI: 10.1007/s11274-013-1560-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/14/2013] [Indexed: 10/26/2022]
Abstract
Legionella pneumophila peptidoglycan-associated lipoprotein (PAL) protein is an extremely conserved antigen among Legionella species. In this study, rabbit and rat anti-PAL immunoglobulin G antibodies were produced by immunization with purified, recombinant PAL (r-PAL) protein of L. pneumophila serogroup 1 and used as capture and detection antibodies in the PAL antigen-based enzyme-linked immunosorbent assay (ELISA) to detect urinary PAL antigen. Urine samples were obtained from rats experimentally infected with L. pneumophila serogroup 1. The PAL antigen was measured in urine samples of 40 infected and 40 uninfected rats. After choosing the cut-off value of 0.192, the sensitivity and specificity of the PAL antigen-based ELISA were 87.5 and 97.5 %, respectively. The results obtained by PAL antigen base ELISA were compared with those obtained by Biotest. The PAL antigen was detected efficiently by both of the assays and all of the control human urine samples were negative by the ELISA test. The PAL antigen-based ELISA assay was relatively simple to perform, precise, highly sensitive and specific, and reproducible. Based on our data the PAL antigen-based ELISA described here is the first indirect sandwich ELISA for urinary antigen detection which could easily be applied for diagnosis of Legionnaires disease.
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Fard S, Nomanpour B, Fatolahzadeh B, Mobarez A, Darban-Sarokhalil D, Fooladi A, Leeuwen W, Feizabadi M. Hospital acquired pneumonia: comparison of culture and real-time PCR assays for detection of Legionella pneumophila from respiratory specimens at Tehran hospitals. Acta Microbiol Immunol Hung 2012; 59:355-65. [PMID: 22982639 DOI: 10.1556/amicr.59.2012.3.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Legionella pneumophila is an important etiological agent in both hospital and community acquired pneumonia. The sensitivity of culture for isolation of L. pneumophila from clinical specimens is low and time consuming. Similar problem also exists when the method of direct immunofluorescence is used. To detect this organism quantitatively from respiratory specimens, a Taq Man based real-time PCR targeting the mip sequence was developed. Both real-time PCR and culture methods were applied on 262 respiratory specimens from 262 ICU patients with pneumonia admitted to 5 different hospitals in Tehran. The results of real-time PCR were compared with those obtained by culture. Real-time PCR and culture found 12 and 4 specimens, respectively, as positive for L. pneumophila. Its technical specificity (100%) was checked against a panel of microorganisms consisting of both Gram-positive and Gram-negative bacteria. Our real-time PCR assay showed high sensitivity (100%) and specificity (96.9%) and could detect 200 organisms per ml from respiratory specimens. Using real-time PCR as a screening method, the frequency of nosocomial pneumonia with L. pneumophila at Tehran hospitals was estimated as 4.58%.
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Affiliation(s)
- Somayeh Fard
- 1 Tehran University of Medical of Sciences Department of Microbiology, School of Medicine Tehran Iran
| | - Bizhan Nomanpour
- 1 Tehran University of Medical of Sciences Department of Microbiology, School of Medicine Tehran Iran
| | - Bahram Fatolahzadeh
- 1 Tehran University of Medical of Sciences Department of Microbiology, School of Medicine Tehran Iran
| | - Ashraf Mobarez
- 2 Tarbiat Modares University Department of Bacteriology, School of Medicine Tehran Iran
| | | | - Abbas Fooladi
- 4 Baqiyatallah University of Medical Sciences Applied Microbiology Research Center Tehran Iran
| | | | - Mohammad Feizabadi
- 1 Tehran University of Medical of Sciences Department of Microbiology, School of Medicine Tehran Iran
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Rai V, Deng J, Toh CS. Electrochemical nanoporous alumina membrane-based label-free DNA biosensor for the detection of Legionella sp. Talanta 2012; 98:112-7. [DOI: 10.1016/j.talanta.2012.06.055] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/22/2012] [Accepted: 06/22/2012] [Indexed: 11/26/2022]
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Lee JY, Jin JH, Kim JH, Kim MJ, Lee CJ, Min NK. Plasma-activated carbon nanotube-based high sensitivity immunosensors for monitoring Legionella pneumophila by direct detection of maltose binding protein peptidoglycan-associated lipoprotein (MBP-PAL). Biotechnol Bioeng 2012; 109:1471-8. [DOI: 10.1002/bit.24418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/26/2011] [Accepted: 12/13/2011] [Indexed: 01/13/2023]
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Legionnaires' disease - Results of a multicentre Canadian study. Can J Infect Dis 2011; 14:154-8. [PMID: 18159449 DOI: 10.1155/2003/951567] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2002] [Accepted: 02/05/2003] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There has never been a cross-Canada surveillance project to determine the rate of Legionella species as a cause of community-acquired pneumonia requiring hospitalization and to determine whether there are any regional differences in the rates of Legionnaires' disease in Canada. Anecdotally, Legionnaires' disease is thought to be uncommon in Western Canada. METHODS From January, 1996 through to October 31, 1997, a prospective study of the etiology of community acquired pneumonia requiring admission to 15 tertiary care hospitals in eight Canadian provinces was conducted. A urine sample from each patient was tested for Legionella pneumophila serogroup 1 antigen using a commercially available ELISA assay. A culture of sputum or other respiratory specimens for Legionellaceae was carried out at the discretion of the attending physician. Two hundred thirty-four patients had acute and 6-week convalescent serum samples tested for antibodies to L pneumophila serogroups 1 through 6 using an ELISA method. RESULTS 28 of the 850 patients (3.2%) had Legionnaires' disease; 18 of 823 (2.1%) were positive for L pneumophila serogroup 1 by urinary antigen testing. The rate of Legionnaires' disease, based on urinary antigen, at the Halifax site was higher than that at the other sites (seven of 163 patients versus 11 of 660 [P=0.04]). Of the 28 cases of Legionnaires' disease identified using all methods, 11 of 277 patients (3.9%) were enrolled from Western provinces versus 17 of 573 patients (2.9%) from Eastern provinces (P=nonsignificant). CONCLUSIONS Legionnaires' disease is just as common in Western as in Eastern Canada. L pneumophila serogroup 1 may be more common in Halifax than at the other sites studied.
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Clinical utility of a Legionella pneumophila urinary antigen test in a large university teaching hospital. Can J Infect Dis 2011; 14:85-8. [PMID: 18159429 DOI: 10.1155/2003/642159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2001] [Accepted: 03/21/2002] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the clinical utility of diagnosing Legionella pneumonia by urinary antigen testing (LPUAT) in a low prevalence centre. DESIGN The results of LPUATs were abstracted and analyzed from the authors' laboratory information system. Medical records were reviewed in detail for all positive tests and a random sample of 50 negative tests. SETTING The Queen Elizabeth II Health Sciences Centre, a large university hospital complex. POPULATION STUDIED Patients who were admitted from the emergency room with pneumonia or who had developed pneumonia in hospital and who had a LPUAT performed between April 1998 and October 2000. MAIN RESULTS One thousand one hundred fifty-four tests were performed on 1007 patients. Seven patients had nine positive LPUATs. Three of these patients had confirmed Legionella pneumophila pneumonia. Three others had probable or possible L pneumophila pneumonia. There was one probable false positive. Six of the seven patients were already on empirical anti-L pneumophila therapy. Of the 50 negative tests reviewed in detail, 31 patients were on one of the antibiotics of choice for L pneumophila at the time the test was ordered; in 21 (68%) of these patients the negative result did not lead to a change in therapy. CONCLUSIONS The cost to diagnose each case of Legionella pneumonia by LPUAT was approximately $5,770 and most patients were already on appropriate antibiotics. In patients with negative tests, antibiotics were often not changed in response to the test result. Rigorous screening of patients is required to increase pretest probability for LPUAT to be justified.
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Affiliation(s)
- Thomas M File
- Infectious Disease Section, Internal Medicine Department, Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, OH 44272, USA.
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Azoulay E. Minimally Invasive Diagnostic Strategy in Immunocompromised Patients with Pulmonary Infiltrates. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123161 DOI: 10.1007/978-3-642-15742-4_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acute respiratory failure (ARF) is the main reason for ICU admission in patients with haematological malignancies. High mortality rates of up to 50% are reported in this situation, and mortality is highest when mechanical ventilation is needed. Rapid and accurate diagnostic methods are needed in these vulnerable patients to ensure the prompt initiation of effective treatment. However, the broad array of possible cause of ARF raises diagnostic challenges. In this review, we discuss the DIRECT strategy, which identifies the most plausible diagnosis in each patient based on the type of immune deficiency and clinical presentation. We will focus on non-invasive laboratory tests developed in recent years, discussing their sensitivity and specificity. We also discuss the usefulness in cancer patients with specific organ dysfunctions of biomarkers introduced over the past few years.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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Chen Y, Tateda K, Fujita K, Ishii T, Ishii Y, Kimura S, Saga T, Annaka T, Yamada S, Zhao L, Li S, Azuma A, Gemma A, Kudoh S, Yamaguchi K. Sequential changes of Legionella antigens and bacterial load in the lungs and urines of a mouse model of pneumonia. Diagn Microbiol Infect Dis 2010; 66:253-60. [DOI: 10.1016/j.diagmicrobio.2009.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 11/02/2009] [Accepted: 11/03/2009] [Indexed: 11/17/2022]
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Insuffisance Respiratoire Aiguë chez le patient immunodéprimé : Quelle approche diagnostique ? REVUE DES MALADIES RESPIRATOIRES ACTUALITÉS 2010; 2:114-124. [PMID: 32288904 PMCID: PMC7140285 DOI: 10.1016/s1877-1203(10)70014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Choi GE, Kang JE, Lee EY, Chang CL, Tateda K, Yamaguchi K, Kim KH, Kim JM. Antimicrobial Susceptibility Patterns of Legionella isolates in the Environment and in Patients. Ann Lab Med 2010; 30:28-33. [DOI: 10.3343/kjlm.2010.30.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Go Eun Choi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Eun Kang
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Chulhun L. Chang
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Keizo Yamaguchi
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Kyeong Hee Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeong Man Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
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Abstract
Despite using modern microbiological diagnostic approaches, the aetiological agents of pneumonia remain unidentified in about 50% of cases. Some bacteria that grow poorly or not at all in axenic media used in routine clinical bacteriology laboratory but which can develop inside amoebae may be the agents of these lower respiratory tract infections (RTIs) of unexplained aetiology. Such amoebae-resisting bacteria, which coevolved with amoebae to resist their microbicidal machinery, may have developed virulence traits that help them survive within human macrophages, i.e. the first line of innate immune defence in the lung. We review here the current evidence for the emerging pathogenic role of various amoebae-resisting microorganisms as agents of RTIs in humans. Specifically, we discuss the emerging pathogenic roles of Legionella-like amoebal pathogens, novel Chlamydiae (Parachlamydia acanthamoebae, Simkania negevensis), waterborne mycobacteria and Bradyrhizobiaceae (Bosea and Afipia spp.).
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Affiliation(s)
- Frédéric Lamoth
- Infectious Diseases Service, University of Lausanne, Lausanne, Switzerland
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Doane M, Moitra VK. Respiratory Failure at Home After Coronary Artery Bypass Graft Surgery Requiring Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2009; 23:937-8. [DOI: 10.1053/j.jvca.2009.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Indexed: 11/11/2022]
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An outbreak of Pontiac fever due toLegionella longbeachaeserogroup 2 found in potting mix in a horticultural nursery in New Zealand. Epidemiol Infect 2009; 138:15-20. [DOI: 10.1017/s0950268809990835] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYPrevious outbreaks of Pontiac fever have invariably been associated with water droplet spread ofLegionellaspp. In January 2007 three workers from a horticultural nursery were admitted to hospital with non-pneumonic legionellosis. Investigations showed that a working party of ten people had been exposed to aerosolized potting mix; nine of these workers met the case definition for Pontiac fever. The presence of genetically indistinguishableLegionella longbeachaeserogroup 2 was demonstrated in clinical specimens from two hospitalized workers and in the potting mix to which they had been exposed. A further seven cases were diagnosed by serological tests. This is the first documented outbreak of Pontiac fever fromL. longbeachaeserogroup 2 confirmed from inhalation of potting mix. Pontiac fever is likely to be under-diagnosed. We advocate the introduction of an industry standard that ensures the use of face masks when handling potting mix and attaching masks and warning labels to potting mix bags sold to the public.
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Hugosson A, Hjorth M, Bernander S, Claesson BEB, Johansson A, Larsson H, Nolskog P, Pap J, Svensson N, Ulleryd P. A community outbreak of Legionnaires’ disease from an industrial cooling tower: Assessment of clinical features and diagnostic procedures. ACTA ACUST UNITED AC 2009; 39:217-24. [PMID: 17366051 DOI: 10.1080/00365540601001930] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An outbreak of Legionnaires' disease (LD) occurred in Lidköping, Sweden, in August 2004. A cooling tower was identified as the probable source of infection. During the outbreak period an unexpected 3-6-fold increase in pneumonia patients was noted at the local hospital. During 7 weeks LD was diagnosed in 15 patients by urinary antigen and/or sputum culture. Additionally, 15 LD patients were diagnosed later by serology. Patients with LD were generally younger, more healthy, and more often smokers compared to other pneumonia patients. On admittance they had more severe symptoms with high fever and raised CRP levels, and more often hyponatraemia, gastrointestinal and CNS symptoms. A causative agent besides Legionella was found in 2 patients only. A significant titre rise for Mycoplasma and/or Chlamydophila pneumoniae was found in 13 of 29 tested patients with confirmed LD. We conclude that the clinical diagnosis of LD is difficult and that available diagnostic methods detect only a minority of patients in the acute phase. Therefore in severe pneumonia, empirically targeted therapy should be instituted on clinical grounds irrespective of the results of diagnostic tests. The observation of increased antibody levels for M. and C. pneumoniae suggests an unspecific immune reaction and merits further study.
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Affiliation(s)
- Anna Hugosson
- Department of Medicine, Uppsala University Hospital. Uppsala, Sweden
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Carrillo J, Gutiérrez J, García F, Muñoz A, Villegas E, Rojas J, Sorlózano A, Rojas A. Development and evaluation of a multiplex test for the detection of atypical bacterial DNA in community-acquired pneumonia during childhood. Clin Microbiol Infect 2009; 15:473-80. [DOI: 10.1111/j.1469-0691.2009.02711.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stupka JE, Mortensen EM, Anzueto A, Restrepo MI. Community-acquired pneumonia in elderly patients. AGING HEALTH 2009; 5:763-774. [PMID: 20694055 PMCID: PMC2917114 DOI: 10.2217/ahe.09.74] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Community-acquired pneumonia continues to have a significant impact on elderly individuals, who are affected more frequently and with more severe consequences than younger populations. As the population ages it is expected that the medical and economic impact of this disease will increase. Despite these concerns, little progress has been made in research specifically focusing on community-acquired pneumonia in the elderly. Data continue to show that a high index of suspicion, early antimicrobial therapy and appropriate medications to cover typical pathogens are extremely important in treating community-acquired pneumonia in older individuals. This review is designed to serve as an update to our previous work published in Aging Health in 2006, with specific emphasis on the most recent evidence published since that time.
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Affiliation(s)
- John E Stupka
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA, Tel.: +1 210 617 5256, Fax: +1 210 567 4423,
| | - Eric M Mortensen
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of General Medicine, San Antonio, TX, USA and VERDICT (11C6) at the South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA, Tel.: +1 210 617 5300, Fax: +1 210 567 4423,
| | - Antonio Anzueto
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA and South Texas Veterans Health Care System, Audie L Murphy Division, TX, USA, Tel.: +1 210 617 5256, Fax: +1 210 567 4423,
| | - Marcos I Restrepo
- The University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA and VERDICT (11C6) at the South Texas Veterans Health Care System, Audie L Murphy Division, San Antonio, TX, USA, Tel.: +1 210 617 5300 ext. 15413, Fax: +1 210 567 4423,
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Sandkovsky U, Sandkovsky G, Suh J, Smith B, Sharp V, Polsky B. Legionella pneumonia and HIV: case reports and review of the literature. AIDS Patient Care STDS 2008; 22:473-81. [PMID: 18462074 DOI: 10.1089/apc.2007.0111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although Legionnaires' disease occurs more commonly in patients with some degree of immunosuppression (diabetes, chronic lung disease, end stage renal disease, cancer, etc.), it has been infrequently described in patients infected with human immunodeficiency virus (HIV) and AIDS. Some studies suggest that pneumonia caused by Legionella tends to present with more severe clinical features and complications in the HIV-infected population. The use of antibiotic prophylaxis or the association of severe pneumonia with other pathogens may account for under diagnosis of the disease. We diagnosed five cases of Legionella pneumonia in patients with HIV infection at our institution during a 1-year period. The cases seen ranged in severity, regardless of the CD4(+) counts of the patients. Based on our observations, it seems impossible to discern whether HIV infection is an additional risk factor for Legionnaires' disease. We describe those five cases and review the available literature.
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Affiliation(s)
- Uriel Sandkovsky
- Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Gabriel Sandkovsky
- Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Jin Suh
- Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center New York, New York
- Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center New York, New York
- Center for Comprehensive Care, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Barbara Smith
- Department of Infection Control, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Victoria Sharp
- Center for Comprehensive Care, St. Luke's-Roosevelt Hospital Center New York, New York
| | - Bruce Polsky
- Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center New York, New York
- Division of Infectious Diseases, St. Luke's-Roosevelt Hospital Center New York, New York
- Department of Infection Control, St. Luke's-Roosevelt Hospital Center New York, New York
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Qasem JA, Mustafa AS, Khan ZU. Legionella in clinical specimens and hospital water supply facilities: molecular detection and genotyping of the isolates. Med Princ Pract 2008; 17:49-55. [PMID: 18059101 DOI: 10.1159/000109590] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate genus- and species-specific polymerase chain reactions (PCRs) for the detection of the genus Legionella and the species Legionella pneumophila in clinical specimens and hospital water supplies, and to establish a simple and reproducible random amplification of polymorphic DNA (RAPD)-PCR technique for genotyping of Legionella. MATERIALS AND METHODS A total of 70 respiratory tract specimens(bronchoalveolar lavage: n = 46; endotracheal secretions: n = 9; sputum: n = 15) from patients with atypical pneumonia, and 283 environmental samples (water: 20; swabs: 263) collected from water storage and supply facilities of the Mubarak Al-Kabeer Hospital, Kuwait, were tested by culture and genus-specific PCR for the detection of Legionella. The L. pneumophila isolates were subsequently typed by serology and RAPD-PCR using serotype-specific sera and arbitrary primers, respectively. RESULTS Of the 70 clinical samples, culture yielded 2 (2.9%) whereas genus-specific PCR detected Legionella in 20 (28.6%) samples. The 2 culture-positive specimens were also positive for L.-pneumophila-specific PCR. Testing of swab and water samples by culture and genus-specific PCR yielded 61 (21.6%) and 67 (23.7%) positive samples, respectively. All of the 61 culture-positive samples were also positive by genus-specific PCR and 45 of them were positive for L.-pneumophila-specific PCR. Serological typing of 43 L. pneumophila isolates showed that 8 of these belonged to serotype 1 and 35 to serotype 3; however, RAPD-PCR analyses demonstrated polymorphisms among the isolates of both serotypes. CONCLUSION A higher association between PCR and culture was observed for the environmental samples than for the clinical samples. The application of genus- and species-specific PCRs and RAPD is useful in the detection and typing of Legionella in clinical and environmental samples.
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Affiliation(s)
- J A Qasem
- Department of Applied Medical Sciences, College of Health Sciences, The Public Authority for Applied Education and Training, Kuwait University, Kuwait.
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Rudbeck M, Mølbak K, Uldum S. High prevalence of antibodies to Legionella spp. in Danish blood donors. A study in areas with high and average incidence of Legionnaires' disease. Epidemiol Infect 2007; 136:257-62. [PMID: 17475092 PMCID: PMC2870808 DOI: 10.1017/s0950268807008606] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The incidence of Legionnaires' disease has an uneven geographical distribution in Denmark, ranging from 3 to 70 notified cases per million inhabitants per year in different towns. We investigated the prevalence of antibodies to Legionella in the one town with a consistently high incidence (Randers, Aarhus County) and compared it with that of an area of average incidence (Vejle, Vejle County). Blood samples were collected from healthy blood donors in Randers (n=308) and in Vejle (n=400), and analysed for antibodies to Legionella by indirect immunofluorescence antibody test with L. pneumophila, L. micdadei, and L. bozemanii as antigens. Overall 22.9% of the donors had antibody titres of > or = 1:128; indicating that antibodies to Legionella are common in healthy individuals, and reflecting that the bacteria may be widely distributed in the environment. Surprisingly, the study did not reveal a higher prevalence in the hyperendemic area. Thus, the high incidence of notified cases in this particular town may not be attributed to an overall increased exposure of the general population.
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Affiliation(s)
- M Rudbeck
- Department of Public Health, Health Consultancy Unit, Aarhus, Denmark.
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Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2:S27-72. [PMID: 17278083 PMCID: PMC7107997 DOI: 10.1086/511159] [Citation(s) in RCA: 4116] [Impact Index Per Article: 242.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Sugihara E, Dambara T, Aiba M, Okamoto M, Yonemitsu J, Sonobe S, Koga H, Inui A, Hada N, Matsumoto N, Goto Y, Naito T, Isonuma H, Hayashida Y. Clinical characteristics of 8 sporadic cases of community-acquired Legionella pneumonia in advanced age. Intern Med 2007; 46:461-5. [PMID: 17443035 DOI: 10.2169/internalmedicine.46.6084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Legionella spp are well recognized as one of the etiologic factor in pneumonia, but it is difficult to distinguish the clinical features of Legionella infection from pneumonia due to other causes. The objective of the present study was to examine the clinical characteristics of community-acquired Legionella pneumonia in elderly patients. We reviewed the clinical, laboratory and radiographic findings in 8 patients diagnosed as having pneumonia caused by Legionella. The diagnosis was confirmed by the presence of urinary antigen, bacterial culture, polymerase chain reaction (PCR) and serum antibody. There were 6 men and 2 women, whose ages ranged from 76 to 85 years. All patients had fever and hypoxia, four patients had respiratory symptoms. The initial chest X-ray findings were varied--consolidation, ground glass opacity, pleural effusion and linear shadow. Urinary antigen was positive in 4 patients, bacterial culture in 2, PCR on the sputum in 3 and serum antibody in 2 patients. As pneumonia caused by Legionella often becomes life-threatening, especially in elderly people, it is imperative to diagnose it at the initial stage. In this study, urinary antigen proved to be the most useful diagnostic means. However, it is important to confirm the diagnosis through plural examinations.
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Affiliation(s)
- Eiichiro Sugihara
- Department of General Medicine, Juntendo University School of Medicine, Tokyo.
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Leroy O. [Contribution of microbiological investigations to the diagnosis of lower respiratory tract infections]. Med Mal Infect 2006; 36:570-98. [PMID: 17095176 PMCID: PMC7119138 DOI: 10.1016/j.medmal.2006.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 12/31/2022]
Abstract
The diagnosis of community-acquired pneumonia is usually based on clinical and radiological criteria. The identification of a causative organism is not required for the diagnosis. Although numerous microbiological techniques are available, their sensitivity and specificity are not high enough to guide first-line antimicrobial therapy. Consequently, this treatment remains most often empiric. If the causative organism is identified, the antimicrobial treatment is adapted. Sputum analysis may be proposed as a diagnostic tool for patients with an acute exacerbation of chronic obstructive pulmonary disease, in specific cases (prior antibiotherapy, hospitalization, failure of the empiric antimicrobial treatment).
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Affiliation(s)
- O Leroy
- Service de réanimation médicale et maladies infectieuses, hôpital G.-Chatiliez, 135, rue du Président-Coty, 59208 Tourcoing, France.
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Philippart F. [Managing lower respiratory tract infections in immunocompetent patients. Definitions, epidemiology, and diagnostic features]. Med Mal Infect 2006; 36:784-802. [PMID: 17092676 PMCID: PMC7131155 DOI: 10.1016/j.medmal.2006.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 11/13/2022]
Abstract
Les infections respiratoires basses sont une des principales cause de mortalité dans le monde et les pneumopathies représentent en France la première cause de décès d'origine infectieuse. Trois entités nosologiques distinctes sont habituellement isolées en fonction de la localisation infectieuse : la bronchite aiguë, la pneumopathie et la bronchopneumopathie (atteignant les bronches et le parenchyme pulmonaire). En cas d'infections de l'arbre bronchique dans le cadre d'une bronchopathie chronique on parle de décompensation infectieuse de la maladie bronchique. Les deux principales difficultés diagnostiques de ces infections sont de déterminer la présence d'une participation alvéolaire au processus infectieux et de définir l'agent (ou les agents) pathogènes. Ces deux éléments vont conditionner la prise en charge thérapeutique. En dehors de l'examen physique, indispensable dans ce contexte, seule la radiographie thoracique pourra, en cas de persistance d'un doute, permettre de confirmer la présence d'une participation alvéolaire. Le diagnostic microbiologique pose la question de sa nécessité systématique et celui de sa valeur. Il n'est pas indispensable de réaliser un diagnostic microbiologique de certitude dans tous les cas. La décision de documentation doit répondre à deux impératifs : faisabilité et valeur diagnostique. La valeur d'un prélèvement dépend de son aptitude à mettre en évidence l'agent pathogène et dans certains cas de la possibilité d'en déterminer le profil de sensibilité (qui reste une indication majeure à la réalisation de ces prélèvements).
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Affiliation(s)
- F Philippart
- Service de réanimation polyvalente, fondation-hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
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Naito T, Suda T, Saga K, Horii T, Chida K. Reactive Legionella pneumophila arthritis diagnosed by polymerase chain reaction. Rheumatol Int 2006; 27:415-6. [PMID: 17009015 DOI: 10.1007/s00296-006-0223-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 09/03/2006] [Indexed: 11/24/2022]
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Montagna MT, Napoli C, Tatò D, Spilotros G, Barbuti G, Barbuti S. Clinical–Environmental Surveillance of Legionellosis: An Experience in Southern Italy. Eur J Epidemiol 2006; 21:325-31. [PMID: 16685585 DOI: 10.1007/s10654-006-0009-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2006] [Indexed: 11/25/2022]
Abstract
In Italy, although the number of cases of legionellosis notified to the health authorities has significantly increased in recent years, the incidence is still believed to be underestimated. To verify the true frequency and identify the sources of infection, an active clinical-environmental surveillance program was instituted in three hospital facilities in Southern Italy. Between January 2001 and March 2005, a total of 1000 patients admitted to the three hospitals with a diagnosis of pneumonia were enrolled. The urinary antigen and anti-Legionella antibody titre were assayed in each subject, and direct searches for the microorganism were made in biological specimens. Legionellosis was found to be present in 5.9% of the patients. For each of the cases of legionellosis, microbiological surveys were made of the water supply in the public and/or private facilities involved. Overall, 197 water samples of hospital origin and 218 of community origin were analysed: Legionella spp was isolated in 44.2 and 36.7% of the cases, respectively. Comparison of our data with those of the routine surveillance system for the same area (only 7 cases during the period 1997-2000), showed that the frequency of legionellosis is grossly underestimated in Southern Italy. It is therefore necessary to set up more rigorous controls in both hospital and community facilities, so that timely preventive measures can be taken to avoid any further spread of the disease.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Internal Medicine and Public Health - Hygiene Section, University of Bari, P. zza G. Cesare, 1170124, Bari, Italy.
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Maniwa K, Taguchi Y, Ito Y, Mishima M, Yoshida SI. Retrospective study of 30 cases of Legionella pneumonia in the Kansai region. J Infect Chemother 2006; 12:272-6. [PMID: 17109091 DOI: 10.1007/s10156-006-0463-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 07/05/2006] [Indexed: 12/01/2022]
Abstract
Thirty Legionella pneumonia cases were clinically investigated retrospectively from 1999 to 2005 at the Respiratory Medicine Department of Kyoto University and affiliated hospitals. Twenty-eight cases were sporadic and two cases were part of an outbreak. The patients consisted of 28 men and 2 women, with a mean age of 58.8 years (range 25-87). Nineteen cases were smokers and 19 had some underlying disease. The mean period from the disease occurrence to presenting at a hospital was 4.8 days (range 1-15). The mean period from presenting at hospital to Legionella pneumonia diagnosis was 4.6 days (range 0-22). Urinary antigen detection tests for Legionella pneumophilla were performed for 25 cases, and resulted in the diagnosis of 22 cases. Other diagnostic tests with positive findings were culture (buffered charcoal-yeast extract agar, BCYE), the polymerase chain reaction (PCR) test, and serological diagnosis (enzyme immunoassay and microagglutination test). Legionella species diagnosis was obtained by culture and serology for 13 cases: 10 cases had Legionella pneumophila serogroup 1, 2 cases had Legionella pneumophila serogroup 6, and 1 case had Legionella longbeachea. Fluoloquinolones (Fq) are most often used for therapy, especially in recent cases, and were predominantly the chosen treatment (70%). Death due to Legionella pneumonia occurred in 4 cases: 3 cases had severe underlying diseases, and 1 case took 18 days to diagnose (doctors' delay). To detect the majority of Legionella pneumonia cases, a combination of diagnostic examinations is still needed. Regarding the management of community-acquired pneumonia, both the cost and the indication of diagnostic examinations for Legionella infection should be considered simultaneously.
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Affiliation(s)
- Ko Maniwa
- Department of Respiratory Medicine, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
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Dirven K, Ieven M, Peeters MF, van der Zee A, De Schrijver K, Goossens H. Comparison of three Legionella urinary antigen assays during an outbreak of legionellosis in Belgium. J Med Microbiol 2005; 54:1213-1216. [PMID: 16278436 DOI: 10.1099/jmm.0.45909-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
During an outbreak of legionellosis in Belgium, urine samples of 32 legionellosis patients were tested with three Legionella urinary antigen assays: the Biotest enzyme immunoassay (EIA) kit, the Binax EIA kit and the Binax NOW Immunochromatographic Test kit. The three tests were concomitantly compared. The test sensitivities on the first urine samples were 65.6 % for the Biotest EIA, 50.0 % for the Binax EIA and 56.3 % for the Binax NOW. Testing of a second urine sample increased the sensitivities to 71.9 %, 59.4 % and 65.6 %, respectively. The differences were not statistically significant. In outbreak settings, testing second samples from patients presenting with symptoms but initially testing negative and/or concentrating urine samples for testing might be valuable additions to the urinary antigen test to increase the sensitivities of the tests.
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Affiliation(s)
- Kristien Dirven
- Laboratory of Medical Microbiology, University of Antwerp UA, Wilrijk, Belgium 2Laboratory of Clinical Microbiology, University Hospital Antwerp UZA, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium 3Laboratory of Molecular Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, NL-5000 AS Tilburg, The Netherlands 4Health Inspectorate of the Province of Antwerp, Ministry of the Flemish Community, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, University of Antwerp UA, Wilrijk, Belgium 2Laboratory of Clinical Microbiology, University Hospital Antwerp UZA, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium 3Laboratory of Molecular Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, NL-5000 AS Tilburg, The Netherlands 4Health Inspectorate of the Province of Antwerp, Ministry of the Flemish Community, Antwerp, Belgium
| | - Marcel F Peeters
- Laboratory of Medical Microbiology, University of Antwerp UA, Wilrijk, Belgium 2Laboratory of Clinical Microbiology, University Hospital Antwerp UZA, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium 3Laboratory of Molecular Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, NL-5000 AS Tilburg, The Netherlands 4Health Inspectorate of the Province of Antwerp, Ministry of the Flemish Community, Antwerp, Belgium
| | - Anneke van der Zee
- Laboratory of Medical Microbiology, University of Antwerp UA, Wilrijk, Belgium 2Laboratory of Clinical Microbiology, University Hospital Antwerp UZA, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium 3Laboratory of Molecular Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, NL-5000 AS Tilburg, The Netherlands 4Health Inspectorate of the Province of Antwerp, Ministry of the Flemish Community, Antwerp, Belgium
| | - Koen De Schrijver
- Laboratory of Medical Microbiology, University of Antwerp UA, Wilrijk, Belgium 2Laboratory of Clinical Microbiology, University Hospital Antwerp UZA, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium 3Laboratory of Molecular Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, NL-5000 AS Tilburg, The Netherlands 4Health Inspectorate of the Province of Antwerp, Ministry of the Flemish Community, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp UA, Wilrijk, Belgium 2Laboratory of Clinical Microbiology, University Hospital Antwerp UZA, Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium 3Laboratory of Molecular Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, NL-5000 AS Tilburg, The Netherlands 4Health Inspectorate of the Province of Antwerp, Ministry of the Flemish Community, Antwerp, Belgium
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Calza L, Briganti E, Casolari S, Manfredi R, Chiodo F, Zauli T. Legionnaires' disease associated with macular rash: two cases. Acta Derm Venereol 2005; 85:342-4. [PMID: 16191857 DOI: 10.1080/00015550510030050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Legionnaires' disease is an acute bacterial infection, generally sustained by Legionella pneumophila, which involves primarily the lower respiratory tract, although it is often associated with multi-systemic extrapulmonary manifestations. Afflicted patients may sometimes have gastrointestinal symptoms, liver function abnormalities, renal failure or central nervous system complications, while cutaneous manifestations are very uncommon and may include erythematous, maculopapular or petechial skin lesions. Pathogenesis of skin involvement in the setting of Legionnaires' disease is still uncertain, but may involve toxic or immunological mechanisms. Two exceptional cases of Legionella pneumonia complicated by diffuse, macular rash in two adult women are described, in association with severe peripheral polyneuropathy and flaccid quadriplegia in one case.
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Affiliation(s)
- Leonardo Calza
- Department of Clinical and Experimental Medicine, Section of Infectious Diseases, University of Bologna Alma Mater Studiorum, S. Orsola Hospital, Italy.
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Ginevra C, Barranger C, Ros A, Mory O, Stephan JL, Freymuth F, Joannès M, Pozzetto B, Grattard F. Development and evaluation of Chlamylege, a new commercial test allowing simultaneous detection and identification of Legionella, Chlamydophila pneumoniae, and Mycoplasma pneumoniae in clinical respiratory specimens by multiplex PCR. J Clin Microbiol 2005; 43:3247-54. [PMID: 16000443 PMCID: PMC1169163 DOI: 10.1128/jcm.43.7.3247-3254.2005] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study describes the development and evaluation of a new commercial test, Chlamylege (Argene Inc.), which allows the simultaneous detection in respiratory samples of Chlamydophila pneumoniae, Mycoplasma pneumoniae, and most Legionella species, as well as PCR inhibitors, by using a multiplex PCR and microplate hybridization. The sensitivities of Chlamylege were 1 x 10(-3) IFU, 5 x 10(-2) color-changing units, and 1 CFU per reaction tube for C. pneumoniae, M. pneumoniae, and Legionella pneumophila, respectively. A cohort of 154 clinical samples from patients with documented respiratory infections was analyzed by the kit, including 2 samples from patients with C. pneumoniae infection, 9 samples from patients with M. pneumoniae infection, 19 samples from patients with Legionella species infection, and 114 samples that tested negative for the three pathogens. All the positive specimens were correctly detected and identified by the Chlamylege kit, and no false-positive result was observed with the negative samples. The kit was then evaluated in a pediatric prospective study that included 220 endotracheal aspirates, and the results were compared with those obtained by three single in-house PCR assays. Four specimens were found to be positive for C. pneumoniae and six were found to be positive for M. pneumoniae by using both strategies. The Chlamylege kit detected two additional samples positive for M. pneumoniae and one additional sample positive for a Legionella species other than L. pneumophila; these three samples were shown to be true positive by other techniques. These overall results demonstrate that the Chlamylege assay is sensitive, specific, and convenient for the rapid detection and identification of atypical pathogens in clinical samples from patients with respiratory infections.
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Affiliation(s)
- C Ginevra
- Laboratoire de Bactériologie-Virologie, GIMAP, Faculté de Médecine Jacques Lisfranc, Saint-Etienne, France
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