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Yaslianifard S, Mohammadzadeh M, Pourmand MR, Yaslianifard S, Sepehr MN, Arfaatabar M, Norouzi M. Prevalence and molecular distribution of Legionella pneumophila in cold water taps across Alborz province, Iran. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Mittal S, Singh AP, Gold M, Leung AN, Haramati LB, Katz DS. Thoracic Imaging Features of Legionnaire's Disease. Infect Dis Clin North Am 2017; 31:43-54. [PMID: 28159175 DOI: 10.1016/j.idc.2016.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Imaging examinations are often performed in patients with Legionnaires' disease. The literature to date has documented that the imaging findings in this disorder are relatively nonspecific, and it is therefore difficult to prospectively differentiate legionella pneumonia from other forms of pneumonia, and from other noninfectious thoracic processes. Through a review of clinical cases and the literature, our objective is for the reader to gain a better understanding of the spectrum of radiographic manifestations of Legionnaires' disease.
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Affiliation(s)
- Sameer Mittal
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA.
| | - Ayushi P Singh
- Department of Medicine, Maimonides Hospital, Fort Hamilton Parkway, Brooklyn, NY 11219, USA
| | - Menachem Gold
- Department of Radiology, Lincoln Hospital, 234 East 149th Street, Suite 2C3, Bronx, NY 10461, USA
| | - Ann N Leung
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room S078, MC5105, Stanford, CA 94305, USA
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 200 East Gun Hill Road, Bronx, NY 10467, USA; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 200 East Gun Hill Road, Bronx, NY 10467, USA
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
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Rakić A, Štambuk-Giljanović N. Physical and chemical parameter correlations with technical and technological characteristics of heating systems and the presence of Legionella spp. in the hot water supply. ENVIRONMENTAL MONITORING AND ASSESSMENT 2016; 188:73. [PMID: 26733467 DOI: 10.1007/s10661-015-5047-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 12/10/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to evaluate the prevalence of Legionella spp. and compare the quality of hot water between four facilities for accommodation located in Southern Croatia (the Split-Dalmatian County). The research included data collection on the technical and technological characteristics in the period from 2009 to 2012. The survey included a type of construction material for the distribution and internal networks, heating system water heater type, and water consumption. Changes in water quality were monitored by determination of the physical and chemical parameters (temperature, pH, free chlorine residual concentrations, iron, zinc, copper and manganese) in the samples, as well as the presence and concentration of bacteria Legionella spp. The temperature is an important factor for the development of biofilms, and it is in negative correlation with the appearance of Legionella spp. Positive correlations between the Fe and Zn concentrations and Legionella spp. were established, while the inhibitory effect of a higher Cu concentration on the Legionella spp. concentration was proven. Legionella spp. were identified in 38/126 (30.2%) of the water samples from the heating system with zinc-coated pipes, as well as in 78/299 (26.1%) of the samples from systems with plastic pipes. A similar number of Legionella spp. positive samples were established regardless of the type of the water heating system (central or independent). The study confirms the necessity of regular microbial contamination monitoring of the drinking water distribution systems (DWDSs).
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Affiliation(s)
- Anita Rakić
- Public Health Institute of Split-Dalmatian County, Vukovarska 46, 21000, Split, Croatia.
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Ji P, Parks J, Edwards MA, Pruden A. Impact of Water Chemistry, Pipe Material and Stagnation on the Building Plumbing Microbiome. PLoS One 2015; 10:e0141087. [PMID: 26495985 PMCID: PMC4619671 DOI: 10.1371/journal.pone.0141087] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/03/2015] [Indexed: 02/07/2023] Open
Abstract
A unique microbiome establishes in the portion of the potable water distribution system within homes and other buildings (i.e., building plumbing). To examine its composition and the factors that shape it, standardized cold water plumbing rigs were deployed at the treatment plant and in the distribution system of five water utilities across the U.S. Three pipe materials (copper with lead solder, CPVC with brass fittings or copper/lead combined pipe) were compared, with 8 hour flush cycles of 10 minutes to simulate typical daily use patterns. High throughput Illumina sequencing of 16S rRNA gene amplicons was employed to profile and compare the resident bulk water bacteria and archaea. The utility, location of the pipe rig, pipe material and stagnation all had a significant influence on the plumbing microbiome composition, but the utility source water and treatment practices were dominant factors. Examination of 21 water chemistry parameters suggested that the total chlorine concentration, pH, P, SO42- and Mg were associated with the most of the variation in bulk water microbiome composition. Disinfectant type exerted a notably low-magnitude impact on microbiome composition. At two utilities using the same source water, slight differences in treatment approaches were associated with differences in rare taxa in samples. For genera containing opportunistic pathogens, Utility C samples (highest pH of 9–10) had the highest frequency of detection for Legionella spp. and lowest relative abundance of Mycobacterium spp. Data were examined across utilities to identify a true universal core, special core, and peripheral organisms to deepen insight into the physical and chemical factors that shape the building plumbing microbiome.
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Affiliation(s)
- Pan Ji
- Via Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Jeffrey Parks
- Via Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Marc A. Edwards
- Via Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Amy Pruden
- Via Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
- * E-mail:
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Rodríguez-Martínez S, Sharaby Y, Pecellín M, Brettar I, Höfle M, Halpern M. Spatial distribution of Legionella pneumophila MLVA-genotypes in a drinking water system. WATER RESEARCH 2015; 77:119-132. [PMID: 25864003 DOI: 10.1016/j.watres.2015.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/10/2015] [Accepted: 03/12/2015] [Indexed: 06/04/2023]
Abstract
Bacteria of the genus Legionella cause water-based infections, resulting in severe pneumonia. To improve our knowledge about Legionella spp. ecology, its prevalence and its relationships with environmental factors were studied. Seasonal samples were taken from both water and biofilm at seven sampling points of a small drinking water distribution system in Israel. Representative isolates were obtained from each sample and identified to the species level. Legionella pneumophila was further determined to the serotype and genotype level. High resolution genotyping of L. pneumophila isolates was achieved by Multiple-Locus Variable number of tandem repeat Analysis (MLVA). Within the studied water system, Legionella plate counts were higher in summer and highly variable even between adjacent sampling points. Legionella was present in six out of the seven selected sampling points, with counts ranging from 1.0 × 10(1) to 5.8 × 10(3) cfu/l. Water counts were significantly higher in points where Legionella was present in biofilms. The main fraction of the isolated Legionella was L. pneumophila serogroup 1. Serogroup 3 and Legionella sainthelensis were also isolated. Legionella counts were positively correlated with heterotrophic plate counts at 37 °C and negatively correlated with chlorine. Five MLVA-genotypes of L. pneumophila were identified at different buildings of the sampled area. The presence of a specific genotype, "MLVA-genotype 4", consistently co-occurred with high Legionella counts and seemed to "trigger" high Legionella counts in cold water. Our hypothesis is that both the presence of L. pneumophila in biofilm and the presence of specific genotypes, may indicate and/or even lead to high Legionella concentration in water. This observation deserves further studies in a broad range of drinking water systems to assess its potential for general use in drinking water monitoring and management.
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Affiliation(s)
- Sarah Rodríguez-Martínez
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - Yehonatan Sharaby
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - Marina Pecellín
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Ingrid Brettar
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Manfred Höfle
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Malka Halpern
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel; Department of Biology and Environment, Faculty of Natural Sciences, University of Haifa, Oranim, Tivon, Israel.
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Detection and Quantification of Legionella pneumophila from Water Systems in Kuwait Residential Facilities. J Pathog 2012; 2012:138389. [PMID: 22888441 PMCID: PMC3409524 DOI: 10.1155/2012/138389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 05/27/2012] [Accepted: 05/30/2012] [Indexed: 11/22/2022] Open
Abstract
The prevalence of Legionella pneumophilia in water systems of residential facilities in Kuwait was performed during the period from November 2007 to November 2011. A total of 204 water samples collected from faucets and showerheads in bathrooms (n = 82), taps in kitchens (n = 51), and water tanks (n = 71), from different locations of residential facilities in Kuwait were screened for Legionella pneumophila by the standard culture method and by real time polymerase chain reaction (RT-PCR). Out of the 204 samples, 89 (43.6%) samples were positive for Legionella spp., 48 (23.5%) samples were detected by the standard culture method, and 85 (41.7%) were detected by RT-PCR. Of the culture positive Legionella samples, counts ranged between 10 to 2250 CFU/L. Serological typing of 48 Legionella isolates revealed that 6 (12.5%) of these isolates belonged to Legionella pneumophila serogroup 1, 37 (77.1%) isolates to Legionella pneumophila serogroup 3, and 1 isolate each (2.1%) belonged to serogroups 4, 7, and 10. The minimum inhibitory concentration (MICs) of the 46 environmental L. pneumophila isolates against the 10 antimicrobials commonly used for Legionella infection treatments were determined. Rifampicin was found to be the most active against L. pneumophila serogroups isolates in vitro.
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Cooper I, Hanlon G. Resistance of Legionella pneumophila serotype 1 biofilms to chlorine-based disinfection. J Hosp Infect 2010; 74:152-9. [DOI: 10.1016/j.jhin.2009.07.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Accepted: 07/03/2009] [Indexed: 10/20/2022]
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Cooper I, Meikle S, Standen G, Hanlon G, Santin M. The rapid and specific real-time detection of Legionella pneumophila in water samples using Optical Waveguide Lightmode Spectroscopy. J Microbiol Methods 2009; 78:40-4. [DOI: 10.1016/j.mimet.2009.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 04/03/2009] [Accepted: 04/06/2009] [Indexed: 11/30/2022]
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Cooper I, White J, Mahenthiralingam E, Hanlon G. Long-term persistence of a single Legionella pneumophila strain possessing the mip gene in a municipal shower despite repeated cycles of chlorination. J Hosp Infect 2008; 70:154-9. [DOI: 10.1016/j.jhin.2008.06.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 06/13/2008] [Indexed: 10/21/2022]
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Abstract
Recent advances in effective antimicrobial prophylactic strategies have led to a decline in the incidence of opportunistic infections in liver transplant recipients. However, morbidity and mortality due to infectious diseases remain as major problems. Bacterial infections occurring early after transplant are mainly related to the technical aspects of the procedure. By contrast, after the first postoperative days and beyond, the nature and variety of infectious complications change. Opportunistic bacterial infections are uncommon after 6 mo in patients receiving stable and reduced maintenance doses of immunosuppression with good graft function and little is documented about these cases in the literature. Transplant recipients may be more susceptible to some pathogens, such as the Nocardia species, Legionella species, Listeria monocytogenes, Mycoplasma species, Salmonella species or Rhodococcus equi. Respiratory infections due to capsulated bacteria, such as Streptococcus pneumoniae and Haemophilus influenza, can be life-threatening if not promptly treated in this population. These late bacterial infections may be very difficult to recognize and treat in this population. In this article, we review what has been described in the literature with regards to late bacterial infections following liver transplantation.
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Chest Computed Tomographic Findings and Clinical Features of Legionella Pneumonia. J Comput Assist Tomogr 2007; 31:950-5. [DOI: 10.1097/rct.0b013e31804b211d] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sethi S, Gore MT, Sethi KK. Increased sensitivity of a direct fluorescent antibody test for Legionella pneumophila in bronchoalveolar lavage samples by immunomagnetic separation based on BioMags. J Microbiol Methods 2007; 70:328-35. [PMID: 17574285 DOI: 10.1016/j.mimet.2007.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/03/2007] [Accepted: 05/10/2007] [Indexed: 11/24/2022]
Abstract
In the present study, immunomagnetic separation of Legionella pneumophila from mock bronchoalveolar lavage (BAL) fluid samples, which were artificially spiked with L. pneumophila, and culture positive patient BAL fluid samples, was achieved using BioMags (superparamagnetic particles) loaded with purified rabbit immunoglobulin G specific for L. pneumophila. Bacteria binding onto BioMag-immunomatrix were directly stained with a L. pneumophila species-specific DFA reagent and examined under a fluorescence microscope. BioMag-based immunomagnetic separation (BIMS) followed by DFA staining (BIMS-DFA) could correctly identify all the 20 (100%) BAL samples which were spiked with low numbers (2x10(2) CFU) of L. pneumophila. Cultures could be recovered from 15 (75%) of these 20 spiked BAL samples, 5 (25%) of the samples failed to yield positive cultures. Both culture and BIMS-DFA methods showed 100% positive results when spiked BAL samples containing high bacterial load (10(4) CFU) were tested. The findings with true patient culture positive BAL specimens which were examined retrospectively indicated that BIMS-DFA is significantly more sensitive for detecting L. pneumophila than conventional cytospin method of DFA staining (cytospin-DFA). Out of the 25 culture positive BAL specimens tested, 7 (28%) proved negative by cytospin-DFA whereas BIMS-DFA correctly detected all the 25 (100%) specimens. It is suggested that the BIMS-DFA procedure increases the sensitivity of DFA testing for L. pneumophila in large volume samples such as BAL fluids.
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Affiliation(s)
- Shneh Sethi
- Institute of Medical Microbiology and Hygiene, University of Saarland Hospital, Kirrberger Strasse, Building No.43, 66421 Homburg/Saar, Germany.
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Borella P, Guerrieri E, Marchesi I, Bondi M, Messi P. Water ecology of Legionella and protozoan: environmental and public health perspectives. BIOTECHNOLOGY ANNUAL REVIEW 2005; 11:355-80. [PMID: 16216783 DOI: 10.1016/s1387-2656(05)11011-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Ecological studies on Legionella spp. are essential to better understand their sources in the natural environments, the mechanism of their entry into man-made water systems and the factors enabling their survival and growth in aquatic habitats. Legionella spp. exhibits peculiar and multiple strategies to adapt to stressful environment conditions which normally impair other germ survival. These strategies include the ability to enter in a viable but non-cultivable (VBNC) state, to multiply intracellularly within a variety of protozoa, such as amoebae, to survive as free organisms within biofilms and to be enhanced/inhibited by the presence of other aquatic bacteria. The host-parasite interaction has been shown to be central in the pathogenesis and ecology of L. pneumophila. The bacterial-protozoan interaction contributes to the amplification of Legionella population in water systems, represents a shelter against unfavourable environmental conditions, acts as a reservoir of infection and contributes to virulence by priming the pathogen to infect human cells. Legionella is able to survive as free organism for long periods within biofilms which are widespread in man-made water systems. Biofilm provides shelter and nutrients, exhibits a remarkable resistance to biocide compounds and chlorination, thus representing ecological niches for legionella persistence in such environments. Further knowledge on biofilm-associated legionellae may lead to effective control measures to prevent legionellosis. Lastly, new perspectives in controlling legionella contamination can arise from investigations on aquatic bacteria able to inhibit legionella growth in natural and artificial water systems.
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Affiliation(s)
- Paola Borella
- Department of Hygiene and Microbiology, University of Modena and Reggio Emilia, Via Campi 287, 41100 Modena, Italy.
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Polesky AH, Ross JT, Falkow S, Tompkins LS. Identification of Legionella pneumophila genes important for infection of amoebas by signature-tagged mutagenesis. Infect Immun 2001; 69:977-87. [PMID: 11159993 PMCID: PMC97977 DOI: 10.1128/iai.69.2.977-987.2001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Legionella pneumophila is a facultative intracellular gram-negative rod that causes pneumonia in humans. Free-living amoebas are thought to serve as a reservoir for Legionella infections. Signature-tagged mutagenesis was employed to identify Legionella pneumophila genes necessary for survival in the amoeba Acanthamoeba castellanii. Six mutant strains were defective in assays of invasion and intracellular growth. Four mutants also exhibited invasion and replication defects in Hartmannella vermiformis, an amoeba linked to hospital outbreaks of Legionella pneumonia. The six mutants also were tested in macrophages derived from peripheral blood mononuclear cells. Two mutants had intracellular replication defects, and two different strains entered cells less efficiently. Two transposon insertions were in known L. pneumophila genes, lspK and aroB. The other four were in novel genes. One gene has similarity to a cytochrome c-type biogenesis protein of Pseudomonas fluorescens. Another has similarity to a transcriptional activator regulating flagellar biosynthesis in Vibrio cholera. The third is similar to traA of Rhizobium sp. strain NGR234, which is involved in conjugal transfer of DNA. The fourth has no homology. By using survival in amoeba as a selection, we have isolated mutant strains with a range of phenotypes; and we have potentially identified new L. pneumophila virulence genes.
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Affiliation(s)
- A H Polesky
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California 94305, USA
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Waterer GW, Baselski VS, Wunderink RG. Legionella and community-acquired pneumonia: a review of current diagnostic tests from a clinician's viewpoint. Am J Med 2001; 110:41-8. [PMID: 11152864 DOI: 10.1016/s0002-9343(00)00624-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many physicians are unaware of the limitations of the available tests for diagnosing infections with Legionella organisms. Geographic differences in the importance of nonpneumophila Legionella species as pathogens are underrecognized, in part because available diagnostic tests are biased toward the detection of pneumophila serogroup 1. Routine laboratory practices reduce the likelihood of culturing Legionella species from clinical isolates. Failure of seroconversion is common, particularly with nonpneumophila species; even when seroconversion occurs, it may take much longer than 4 weeks. Urinary antigen testing has insufficient sensitivity to affect clinical management in most regions of the United States, as it can reliably detect only L. pneumophila serogroup 1 infections. Polymerase chain reaction-based techniques offer hope of providing highly sensitive, rapid diagnostic tests for all Legionella species, but limitations in the current tests will make validating them difficult.
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Affiliation(s)
- G W Waterer
- Methodist Le Bonheur Healthcare Foundation, Memphis, Tennessee, USA
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Gerhardt H, Walz MJ, Faigle M, Northoff H, Wolburg H, Neumeister B. Localization of Legionella bacteria within ribosome-studded phagosomes is not restricted to Legionella pneumophila. FEMS Microbiol Lett 2000; 192:145-52. [PMID: 11040443 DOI: 10.1111/j.1574-6968.2000.tb09373.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In this report, we investigate the intracellular fate of selected members of the genus Legionella within the monocytic cell line Mono Mac 6 cells. By means of electron microscopy and immunocytochemistry, we could show that Legionella pneumophila as well as Legionella longbeachae are able to induce ribosome-studded phagosomes which associate with the rough endoplasmic reticulum (RER), whereas Legionella micdadei remains to be located within smooth phagosomes but also shows signs of RER association. In addition, we could demonstrate a remarkable correlation between the phagosome type and the morphological phenotype of intracellular bacteria: within ribosome-studded phagosomes, bacteria generally lacked the outer coat of low electron density whereas bacteria within the smooth phagosomes still possessed this outer coat. The virulence factors responsible for inhibition of phagosome maturation and their distribution within the genus Legionella as well as the biological significance of the morphological difference of bacteria within smooth and ER-associated phagosomes remain to be investigated.
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Affiliation(s)
- H Gerhardt
- Pathologisches Institut der Universität Tübingen, Tübingen, Germany
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Chaudhry R, Dhawan B, Dey AB. The incidence of Legionella pneumophila: a prospective study in a tertiary care hospital in India. Trop Doct 2000; 30:197-200. [PMID: 11075648 DOI: 10.1177/004947550003000405] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The prevalence of Legionella pneumophila causing community-acquired pneumonia (CAP) in patients who were admitted to hospital was investigated. Between April 1997 and December 1998, 60 patients admitted to the All India Institute of Medical Sciences with CAP, were included in the study. Aetiological diagnosis was based on the results of routine microbiological blood culture for bacteria and serological test by enzyme linked immunosorbent assay (ELISA) for L. pneumophila serogroup 1-7. Eight (13%) patients had a conventional bacterial aetiology and nine (15%) had serological evidence of recent infection with L. pneumophila. Legionella pneumophila may be an important cause of CAP in adults in developing countries. Empiric antimicrobial treatment should include a combination of agents to cover both atypical agents and bacterial pathogens.
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Affiliation(s)
- R Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi
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Köhler JR, Maiwald M, Lück PC, Helbig JH, Hingst V, Sonntag HG. Detecting legionellosis by unselected culture of respiratory tract secretions and developing links to hospital water strains. J Hosp Infect 1999; 41:301-11. [PMID: 10392336 DOI: 10.1053/jhin.1998.0517] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
For a 13-month period, all respiratory tract secretions submitted for routine bacteriology from a large hospital complex were cultured for legionella, irrespective of clinical diagnosis and laboratory requests. Ten cases of legionellosis were detected in this manner, three of which met a strict epidemiological definition of hospital-acquired. Therefore, the 16 warm-water systems of the hospitals, spread out over two locations, were examined for the presence of legionella. Legionella pneumophila was found in 15 warm water systems, with a distinct pattern of serogroups between the two locations. Legionella of the same serogroups as those isolated from patients were present in each hospital water supply. The isolates were further typed by monoclonal antibodies and by genomic macrorestriction analysis. Similarity between clinical and environmental isolates was found in seven cases. In these cases, acquisition from the hospital water supply appears very likely. The strains of the remaining three patients did not match those in hospital water, suggesting that community-acquired legionellosis was occurring as well. This study suggests that routinely culturing respiratory tract secretions of pneumonia patients for legionella can help diagnose unsuspected cases of legionellosis. Typing legionella strains beyond the serogroup level with tools such as macrorestriction analysis is useful to define sources of infection, which can then be targeted for control measures.
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Affiliation(s)
- J R Köhler
- Hygiene-Institut der Universität, Abteilung Hygiene und Medizinische Mikrobiologie, Heidelberg, Germany
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Schülin T, Wennersten CB, Ferraro MJ, Moellering RC, Eliopoulos GM. Susceptibilities of Legionella spp. to newer antimicrobials in vitro. Antimicrob Agents Chemother 1998; 42:1520-3. [PMID: 9624509 PMCID: PMC105637 DOI: 10.1128/aac.42.6.1520] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The in vitro activities of 13 antimicrobial agents against 30 strains of Legionella spp. were determined. Rifapentine, rifampin, and clarithromycin were the most potent agents (MICs at which 90% of isolates are inhibited [MIC90s], < or = 0.008 microgram/ml). The ketolide HMR 3647 and the fluoroquinolones levofloxacin and BAY 12-8039 (MIC90s, 0.03 to 0.06 microgram/ml) were more active than erythromycin A or roxithromycin. The MIC90s of dalfopristin-quinupristin and linezolid were 0.5 and 8 micrograms/ml, respectively. Based on class characteristics and in vitro activities, several of these agents may have potential roles in the treatment of Legionella infections.
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Affiliation(s)
- T Schülin
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Ernst A, Gordon FD, Hayek J, Silvestri RC, Koziel H. Lung abcess complicating Legionella micdadei pneumonia in an adult liver transplant recipient: case report and review. Transplantation 1998; 65:130-4. [PMID: 9448158 DOI: 10.1097/00007890-199801150-00025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Legionella micdadei (Pittsburgh pneumonia agent) is the second most common cause of Legionella pneumonia, and occurs predominantly in immunocompromised hosts. L micdadei is the cause of nosocomial pneumonia in renal transplant recipients, but has not been described in other adult solid organ transplant recipients. This report describes the first case of L micdadei pneumonia in an adult liver transplant recipient on immunosuppressive therapy. Importantly, this case highlights the difficulties in establishing the diagnosis, as the Legionella urinary antigen is negative, and special culture conditions are required. Furthermore, this case illustrates several atypical clinical features of L micdadei pneumonia in a transplant recipient, including a community acquired mode of transmission, occurrence several years after organ transplantation, and lung abcess formation. The patient was successfully treated with limited surgical resection and quinolone antimicrobial monotherapy.
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Affiliation(s)
- A Ernst
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA
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NEUMEISTER B, KLEIHAUER A, ROSSMANN V, FEHRENBACH E, FAIGLE M, BAUMBACH S, NORTHOFF H. Induction of cvtokines and expression of surface receptors in Mono Mac 6 cells after infection with differentLegionellaspecies. APMIS 1998. [DOI: 10.1111/j.1699-0463.1998.tb01353.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Neumeister B, Schöniger S, Faigle M, Eichner M, Dietz K. Multiplication of different Legionella species in Mono Mac 6 cells and in Acanthamoeba castellanii. Appl Environ Microbiol 1997; 63:1219-24. [PMID: 9097418 PMCID: PMC168415 DOI: 10.1128/aem.63.4.1219-1224.1997] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Survival and distribution of legionellae in the environment are assumed to be associated with their multiplication in amoebae, whereas the ability to multiply in macrophages is usually regarded to correspond to pathogenicity. Since most investigations focused on Legionella pneumophila serogroup 1, we examined the intracellular multiplication of different Legionella species in Mono Mac 6 cells, which express phenotypic and functional features of mature monocytes, and in Acanthamoeba castellanii, an environmental host of Legionella spp. According to the bacterial doubling time in Mono Mac 6 cells and in A. castellanii, seven clusters of legionellae could be defined which could be split further with regard to finer differences. L. longbeachae serogroup 1, L. jordanis, and L. anisa were not able to multiply in either A. castellanii or Mono Mac 6 cells and are members of the first cluster. L. dumoffi did not multiply in Mono Mac 6 cells but showed a delayed multiplication in A. castellanii 72 h after infection and is the only member of the second cluster. L. steigerwaltii, L. gormanii, L. pneumophila serogroup 6 ATCC 33215, L. bozemanii, and L. micdadei showed a stable bacterial count in Mono Mac 6 cells after infection but a decreasing count in amoebae. They can be regarded as members of the third cluster. As the only member of the fourth cluster, L. oakridgensis was able to multiply slight in Mono Mac 6 cells but was killed within amoebae. A strain of L. pneumophila serogroup 1 Philadelphia obtained after 30 passages on SMH agar and a strain of L. pneumophila serogroup 1 Philadelphia obtained after intraperitoneal growth in guinea pigs are members of the fifth cluster, which showed multiplication in Mono Mac 6 cells but a decrease of bacterial counts in A. castellanii. The sixth cluster is characterized by intracellular multiplication in both host cell systems and consists of several strains of L. pneumophila serogroup 1 Philadelphia, a strain of L. pneumophila serogroup 2, and a fresh clinical isolate of L. pneumophila serogroup 6. Members of the seventh cluster are a strain of agar-adapted L. pneumophila serogroup 1 Bellingham and a strain of L. pneumophila serogroup 1 Bellingham which was passaged fewer than three times on BCYE alpha agar after inoculation and intraperitoneal growth in guinea pigs. In comparison to members of the sixth cluster, both strains showed a slightly enhanced multiplication in Mono Mac 6 cells but a reduced multiplication in amoebae. From our investigations, we could demonstrate a correlation between prevalence of a given Legionella species and their intracellular multiplication in Mono Mac 6 cells. Multiplication of members of the genus Legionella in A. castellanii seems to be dependent on mechanisms different from those in monocytes.
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Affiliation(s)
- B Neumeister
- Abteilung Medizinische Mikrobiologie und Hygiene, Universität Ulm, Germany
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Lieberman D, Porath A, Schlaeffer F, Lieberman D, Boldur I. Legionella species community-acquired pneumonia. A review of 56 hospitalized adult patients. Chest 1996; 109:1243-9. [PMID: 8625675 DOI: 10.1378/chest.109.5.1243] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In a prospective study, Legionella species (Lsp) was identified as the causative agent in 56 (16.2%) of 346 adult patients hospitalized over the course of 1 year with community-acquired pneumonia (CAP), in the Soroka Medical Center, Beer-Sheva, Israel. OBJECTIVE To characterize patients with Lsp CAP in our study. METHODS The diagnosis of infection with Lsp was based on serologic testing of antibodies using the indirect immunofluorescent method. RESULTS In 35 (62.5%) of the patients, at least one other etiologic agent for CAP was identified in addition to Lsp. The patient population was relatively young, with relatively low rates of chronic comorbidity, and a broad spectrum of disease severity compared with previously published studies. No single epidemiologic, clinical, laboratory, or radiographic characteristic differentiated between Lsp CAP and other CAP patients in our study. Three patients (5.4%) who were not treated with erythromycin died. However, in contrast, nine patients who were treated with beta-lactam antibiotics recovered completely. CONCLUSIONS Lsp is a common cause of CAP in our region, usually as a coinfection with another causative agent. Lsp CAP, which cannot be characterized on the basis of clinical, routine laboratory, or radiographic data, requires specific microbiologic or serologic diagnosis. Treatment with erythromycin appears to be important to reduce mortality from this disease, but in a significant number of patients, the disease may be self-limited.
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Affiliation(s)
- D Lieberman
- Division of Internal Medicine, Soroka Medical Center of Kupat Holim, Israel
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Abstract
Legionella usually causes pneumonia, but occasionally is in the differential diagnosis of "culture negative endocarditis" which sometimes involves prosthetic heart valves. Legionella prosthetic valve endocarditis is nearly always due to Legionella pneumophila and its clinical presentation is indistinguishable from other causes of prosthetic valve endocarditis. Diagnosis of Legionella prosthetic valve endocarditis is by recovery of the organism from the blood, demonstration or isolation of the organism from the prosthetic heart valve, or by persistently high Legionella titers which are extremely elevated in prosthetic valve endocarditis compared to Legionella pneumonia. We believe this is the first case reported of prosthetic valve endocarditis caused by Legionella micdadei, and the first case of Legionella prosthetic valve endocarditis with microscopic hematuria.
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Affiliation(s)
- D Park
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501
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Daaka Y, Yamamoto Y, Klein TW, Newton C, Friedman H. Correlation ofLegionella pneumophila virulence with the presence of a plasmid. Curr Microbiol 1994. [DOI: 10.1007/bf01575964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Akalin HE. Atypical pneumonias: therapeutic possibilities. Int J Antimicrob Agents 1993; 3 Suppl 1:S75-9. [PMID: 18611582 DOI: 10.1016/0924-8579(93)90038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/1993] [Indexed: 10/27/2022]
Abstract
The atypical pneumonia syndrome is characterized by systemic complaints rather than respiratory symptoms. The causative pathogens include Mycoplasma, Chlamydia, Legionella and respiratory viruses (influenza, adenovirus, respiratory syncytial virus). The reported incidence of disease caused by these pathogens in community-acquired pneumonias varies from study to study. As most of these pathogens are intracellular, the antibiotics used in the treatment of atypical pneumonia are those able to penetrate into cells. Empirical antimicrobial therapy consists of macrolides (erythromycin or some of the newer agents such as roxithromycin, azithromycin or clarithromycin) or tetracyclines (e.g. doxycycline). In cases of severe legionellosis and in immunocompromised and critically-ill patients, the macrolides are sometimes given in combination with rifampicin. Promising alternatives are some of the newer fluoroquinolones (e.g. ofloxacin, pefloxacin) in the treatment of legionellosis.
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Affiliation(s)
- H E Akalin
- Hacettepe University School of Medicine, Ankara, Turkey
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Legionella pneumophila virulence conserved after multiple single-colony passage on agar. Curr Microbiol 1993. [DOI: 10.1007/bf01692883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Henderson E, Ledgerwood D, Hope KM, Hume K, Krulicki W, Ford G, Golar S, Sutherland L, Louie TJ. Prolonged and multipatient use of prefilled disposable oxygen humidifier bottles: safety and cost. Infect Control Hosp Epidemiol 1993; 14:463-8. [PMID: 8376736 DOI: 10.1086/646780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Multipatient use and prolonged use of prefilled disposable oxygen humidifier bottles (Aquapak 301, Respiratory Care, Inc., Arlington Heights, IL) were evaluated by performing microbiologic monitoring and a cost analysis on bottles used for varying numbers of patients and lengths of time. METHODS Humidifiers were hung for a maximum of one month. Monitoring was conducted in 6 different nursing areas. Quantitative cultures were done for aerobes and Legionella. Reusable humidifier bottles also were monitored. RESULTS Cultures were obtained from 1,311 disposable and 60 reusable humidifiers. No significant bacterial contamination was detected in the prefilled disposable oxygen humidifier units. Ten percent of the reusable bottles were contaminated by organisms associated with skin flora. CONCLUSIONS Multipatient use and increased duration of use of disposable humidifiers result in cost savings without increasing patient risk. Restricted multipatient use of prefilled disposable oxygen humidifier bottles for a period of one month is a safe and cost-efficient practice.
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Affiliation(s)
- E Henderson
- Office of Infection Control, Calgary General Hospital, East Calgary, Alberta, Canada
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Henderson E, Ledgerwood D, Hope KM, Hume K, Krulicki W, Ford G, Golar S, Sutherland L, Louie TJ. Prolonged and Multipatient Use of Prefilled Disposable Oxygen Humidifier Bottles: Safety and Cost. Infect Control Hosp Epidemiol 1993. [DOI: 10.2307/30145518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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APPROACH TO PNEUMONIA IN ADULTS AND THE ELDERLY. Immunol Allergy Clin North Am 1993. [DOI: 10.1016/s0889-8561(22)00439-8] [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]
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Yamamoto Y, Klein TW, Friedman H. Ethanol affects macrophage production of IL-6 and susceptibility to infection by Legionella pneumophila. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1993; 335:169-73. [PMID: 8237592 DOI: 10.1007/978-1-4615-2980-4_24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Y Yamamoto
- Department of Medical Microbiology and Immunology, University of South Florida College of Medicine, Tampa 33612
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