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Cavallazzi R, Ramirez JA. Definition, Epidemiology, and Pathogenesis of Severe Community-Acquired Pneumonia. Semin Respir Crit Care Med 2024; 45:143-157. [PMID: 38330995 DOI: 10.1055/s-0044-1779016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The clinical presentation of community-acquired pneumonia (CAP) can vary widely among patients. While many individuals with mild symptoms can be managed as outpatients with excellent outcomes, there is a distinct subgroup of patients who present with severe CAP. In these cases, the mortality rate can reach approximately 25% within 30 days and even up to 50% within a year. It is crucial to focus attention on these patients who are at higher risk. Among the various definitions of severe CAP found in the literature, one commonly used criterion is the requirement for admission to intensive care unit. Notable epidemiological characteristics of these patients include the impact of acute cardiovascular diseases on clinical outcomes and the enduring, independent effect of pneumonia on long-term outcomes. Factors such as pathogen virulence, the presence of comorbidities, and the host response are important contributors to the pathogenesis of severe CAP. In these patients, the host response may be dysregulated and compartmentalized. Gaining a better understanding of the epidemiology and pathogenesis of severe CAP will provide a foundation for the development of new therapies for this condition. This manuscript aims to review the definition, epidemiology, and pathogenesis of severe CAP, shedding light on important aspects that can aid in the improvement of patient care and outcomes.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
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2
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Gea-Izquierdo E. Biological risk of Legionella pneumophila in irrigation systems. Rev Salud Publica (Bogota) 2023; 22:434-439. [PMID: 36753243 DOI: 10.15446/rsap.v22n4.96429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/22/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The goal of this study is to determine the risk of exposure to Legionella pneumophila in hotel golf courses located in the province of Malaga (Spain). METHOD Spray irrigation systems were analyzed as sources for spreading the Legionella bacterium. Spanish legislation requires that irrigation systems be monitored for their water quality as well as for reasons related to health and hygiene. Based on an observational study and non-parametric tests (Goodman-Kruskal Tau and uncertainty coefficient), this study states the regulatory enforcement among the systems and contributed to announce Legionella prevention. The quality criteria for recycled water, waste water treatment plant and well water were analyzed in relationship to the hotels' categories. RESULTS Deficiencies were found in the preventive maintenance of irrigation systems, but no relationship exists between the type of water and the risk detected. CONCLUSIONS The study suggests that aerosolized water used in golf course watering systems could pose risk to the population by exposing them to Legionella.
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Affiliation(s)
- Enrique Gea-Izquierdo
- EG: Ph. D. Epidemiología. Ph. D. Salud Pública. M. Sc. Medicina Preventiva y Salud Pública. M. Sc. Gestión de Riesgos Laborales, Calidad y Medio Ambiente. M. Sc. Prevención de Riesgos Profesionales en la Empresa. Pontificia Universidad Católica del Ecuador, Facultad de Medicina. Quito, Ecuador. Universidad de Málaga, Cátedra de Seguridad y Salud en el Trabajo. Málaga, España.
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Ibekwe AM, Murinda SE. Linking Microbial Community Composition in Treated Wastewater with Water Quality in Distribution Systems and Subsequent Health Effects. Microorganisms 2019; 7:microorganisms7120660. [PMID: 31817873 PMCID: PMC6955928 DOI: 10.3390/microorganisms7120660] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022] Open
Abstract
The increases in per capita water consumption, coupled in part with global climate change have resulted in increased demands on available freshwater resources. Therefore, the availability of safe, pathogen-free drinking water is vital to public health. This need has resulted in global initiatives to develop sustainable urban water infrastructure for the treatment of wastewater for different purposes such as reuse water for irrigation, and advanced waste water purification systems for domestic water supply. In developed countries, most of the water goes through primary, secondary, and tertiary treatments combined with disinfectant, microfiltration (MF), reverse osmosis (RO), etc. to produce potable water. During this process the total bacterial load of the water at different stages of the treatment will decrease significantly from the source water. Microbial diversity and load may decrease by several orders of magnitude after microfiltration and reverse osmosis treatment and falling to almost non-detectable levels in some of the most managed wastewater treatment facilities. However, one thing in common with the different end users is that the water goes through massive distribution systems, and the pipes in the distribution lines may be contaminated with diverse microbes that inhabit these systems. In the main distribution lines, microbes survive within biofilms which may contain opportunistic pathogens. This review highlights the role of microbial community composition in the final effluent treated wastewater, biofilms formation in the distribution systems as the treated water goes through, and the subsequent health effects from potential pathogens associated with poorly treated water. We conclude by pointing out some basic steps that may be taken to reduce the accumulation of biofilms in the water distribution systems.
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Affiliation(s)
- Abasiofiok Mark Ibekwe
- US Salinity Laboratory, USDA-ARS, 450 W. Big Springs Rd., Riverside, CA 92507, USA
- Correspondence: ; Tel.: +951-369-4828
| | - Shelton E. Murinda
- Animal and Veterinary Sciences Department, Center for Antimicrobial Research and Food Safety, California State Polytechnic University, Pomona, CA 91768, USA;
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Chaudhry R, Sreenath K, Agrawal SK, Valavane A. Legionella and Legionnaires' disease: Time to explore in India. Indian J Med Microbiol 2019; 36:324-333. [PMID: 30429383 DOI: 10.4103/ijmm.ijmm_18_298] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Legionella pneumophila was first recognised as a fatal cause of pneumonia more than four decades ago, during the 1976-American Legion convention in Philadelphia, USA. Legionella spp. continue to cause disease outbreaks of public health significance, and at present, Legionnaires' disease (LD) has emerged as an important cause of community and hospital-acquired pneumonia. Parallel to this, the understanding of LD has also increased exponentially. However, the disease is likely to be underreported in many countries because of the dearth of common definitions, diagnostic tests and active surveillance systems. In this review, we outline the basic concepts of Legionella including clinical presentations, epidemiology, laboratory diagnosis and the status of LD in India. This article also summarises the progress of research related to Legionella in this country, identifying the research gaps and discussing priorities to explore this unexplored pathogen in India.
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Affiliation(s)
- Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - K Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sonu Kumari Agrawal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Valavane
- Department of Microbiology, Indira Gandhi Medical College and Research Institute, Puducherry, India
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David S, Mentasti M, Lai S, Vaghji L, Ready D, Chalker VJ, Parkhill J. Spatial structuring of a Legionella pneumophila population within the water system of a large occupational building. Microb Genom 2018; 4. [PMID: 30312149 PMCID: PMC6249432 DOI: 10.1099/mgen.0.000226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The diversity of Legionella pneumophila populations within single water systems is not well understood, particularly in those unassociated with cases of Legionnaires’ disease. Here, we performed genomic analysis of 235 L. pneumophila isolates obtained from 28 water samples in 13 locations within a large occupational building. Despite regular treatment, the water system of this building is thought to have been colonized by L. pneumophila for at least 30 years without evidence of association with Legionnaires’ disease cases. All isolates belonged to one of three sequence types (STs), ST27 (n=81), ST68 (n=122) and ST87 (n=32), all three of which have been recovered from Legionnaires’ disease patients previously. Pairwise single nucleotide polymorphism differences amongst isolates of the same ST were low, ranging from 0 to 19 in ST27, from 0 to 30 in ST68 and from 0 to 7 in ST87, and no homologous recombination was observed in any lineage. However, there was evidence of horizontal transfer of a plasmid, which was found in all ST87 isolates and only one ST68 isolate. A single ST was found in 10/13 sampled locations, and isolates of each ST were also more similar to those from the same location compared with those from different locations, demonstrating spatial structuring of the population within the water system. These findings provide the first insights into the diversity and genomic evolution of a L. pneumophila population within a complex water system not associated with disease.
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Affiliation(s)
- Sophia David
- 1Pathogen Genomics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK.,2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK.,†Present address: The Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Cambridge, UK
| | - Massimo Mentasti
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK.,‡Present address: Microbiology Cardiff, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - Sandra Lai
- 3Food, Water and Environmental Laboratory, Public Health England, Colindale, London, UK
| | - Lalita Vaghji
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK
| | - Derren Ready
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK
| | - Victoria J Chalker
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK
| | - Julian Parkhill
- 1Pathogen Genomics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
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Rolling epidemic of Legionnaires' disease outbreaks in small geographic areas. Emerg Microbes Infect 2018; 7:36. [PMID: 29559643 PMCID: PMC5861071 DOI: 10.1038/s41426-018-0051-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/28/2017] [Accepted: 12/14/2017] [Indexed: 11/20/2022]
Abstract
Legionnaires’ disease (LD) is reported from many parts of the world, mostly linked to drinking water sources or cooling towers. We reviewed two unusual rolling outbreaks in Sydney and New York, each clustered in time and space. Data on these outbreaks were collected from public sources and compared to previous outbreaks in Australia and the US. While recurrent outbreaks of LD over time linked to an identified single source have been described, multiple unrelated outbreaks clustered in time and geography have not been previously described. We describe unusual geographic and temporal clustering of Legionella outbreaks in two cities, each of which experienced multiple different outbreaks within a small geographic area and within a short timeframe. The explanation for this temporal and spatial clustering of LD outbreaks in two cities is not clear, but climate variation and deteriorating water sanitation are two possible explanations. There is a need to critically analyse LD outbreaks and better understand changing trends to effectively prevent disease.
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Prevalence of Infection-Competent Serogroup 6 Legionella pneumophila within Premise Plumbing in Southeast Michigan. mBio 2018; 9:mBio.00016-18. [PMID: 29437918 PMCID: PMC5801461 DOI: 10.1128/mbio.00016-18] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coinciding with major changes to its municipal water system, Flint, MI, endured Legionnaires’ disease outbreaks in 2014 and 2015. By sampling premise plumbing in Flint in the fall of 2016, we found that 12% of homes harbored legionellae, a frequency similar to that in residences in neighboring areas. To evaluate the genetic diversity of Legionella pneumophila in Southeast Michigan, we determined the sequence type (ST) and serogroup (SG) of the 18 residential isolates from Flint and Detroit, MI, and the 33 clinical isolates submitted by hospitals in three area counties in 2013 to 2016. Common to one environmental and four clinical samples were strains of L. pneumophila SG1 and ST1, the most prevalent ST worldwide. Among the Flint premise plumbing isolates, 14 of 16 strains were of ST367 and ST461, two closely related SG6 strain types isolated previously from patients and corresponding environmental samples. Each of the representative SG1 clinical strains and SG6 environmental isolates from Southeast Michigan infected and survived within macrophage cultures at least as well as a virulent laboratory strain, as judged by microscopy and by enumerating CFU. Likewise, 72 h after infection, the yield of viable-cell counts increased >100-fold for each of the representative SG1 clinical isolates, Flint premise plumbing SG6 ST367 and -461 isolates, and two Detroit residential isolates. We verified by immunostaining that SG1-specific antibody does not cross-react with the SG6 L. pneumophila environmental strains. Because the widely used urinary antigen diagnostic test does not readily detect non-SG1 L. pneumophila, Legionnaires’ disease caused by SG6 L. pneumophila is likely underreported worldwide. L. pneumophila is the leading cause of disease outbreaks associated with drinking water in the United States. Compared to what is known of the established risks of colonization within hospitals and hotels, relatively little is known about residential exposure to L. pneumophila. One year after two outbreaks of Legionnaires’ disease in Genesee County, MI, that coincided with damage to the Flint municipal water system, our multidisciplinary team launched an environmental surveillance and laboratory research campaign aimed at informing risk management strategies to provide safe public water supplies. The most prevalent L. pneumophila strains isolated from residential plumbing were closely related strains of SG6. In laboratory tests of virulence, the SG6 environmental isolates resembled SG1 clinical strains, yet they are not readily detected by the common diagnostic urinary antigen test, which is specific for SG1. Therefore, our study complements the existing epidemiological literature indicating that Legionnaires’ disease due to non-SG1 strains is underreported around the globe.
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Gamage SD, Ambrose M, Kralovic SM, Roselle GA. Water Safety and Legionella in Health Care: Priorities, Policy, and Practice. Infect Dis Clin North Am 2017; 30:689-712. [PMID: 27515143 DOI: 10.1016/j.idc.2016.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Health care facility water distribution systems have been implicated in the transmission of pathogens such as Legionella and nontuberculous mycobacteria to building occupants. These pathogens are natural inhabitants of water at low numbers and can amplify in premise plumbing water, especially if conditions are conducive to their growth. Because patients and residents in health care facilities are often at heightened risk for opportunistic infections, a multidisciplinary proactive approach to water safety is important to balance the various water priorities in health care and prevent water-associated infections in building occupants.
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Affiliation(s)
- Shantini D Gamage
- National Infectious Diseases Service, Specialty Care Services, Patient Care Services, Veterans Health Administration, Department of Veterans Affairs (VA), 810 Vermont Avenue, NW, Washington, DC 20420, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - Meredith Ambrose
- National Infectious Diseases Service, Specialty Care Services, Patient Care Services, Veterans Health Administration, Department of Veterans Affairs (VA), 810 Vermont Avenue, NW, Washington, DC 20420, USA
| | - Stephen M Kralovic
- National Infectious Diseases Service, Specialty Care Services, Patient Care Services, Veterans Health Administration, Department of Veterans Affairs (VA), 810 Vermont Avenue, NW, Washington, DC 20420, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA; Medical Service, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA
| | - Gary A Roselle
- National Infectious Diseases Service, Specialty Care Services, Patient Care Services, Veterans Health Administration, Department of Veterans Affairs (VA), 810 Vermont Avenue, NW, Washington, DC 20420, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA; Medical Service, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA
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9
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Mercante JW, Morrison SS, Desai HP, Raphael BH, Winchell JM. Genomic Analysis Reveals Novel Diversity among the 1976 Philadelphia Legionnaires' Disease Outbreak Isolates and Additional ST36 Strains. PLoS One 2016; 11:e0164074. [PMID: 27684472 PMCID: PMC5042515 DOI: 10.1371/journal.pone.0164074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/19/2016] [Indexed: 11/18/2022] Open
Abstract
Legionella pneumophila was first recognized as a cause of severe and potentially fatal pneumonia during a large-scale outbreak of Legionnaires’ disease (LD) at a Pennsylvania veterans’ convention in Philadelphia, 1976. The ensuing investigation and recovery of four clinical isolates launched the fields of Legionella epidemiology and scientific research. Only one of the original isolates, “Philadelphia-1”, has been widely distributed or extensively studied. Here we describe the whole-genome sequencing (WGS), complete assembly, and comparative analysis of all Philadelphia LD strains recovered from that investigation, along with L. pneumophila isolates sharing the Philadelphia sequence type (ST36). Analyses revealed that the 1976 outbreak was due to multiple serogroup 1 strains within the same genetic lineage, differentiated by an actively mobilized, self-replicating episome that is shared with L. pneumophila str. Paris, and two large, horizontally-transferred genomic loci, among other polymorphisms. We also found a completely unassociated ST36 strain that displayed remarkable genetic similarity to the historical Philadelphia isolates. This similar strain implies the presence of a potential clonal population, and suggests important implications may exist for considering epidemiological context when interpreting phylogenetic relationships among outbreak-associated isolates. Additional extensive archival research identified the Philadelphia isolate associated with a non-Legionnaire case of “Broad Street pneumonia”, and provided new historical and genetic insights into the 1976 epidemic. This retrospective analysis has underscored the utility of fully-assembled WGS data for Legionella outbreak investigations, highlighting the increased resolution that comes from long-read sequencing and a sequence type-matched genomic data set.
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Affiliation(s)
- Jeffrey W. Mercante
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shatavia S. Morrison
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Heta P. Desai
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brian H. Raphael
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonas M. Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Garrison LE, Kunz JM, Cooley LA, Moore MR, Lucas C, Schrag S, Sarisky J, Whitney CG. Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires’ Disease-North America, 2000-2014. Am J Transplant 2016. [DOI: 10.1111/ajt.14024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. E. Garrison
- Division of Bacterial Diseases; National Center for Immunization and Respiratory Diseases; CDC; Atlanta GA
| | - J. M. Kunz
- Division of Emergency and Environmental Health Services; National Center for Environmental Health; CDC; Atlanta GA
| | - L. A. Cooley
- Division of Bacterial Diseases; National Center for Immunization and Respiratory Diseases; CDC; Atlanta GA
| | - M. R. Moore
- Division of Bacterial Diseases; National Center for Immunization and Respiratory Diseases; CDC; Atlanta GA
| | - C. Lucas
- Division of Bacterial Diseases; National Center for Immunization and Respiratory Diseases; CDC; Atlanta GA
| | - S. Schrag
- Division of Bacterial Diseases; National Center for Immunization and Respiratory Diseases; CDC; Atlanta GA
| | - J. Sarisky
- Division of Emergency and Environmental Health Services; National Center for Environmental Health; CDC; Atlanta GA
| | - C. G. Whitney
- Division of Bacterial Diseases; National Center for Immunization and Respiratory Diseases; CDC; Atlanta GA
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Hampton LM, Garrison L, Kattan J, Brown E, Kozak-Muiznieks NA, Lucas C, Fields B, Fitzpatrick N, Sapian L, Martin-Escobar T, Waterman S, Hicks LA, Alpuche-Aranda C, Lopez-Gatell H. Legionnaires' Disease Outbreak at a Resort in Cozumel, Mexico. Open Forum Infect Dis 2016; 3:ofw170. [PMID: 27704023 PMCID: PMC5047414 DOI: 10.1093/ofid/ofw170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/05/2016] [Indexed: 11/24/2022] Open
Abstract
An investigation of a Legionnaires' disease outbreak at a Cozumel Island resort identified the source of the first reported Legionnaires' disease outbreak in Mexico and highlighted the need for all countries to make Legionnaires' disease a reportable disease. Background. A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease. Methods. Reports of LD among travelers were solicited from US health departments and the European Working Group for Legionella Infections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possible Legionella exposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested for Legionella. Results. Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers. Legionellae were found to have extensively colonized the resort's potable water system. Legionellae matching a case isolate were found in the resort's potable water system. Conclusions. Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so.
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Affiliation(s)
- Lee M Hampton
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Laurel Garrison
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Jessica Kattan
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office; Connecticut Department of Public Health, Hartford
| | - Ellen Brown
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | | | - Claressa Lucas
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Barry Fields
- Division of Global Health Protection, Center for Global Health
| | - Nicole Fitzpatrick
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Luis Sapian
- Instituto de Diagnóstico y Referencia Epidemiologicos , Ciudad de Mexico, Distrito Federal
| | | | - Stephen Waterman
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Lauri A Hicks
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Celia Alpuche-Aranda
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos , Mexico
| | - Hugo Lopez-Gatell
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos , Mexico
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Garrison LE, Kunz JM, Cooley LA, Moore MR, Lucas C, Schrag S, Sarisky J, Whitney CG. Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires’ Disease — North America, 2000–2014. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:576-84. [DOI: 10.15585/mmwr.mm6522e1] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Evaluation of an Optimal Epidemiological Typing Scheme for Legionella pneumophila with Whole-Genome Sequence Data Using Validation Guidelines. J Clin Microbiol 2016; 54:2135-48. [PMID: 27280420 PMCID: PMC4963484 DOI: 10.1128/jcm.00432-16] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/20/2016] [Indexed: 01/23/2023] Open
Abstract
Sequence-based typing (SBT), analogous to multilocus sequence typing (MLST), is the current "gold standard" typing method for investigation of legionellosis outbreaks caused by Legionella pneumophila However, as common sequence types (STs) cause many infections, some investigations remain unresolved. In this study, various whole-genome sequencing (WGS)-based methods were evaluated according to published guidelines, including (i) a single nucleotide polymorphism (SNP)-based method, (ii) extended MLST using different numbers of genes, (iii) determination of gene presence or absence, and (iv) a kmer-based method. L. pneumophila serogroup 1 isolates (n = 106) from the standard "typing panel," previously used by the European Society for Clinical Microbiology Study Group on Legionella Infections (ESGLI), were tested together with another 229 isolates. Over 98% of isolates were considered typeable using the SNP- and kmer-based methods. Percentages of isolates with complete extended MLST profiles ranged from 99.1% (50 genes) to 86.8% (1,455 genes), while only 41.5% produced a full profile with the gene presence/absence scheme. Replicates demonstrated that all methods offer 100% reproducibility. Indices of discrimination range from 0.972 (ribosomal MLST) to 0.999 (SNP based), and all values were higher than that achieved with SBT (0.940). Epidemiological concordance is generally inversely related to discriminatory power. We propose that an extended MLST scheme with ∼50 genes provides optimal epidemiological concordance while substantially improving the discrimination offered by SBT and can be used as part of a hierarchical typing scheme that should maintain backwards compatibility and increase discrimination where necessary. This analysis will be useful for the ESGLI to design a scheme that has the potential to become the new gold standard typing method for L. pneumophila.
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Gamage SD, Kralovic SM, Roselle GA. The Case for Routine Environmental Testing forLegionellaBacteria in Healthcare Facility Water Distribution Systems—Reconciling CDC Position and Guidance Regarding Risk. Clin Infect Dis 2015. [DOI: 10.1093/cid/civ589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Altmann E. Industry professionalisation of strata title managers: what are the implications for governance? PROPERTY MANAGEMENT 2015. [DOI: 10.1108/pm-07-2014-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose– The purpose of this paper is to explore the rise of strata manager as a newly emergent profession and note their impact on the governance within medium and high density, strata titled housing such as flats, apartments, town-houses and CIDs.Design/methodology/approach– This research presents finding from a small scale, qualitative research project focused on the interaction between the owner committee of management and strata managers.Findings– The introduction mandatory certification is championed by industry bodies. The strata managers considered they already demonstrated valuable attributes desired by committees of management. These differed to the attributes targeted by the new training regime, and the attributes valued by the committees of management.Research limitations/implications– This is a small scale pilot study. A larger study will need to be undertaken to confirm these results.Practical implications– There is a disjunct between the training and what strata managers consider relevant to undertaking their duties. This has significance for the ongoing governance of these properties and industry professionalisation. The resilience of Australia’s densification policies will depend on how learning will translate into better governance outcomes for owners.Social implications– One in three people within Australia’s eastern states lives or owns property within strata titled complex (apartments, flats and townhouse developments). The increasing number of strata managers and professionalisation within their industry has the ability to impact an increasing number of people.Originality/value– The impact of this new profession, and their requirements in terms of expertise has not been fully considered within existing academic literature.
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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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Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K, Lortholary O, Zumla A, Abubakar I. Epidemiology and clinical management of Legionnaires' disease. THE LANCET. INFECTIOUS DISEASES 2014; 14:1011-21. [DOI: 10.1016/s1473-3099(14)70713-3] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Large outbreak of Legionnaires' disease and Pontiac fever at a military base. Epidemiol Infect 2014; 142:2336-46. [DOI: 10.1017/s0950268813003440] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYWe investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2–22·0] and 5·5 (95% CI 2·1–14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.
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Kozak-Muiznieks NA, Lucas CE, Brown E, Pondo T, Taylor TH, Frace M, Miskowski D, Winchell JM. Prevalence of sequence types among clinical and environmental isolates of Legionella pneumophila serogroup 1 in the United States from 1982 to 2012. J Clin Microbiol 2014; 52:201-11. [PMID: 24197883 PMCID: PMC3911437 DOI: 10.1128/jcm.01973-13] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/28/2013] [Indexed: 11/20/2022] Open
Abstract
Since the establishment of sequence-based typing as the gold standard for DNA-based typing of Legionella pneumophila, the Legionella laboratory at the Centers for Disease Control and Prevention (CDC) has conducted routine sequence-based typing (SBT) analysis of all incoming L. pneumophila serogroup 1 (Lp1) isolates to identify potential links between cases and to better understand genetic diversity and clonal expansion among L. pneumophila bacteria. Retrospective genotyping of Lp1 isolates from sporadic cases and Legionnaires' disease (LD) outbreaks deposited into the CDC reference collection since 1982 has been completed. For this study, we compared the distribution of sequence types (STs) among Lp1 isolates implicated in 26 outbreaks in the United States, 571 clinical isolates from sporadic cases of LD in the United States, and 149 environmental isolates with no known association with LD. The Lp1 isolates under study had been deposited into our collection between 1982 and 2012. We identified 17 outbreak-associated STs, 153 sporadic STs, and 49 environmental STs. We observed that Lp1 STs from outbreaks and sporadic cases are more similar to each other than either group is to environmental STs. The most frequent ST for both sporadic and environmental isolates was ST1, accounting for 25% and 49% of the total number of isolates, respectively. The STs shared by both outbreak-associated and sporadic Lp1 included ST1, ST35, ST36, ST37, and ST222. The STs most commonly found in sporadic and outbreak-associated Lp1 populations may have an increased ability to cause disease and thus may require special attention when detected.
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Affiliation(s)
- Natalia A. Kozak-Muiznieks
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claressa E. Lucas
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ellen Brown
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tracy Pondo
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas H. Taylor
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Frace
- Biotechnology Core Facility Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jonas M. Winchell
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Khan MA, Knox N, Prashar A, Alexander D, Abdel-Nour M, Duncan C, Tang P, Amatullah H, Dos Santos CC, Tijet N, Low DE, Pourcel C, Van Domselaar G, Terebiznik M, Ensminger AW, Guyard C. Comparative Genomics Reveal That Host-Innate Immune Responses Influence the Clinical Prevalence of Legionella pneumophila Serogroups. PLoS One 2013; 8:e67298. [PMID: 23826259 PMCID: PMC3694923 DOI: 10.1371/journal.pone.0067298] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/16/2013] [Indexed: 11/19/2022] Open
Abstract
Legionella pneumophila is the primary etiologic agent of legionellosis, a potentially fatal respiratory illness. Amongst the sixteen described L. pneumophila serogroups, a majority of the clinical infections diagnosed using standard methods are serogroup 1 (Sg1). This high clinical prevalence of Sg1 is hypothesized to be linked to environmental specific advantages and/or to increased virulence of strains belonging to Sg1. The genetic determinants for this prevalence remain unknown primarily due to the limited genomic information available for non-Sg1 clinical strains. Through a systematic attempt to culture Legionella from patient respiratory samples, we have previously reported that 34% of all culture confirmed legionellosis cases in Ontario (n = 351) are caused by non-Sg1 Legionella. Phylogenetic analysis combining multiple-locus variable number tandem repeat analysis and sequence based typing profiles of all non-Sg1 identified that L. pneumophila clinical strains (n = 73) belonging to the two most prevalent molecular types were Sg6. We conducted whole genome sequencing of two strains representative of these sequence types and one distant neighbour. Comparative genomics of the three L. pneumophila Sg6 genomes reported here with published L. pneumophila serogroup 1 genomes identified genetic differences in the O-antigen biosynthetic cluster. Comparative optical mapping analysis between Sg6 and Sg1 further corroborated this finding. We confirmed an altered O-antigen profile of Sg6, and tested its possible effects on growth and replication in in vitro biological models and experimental murine infections. Our data indicates that while clinical Sg1 might not be better suited than Sg6 in colonizing environmental niches, increased bloodstream dissemination through resistance to the alternative pathway of complement mediated killing in the human host may explain its higher prevalence.
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Affiliation(s)
- Mohammad Adil Khan
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Knox
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Akriti Prashar
- Cell and Systems Biology and Biological Sciences, University of Toronto at Scarborough, Scarborough, Ontario, Canada
| | - David Alexander
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mena Abdel-Nour
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Hajera Amatullah
- The Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Claudia C. Dos Santos
- The Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Donald E. Low
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Christine Pourcel
- Institut de Génétique et Microbiologie, Université Paris-Sud, Paris, France
| | - Gary Van Domselaar
- Cell and Systems Biology and Biological Sciences, University of Toronto at Scarborough, Scarborough, Ontario, Canada
| | - Mauricio Terebiznik
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Alexander W. Ensminger
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cyril Guyard
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
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