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Timms VJ, Sim E, Pey K, Sintchenko V. Can genomics and meteorology predict outbreaks of legionellosis in urban settings? Appl Environ Microbiol 2024; 90:e0065824. [PMID: 39016616 PMCID: PMC11337837 DOI: 10.1128/aem.00658-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024] Open
Abstract
Legionella pneumophila is ubiquitous and sporadically infects humans causing Legionnaire's disease (LD). Globally, reported cases of LD have risen fourfold from 2000 to 2014. In 2016, Sydney, Australia was the epicenter of an outbreak caused by L. pneumophila serogroup 1 (Lpsg1). Whole-genome sequencing was instrumental in identifying the causal clone which was found in multiple locations across the city. This study examined the epidemiology of Lpsg1 in an urban environment, assessed typing schemes to classify resident clones, and investigated the association between local climate variables and LD outbreaks. Of 223 local Lpsg1 isolates, we identified dominant clones with one clone isolated from patients in high frequency during outbreak investigations. The core genome multi-locus sequence typing scheme was the most reliable in identifying this Lpsg1 clone. While an increase in humidity and rainfall was found to coincide with a rise in LD cases, the incidence of the major L. pneumophila outbreak clone did not link to weather phenomena. These findings demonstrated the role of high-resolution typing and weather context assessment in determining source attribution for LD outbreaks in urban settings, particularly when clinical isolates remain scarce.IMPORTANCEWe investigated the genomic and meteorological influences of infections caused by Legionella pneumophila in Sydney, Australia. Our study contributes to a knowledge gap of factors that drive outbreaks of legionellosis compared to sporadic infections in urban settings. In such cases, clinical isolates can be rare, and thus, other data are needed to inform decision-making around control measures. The study revealed that core genome multi-locus sequence typing is a reliable and adaptable technique when investigating Lpsg1 outbreaks. In Sydney, the genomic profile of Lpsg1 was dominated by a single clone, which was linked to numerous community cases over a period of 40 years. Interestingly, the peak in legionellosis cases during Autumn was not associated with this prevalent outbreak clone. Incorporating meteorological data with Lpsg1 genomics can support risk assessment strategies for legionellosis in urban environments, and this approach may be relevant for other densely populated regions globally.
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Affiliation(s)
- Verlaine J. Timms
- Center for Infectious Diseases and Microbiology- Public Health, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, New South Wales, Australia
- School of Environmental and Life Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Eby Sim
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, New South Wales, Australia
- Center for Infectious Diseases and Microbiology- Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Keenan Pey
- Center for Infectious Diseases and Microbiology- Public Health, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Vitali Sintchenko
- Center for Infectious Diseases and Microbiology- Public Health, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Sydney, New South Wales, Australia
- Center for Infectious Diseases and Microbiology- Laboratory Services, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
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Ferrari DDDM, Lima SC, Teixeira RLF, Lopes MQP, Vaconcellos SEG, Machado ES, Suffys PN, Gomes HM. Genetic Diversity of Legionella pneumophila Isolates from Artificial Water Sources in Brazil. Curr Microbiol 2024; 81:165. [PMID: 38714565 PMCID: PMC11076386 DOI: 10.1007/s00284-024-03645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/19/2024] [Indexed: 05/10/2024]
Abstract
Legionella pneumophila (Lp) is a Gram-negative bacterium found in natural and artificial aquatic environments and inhalation of contaminated aerosols can cause severe pneumonia known as Legionnaires' Disease (LD). In Brazil there is hardly any information about this pathogen, so we studied the genetic variation of forty Legionella spp. isolates obtained from hotels, malls, laboratories, retail centers, and companies after culturing in BCYE medium. These isolates were collected from various sources in nine Brazilian states. Molecular identification of the samples was carried out using Sequence-Based Typing (SBT), which consists of sequencing and analysis of seven genes (flaA, pilE, asd, mip, mompS, proA, and neuA) to define a Sequence Type (ST). Eleven STs were identified among 34/40 isolates, of which eight have been previously described (ST1, ST80, ST152, ST242, ST664, ST1185, ST1464, ST1642) and three were new STs (ST2960, ST2962, and ST2963), the former identified in five different cooling towers in the city of São Paulo. The ST1 that is widely distributed in many countries was also the most prevalent in this study. In addition, other STs that we observed have also been associated with legionellosis in other countries, reinforcing the potential of these isolates to cause LD in Brazil. Unfortunately, no human isolates could be characterized until presently, but our observations strongly suggest the need of surveillance implementation system and control measures of Legionella spp. in Brazil, including the use of more sensitive genotyping procedures besides ST.
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Affiliation(s)
- Dândrea Driely de Melo Ferrari
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil.
| | | | - Raquel Lima Figueiredo Teixeira
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil
| | - Marcia Quinhones Pires Lopes
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil
| | | | - Edson Silva Machado
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil
| | - Philip Noel Suffys
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil.
| | - Harrison Magdinier Gomes
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, 21040-360, Brazil.
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Kanatani JI, Fujiyoshi S, Isobe J, Kimata K, Watahiki M, Maenishi E, Izumiyama S, Amemura-Maekawa J, Maruyama F, Oishi K. Correlation between bacterial microbiome and Legionella species in water from public bath facilities by 16S rRNA gene amplicon sequencing. Microbiol Spectr 2024; 12:e0345923. [PMID: 38363136 PMCID: PMC10986325 DOI: 10.1128/spectrum.03459-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Public bath facilities are a major source of Legionella infections in Japan. In this study, we performed 16S rRNA gene amplicon sequencing to characterize the bacterial community in bath and shower water from public bath facilities, along with chemical parameters, and investigated the effect of the bacterial microbiome on the presence of Legionella species. Although no significant difference in bacterial community richness was observed between bath and shower water samples, there was a remarkable difference in the bacterial community structure between them. Distance-based redundancy analysis revealed that several factors (free residual chlorine, pH, and conductivity) were correlated with the bacterial community in bath water. The most abundant bacterial genera in the samples were Pseudomonas (13.7%) in bath water and Phreatobacter (13.6%) in shower water, as indicated by the taxonomic composition, and the dominant bacteria differed between these environmental samples. Legionella pneumophila was the most frequently detected Legionella species, with additional 15 other Legionella species detected in water samples. In Legionella-positive water samples, several unassigned and uncultured bacteria were enriched together. In addition, the co-occurrence network showed that Legionella was strongly interconnected with two uncultured bacteria. Corynebacterium and Sphingomonas negatively correlated with Legionella species. The present study reveals the ecology of Legionella species, especially their interactions with other bacteria that are poorly understood to date. IMPORTANCE Public bath facilities are major sources of sporadic cases and outbreaks of Legionella infections. Recently, 16S rRNA gene amplicon sequencing has been used to analyze bacterial characteristics in various water samples from both artificial and natural environments, with a particular focus on Legionella bacterial species. However, the relationship between the bacterial community and Legionella species in the water from public bath facilities remains unclear. In terms of hygiene management, it is important to reduce the growth of Legionella species by disinfecting the water in public bath facilities. Our findings contribute to the establishment of appropriate hygiene management practices and provide a basis for understanding the potential health effects of using bath and shower water available in public bath facilities.
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Affiliation(s)
- Jun-ichi Kanatani
- Department of Bacteriology, Toyama Institute of Health, Imizu, Toyama, Japan
| | - So Fujiyoshi
- Section of Microbial Genomics and Ecology, Hiroshima University, Hiroshima, Japan
| | - Junko Isobe
- Department of Bacteriology, Toyama Institute of Health, Imizu, Toyama, Japan
| | - Keiko Kimata
- Department of Bacteriology, Toyama Institute of Health, Imizu, Toyama, Japan
| | - Masanori Watahiki
- Department of Bacteriology, Toyama Institute of Health, Imizu, Toyama, Japan
| | - Emi Maenishi
- Department of Bacteriology, Toyama Institute of Health, Imizu, Toyama, Japan
| | - Shinji Izumiyama
- Department of Parasitology, National Institute of Infectious Diseases, Toyama, Japan
| | - Junko Amemura-Maekawa
- Department of Bacteriology, National Institute of Infectious Diseases, Toyama, Japan
| | - Fumito Maruyama
- Section of Microbial Genomics and Ecology, Hiroshima University, Hiroshima, Japan
| | - Kazunori Oishi
- Department of Bacteriology, Toyama Institute of Health, Imizu, Toyama, Japan
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Donovan CV, MacFarquhar JK, Wilson E, Sredl M, Tanz LJ, Mullendore J, Fleischauer A, Smith JC, Lucas C, Kunz J, Moore Z. Legionnaires' Disease Outbreak Associated With a Hot Tub Display at the North Carolina Mountain State Fair, September 2019. Public Health Rep 2024; 139:79-87. [PMID: 36971250 PMCID: PMC10905752 DOI: 10.1177/00333549231159159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES On September 23, 2019, the North Carolina Division of Public Health identified a legionellosis increase in western North Carolina; most patients had recently attended the North Carolina Mountain State Fair. We conducted a source investigation. METHODS Cases were fair attendees with laboratory-confirmed legionellosis and symptom onset within 2 to 14 days (Legionnaires' disease) or ≤3 days (Pontiac fever). We conducted a case-control study matching cases to non-ill fair attendees as control participants and an environmental investigation, and we performed laboratory testing (Legionella bacteria culture and polymerase chain reaction) of 27 environmental samples from fairgrounds and hot tubs and 14 specimens from case patients. We used multivariable unconditional logistic regression models to calculate adjusted odds ratios for potential Legionella exposure sources and risk factors. RESULTS Of 136 people identified with fair-associated legionellosis, 98 (72%) were hospitalized and 4 (3%) died. Case patients were more likely than control participants to report walking by hot tub displays (adjusted odds ratio = 10.0; 95% CI, 4.2-24.1). Complete hot tub water treatment records were not kept, precluding evaluation of water maintenance conducted on display hot tubs. Legionella pneumophila sequence types (STs) were consistent among 10 typed clinical specimens (ST224) but distinct from the only positive environmental sample from the fair (ST7 and ST8). CONCLUSIONS Hot tub displays were identified as the most likely outbreak source, making this the largest hot tub-associated Legionnaires' disease outbreak worldwide. Following the investigation, the North Carolina Division of Public Health and the Centers for Disease Control and Prevention released guidance on mitigating risk of Legionella exposure from hot tub displays. Results highlight the importance of properly maintaining equipment that aerosolizes water, including hot tubs intended for display purposes only.
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Affiliation(s)
- Catherine V. Donovan
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Now with the Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer K. MacFarquhar
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erica Wilson
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Megan Sredl
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Lauren J. Tanz
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Aaron Fleischauer
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica C. Smith
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claressa Lucas
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jasen Kunz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zack Moore
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
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Komatsu S, Tanaka S, Nakanishi N. Prevalence and genetic distribution of Legionella spp. in public bath facilities in Kobe City, Japan. JOURNAL OF WATER AND HEALTH 2023; 21:1727-1734. [PMID: 38017602 PMCID: wh_2023_247 DOI: 10.2166/wh.2023.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Legionella is an important waterborne pathogen that causes legionellosis. Public baths are considered the primary cause of legionellosis infection in Japan. We investigated the prevalence and genetic distribution of 338 Legionella spp. isolates from 81 public bath facilities, including 35 hot springs and 46 other facilities, through annual periodic surveillance in Kobe, Japan, from 2016 to 2021. In addition, the genotypes of nine clinical strains of unknown infectious source from the same period were compared to those of bathwater isolates. We elucidated the differences in the distribution of Legionella species, serogroups, and genotypes between hot springs and other public baths. Legionella israelensis, L. londiniensis, and L. micdadei colonized hot springs along with L. pneumophila. The minimum spanning tree analysis based on multiple-locus variable number tandem repeat analysis (MLVA) also identified four major clonal complexes (CCs) in L. pneumophila SG1 and found that CC1 of the four CCs is a specific novel genotype with the lag-1 gene in hot springs. The same MLVA genotypes and sequence types as those of the clinical strains were not present among the strains isolated from bath water. Thus, our surveillance is useful for estimating the sources of legionellosis infection in Japan and developing prevention strategies.
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Affiliation(s)
- Shoko Komatsu
- Department of Infectious Diseases, Kobe Institute of Health, Kobe, Japan E-mail:
| | - Shinobu Tanaka
- Department of Infectious Diseases, Kobe Institute of Health, Kobe, Japan
| | - Noriko Nakanishi
- Department of Infectious Diseases, Kobe Institute of Health, Kobe, Japan
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Song Y, Pruden A, Rhoads WJ, Edwards MA. Pilot-scale assessment reveals effects of anode type and orthophosphate in governing antimicrobial capacity of copper for Legionella pneumophila control. WATER RESEARCH 2023; 242:120178. [PMID: 37307684 DOI: 10.1016/j.watres.2023.120178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/07/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
Copper (Cu) is sometimes applied as an antimicrobial for controlling Legionella in hot water plumbing systems, but its efficacy is inconsistent. Here we examined the effects of Cu (0 - 2 mg/L), orthophosphate corrosion inhibitor (0 or 3 mg/L as phosphate), and water heater anodes (aluminum, magnesium, and powered anodes) on both bulk water and biofilm-associated L. pneumophila in pilot-scale water heater systems. Soluble, but not total, Cu was a good predictor of antimicrobial capacity of Cu. Even after months of exposure to very high Cu levels (>1.2 mg/L) and low pH (<7), which increases solubility and enhances bioavailability of Cu, culturable L. pneumophila was only reduced by ∼1-log. Cu antimicrobial capacity was shown to be limited by various factors, including binding of Cu ions by aluminum hydroxide precipitates released from corrosion of aluminum anodes, higher pH due to magnesium anode corrosion, and high Cu tolerance of the outbreak-associated L. pneumophila strain that was inoculated into the systems. L. pneumophila numbers were also higher in several instances when Cu was dosed together with orthophosphate (e.g., with an Al anode), revealing at least one scenario where high levels of total Cu appeared to stimulate Legionella. The controlled, pilot-scale nature of this study provides new understanding of the limitations of Cu as an antimicrobial in real-world plumbing systems.
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Affiliation(s)
- Yang Song
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061; Utilities Department, Town of Cary, 316 N. Academy St., Cary, NC, 27512.
| | - Amy Pruden
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061
| | - William J Rhoads
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061; Black & Veatch, 8400 Ward Pkwy, Kansas City, MO, 64114
| | - Marc A Edwards
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061.
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Marino F, Mazzotta M, Pascale MR, Derelitto C, Girolamini L, Cristino S. First water safety plan approach applied to a Dental Clinic complex: identification of new risk factors associated with Legionella and P. aeruginosa contamination, using a novel sampling, maintenance and management program. J Oral Microbiol 2023; 15:2223477. [PMID: 37346998 PMCID: PMC10281406 DOI: 10.1080/20002297.2023.2223477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Dental unit waterlines (DUWLs) represent a complex environment able to promote microbial contamination, due to functional, mechanical and practical risk factors. According to a water safety plan approach, the main goal is to preserve the health of dentists, dental staff and patients. The aim of this study is to develop a DUWLs water safety plan that is able to support correct and effective maintenance and disinfection procedures. Three different water systems serve 60 dental chairs: (i) water that comes directly from municipal water (Type A), (ii) water supplied by municipal water and water bottles (Type B) and (iii) water supplied only via water bottles (Type C). For each type, Legionella and Pseudomonas aeruginosa contamination was studied, by applying a new sampling scheme, based on separate sampling from water bottles, cup filler and handpieces. Type B DUWL is the only type of DUWL contaminated by L. pneumophila (ST 59) and L. anisa (mean contamination: 608.33 ± 253.33 cfu/L) detected in cup filler and handpieces, as well as the high presence of P. aeruginosa (44.42 ± 13.25 cfu/100 mL). Two subsequent shock treatments and resampling procedures were performed by increasing disinfectant dosage and contact time and removing some DUWL components linked to biofilm growth in DUWLs. A significant reduction of contamination was obtained for both microorganisms (Legionella spp.: -100%, p < 0.001 and P. aeruginosa: -99.86%, p = 0.006). The sampling strategy proposed allows us to identify the source of contamination and better focus on the maintenance and disinfection procedures. DUWLs represent an environment that requires a multidisciplinary approach, combining the knowledge of all DUWL components to correct procedures that are able to preserve the health of personnel and patients, as well as guaranteeing DUWLs' safe functionality.
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Affiliation(s)
- Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Civil, Chemical, Environmental and Materials Engineering, University of Bologna, Bologna, Italy
| | - Carlo Derelitto
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
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Krøvel AV, Hetland MAK, Bernhoff E, Bjørheim AS, Soma MA, Löhr IH. Long-read sequencing for reliably calling the mompS allele in Legionella pneumophila sequence-based typing. Front Cell Infect Microbiol 2023; 13:1176182. [PMID: 37256104 PMCID: PMC10226664 DOI: 10.3389/fcimb.2023.1176182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/21/2023] [Indexed: 06/01/2023] Open
Abstract
Sequence-based typing (SBT) of Legionella pneumophila is a valuable tool in epidemiological studies and outbreak investigations of Legionnaires' disease. In the L. pneumophila SBT scheme, mompS2 is one of seven genes that determine the sequence type (ST). The Legionella genome typically contains two copies of mompS (mompS1 and mompS2). When they are non-identical it can be challenging to determine the mompS2 allele, and subsequently the ST, from Illumina short-reads. In our collection of 233 L. pneumophila genomes, there were 62 STs, 18 of which carried non-identical mompS copies. Using short-reads, the mompS2 allele was misassembled or untypeable in several STs. Genomes belonging to ST154 and ST574, which carried mompS1 allele 7 and mompS2 allele 15, were assigned an incorrect mompS2 allele and/or mompS gene copy number when short-read assembled. For other isolates, mainly those carrying non-identical mompS copies, short-read assemblers occasionally failed to resolve the structure of the mompS-region, also resulting in untypeability from the short-read data. In this study, we wanted to understand the challenges we observed with calling the mompS2 allele from short-reads, assess if other short-read methods were able to resolve the mompS-region, and investigate the possibility of using long-reads to obtain the mompS alleles, and thereby perform L. pneumophila SBT from long-reads only. We found that the choice of short-read assembler had a major impact on resolving the mompS-region and thus SBT from short-reads, but no method consistently solved the mompS2 allele. By using Oxford Nanopore Technology (ONT) sequencing together with Trycycler and Medaka for long-read assembly and polishing we were able to resolve the mompS copies and correctly identify the mompS2 allele, in accordance with Sanger sequencing/EQA results for all tested isolates (n=35). The remaining six genes of the SBT profile could also be determined from the ONT-only reads. The STs called from ONT-only assemblies were also consistent with hybrid-assemblies of Illumina and ONT reads. We therefore propose ONT sequencing as an alternative method to perform L. pneumophila SBT to overcome the mompS challenge observed with short-reads. To facilitate this, we have developed ONTmompS (https://github.com/marithetland/ONTmompS), an in silico approach to determine L. pneumophila ST from long-read or hybrid assemblies.
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Affiliation(s)
- Anne Vatland Krøvel
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
- National Reference Laboratory for Legionella, Stavanger University Hospital, Stavanger, Norway
| | - Marit A. K. Hetland
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
- Department of Biological Sciences, Faculty of Mathematics and Natural Sciences, University of Bergen, Bergen, Norway
| | - Eva Bernhoff
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
- National Reference Laboratory for Legionella, Stavanger University Hospital, Stavanger, Norway
| | - Anna Steensen Bjørheim
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
- National Reference Laboratory for Legionella, Stavanger University Hospital, Stavanger, Norway
| | - Markus André Soma
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Iren H. Löhr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
- National Reference Laboratory for Legionella, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Gumá M, Drasar V, Santandreu B, Cano R, Afshar B, Nicolau A, Bennassar M, del Barrio J, Crespi P, Crespi S. A community outbreak of Legionnaires' disease caused by outdoor hot tubs for private use in a hotel. Front Microbiol 2023; 14:1137470. [PMID: 37180254 PMCID: PMC10167275 DOI: 10.3389/fmicb.2023.1137470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/30/2023] [Indexed: 05/16/2023] Open
Abstract
During the period October-November 2017, an outbreak of Legionnaires' disease involving 27 cases occurred in the tourist area of Palmanova (Mallorca, Spain). The majority of cases were reported by the European Centre of Disease Prevention and Control (ECDC) as travel associated cases of Legionnaires' disease (TALD). Most cases belonged to different hotel cluster alerts. No cases were reported among the local population residing in the area. All tourist establishments associated with one or more TALD cases were inspected and sampled by public health inspectors. All relevant sources of aerosol emission detected were investigated and sampled. The absence of active cooling towers in the affected area was verified, by documents and on-site. Samples from hot tubs for private use located on the terraces of the penthouse rooms of a hotel in the area were included in the study. Extremely high concentrations (> 106 CFU/l) of Legionella pneumophila, including the outbreak strain, were found in the hot tubs of vacant rooms of this hotel thus identifying the probable source of infection. Meteorological situation may have contributed to the geographical distribution pattern of this outbreak. In conclusion, hot tubs for private use located outdoors should be considered when investigating community outbreaks of Legionnaires' disease of unclear origin.
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Affiliation(s)
- Mercedes Gumá
- Conselleria de Salut i Consum, Govern Balear, Palma de Mallorca, Spain
| | - Vladimir Drasar
- Public Health Institute Ostrava, National Legionella Reference Laboratory, Ostrava, Czechia
| | - Beatriz Santandreu
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Rosa Cano
- Centro Nacional de Epidemiología and CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Baharak Afshar
- Respiratory and Vaccine Preventable Bacteria Reference Unit (RVPBRU), UK Health Security Agency (UKHSA), London, United Kingdom
| | - Antonio Nicolau
- Conselleria de Salut i Consum, Govern Balear, Palma de Mallorca, Spain
| | - Magdalena Bennassar
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Jorge del Barrio
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Pau Crespi
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Sebastian Crespi
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
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10
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Komatsu S, Tanaka S, Nakanishi N. Evaluation of Legionella pneumophila SGUT Serotypes Isolated from Bath Water Using a Multiplex-PCR Serotyping Assay. Jpn J Infect Dis 2023; 76:77-79. [PMID: 36047173 DOI: 10.7883/yoken.jjid.2022.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Legionella pneumophila, the primary causative agent of Legionnaires' disease, is classified into at least 15 serogroups (SGs). Before genotyping, serotyping is first performed to limit the sources of L. pneumophila infections that caused an outbreak. In addition to conventional assays using monoclonal or polyclonal antisera, serotyping using multiplex polymerase chain reaction (M-PCR) was recently developed for L. pneumophila. In this study, we applied the M-PCR system to 41 strains that remained to be SGUT (untypable) by slide agglutination tests among the 220 L. pneumophila strains isolated from bath water in Kobe City during 2016-2020, to determine SG-genotypes (SGg) by PCR amplification of the specific target gene of the SGs. Among the 41 SGUT strains, SGg4/10/14 was the most predominant (24/41, 58.5%), followed by SGg1 (7/41, 17.1%). Seven strains, except for the strains determined as SGg1, were identified as belonging to a single SGg by M-PCR serotyping (SGg5 [3/41, 7.3%], SGg8 [3/41, 7.3%], and SGg7 [1/41, 2.4%]). Furthermore, we found that the seven strains identified as SGg1 harbored particular genotypes. In conclusion, the M-PCR serotyping assay will be helpful for investigating the distribution of L. pneumophila in environmental and clinical settings.
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Affiliation(s)
- Shoko Komatsu
- Department of Infectious Diseases, Kobe Institute of Health, Japan
| | - Shinobu Tanaka
- Department of Infectious Diseases, Kobe Institute of Health, Japan
| | - Noriko Nakanishi
- Department of Infectious Diseases, Kobe Institute of Health, Japan
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11
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Zayed AR, Bunk B, Jaber L, Abu-Teer H, Ali M, Steinert M, Höfle MG, Brettar I, Bitar DM. Whole-genome sequencing of the clinical isolate of Legionella pneumophila ALAW1 from the West Bank allows high-resolution typing and determination of pathogenicity mechanisms. Eur Clin Respir J 2023; 10:2168346. [PMID: 36698751 PMCID: PMC9869991 DOI: 10.1080/20018525.2023.2168346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Legionella pneumophila is water-based bacterium causing Legionnaires' disease (LD). We describe the first documented case of nosocomial LD caused by L. pneumophila sequence type (ST) 461 and serogroup 6. The etiology of LD was confirmed by culturing the bronchoalveolar lavage sample retrieving L. pneumophila strain ALAW1. A 7-days treatment of the LD patient with Azithromycin and Levofloxacin allowed complete recovery. Methods In details, we sequenced the whole genome of the L. pneumophila ALAW1 using Illumina HiSeq platform. The sequence of ALAW1 was aligned with the genome sequence from the closely related reference strain Alcoy 2300/99 and a whole-genome phylogeny based on single nucleotide polymorphisms (SNPs) was created using Parsnp software. Also, the TYGS web-server was used in order to compare the genome with type strain. Results An analysis of the population structure by SNP and TYGS comparison clustered ALAW1 with the reference genome Alcoy 2300/99. Blastp analysis of the type IV secretion Dot/Icm system genes showed that these genes were highly conserved with (≤25%) structural differences at the protein level. Conclusions Overall, this study provides insights into detailed genome structure and demonstrated the value of whole-genome sequencing as the ultimate typing tool for Legionella.
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Affiliation(s)
- Ashraf R. Zayed
- CONTACT Ashraf R. Zayed Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, P. O. Box. 7, Palestine;Microbiology Research laboratory Faculty of Medicine Al-Quds University Abu-Dies, East Jerusalem 9993100, Palestine Zayed
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12
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Tata A, Marzoli F, Cordovana M, Tiengo A, Zacometti C, Massaro A, Barco L, Belluco S, Piro R. A multi-center validation study on the discrimination of Legionella pneumophila sg.1, Legionella pneumophila sg. 2-15 and Legionella non- pneumophila isolates from water by FT-IR spectroscopy. Front Microbiol 2023; 14:1150942. [PMID: 37125166 PMCID: PMC10133462 DOI: 10.3389/fmicb.2023.1150942] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
This study developed and validated a method, based on the coupling of Fourier-transform infrared spectroscopy (FT-IR) and machine learning, for the automated serotyping of Legionella pneumophila serogroup 1, Legionella pneumophila serogroups 2-15 as well as their successful discrimination from Legionella non-pneumophila. As Legionella presents significant intra- and inter-species heterogeneities, careful data validation strategies were applied to minimize late-stage performance variations of the method across a large microbial population. A total of 244 isolates were analyzed. In details, the method was validated with a multi-centric approach with isolates from Italian thermal and drinking water (n = 82) as well as with samples from German, Italian, French, and British collections (n = 162). Specifically, robustness of the method was verified over the time-span of 1 year with multiple operators and two different FT-IR instruments located in Italy and Germany. Moreover, different production procedures for the solid culture medium (in-house or commercial) and different culture conditions (with and without 2.5% CO2) were tested. The method achieved an overall accuracy of 100, 98.5, and 93.9% on the Italian test set of Legionella, an independent batch of Legionella from multiple European culture collections, and an extra set of rare Legionella non-pneumophila, respectively.
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Affiliation(s)
- Alessandra Tata
- Laboratorio di Chimica Sperimentale, Istituto Zooprofilattico Sperimentale delle Venezie, Vicenza, Italy
- *Correspondence: Alessandra Tata,
| | - Filippo Marzoli
- Department of Food Safety, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | | | - Alessia Tiengo
- OIE Italian Reference Laboratory for Salmonella, Istituto Zooprofilattico Sperimentale delle Venezie, Padova, Italy
| | - Carmela Zacometti
- Laboratorio di Chimica Sperimentale, Istituto Zooprofilattico Sperimentale delle Venezie, Vicenza, Italy
| | - Andrea Massaro
- Laboratorio di Chimica Sperimentale, Istituto Zooprofilattico Sperimentale delle Venezie, Vicenza, Italy
| | - Lisa Barco
- OIE Italian Reference Laboratory for Salmonella, Istituto Zooprofilattico Sperimentale delle Venezie, Padova, Italy
| | - Simone Belluco
- Department of Food Safety, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Roberto Piro
- Laboratorio di Chimica Sperimentale, Istituto Zooprofilattico Sperimentale delle Venezie, Vicenza, Italy
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Investigation of a Legionella pneumophila Outbreak at a Bath Facility in Japan Using Whole-Genome Sequencing of Isolates from Clinical and Environmental Samples. Microorganisms 2022; 11:microorganisms11010028. [PMID: 36677320 PMCID: PMC9865471 DOI: 10.3390/microorganisms11010028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Exposure to aerosols containing Legionella from artificially made water systems has been established as a primary cause of Legionnaires' disease. In this study, we investigated an outbreak of L. pneumophila serogroup 1 sequence type 138 which occurred at a bath facility in 2022. The whole-genome sequencing of isolates revealed that the colonization of L. pneumophila at the bath facility had occurred before 2013, and the patients had been exposed to multiple genetic lineages of the strain. Our study demonstrates the importance of performing a careful comparative genetic analysis of clinical and environmental isolates from LD outbreaks in order to effectively investigate and prevent future LD outbreaks.
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14
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Domazetovska A, Jensen SO, Gray M, Radzieta M, Maley M. Culture-Free Phylogenetic Analysis of Legionella pneumophila Using Targeted CRISPR/Cas9 Next-Generation Sequencing. Microbiol Spectr 2022; 10:e0035922. [PMID: 35862996 PMCID: PMC9430934 DOI: 10.1128/spectrum.00359-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/19/2022] [Indexed: 11/20/2022] Open
Abstract
Currently available methods for the laboratory investigation of Legionella pneumophila outbreaks require organism culture. The ability to sequence L. pneumophila directly from clinical samples would significantly reduce delays. Here, we develop a method for targeted next-generation sequencing (NGS) of selected L. pneumophila genes utilizing a CRISPR/Cas9-based target enrichment system. We determine the method's utility by typing cultured L. pneumophila isolates and subsequently apply the method directly to patient samples. We sequenced 10 L. pneumophila isolates by 2 methods, (i) whole-genome sequencing (WGS) and (ii) targeted (CRISPR/Cas9-based) finding low-abundance sequences by hybridization (FLASH)-NGS, sequencing 57 selected genes. The targeted NGS of 57 genes was more efficient than WGS, and phylogenetic analysis of the 57 genes yielded the same classification of the L. pneumophila isolates as that based on analysis of whole-genome data. Furthermore, targeted NGS of L. pneumophila performed directly on patient respiratory samples correctly classified the patients according to their corresponding cultured isolates. This provides proof of concept that targeted NGS can be used to sequence L. pneumophila directly from patient samples. Studies on a larger number of patient samples will further validate this method. Nonetheless, CRISPR/Cas9 targeted NGS methods have the potential to be widely applicable to microbial-outbreak investigations in the future, particularly in the context of difficult and slow-growing organisms. IMPORTANCE The bacterium Legionella pneumophila is responsible for outbreaks of serious and life-threatening pneumonia called Legionnaires' disease. There is a need for new molecular methods that allow investigation of Legionella outbreaks directly from patient samples, without the need for prior microbiological culture, which causes delays. Our study aims to address this problem. We have utilized a CRISPR/Cas9-based targeted next-generation sequencing (NGS) method that can be applied directly on human specimens. Furthermore, we show that analysis of the sequences of a small number of targeted genes offers the same classification of L. pneumophila as that based on data derived from the whole genome. Given the rising interest globally in sequencing pathogens directly from human samples, CRISPR/Cas9 targeted NGS methods have the potential to be widely applicable to microbial-outbreak investigations in the future, particularly in the context of difficult and slow-growing organisms.
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Affiliation(s)
- Ana Domazetovska
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Liverpool, New South Wales, Australia
- NSW Health Pathology, Microbiology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Antibiotic Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Slade O. Jensen
- Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
- Antibiotic Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Matthew Gray
- NSW Health Pathology, Microbiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Michael Radzieta
- Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
- Antibiotic Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Michael Maley
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Liverpool, New South Wales, Australia
- NSW Health Pathology, Microbiology, Liverpool Hospital, Liverpool, New South Wales, Australia
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15
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Girolamini L, Pascale MR, Mazzotta M, Spiteri S, Marino F, Salaris S, Grottola A, Orsini M, Cristino S. Combining Traditional and Molecular Techniques Supports the Discovery of a Novel Legionella Species During Environmental Surveillance in a Healthcare Facility. Front Microbiol 2022; 13:900936. [PMID: 35770167 PMCID: PMC9234573 DOI: 10.3389/fmicb.2022.900936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Legionella surveillance plays a significant role not only to prevent the risk of infection but also to study the ecology of isolates, their characteristics, and how their prevalence changes in the environment. The difficulty in Legionella isolation, identification, and typing results in a low notification rate; therefore, human infection is still underestimated. In addition, during Legionella surveillance, the special attention given to Legionella pneumophila leads to an underestimation of the prevalence and risk of infection for other species. This study describes the workflow performed during environmental Legionella surveillance that resulted in the isolation of two strains, named 8cVS16 and 9fVS26, associated with the genus Legionella. Traditional and novel approaches such as standard culture technique, MALDI-TOF MS, gene sequencing, and whole-genome sequencing (WGS) analysis were combined to demonstrate that isolates belong to a novel species. The strain characteristics, the differences between macrophage infectivity potential (mip), RNA polymerase β subunit (rpoB), and reference gene sequences, the average nucleotide identity (ANI) of 90.4%, and the DNA–DNA digital hybridization (dDDH) analysis of 43% demonstrate that these isolates belong to a new Legionella species. The finding suggests that, during the culture technique, special attention should be paid to the characteristics of the isolates that are less associated with the Legionella genus in order to investigate the differences found using more sensitive methods. The characterization of the two newly discovered isolates based on morphological, biochemical, and microscopic characteristics is currently underway and will be described in another future study.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Civil, Chemical, Environmental, and Materials Engineering, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Simona Spiteri
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Antonella Grottola
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Massimiliano Orsini
- Laboratory of Microbial Ecology and Genomics of Microorganisms, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- *Correspondence: Sandra Cristino
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16
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Scaturro M, Girolamini L, Pascale MR, Mazzotta M, Marino F, Errico G, Monaco M, Girolamo A, Rota MC, Ricci ML, Cristino S. Case Report: First Report of Fatal Legionella pneumophila and Klebsiella pneumoniae Coinfection in a Kidney Transplant Recipient. Front Med (Lausanne) 2022; 9:912649. [PMID: 35770012 PMCID: PMC9234666 DOI: 10.3389/fmed.2022.912649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
A very rare case of pulmonary Klebsiella pneumoniae-Legionella pneumophila coinfection in a double kidney transplanted man affected by the chronic renal disease is described. Cases of Legionnaires' disease with an incubation period of 14 days have rarely been documented. Despite the long period of hospitalization, typing of clinical and environmental L. pneumophila strains demonstrated that the patient's home water distribution system was the source of infection, highlighting that Legionella house contamination can be a hidden risk, especially for immune-compromised people.
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Affiliation(s)
- Maria Scaturro
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Luna Girolamini
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Giulia Errico
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonietta Girolamo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Luisa Ricci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sandra Cristino
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- *Correspondence: Sandra Cristino
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Krøvel AV, Bernhoff E, Austerheim E, Soma MA, Romstad MR, Löhr IH. Legionella pneumophila in Municipal Shower Systems in Stavanger, Norway; A Longitudinal Surveillance Study Using Whole Genome Sequencing in Risk Management. Microorganisms 2022; 10:microorganisms10030536. [PMID: 35336109 PMCID: PMC8954845 DOI: 10.3390/microorganisms10030536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/10/2022] Open
Abstract
Following an incidence of Legionnaires disease (LD) in 2007, where a municipal shower system was the likely source of infection, Stavanger municipality initiated a surveillance program for Legionella as part of establishing internal risk evaluation and prevention routines. More than 250 shower systems were examined for cultivatable Legionella pneumophila. The prevalence and diversity of serogroups (sg) and sequence types (STs) of L. pneumophila were mapped using available typing techniques over a period of more than 10 years (2010–2021). The surveillance showed an overall reduction in the L. pneumophila colonisation rate in municipal systems from 11 to 4.5% following prevention measures during the period, with the highest colonisation rate in complex systems (e.g., larger nursing homes and sports complexes). Further, an approximately even distribution between sg1 and 2–14 was seen. Whole genome sequencing (WGS) revealed that only a limited number of STs were detected, and they were consistent at specific locations over time. This study showed that environmental surveillance data in combination with available typing techniques and WGS can give the municipality a better tool for risk management and an overview of ST distributions that can be a valuable asset in future source investigations.
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Affiliation(s)
- Anne Vatland Krøvel
- NORCE—Norwegian Research Centre, Environment Department, Professor Olav Hansenssvei 15, N-4021 Stavanger, Norway;
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
- Correspondence:
| | - Eva Bernhoff
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
| | - Elin Austerheim
- NORCE—Norwegian Research Centre, Environment Department, Professor Olav Hansenssvei 15, N-4021 Stavanger, Norway;
| | - Markus André Soma
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
| | - Monica Regine Romstad
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
| | - Iren Høyland Löhr
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
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Paranjape K, Lévesque S, Faucher SP. Bacterial Antagonistic Species of the Pathogenic Genus Legionella Isolated from Cooling Tower. Microorganisms 2022; 10:392. [PMID: 35208847 PMCID: PMC8877877 DOI: 10.3390/microorganisms10020392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Legionella pneumophila is the causative agent of Legionnaires' disease, a severe pneumonia. Cooling towers are a major source of large outbreaks of the disease. The growth of L. pneumophila in these habitats is influenced by the resident microbiota. Consequently, the aim of this study was to isolate and characterize bacterial species from cooling towers capable of inhibiting several strains of L. pneumophila and one strain of L. quinlivanii. Two cooling towers were sampled to isolate inhibiting bacterial species. Seven inhibitory isolates were isolated, through serial dilution plating and streaking on agar plates, belonging to seven distinct species. The genomes of these isolates were sequenced to identify potential genetic elements that could explain the inhibitory effect. The results showed that the bacterial isolates were taxonomically diverse and that one of the isolates may be a novel species. Genome analysis showed a high diversity of antimicrobial gene products identified in the genomes of the bacterial isolates. Finally, testing different strains of Legionella demonstrated varying degrees of susceptibility to the antimicrobial activity of the antagonistic species. This may be due to genetic variability between the Legionella strains. The results demonstrate that though cooling towers are breeding grounds for L. pneumophila, the bacteria must contend with various antagonistic species. Potentially, these species could be used to create an inhospitable environment for L. pneumophila, and thus decrease the probability of outbreaks occurring.
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Affiliation(s)
- Kiran Paranjape
- Department of Natural Resource Sciences, McGill University, 21 111 Lakeshore Drive, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada;
- Department of Medical Biochemistry and Microbiology, Husargatan 3, BMC, Uppsala University, 752 37 Uppsala, Sweden
| | - Simon Lévesque
- Département de Microbiologie et Infectiologie, Université de Sherbrooke, 3201 Jean Mignault, Sherbrooke, QC J1E 4K8, Canada;
- Service de Microbiologie, CIUSSS de l’Estrie-CHUS, 3001, 12è Avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Sébastien P. Faucher
- Department of Natural Resource Sciences, McGill University, 21 111 Lakeshore Drive, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada;
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Girolamini L, Salaris S, Pascale MR, Mazzotta M, Cristino S. Dynamics of Legionella Community Interactions in Response to Temperature and Disinfection Treatment: 7 Years of Investigation. MICROBIAL ECOLOGY 2022; 83:353-362. [PMID: 34091718 PMCID: PMC8891097 DOI: 10.1007/s00248-021-01778-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 05/12/2023]
Abstract
In man-made water distribution systems, Legionella community interactions remain unknown, due to their ability to change from sessile to planktonic states or live in viable but non-culturable forms, in response to anthropic and environmental stress. During 7 years of hospital Legionella surveillance, in 191 hot water positive samples, the interactions among the Legionella species, temperature, and disinfection treatment were evaluated. Legionella was isolated following ISO 11731:2017, and identification was performed by mip gene sequencing and sequence-based typing (SBT) for L. anisa or L. rubrilucens and L. pneumophila, respectively. The species with the higher frequency of isolation was L. pneumophila serogroup 1 (78.53%; 4865.36 ± 25,479.11 cfu/L), followed by L. anisa (54.45%; 558.79 ± 2637.41 cfu/L) and L. rubrilucens (21.99%; 307.73 ± 1574.95 cfu/L), which were sometimes present together. Spearman's rho correlation test was conducted among the species with respect to temperature and disinfectant (H2O2/Ag+). The results showed a generally positive interaction among these species sharing the same environment, except for competition between L. anisa and L. rubrilucens. High temperature (48.83 ± 2.59 °C) and disinfection treatment (11.58 ± 4.99 mg/L) affected the presence of these species. An exception was observed with L. anisa, which showed disinfection treatment resistance. For the purposes of environmental surveillance, it is fundamental to better understand the interactions and dynamic of the Legionella community in man-made water systems in order to choose the proper physical or chemical treatments. The simultaneous presence of different Legionella species could result in an increased resistance to high temperature and disinfectant treatment, leading to changes in contamination level and species diversity.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, BO Italy
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20
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Knežević M, Rončević D, Vukić Lušić D, Mihelčić M, Kogoj R, Keše D, Glad M, Cenov A, Ožanič M, Glažar Ivče D, Šantić M. Decreasing Pasteurization Treatment Efficiency against Amoeba-Grown Legionella pneumophila—Recognized Public Health Risk Factor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031099. [PMID: 35162120 PMCID: PMC8834526 DOI: 10.3390/ijerph19031099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/16/2022]
Abstract
Legionellae are gram-negative bacteria most commonly found in freshwater ecosystems and purpose-built water systems. In humans, the bacterium causes Legionnaires’ disease (LD) or a Pontiac fever. In this study, the different waters (drinking water, pool water, cooling towers) in which Legionella pneumophila has been isolated were studied to assess the possible risk of bacterial spreading in the population. The influence of physical and chemical parameters, and interactions with Acanthamoeba castellanii on L. pneumophila, were analyzed by Heterotrophic Plate Count, the Colony-forming units (CFU) methods, transmission electron microscopy (TEM), and Sequence-Based Typing (SBT) analysis. During the study period (2013–2019), a total of 1932 water samples were analyzed, with the average annual rate of Legionella-positive water samples of 8.9%, showing an increasing trend. The largest proportion of Legionella-positive samples was found in cooling towers and rehabilitation centers (33.9% and 33.3%, respectively). Among the isolates, L. pneumophila SGs 2–14 was the most commonly identified strain (76%). The survival of Legionella was enhanced in the samples with higher pH values, while higher electrical conductivity, nitrate, and free residual chlorine concentration significantly reduced the survival of Legionella. Our results show that growth in amoeba does not affect the allelic profile, phenotype, and morphology of the bacterium but environmental L. pneumophila becomes more resistant to pasteurization treatment.
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Affiliation(s)
- Maša Knežević
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
| | - Dobrica Rončević
- Department of Epidemiology, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia;
- Department of Public Health, Faculty of Health Studies, Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Darija Vukić Lušić
- Department of Environmental Health, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
- Department of Environmental Health, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia; (M.G.); (A.C.)
- Center for Advanced Computing and Modeling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
- Correspondence: ; Tel.: +385-(0)51-358-755
| | - Mirna Mihelčić
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
| | - Rok Kogoj
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloska 4, 1000 Ljubljana, Slovenia; (R.K.); (D.K.)
| | - Darja Keše
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloska 4, 1000 Ljubljana, Slovenia; (R.K.); (D.K.)
| | - Marin Glad
- Department of Environmental Health, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia; (M.G.); (A.C.)
| | - Arijana Cenov
- Department of Environmental Health, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia; (M.G.); (A.C.)
| | - Mateja Ožanič
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
| | - Daniela Glažar Ivče
- Branch Office Rab, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Palit 143a, 51280 Rab, Croatia;
| | - Marina Šantić
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
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Pascale MR, Salaris S, Mazzotta M, Girolamini L, Fregni Serpini G, Manni L, Grottola A, Cristino S. New Insight regarding Legionella Non- Pneumophila Species Identification: Comparison between the Traditional mip Gene Classification Scheme and a Newly Proposed Scheme Targeting the rpoB Gene. Microbiol Spectr 2021; 9:e0116121. [PMID: 34908503 PMCID: PMC8672888 DOI: 10.1128/spectrum.01161-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
The identification of Legionella non-pneumophila species (non-Lp) in clinical and environmental samples is based on the mip gene, although several studies suggest its limitations and the need to expand the classification scheme to include other genes. In this study, the development of a new classification scheme targeting the rpoB gene is proposed to obtain a more reliable identification of 135 Legionella environmental isolates. All isolates were sequenced for the mip and rpoB genes, and the results were compared to study the discriminatory power of the proposed rpoB scheme. Complete concordance between the mip and rpoB results based on genomic percent identity was found for 121/135 (89.6%) isolates; in contrast, discordance was found for 14/135 (10.4%) isolates. Additionally, due to the lack of reference values for the rpoB gene, inter- and intraspecies variation intervals were calculated based on a pairwise identity matrix that was built using the entire rpoB gene (∼4,107 bp) and a partial region (329 bp) to better evaluate the genomic identity obtained. The interspecies variation interval found here (4.9% to 26.7%) was then proposed as a useful sequence-based classification scheme for the identification of unknown non-Lp isolates. The results suggest that using both the mip and rpoB genes makes it possible to correctly discriminate between several species, allowing possible new species to be identified, as confirmed by preliminary whole-genome sequencing analyses performed on our isolates. Therefore, starting from a valid and reliable identification approach, the simultaneous use of mip and rpoB associated with other genes, as it occurs with the sequence-based typing (SBT) scheme developed for Legionella pneumophila, could support the development of multilocus sequence typing to improve the knowledge and discovery of Legionella species subtypes. IMPORTANCELegionella spp. are a widely spread bacteria that cause a fatal form of pneumonia. While traditional laboratory techniques have provided valuable systems for Legionella pneumophila identification, the amplification of the mip gene has been recognized as the only useful tool for Legionella non-pneumophila species identification both in clinical and environmental samples. Several studies focused on the mip gene classification scheme showed its limitations and the need to improve the classification scheme, including other genes. Our study provides significant advantages on Legionella identification, providing a reproducible new rpoB gene classification scheme that seems to be more accurate than mip gene sequencing, bringing out greater genetic variation on Legionella species. In addition, the combined use of both the mip and rpoB genes allowed us to identify presumed new Legionella species, improving epidemiological investigations and acquiring new understanding on Legionella fields.
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Affiliation(s)
- Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Giulia Fregni Serpini
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Laura Manni
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Antonella Grottola
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
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Sequence-based typing of clinical and environmental Legionella pneumophila isolates in Shenyang, China. ACTA ACUST UNITED AC 2021; 39:383-389. [PMID: 34620473 DOI: 10.1016/j.eimce.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We performed SBT (sequence-based typing) on clinical and environmental Legionellapneumophila isolates in Shenyang (China). We analyzed and compared the results with those obtained by PFGE (pulsed field gel electrophoresis). METHODS Twenty-two L. pneumophila isolates were collected from two patients with L. pneumophila infection, two hospitals, and 13 office buildings. There were two clinical isolates, one strain isolated from domestic tap water, another from shower water and 18 strains from cooling tower water. All these isolates were analyzed by SBT and PFGE methods. RESULTS The 22 isolates were divided into 7 types by SBT. Five isolates belonged to novel sequence types (ST2345, ST2344, ST2406, ST2407, and ST2408) and one isolate belonged to ST328. The STs were not obtained for two of the isolates. The remaining 14 isolates belonged to ST1. PFGE typing divided the 22 isolates into 14 pulsotypes. The main pulsotype was SYC, which included seven isolates. CONCLUSION Both typing methods showed that predominant clonal lines exist in the Shenyang region, with high levels of genetic polymorphisms. Five novel STs were identified, indicating a unique genetic composition of L. pneumophila strains in this region, which are significantly different from those found in other environmental water systems in the world.
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Legionella pneumophila-Epidemiology and Characterization of Clinical Isolates, Slovenia, 2006-2020. Diagnostics (Basel) 2021; 11:diagnostics11071201. [PMID: 34359283 PMCID: PMC8308060 DOI: 10.3390/diagnostics11071201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Legionella pneumophila is the causative agent of severe Legionnaires’ disease (LD). Although an increasing number of LD cases have been observed, published data from Slovenia are very limited and data on molecular epidemiology are even scarcer. The present retrospective study (2006–2020) reports the results of the microbiological diagnosis of LD, as well as the epidemiology and characterization of the Legionella clinical isolates. We tested urine samples from 15,540 patients with pneumonia symptoms for L. pneumophila infection by urine antigen test, of which 717 (4.6%) tested positive. Isolation of L. pneumophila was successfully performed from 88 clinical specimens, with 82 (93.2%) being identified as L. pneumophila sg 1 and six (6.8%) as L. pneumophila sg 2–14. Sequence-based typing (SBT) identified 33 different sequence types (STs), the most frequent being ST1 and ST23. Sequence type 1 mainly comprised isolates belonging to the Philadelphia subgroup, and ST23 mostly to Allentown/France. The standard SBT scheme, as well as Dresden phenotyping for L. pneumophila, presented a high diversity among isolates.
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Mazzotta M, Salaris S, Pascale MR, Girolamini L, Cristino S. Occurrence of Legionella spp. in Man-Made Water Sources: Isolates Distribution and Phylogenetic Characterization in the Emilia-Romagna Region. Pathogens 2021; 10:552. [PMID: 34063633 PMCID: PMC8147600 DOI: 10.3390/pathogens10050552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
Legionella species distribution in the Emilia-Romagna region, involving hospital (H) and community (C) environments, was conducted. Legionella culture, agglutination test, and mip-gene sequencing were applied on 240 isolates. The analysis showed a higher prevalence of non-Legionellapneumophila (n-Lp) species (84.1%) compared with L. pneumophila (Lp) (15.9%), with a higher frequency of n-Lp with respect to Lp species in both environments (77.6% and 96.4%, in H and C, respectively). The Shannon index showed a significant difference in Legionella distribution (p = 0.00017), with a significant abundance of Lp in the H compared with C environment (p = 0.00028). The continuous disinfection treatment in H could contribute to adaptive survival of the Lp species. Phylogenetic analysis revealed a conservative clade distribution between H and C: L. feeleii clade with three subclades in C and the Lp clade with five subclades in H and two in C, respectively. Our findings suggest the importance of Legionella surveillance both in H and C, with a focus on n-Lp species less connected to human disease. The Legionella prevalence and diversity found here indicate that geographical and temporal isolate evolution should be considered during surveillance, particularly in the light of global warming and changes in population risk factors.
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Affiliation(s)
| | | | | | | | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy; (M.M.); (S.S.); (M.R.P.); (L.G.)
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Bédard E, Trigui H, Liang J, Doberva M, Paranjape K, Lalancette C, Allegra S, Faucher SP, Prévost M. Local Adaptation of Legionella pneumophila within a Hospital Hot Water System Increases Tolerance to Copper. Appl Environ Microbiol 2021; 87:e00242-21. [PMID: 33674435 PMCID: PMC8117758 DOI: 10.1128/aem.00242-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 11/20/2022] Open
Abstract
In large-building water systems, Legionella pneumophila is exposed to common environmental stressors such as copper. The aim of this study was to evaluate the susceptibility to copper of L. pneumophila isolates recovered from various sites: two clinical and seven environmental isolates from hot water system biofilm and water and from cooling tower water. After a 1-week acclimation in simulated drinking water, strains were exposed to various copper concentrations (0.8 to 5 mg/liter) for over 672 h. Complete loss of culturability was observed for three isolates following copper exposure to 5 mg/liter for 672 h. Two sequence type 1427 (ST1427)-like isolates were highly sensitive to copper, while the other two, isolated from biofilm samples, maintained higher culturability. The expression of the copper resistance gene copA evaluated by reverse transcription-quantitative PCR (RT-qPCR) was significantly higher for the biofilm isolates. All four ST1427-like isolates were recovered from the same water system during an outbreak. Whole-genome sequencing results confirmed that the four isolates are very close phylogenetically, differing by only 29 single nucleotide polymorphisms, suggesting in situ adaptation to microenvironmental conditions, possibly due to epigenetic regulation. These results indicate that the immediate environment within a building water distribution system influences the tolerance of L. pneumophila to copper. Increased contact of L. pneumophila biofilm strains with copper piping or copper alloys in the heat exchanger might lead to local adaptation. The phenotypic differences observed between water and biofilm isolates from the hot water system of a health care facility warrants further investigation to assess the relevance of evaluating disinfection performances based on water sampling alone.IMPORTANCELegionella pneumophila is a pathogen indigenous to natural and large building water systems in the bulk and the biofilm phases. The immediate environment within a system can impact the tolerance of L. pneumophila to environmental stressors, including copper. In health care facilities, copper levels in water can vary, depending on water quality, plumbing materials, and age. This study evaluated the impact of the isolation site (water versus biofilm, hot water system versus cooling tower) within building water systems. Closely related strains isolated from a health care facility hot water system exhibited variable tolerance to copper stress, shown by differential expression of copA, with biofilm isolates displaying highest expression and tolerance. Relying on the detection of L. pneumophila in water samples following exposure to environmental stressors such as copper may underestimate the prevalence of L. pneumophila, leading to inappropriate risk management strategies and increasing the risk of exposure for vulnerable patients.
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Affiliation(s)
- Emilie Bédard
- Department of Civil Engineering, Polytechnique Montréal, Montréal, Quebec, Canada
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Hana Trigui
- Department of Civil Engineering, Polytechnique Montréal, Montréal, Quebec, Canada
| | - Jeffrey Liang
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Margot Doberva
- Department of Civil Engineering, Polytechnique Montréal, Montréal, Quebec, Canada
| | - Kiran Paranjape
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Cindy Lalancette
- Laboratoire de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Séverine Allegra
- University of Lyon, UJM-Saint-Etienne, UMR 5600 CNRS, EVS-ISTHME, Saint-Etienne, France
| | - Sebastien P Faucher
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montréal, Montréal, Quebec, Canada
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Linsak DT, Kese D, Broznic D, Lusic DV, Cenov A, Moric M, Gobin I. Sea water whirlpool spa as a source of Legionella infection. JOURNAL OF WATER AND HEALTH 2021; 19:242-253. [PMID: 33901021 DOI: 10.2166/wh.2021.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bacterial pneumonia caused by the inhalation of aerosols contaminated with Legionella spp. is also known as Legionnaires' disease. In this study, we report a case of pneumonia caused by Legionella pneumophila sg.1 in a 58-year-old man who visited a sea water-filled whirlpool within a hotel and spa complex. The patient's Legionella urine antigen test was positive for L. pneumophila sg.1. During the field study, samples were taken from both the outdoor and indoor sea water-filled pools. Samples from the whirlpool were culture positive for L. pneumophila sg.1. Typing results indicated sea water isolate belonged to Sequence type ST82 and Allentown/France MAb subgroup. In vitro experiments showed that L. pneumophila strains are able to survive within sea water up to 7 days, and survival time is prolonged with sea water dilution. Also, our results indicate that L. pneumophila Allentown strain was the most resistant to adverse conditions in sea water with the highest values of DT50 (420 min) and DT90 (1,396 min). The possible source of infection was adding potable water for filling up the whirlpool. The survival of the L. pneumophila in additionally conditioned sea water should be considered in a further study.
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Affiliation(s)
- Dijana Tomic Linsak
- Faculty of Medicine, Department of Health Ecology, University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia E-mail: ; Teaching Institute of Public Health of Primorje-Gorski Kotar County, Kresimirova 52a, 51000 Rijeka, Croatia
| | - Darja Kese
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloska 4, 1000 Ljubljana, Slovenia
| | - Dalibor Broznic
- Faculty of Medicine, Department of Medical Chemistry, Biochemistry and Clinical Chemistry, University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
| | - Darija Vukic Lusic
- Faculty of Medicine, Department of Health Ecology, University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia E-mail: ; Teaching Institute of Public Health of Primorje-Gorski Kotar County, Kresimirova 52a, 51000 Rijeka, Croatia
| | - Arijana Cenov
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Kresimirova 52a, 51000 Rijeka, Croatia
| | - Milan Moric
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Kresimirova 52a, 51000 Rijeka, Croatia
| | - Ivana Gobin
- Faculty of Medicine, Department of Microbiology, University of Rijeka, Brace Branchetta 20, 51000 Rijeka, Croatia
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Seto J, Amemura-Maekawa J, Sampei M, Araki K, Endo M, Kura F, Ikeda T, Kato T, Ohnishi M, Mizuta K. Investigation of a Legionnaires' disease outbreak using direct sequence-based typing in Yamagata City, Japan, 2019. Jpn J Infect Dis 2021; 74:491-494. [PMID: 33642433 DOI: 10.7883/yoken.jjid.2020.815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Junji Seto
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
| | | | - Mika Sampei
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
| | - Kyoko Araki
- Yamagata City Institute of Public Health, Japan
| | - Misao Endo
- Yamagata City Institute of Public Health, Japan
| | - Fumiaki Kura
- Department of Bacteriology I, National Institute of Infectious Diseases, Japan
| | - Tatsuya Ikeda
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
| | - Takeo Kato
- Yamagata City Institute of Public Health, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Japan
| | - Katsumi Mizuta
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
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Closed Genome and Plasmid Sequences of Legionella pneumophila AW-13-4, Isolated from a Hot Water Loop System of a Large Occupational Building. Microbiol Resour Announc 2021; 10:10/1/e01276-20. [PMID: 33414354 PMCID: PMC8407730 DOI: 10.1128/mra.01276-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Unused water in unoccupied buildings can become stagnant, with reductions in temperature and levels of disinfectant resulting in increased microbial growth. We report the closed and complete genome and plasmid of Legionella pneumophila strain AW-13-4 (serogroup 1), which was isolated from a hot water loop system of a large building.
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Pouderoux C, Ginevra C, Descours G, Ranc AG, Beraud L, Boisset S, Magand N, Conrad A, Bergeron-Lafaurie A, Jarraud S, Ader F. Slowly or Nonresolving Legionnaires' Disease: Case Series and Literature Review. Clin Infect Dis 2021; 70:1933-1940. [PMID: 31242293 DOI: 10.1093/cid/ciz538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 06/21/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rarely, Legionnaires' disease (LD) can progress into a slowly or nonresolving form. METHODS A nationwide retrospective study was conducted by the French National Reference Center for Legionella (2013-2017) including cases of slowly or nonresolving LD defined as persistent clinical symptoms, computed tomography (CT) scan abnormalities, and Legionella detection in lower respiratory tract specimens by culture and/or real-time (RT) polymerase chain reaction (PCR) >30 days after symptom onset. RESULTS Twelve cases of community-acquired slowly or nonresolving LD were identified among 1686 cases of culture-positive LD. Median (interquartile range [IQR]) age was 63 (29-82) years. Ten (83.3%) patients had ≥1 immunosuppressive factor. Clinically, 9 patients transiently recovered before further deterioration (median [IQR] symptom-free interval, 30 [18-55] days), 3 patients had uniformly persistent symptoms (median [IQR] time, 48 [41.5-54] days). Two patients had >2 recurrences. CT scan imagery found lung abscess in 5 (41.6%) cases. Slowly or nonresolving LD was diagnosed on positive Legionella cultures (n = 10, 83.3%) at 49.5 (IQR, 33.7-79) days. Two cases were documented through positive Legionella RT PCR at 52 and 53 days (cycle threshold detection of 21.5 and 33.7, respectively). No genomic microevolution and no Legionella resistance to antibiotics were detected. The median (IQR) duration of treatment was 46.5 (21-92.5) days. Two empyema cases required thoracic surgery. At a median (IQR) follow-up of 26 (14-41.5) months, LD-attributable mortality was 16.6% (n = 2). CONCLUSIONS Slowly or nonresolving LD may occur in immunocompromised patients, possibly leading to lung abscess and empyema.
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Affiliation(s)
- Cécile Pouderoux
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Paris, France.,Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France
| | - Christophe Ginevra
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Ghislaine Descours
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Anne-Gaëlle Ranc
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Laetitia Beraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France
| | - Sandrine Boisset
- Centre Hospitalier Universitaire de Grenoble, Institut de Biologie et de Pathologie, Paris, France
| | - Nicolas Magand
- Service de Radiologie, Hospices Civils de Lyon, Paris, France
| | - Anne Conrad
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Paris, France.,Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | | | - Sophie Jarraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
| | - Florence Ader
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Paris, France.,Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Paris, France.,CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, CNRS, UMR 5308, Université Lyon 1, École Normale Supérieure de Lyon, Paris, France
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Pascale MR, Mazzotta M, Salaris S, Girolamini L, Grottola A, Simone ML, Cordovana M, Bisognin F, Dal Monte P, Bucci Sabattini MA, Viggiani M, Cristino S. Evaluation of MALDI-TOF Mass Spectrometry in Diagnostic and Environmental Surveillance of Legionella Species: A Comparison With Culture and Mip-Gene Sequencing Technique. Front Microbiol 2021; 11:589369. [PMID: 33384668 PMCID: PMC7771186 DOI: 10.3389/fmicb.2020.589369] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/19/2020] [Indexed: 12/19/2022] Open
Abstract
Legionella spp. are widespread bacteria in aquatic environments with a growing impact on human health. Between the 61 species, Legionella pneumophila is the most prevalent in human diseases; on the contrary, Legionella non-pneumophila species are less detected in clinical diagnosis or during environmental surveillance due to their slow growth in culture and the absence of specific and rapid diagnostic/analytical tools. Reliable and rapid isolate identification is essential to estimate the source of infection, to undertake containment measures, and to determine clinical treatment. Matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI–TOF MS), since its introduction into the routine diagnostics of laboratories, represents a widely accepted method for the identification of different bacteria species, described in a few studies on the Legionella clinical and environmental surveillance. The focus of this study was the improvement of MALDI–TOF MS on Legionella non-pneumophila species collected during Legionella nosocomial and community surveillance. Comparative analysis with cultural and mip-gene sequencing results was performed. Moreover, a phylogenetic analysis was carried out to estimate the correlations amongst isolates. MALDI–TOF MS achieved correct species-level identification for 45.0% of the isolates belonging to the Legionella anisa, Legionella rubrilucens, Legionella feeleii, and Legionella jordanis species, displaying a high concordance with the mip-gene sequencing results. In contrast, less reliable identification was found for the remaining 55.0% of the isolates, corresponding to the samples belonging to species not yet included in the database. The phylogenetic analysis showed relevant differences inside the species, regruped in three main clades; among the Legionella anisa clade, a subclade with a divergence of 3.3% from the main clade was observed. Moreover, one isolate, identified as Legionella quinlivanii, displayed a divergence of 3.8% from the corresponding reference strain. However, these findings require supplementary investigation. The results encourage the implementation of MALDI–TOF MS in routine diagnostics and environmental Legionella surveillance, as it displays a reliable and faster identification at the species level, as well as the potential to identify species that are not yet included in the database. Moreover, phylogenetic analysis is a relevant approach to correlate the isolates and to track their spread, especially in unconventional reservoirs, where Legionella prevention is still underestimated.
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Affiliation(s)
- Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Antonella Grottola
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Unit of Microbiology and Virology, Modena University Hospital, Modena, Italy
| | - Maria Luisa Simone
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Miriam Cordovana
- Microbiology Unit-Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Bisognin
- Microbiology Unit-Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paola Dal Monte
- Microbiology Unit-Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
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Sreenath K, Chaudhry R, Vinayaraj EV, Dey AB, Kabra SK, Thakur B, Guleria R. Distribution of Virulence Genes and Sequence-Based Types Among Legionella pneumophila Isolated From the Water Systems of a Tertiary Care Hospital in India. Front Public Health 2020; 8:596463. [PMID: 33330340 PMCID: PMC7719716 DOI: 10.3389/fpubh.2020.596463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/12/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Legionnaires' disease (LD) is a potentially fatal pneumonia predominantly caused by infection due to Legionella pneumophila although more than 50 other Legionella species are described. Water systems contaminated with Legionella spp. are the implicated sources of Legionnaires' disease. In this study, we aimed to assess Legionella contamination in the water sources of a tertiary care hospital and to determine the virulence properties and molecular characteristics of L. pneumophila environmental isolates. Methods: During May 2015 through August 2018, a total of 201 hospital water samples were tested for L. pneumophila by standardized culture procedures; environmental isolates were examined for the presence of two virulence genes: Legionella vir homolog (lvh) and repeats in structural toxin (rtxA) by PCR. The genotyping of isolates was performed by sequence-based typing (SBT) according to the protocol of the European Study Group for Legionella Infections (ESGLI). Results:L. pneumophila was isolated from 38/201 (18.9%) water samples; among the 46 isolates, the lvh locus was present in 45 (97.8%), the rtxA locus was found in 45 (97.8%), and both loci were found in 44 (95.7%) isolates. A total of 23 sequence types (STs) were identified among the 44 isolates (index of discrimination [IOD] of 0.929), and 11/23 (47.8%) STs were new to the ESGLI database. Conclusions: The study results showed genetic diversity in L. pneumophila isolates from the hospital environment along with a high percentage of pathogenicity loci. Besides, certain STs may have an increased ability to cause legionellosis, thus requires specific infection control and prevention strategies whenever identified.
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Affiliation(s)
- K Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - E V Vinayaraj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - A B Dey
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Thakur
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Jiang L, Zhao S, Cai X, Mu D, Zhang X, Kang J, Zhao L, Chen Y. Sequence-based typing of clinical and environmental Legionella pneumophila isolates in Shenyang, China. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30243-3. [PMID: 32718496 DOI: 10.1016/j.eimc.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We performed SBT (sequence-based typing) on clinical and environmental Legionellapneumophila isolates in Shenyang (China). We analyzed and compared the results with those obtained by PFGE (pulsed field gel electrophoresis). METHODS Twenty-two L. pneumophila isolates were collected from two patients with L. pneumophila infection, two hospitals, and 13 office buildings. There were two clinical isolates, one strain isolated from domestic tap water, another from shower water and 18 strains from cooling tower water. All these isolates were analyzed by SBT and PFGE methods. RESULTS The 22 isolates were divided into 7 types by SBT. Five isolates belonged to novel sequence types (ST2345, ST2344, ST2406, ST2407, and ST2408) and one isolate belonged to ST328. The STs were not obtained for two of the isolates. The remaining 14 isolates belonged to ST1. PFGE typing divided the 22 isolates into 14 pulsotypes. The main pulsotype was SYC, which included seven isolates. CONCLUSION Both typing methods showed that predominant clonal lines exist in the Shenyang region, with high levels of genetic polymorphisms. Five novel STs were identified, indicating a unique genetic composition of L. pneumophila strains in this region, which are significantly different from those found in other environmental water systems in the world.
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Affiliation(s)
- Luxi Jiang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Sihong Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China; Department of Respiratory Medicine, the First Hospital of Shijiazhuang, Hebei, China
| | - Xu Cai
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Deguang Mu
- Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xianghua Zhang
- Department of Respiratory Medicine, the First Hospital of Shijiazhuang, Hebei, China
| | - Jian Kang
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Li Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yu Chen
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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Yakunin E, Kostyal E, Agmon V, Grotto I, Valinsky L, Moran-Gilad J. A Snapshot of the Prevalence and Molecular Diversity of Legionella pneumophila in the Water Systems of Israeli Hotels. Pathogens 2020; 9:pathogens9060414. [PMID: 32471136 PMCID: PMC7350324 DOI: 10.3390/pathogens9060414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 11/16/2022] Open
Abstract
Exposure to Legionella spp. contaminated aerosols in hotel settings confers risk for travel-associated Legionnaire’s disease (TALD). In this study, we investigated the prevalence of Legionella contamination and its molecular diversity in hotels and resorts across Israel. The study was comprised of a convenience sample of water systems from 168 hotels and resorts countrywide, routinely inspected between March 2015 and February 2017. Isolation and quantitation of Legionella were performed in a water laboratory using the ISO 11731 method. The distribution of Legionella isolates was analyzed according to geography and source. The genetic diversity of a subset of isolates was analyzed by sequence-based typing (SBT) at the National Reference Laboratory for Legionella and compared to the national database. Out of 2830 samples tested, 470 (17%) obtained from 102 different premises (60% of hotels) were positive for Legionella spp. In 230 samples (49% of all positive, 8% of total samples), accounting for 37% of hotels, Legionella spp. counts exceeded the regulatory threshold of 1000 CFU/L. The most frequently contaminated water sources were cooling towers (38%), followed by faucets, hot tubs, water lines, and storage tanks (14–17% each). Furthermore, 32% and 17% of samples obtained from cooling towers and hot tubs, respectively, exceeded the regulatory thresholds. SBT was performed on 78 strains and revealed 27 different sequence types (STs), including two novel STs. The most prevalent STs found were ST1 (26%), ST87 (10%), ST93 (6%), and ST461 and ST1516 (5% each). Several L. pneumophila STs were found to be limited to certain geographical regions. This is the first study to investigate the prevalence and diversity of Legionella in hotels and resorts in Israel during non-outbreak environmental inspections. These findings will inform risk assessment, surveillance, and control measures of TALD.
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Affiliation(s)
- Eugenia Yakunin
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
| | - Eszter Kostyal
- Department of Water Microbiology, Biolab Ltd., Jerusalem 9134001, Israel;
| | - Vered Agmon
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
| | - Itamar Grotto
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Lea Valinsky
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
| | - Jacob Moran-Gilad
- Central Laboratories and Public Health Services, Ministry of Health, Jerusalem 9134302, Israel; (E.Y.); (V.A.); (I.G.); (L.V.)
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Correspondence:
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Kyritsi MA, Kristo I, Hadjichristodoulou C. Serotyping and detection of pathogenecity loci of environmental isolates of Legionella pneumophila using MALDI-TOF MS. Int J Hyg Environ Health 2020; 224:113441. [DOI: 10.1016/j.ijheh.2019.113441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 02/05/2023]
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Hammami N, Laisnez V, Wybo I, Uvijn D, Broucke C, Van Damme A, Van Zandweghe L, Bultynck W, Temmerman W, Van De Ginste L, Moens T, Robesyn E. A cluster of Legionnaires' disease in Belgium linked to a cooling tower, August-September 2016: practical approach and challenges. Epidemiol Infect 2019; 147:e326. [PMID: 31858932 PMCID: PMC7006017 DOI: 10.1017/s0950268819001821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/06/2022] Open
Abstract
A cluster of Legionnaires' disease (LD) with 10 confirmed, three probable and four possible cases occurred in August and September 2016 in Dendermonde, Belgium. The incidence in the district was 7 cases/100 000 population, exceeding the maximum annual incidence in the previous 5 years of 1.5/100 000. Epidemiological, environmental and geographical investigations identified a cooling tower (CT) as the most likely source. The case risk around the tower decreased with increasing distance and was highest within 5 km. Legionella pneumophila serogroup 1, ST48, was identified in a human respiratory sample but could not be matched with the environmental results. Public health authorities imposed measures to control the contamination of the CT and organised follow-up sampling. We identified obstacles encountered during the cluster investigation and formulated recommendations for improved LD cluster management, including faster coordination of teams through the outbreak control team, improved communication about clinical and environmental sample analysis, more detailed documentation of potential exposures obtained through the case questionnaire and earlier use of a geographical information tool to compare potential sources and for hypothesis generation.
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Affiliation(s)
- N. Hammami
- Agency for Care and Health, Infection Prevention and Control, Flemish Community, Ghent, Belgium
| | - V. Laisnez
- Agency for Care and Health, Infection Prevention and Control, Flemish Community, Ghent, Belgium
| | - I. Wybo
- Department of Microbiology and Infection Control, National Reference Centre for Legionella Pneumophila, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D. Uvijn
- Agency for Care and Health, Environmental Health, Flemish Community, Ghent, Belgium
| | - C. Broucke
- Agency for Care and Health, Infection Prevention and Control, Flemish Community, Ghent, Belgium
| | - A. Van Damme
- Agency for Care and Health, Infection Prevention and Control, Flemish Community, Ghent, Belgium
| | - L. Van Zandweghe
- Pneumology Department, Sint-Blasius Hospital, Dendermonde, Belgium
| | - W. Bultynck
- Pneumology Department, Sint-Blasius Hospital, Dendermonde, Belgium
| | - W. Temmerman
- Pneumology Department, Sint-Blasius Hospital, Dendermonde, Belgium
| | - L. Van De Ginste
- Pneumology Department, Sint-Blasius Hospital, Dendermonde, Belgium
| | - T. Moens
- Agency for Care and Health, Environmental Health, Flemish Community, Ghent, Belgium
| | - E. Robesyn
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Ginevra C, Chastang J, David S, Mentasti M, Yakunin E, Chalker VJ, Chalifa-Caspi V, Valinsky L, Jarraud S, Moran-Gilad J. A real-time PCR for specific detection of the Legionella pneumophila serogroup 1 ST1 complex. Clin Microbiol Infect 2019; 26:514.e1-514.e6. [PMID: 31525518 DOI: 10.1016/j.cmi.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Legionella pneumophila serogroup 1 (Lp1) sequence type (ST) 1 is globally widespread in the environment and accounts for a significant proportion of Legionella infections, including nosocomial Legionnaires' disease (LD). This study aimed to design a sensitive and specific detection method for Lp ST1 that will underpin epidemiological investigations and risk assessment. METHODS A total of 628 Lp genomes (126 ST1s) were analyzed by comparative genomics. Interrogation of more than 900 accessory genes revealed seven candidate targets for specific ST1 detection and specific primers and hydrolysis probes were designed and evaluated. The analytical sensitivity and specificity of the seven primer and probe sets were evaluated on serially diluted DNA extracted from the reference strain CIP107629 and via qPCR applied on 200 characterized isolates. The diagnostic performance of the assay was evaluated on 142 culture-proven clinical samples from LD cases and a real-life investigation of a case cluster. RESULTS Of seven qPCR assays that underwent analytical validation, one PCR target (lpp1868) showed higher sensitivity and specificity for ST1 and ST1-like strains. The diagnostic performance of the assay using respiratory samples corresponded to a sensitivity of 95% (19/20) (95% CI (75.1-99.9)) and specificity of 100% (122/122) (95% CI (97-100)). The ST1 PCR assay could link two out of three culture-negative hospitalized LD cases to ST1 during a real-time investigation. CONCLUSION Using whole genome sequencing (WGS) data, we developed and validated a sensitive and specific qPCR assay for the detection of Lp1 belonging to the ST1 clonal complex by amplification of the lpp1868 gene. The ST1 qPCR is expected to deliver an added value for Lp control and prevention, in conjunction with other recently developed molecular assays.
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Affiliation(s)
- C Ginevra
- CIRI, Centre International de Recherche en Infectiologie, Legionella Pathogenesis Team, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; National Reference Centre of Legionella, Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France; ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - J Chastang
- National Reference Centre of Legionella, Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France
| | - S David
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Pathogen Genomics, Welcome Trust Sanger Institute, Cambridge, UK; Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, UK
| | - M Mentasti
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, UK
| | - E Yakunin
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - V J Chalker
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, London, UK
| | - V Chalifa-Caspi
- National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - L Valinsky
- Central Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - S Jarraud
- CIRI, Centre International de Recherche en Infectiologie, Legionella Pathogenesis Team, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; National Reference Centre of Legionella, Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France; ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - J Moran-Gilad
- ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland; School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev. Beer-Sheva, Israel; Public Health Services, Ministry of Health, Jerusalem, Israel.
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Jiang L, Amemura-Maekawa J, Ren H, Li Y, Sakata M, Zhou H, Murai M, Chang B, Ohnishi M, Qin T. Distribution of lag-1 Alleles, ORF7, and ORF8 Genes of Lipopolysaccharide and Sequence-Based Types Among Legionella pneumophila Serogroup 1 Isolates in Japan and China. Front Cell Infect Microbiol 2019; 9:274. [PMID: 31448241 PMCID: PMC6691400 DOI: 10.3389/fcimb.2019.00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/17/2019] [Indexed: 01/08/2023] Open
Abstract
Approximately 85% of cases of Legionnaires' disease are caused by Legionella pneumophila serogroup 1. In this study, we analyzed the distribution of lag-1 alleles, ORF 7 and ORF 8 genes of lipopolysaccharide (LPS) and sequence-based types of 616 L. pneumophila serogroup 1 strains isolated in Japan (206 clinical, 225 environmental) and China (13 clinical and 172 environmental). The lag-1 gene was harbored by significantly more of the clinical isolates compared with the environmental isolates (90.3 vs. 19.1% and 61.6 vs. 3.0%, respectively; both P < 0.001). ORF 7 genes were detected in 51.0% of Japanese clinical and 36.0% of Japanese environmental (P = 0.001) isolates, as well as 15.3% of Chinese clinical and 9.9% of Chinese environmental isolates (P = 0.544). ORF 8 genes were detected in 12.1% of Japanese clinical and 5.8% of Japanese environmental (P = 0.017) isolates, as well as 7.7% of Chinese clinical and 3.4% of Chinese environmental isolates (P = 0.388). The Japanese and Chinese isolates were assigned to 203 and 36 different sequence-types (ST), respectively. ST1 was predominant. Most isolates with the same ST also had the same lag-1, ORF 7, and ORF 8 gene subgroups. In conclusion, the lag-1 was present in most of the clinical isolates, but was absent from most of the environmental isolates from both China and Japan, regardless of the water source and SBT type. PCR-based serotyping and subgrouping methods can be used to define a hierarchy of virulence genotypes that require stringent surveillance to prevent human disease.
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Affiliation(s)
- Luxi Jiang
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China.,Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Junko Amemura-Maekawa
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hongyu Ren
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China
| | - Yinan Li
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China
| | - Miho Sakata
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Miyo Murai
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tian Qin
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Attenuated Legionella pneumophila Survives for a Long Period in an Environmental Water Site. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8601346. [PMID: 31355284 PMCID: PMC6636516 DOI: 10.1155/2019/8601346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/05/2019] [Accepted: 06/16/2019] [Indexed: 01/25/2023]
Abstract
Legionella pneumophila is known as a human pathogen and is ubiquitous in natural and artificial aquatic environments. Many studies have revealed the virulence traits of L. pneumophila using clinical strains and a number of studies for characterizing environmental strains are also reported. However, the association between the virulence and survivability in the environment is unclear. In the present study, L. pneumophila was isolated from environmental water sites (Ashiyu foot spa, water fountain, and public bath), and the serogroups of isolated strains were determined by serological tests. Isolated strains were found to belong to serogroups SG1, SG2, SG3, SG4, SG5, SG8, SG9, and SG13. Untypeable strains were also obtained. Isolated strains were used for intracellular growth assay in a human monocytic cell line, THP-1. Among these strains, only an untypeable strain, named AY3, failed to replicate in THP-1. In addition, AY3 was maintained for a long period in an environmental water site, Ashiyu foot spa 2. Further, we compared the characteristics of several strains isolated from Ashiyu foot spa 2 and a clinical strain, Togus-1. AY3 failed to replicate in THP-1 cells but replicated in an amoeba model, Dictyostelium discoideum. Compared with Togus-1, the culturable cell number of environmental strains under stress conditions was higher. Moreover, biofilm formation was assessed, and AY3 showed the same degree of biofilm formation as Togus-1. Biofilm formation, replication in amoebae, and resistance against stress factors would explain the predominance of AY3 at one environmental site. Although the mechanism underlying the difference in the ability of AY3 to replicate in THP-1 cells or amoebae is still unclear, AY3 may abandon the ability to replicate in THP-1 cells to survive in one environment for a long period. Understanding the mechanisms of L. pneumophila in replication within different hosts should help in the control of Legionnaires' disease, but further study is necessary.
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Cluster of Legionnaires' Disease in an Italian Prison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112062. [PMID: 31212678 PMCID: PMC6604178 DOI: 10.3390/ijerph16112062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Legionella pneumophila (Lp) is the most common etiologic agent causing Legionnaires' Disease (LD). Water systems offer the best growth conditions for Lp and support its spread by producing aerosols. From 2015 to 2017, the Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis of Palermo monitored the presence of Lp in nine prisons in Western Sicily. During this investigation, we compared Lp isolates from environmental samples in a prison located in Palermo with isolates from two prisoners in the same prison. METHODS We collected 93 water samples from nine Sicilian prisons and the bronchoalveolar lavages (BALs) of two prisoners considered cases of LD. These samples were processed following the procedures described in the Italian Guidelines for the Prevention and Control of Legionellosis of 2015. Then, genotyping was performed on 19 Lp colonies (17 from water samples and 2 from clinical samples) using the Sequence-Based Typing (SBT) method, according to European Study Group for Legionella Infections (ESGLI) protocols. RESULTS Lp serogroup (sg) 6 was the most prevalent serogroup isolated from the prisons analyzed (40%), followed by Lp sg 1 (16%). Most of all, in four penitentiary institutions, we detected a high concentration of Lp >104 Colony Forming Unit/Liter (CFU/L). The environmental molecular investigation found the following Sequence Types (STs) in Lp sg 6: ST 93, ST 292, ST 461, ST 728, ST 1317 and ST 1362, while most of the isolates in sg 1 belonged to ST 1. We also found a new ST that has since been assigned the number 2451 in the ESGLI-SBT database. From the several Lp sg 1 colonies isolated from the two BALs, we identified ST 2451. CONCLUSIONS In this article, we described the results obtained from environmental and epidemiological investigations of Lp isolated from prisons in Western Sicily. Furthermore, we reported the first cluster of Legionnaires' in an Italian prison and the molecular typing of Lp sg 1 from one prison's water system and two BALs, identified the source of the contamination, and discovered a new ST.
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Qin T, Ren H, Chen D, Zhou H, Jiang L, Wu D, Shen J, Pei F. National Surveillance of Legionnaires' Disease, China, 2014-2016. Emerg Infect Dis 2019; 25:1218-1219. [PMID: 31107214 PMCID: PMC6537748 DOI: 10.3201/eid2506.171431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report national surveillance of Legionnaires' disease in China. Urine samples from 11 (3.85%) of 286 patients with severe pneumonia of unknown cause were positive for the Legionella pneumophila serogroup 1 antigen. We isolated Legionella strains from 7 patients. Improved diagnostic testing is needed for this underestimated disease in China.
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Scherler A, Ardissone S, Moran-Gilad J, Greub G. ESCMID/ESGMD postgraduate technical workshop on diagnostic microbiology. Microbes Infect 2019; 21:343-352. [PMID: 31103724 DOI: 10.1016/j.micinf.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Aurélie Scherler
- Centre for Research on Intracellular Bacteria, Institute of Microbiology, University Hospital Centre, University of Lausanne, Lausanne, Switzerland
| | - Silvia Ardissone
- Centre for Research on Intracellular Bacteria, Institute of Microbiology, University Hospital Centre, University of Lausanne, Lausanne, Switzerland
| | - Jacob Moran-Gilad
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheeva, Israel; Members of the Board of the European Study Group for Genomic and Molecular Diagnostics (ESGMD)
| | - Gilbert Greub
- Centre for Research on Intracellular Bacteria, Institute of Microbiology, University Hospital Centre, University of Lausanne, Lausanne, Switzerland; Members of the Board of the European Study Group for Genomic and Molecular Diagnostics (ESGMD).
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Loenenbach AD, Beulens C, Euser SM, van Leuken JPG, Bom B, van der Hoek W, Husman AMDR, Ruijs WLM, Bartels AA, Rietveld A, den Boer JW, Brandsema PS. Two Community Clusters of Legionnaires' Disease Directly Linked to a Biologic Wastewater Treatment Plant, the Netherlands. Emerg Infect Dis 2019; 24:1914-1918. [PMID: 30226165 PMCID: PMC6154163 DOI: 10.3201/eid2410.180906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A biologic wastewater treatment plant was identified as a common source for 2 consecutive Legionnaires' disease clusters in the Netherlands in 2016 and 2017. Sequence typing and transmission modeling indicated direct and long-distance transmission of Legionella, indicating this source type should also be investigated in sporadic Legionnaires' disease cases.
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Nakanishi N, Nomoto R, Tanaka S, Arikawa K, Iwamoto T. Analysis of Genetic Characterization and Clonality of Legionella pneumophila Isolated from Cooling Towers in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091664. [PMID: 31086119 PMCID: PMC6540132 DOI: 10.3390/ijerph16091664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 01/01/2023]
Abstract
We investigated the genetic characteristics of 161 Legionella pneumophila strains isolated over a period of 10 years from cooling towers in Japan. Minimum spanning tree analysis based on the sequence-based typing (SBT) of them identified three clonal complexes (CCs); CC1 (105/161, 65.2%), CC2 (22 /161, 13.7%), and CC3 (20/161, 12.4%). CC1 was formed by serogroup (SG) 1 and SG7, whereas CC2 was mainly formed by SG1. All of the CC3 isolates except two strains were SG13. The major sequence types (STs) in CC1 and CC2 were ST1 (88/105, 83.8%) and ST154 (15/22, 68.2%), respectively. These STs are known as typical types of L. pneumophila SG1 in Japanese cooling tower. Additionally, we identified 15 strains of ST2603 as the major type in CC3. This ST has not been reported in Japanese cooling tower. Whole genome sequencing (WGS) analysis of the representative strains in the three CCs, which were isolated from various cooling towers over the 10 years, elucidated high clonal population of L. pneumophila in Japanese cooling tower. Moreover, it revealed that the strains of CC2 are phylogenetically distant compared to those of CC1 and CC3, and belonged to L. pneumophila subsp. fraseri.
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Affiliation(s)
- Noriko Nakanishi
- Department of Infectious Diseases, Kobe Institute of Health, 4-6-5 Minatojima-nakamichi, Chuo-ku, Kobe 650-0046, Japan.
| | - Ryohei Nomoto
- Department of Infectious Diseases, Kobe Institute of Health, 4-6-5 Minatojima-nakamichi, Chuo-ku, Kobe 650-0046, Japan.
| | - Shinobu Tanaka
- Department of Infectious Diseases, Kobe Institute of Health, 4-6-5 Minatojima-nakamichi, Chuo-ku, Kobe 650-0046, Japan.
| | - Kentaro Arikawa
- Department of Infectious Diseases, Kobe Institute of Health, 4-6-5 Minatojima-nakamichi, Chuo-ku, Kobe 650-0046, Japan.
| | - Tomotada Iwamoto
- Department of Infectious Diseases, Kobe Institute of Health, 4-6-5 Minatojima-nakamichi, Chuo-ku, Kobe 650-0046, Japan.
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Draft Genome Sequences of Seven Legionella pneumophila Isolates from a Hot Water System of a Large Building. Microbiol Resour Announc 2019; 8:8/18/e00384-19. [PMID: 31048385 PMCID: PMC6498240 DOI: 10.1128/mra.00384-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Public health data show that a significant fraction of the nation's waterborne disease outbreaks are attributable to premise plumbing. We report the draft genome sequences of seven Legionella pneumophila serogroup 1 isolates from hot water lines of a large building. Genomic analysis identified the isolates as belonging to sequence type 1.
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Natås OB, Brekken AL, Bernhoff E, Hetland MAK, Löhr IH, Lindemann PC. Susceptibility of Legionella pneumophila to antimicrobial agents and the presence of the efflux pump LpeAB. J Antimicrob Chemother 2019; 74:1545-1550. [DOI: 10.1093/jac/dkz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Olav Bjarte Natås
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Anita Løvås Brekken
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Eva Bernhoff
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Iren Høyland Löhr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Paul Christoffer Lindemann
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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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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Graells T, Hernández-García M, Pérez-Jové J, Guy L, Padilla E. Legionella pneumophila recurrently isolated in a Spanish hospital: Two years of antimicrobial resistance surveillance. ENVIRONMENTAL RESEARCH 2018; 166:638-646. [PMID: 29982152 DOI: 10.1016/j.envres.2018.06.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aim of this study was to monitor the spread, persistence and antibiotic resistance patterns of Legionella spp. strains found in a hospital water distribution system. These environmental studies are intended to help detect the presence of antibiotic resistant strains before they infect patients. METHODS Antimicrobial surveillance tests were performed at 27 different sampling points of the water network of a large Spanish hospital over two years. Water samples were screened for Legionella according to ISO 11731:2007. Legionella spp. isolates were identified by serotyping and by mass spectrometry (MALDI-ToF). Epidemiological molecular typing was done by Pulse-Field Gel Electrophoresis (PFGE) and by Sequence-Based Typing (SBT). Antibiotic susceptibility tests were performed using disk diffusion and ETEST®. RESULTS Legionella spp. were recurrently isolated for 2 years. All isolates belonged the same group, L. pneumophila serogroups 2-14. Isolates were all attributed by SBT to sequence type (ST) ST328, although PFGE revealed 5 different patterns. No significant change in antibiotic susceptibility could be observed for this study period, irrespectively of the method used. CONCLUSION Colonization of water systems by Legionella spp. is still occurring, although all the prevention rules were strictly followed. Antibiotic resistance monitoring may help us to find resistance in bacteria with environmental reservoirs but difficult to isolate from patients. The knowledge of the antibiotic susceptibility in environmental strains may help us to predict changes in clinical strains. This study might also help reconsidering Legionnaires' disease (LD) diagnostic methods. L. pneumophila serogroups 2-14 present all along the time of the investigation in the water distribution system can cause LD. However, they may not be detected by routine urine tests run on patients, thereby missing an ongoing LD infection.
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Affiliation(s)
- Tiscar Graells
- Departament de Microbiologia, CATLAB Centre Analítiques AIE, Viladecavalls, Barcelona, Spain; Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Division of Microsystems Technology, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona (UAB), Spain.
| | - Marta Hernández-García
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Josefa Pérez-Jové
- Departament de Microbiologia, CATLAB Centre Analítiques AIE, Viladecavalls, Barcelona, Spain
| | - Lionel Guy
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Emma Padilla
- Departament de Microbiologia, CATLAB Centre Analítiques AIE, Viladecavalls, Barcelona, Spain; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona (UAB), Spain
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Wells M, Lasek-Nesselquist E, Schoonmaker-Bopp D, Baker D, Thompson L, Wroblewski D, Nazarian E, Lapierre P, Musser KA. Insights into the long-term persistence of Legionella in facilities from whole-genome sequencing. INFECTION GENETICS AND EVOLUTION 2018; 65:200-209. [PMID: 30075256 DOI: 10.1016/j.meegid.2018.07.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
We investigated the value of whole-genome sequencing (WGS) and single nucleotide polymorphism (SNP) analyses in determining the relationships among and evolutionary rates of Legionella species with long-term persistence in three healthcare facilities. We examined retrospective clinical and environmental isolates of Legionella micdadei and Legionella pneumophila serogroup 1 isolates with identical PFGE DNA fingerprints sampled over the course of up to 18 years. WGS analyses demonstrated that heterogeneous populations of Legionella were present within each facility despite displaying the same PFGE profiles. Additionally, clustering of some clinical isolates with those from a separate but related institution exposed a source of infection not previously detected, underscoring the importance of considering phylogenetic relationships when assessing epidemiological links. The data supported an average substitution rate of 0.80 SNPs per genome per year for L. micdadei but a reliable estimate for L. pneumophila serogroup 1 could not be obtained due to complicating factors such as non-chronological links among isolates and inadequate sampling depths. While the substitution rate for L. micdadei is consistent with previous estimates for L. pneumophila, the lack of a temporal signal in our sequence data for L. pneuomphila serogroup 1 isolates suggests either insufficient change to provide an estimate or variable evolutionary rates, which could reflect the presence of both actively dividing and viable but non-culturable Legionella spp. in the built environment. This study highlights the increased discriminatory power of WGS SNP analysis as compared to PFGE, emphasizes the need for extended sampling, and provides insight into the evolution of Legionella from longitudinal investigations.
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Affiliation(s)
- Megan Wells
- Union College, 807 Union St., Schenectady, NY 12308, USA
| | - Erica Lasek-Nesselquist
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA.
| | - Dianna Schoonmaker-Bopp
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA
| | - Deborah Baker
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA
| | - Lisa Thompson
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA
| | - Danielle Wroblewski
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA
| | - Elizabeth Nazarian
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA
| | - Pascal Lapierre
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA
| | - Kimberlee A Musser
- Wadsworth Center, New York State Department of Health, 120 New Scotland Ave., Albany, NY 12208, USA
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Borthong J, Omori R, Sugimoto C, Suthienkul O, Nakao R, Ito K. Comparison of Database Search Methods for the Detection of Legionella pneumophila in Water Samples Using Metagenomic Analysis. Front Microbiol 2018; 9:1272. [PMID: 29971047 PMCID: PMC6018159 DOI: 10.3389/fmicb.2018.01272] [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] [Received: 12/03/2017] [Accepted: 05/24/2018] [Indexed: 12/12/2022] Open
Abstract
Metagenomic analysis has become a powerful tool to analyze bacterial communities in environmental samples. However, the detection of a specific bacterial species using metagenomic analysis remains difficult due to false positive detections of sequences shared between different bacterial species. In this study, 16S rRNA amplicon and shotgun metagenomic analyses were conducted on samples collected along a stream and ponds in the campus of Hokkaido University. We compared different database search methods for bacterial detection by focusing on Legionella pneumophila. In this study, we used L. pneumophila-specific nested PCR as a gold standard to evaluate the results of the metagenomic analysis. Comparison with the results from L. pneumophila-specific nested PCR indicated that a blastn search of shotgun reads against the NCBI-NT database led to false positive results and had problems with specificity. We also found that a blastn search of shotgun reads against a database of the catalase-peroxidase (katB) gene detected L. pneumophila with the highest area under the receiver operating characteristic curve among the tested search methods; indicating that a blastn search against the katB gene database had better diagnostic ability than searches against other databases. Our results suggest that sequence searches targeting long genes specifically associated with the bacterial species of interest is a prerequisite to detecting the bacterial species in environmental samples using metagenomic analyses.
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Affiliation(s)
- Jednipit Borthong
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan
| | - Ryosuke Omori
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan.,Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Kawaguchi, Japan
| | - Chihiro Sugimoto
- Division of Collaboration and Education, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan.,Global Institute for Collaborative Research and Education, Hokkaido University, Sapporo, Japan
| | - Orasa Suthienkul
- Faculty of Public Health, Thammasat University, Rangsit Campus, Pathumthani, Thailand
| | - Ryo Nakao
- Laboratory of Parasitology, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kimihito Ito
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo, Japan.,Global Institute for Collaborative Research and Education, Hokkaido University, Sapporo, Japan.,Faculty of Public Health, Thammasat University, Rangsit Campus, Pathumthani, Thailand
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Population structure of Environmental and Clinical Legionella pneumophila isolates in Catalonia. Sci Rep 2018; 8:6241. [PMID: 29674708 PMCID: PMC5908911 DOI: 10.1038/s41598-018-24708-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 04/09/2018] [Indexed: 11/13/2022] Open
Abstract
Legionella is the causative agent of Legionnaires’ disease (LD). In Spain, Catalonia is the region with the highest incidence of LD cases. The characterisation of clinical and environmental isolates using molecular epidemiology techniques provides epidemiological data for a specific geographic region and makes it possible to carry out phylogenetic and population-based analyses. The aim of this study was to describe and compare environmental and clinical isolates of Legionella pneumophila in Catalonia using sequence-based typing and monoclonal antibody subgrouping. A total of 528 isolates were characterised. For data analysis, the isolates were filtered to reduce redundancies, and 266 isolates (109 clinical and 157 environmental) were finally included. Thirty-two per cent of the clinical isolates were ST23, ST37 and ST1 while 40% of the environmental isolates were ST284 and ST1. Although the index of diversity was higher in clinical than in environmental ST isolates, we observed that clinical STs were similar to those recorded in other regions but that environmental STs were more confined to particular study areas. This observation supports the idea that only certain STs trigger cases or outbreaks in humans. Therefore, comparison of the genomes of clinical and environmental isolates could provide important information about the traits that favour infection or environmental persistence.
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