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Riccò M, Ferraro P, Peruzzi S, Zaniboni A, Ranzieri S. SARS-CoV-2-Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020-2021). Microorganisms 2022; 10:499. [PMID: 35336074 PMCID: PMC8951730 DOI: 10.3390/microorganisms10030499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
Legionnaires' Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila. Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129-0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2-Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.
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Affiliation(s)
- Matteo Riccò
- AUSL–IRCCS di Reggio Emilia, Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), Local Health Unit of Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Pietro Ferraro
- Servizio di Medicina del Lavoro, ASL di Foggia, 71121 Foggia, Italy;
| | - Simona Peruzzi
- AUSL–IRCCS di Reggio Emilia, Laboratorio Analisi Chimico Cliniche e Microbiologiche, Ospedale Civile di Guastalla, 42016 Guastalla, Italy;
| | - Alessandro Zaniboni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.Z.); (S.R.)
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.Z.); (S.R.)
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Hambridge T, Nanjan Chandran SL, Geluk A, Saunderson P, Richardus JH. Mycobacterium leprae transmission characteristics during the declining stages of leprosy incidence: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009436. [PMID: 34038422 PMCID: PMC8186771 DOI: 10.1371/journal.pntd.0009436] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/08/2021] [Accepted: 05/03/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Leprosy is an infectious disease caused by Mycobacterium leprae. As incidence begins to decline, the characteristics of new cases shifts away from those observed in highly endemic areas, revealing potentially important insights into possible ongoing sources of transmission. We aimed to investigate whether transmission is driven mainly by undiagnosed and untreated new leprosy cases in the community, or by incompletely treated or relapsing cases. METHODOLOGY/PRINCIPAL FINDINGS A literature search of major electronic databases was conducted in January, 2020 with 134 articles retained out of a total 4318 records identified (PROSPERO ID: CRD42020178923). We presented quantitative data from leprosy case records with supporting evidence describing the decline in incidence across several contexts. BCG vaccination, active case finding, adherence to multidrug therapy and continued surveillance following treatment were the main strategies shared by countries who achieved a substantial reduction in incidence. From 3950 leprosy case records collected across 22 low endemic countries, 48.3% were suspected to be imported, originating from transmission outside of the country. Most cases were multibacillary (64.4%) and regularly confirmed through skin biopsy, with 122 cases of suspected relapse from previous leprosy treatment. Family history was reported in 18.7% of cases, while other suspected sources included travel to high endemic areas and direct contact with armadillos. None of the countries included in the analysis reported a distinct increase in leprosy incidence in recent years. CONCLUSIONS/SIGNIFICANCE Together with socioeconomic improvement over time, several successful leprosy control programmes have been implemented in recent decades that led to a substantial decline in incidence. Most cases described in these contexts were multibacillary and numerous cases of suspected relapse were reported. Despite these observations, there was no indication that these cases led to a rise in new secondary cases, suggesting that they do not represent a large ongoing source of human-to-human transmission.
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Affiliation(s)
- Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Shri Lak Nanjan Chandran
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Saunderson
- American Leprosy Missions, Greenville, South Carolina, United States of America
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Beltrame A, Barabino G, Wei Y, Clapasson A, Orza P, Perandin F, Piubelli C, Monteiro GB, Longoni SS, Rodari P, Duranti S, Silva R, Fittipaldo VA, Bisoffi Z. Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018. Microorganisms 2020; 8:microorganisms8081113. [PMID: 32722218 PMCID: PMC7463815 DOI: 10.3390/microorganisms8081113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.
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Affiliation(s)
- Anna Beltrame
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
- Correspondence: ; Tel.: +39-045-601-4748
| | - Gianfranco Barabino
- Dermatological Clinic, National Reference Center for Hansen’s Disease, Ospedale Policlinico San Martino, Sistema Sanitario Regione Liguria, Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (G.B.); (Y.W.); (A.C.)
| | - Yiran Wei
- Dermatological Clinic, National Reference Center for Hansen’s Disease, Ospedale Policlinico San Martino, Sistema Sanitario Regione Liguria, Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (G.B.); (Y.W.); (A.C.)
| | - Andrea Clapasson
- Dermatological Clinic, National Reference Center for Hansen’s Disease, Ospedale Policlinico San Martino, Sistema Sanitario Regione Liguria, Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Largo Rosanna Benzi 10, 16132 Genoa, Italy; (G.B.); (Y.W.); (A.C.)
| | - Pierantonio Orza
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Francesca Perandin
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Chiara Piubelli
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Geraldo Badona Monteiro
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Silvia Stefania Longoni
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Paola Rodari
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Silvia Duranti
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Ronaldo Silva
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
| | - Veronica Andrea Fittipaldo
- Oncology Department, Mario Negri Institute for Pharmacological Research I.R.C.C.S., Via Giuseppe La Masa 19, 20156 Milano, Italy;
| | - Zeno Bisoffi
- Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; (P.O.); (F.P.); (C.P.); (G.B.M.); (S.S.L.); (P.R.); (S.D.); (R.S.); (Z.B.)
- Department of Diagnostic and Public Health, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy
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BALESTRINO A, RICCARDI N, FIASCHI P, ANANIA P, MARTINOLI C, GENNARO S. Endoneural abscess of common popliteal nerve as first clinical manifestation of leprosy: the first reported case in history in a low-incidence country. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E148-E151. [PMID: 32802998 PMCID: PMC7419112 DOI: 10.15167/2421-4248/jpmh2020.61.2.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/20/2020] [Indexed: 11/18/2022]
Abstract
A migrant from Palestine came to our attention for weakness of dorsiflexion of the left foot and hypoesthesia of the homolateral common peroneal nerve territory. Skin biopsies from skin lesions in the hypoesthetic area were not diagnostic. Radiological investigation showed focal nerve enlargement with a possible focal lesion. At this time, and given the uncertainty of the diagnosis, we had to choose between medical therapy with steroid and a surgical exploration of the nerve. We decided for the latter option. Intraoperatively, we found a focal round enlargement of the nerve. Epineurotomy was performed at that level, revealing a round caseous granulomatous mass that was excised. Microbiological examination revealed presence of Mycobacterium Leprae allowing diagnosis of leprosy. Medical therapy was then started, leading to resolution of clinical symptoms. Endoneural lepromatous abscesses are uncommon lesions that should be suspected in patients presenting with peripheral nerve dysfunction with anamnesis of travel in leprosy endemic regions or contacts with people from endemic regions with or even without skin lesions. Detection of endoneural abscesses is of critical importance because prompt surgical excision in conjunction with medical therapy leads to improvement of symptoms and permits correct diagnosis. In times of large human migrations from leprosy endemic areas, knowledge of this uncommon presentation of leprosy and its management will help lead to the best management of these patients.
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Affiliation(s)
- A. BALESTRINO
- Division of Neurosurgery, Department of Neuroscience, Ospedale Policlinico San Martino-IST, University of Genoa, Genoa, Italy
- Correspondence: Alberto Balestrino, Division of Neurosurgery, Department of Neuroscience, Ospedale Policlinico San Martino-IST, University of Genoa, largo Rosanna Benzi 10, 16132 Genoa, Italy - Tel.: +39 3405836354 - E-mail:
| | - N. RICCARDI
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
- Stop TB Italia Onlus, Milan, Italy
| | - P. FIASCHI
- Division of Neurosurgery, Department of Neuroscience, Ospedale Policlinico San Martino-IST, University of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy
| | - P. ANANIA
- Division of Neurosurgery, Department of Neuroscience, Ospedale Policlinico San Martino-IST, University of Genoa, Genoa, Italy
| | - C. MARTINOLI
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy
- Department of Radiology, Department of Health Sciences, Ospedale Policlinico San Martino-IST, University of Genoa, Genoa, Italy
| | - S. GENNARO
- Division of Neurosurgery, Department of Neuroscience, Ospedale Policlinico San Martino-IST, University of Genoa, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy
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