A Legionnaires' Disease Cluster in a Private Building in Italy

Experimental assessment of low temperature plasma devices for bacterial aerosol inactivation in the air duct of HVAC systems

In light of growing concerns about indoor air quality and the transmission of pathogens, this study aims to evaluate the effectiveness of low temperature plasma (LTP) devices in inactivating bacterial aerosols in the air duct of HVAC systems, exploring methods to enhance air purification efficiency. This research employed experimental methods to explore the deactivation effects of LTP on common bacteria such as E. coli and Bacillus subtilis, focusing on the role of air parameters such as the airflow rate, relative humidity, and temperature in influencing the device's performance. Notably, the study determined that an operational voltage of 3000 V for the LTP device, combined with conditions of low airflow, low humidity, and high temperature, significantly enhances the inactivation of bacterial aerosols, achieving an 82% inactivation rate at a negative ion concentration of 2.4 × 1011 ions per m3 and a wind speed of 3 m s-1. Despite the generation of ozone and ultraviolet light as by-products, their concentrations were found to be within safe limits for human exposure. In addition, this study identified an effective inactivation range, alongside an optimal arrangement for the airflow direction within ducts, to maximize the sterilization efficiency of the LTP device. Given these promising results, the study advocates for the integration of LTP technology into the air duct of HVAC systems of public buildings to improve air quality and reduce the risk of airborne disease transmission.

Tap water as the source of a Legionnaires' disease outbreak spread to several residential buildings and one hospital, Finland, 2020 to 2021

In Finland, all microbiology laboratories notify Legionella findings and physicians notify Legionnaires' disease (LD) cases to the National Infectious Disease Register. All cases are interviewed, and water samples obtained from potential places of exposure. Legionella isolates from humans and water are compared by whole genome sequencing (WGS). In March 2021, Legionella pneumophila serogroup 1 (Lp 1) pneumonia cases increased in one Finnish city (120,000 inhabitants) where single LD cases are detected annually. We identified 12 LD cases, nine living in different residential buildings and three nosocomial, linked by identical human and/or water isolates. Three of these cases were from January 2020, October 2020 and February 2021 and identified retrospectively. Eleven were diagnosed by urinary antigen test, 10 by PCR and five by culture; age ranged between 52 and 85 years, and 10 had underlying diseases. Nine of 12 homes of LD cases and 15 of 26 water samples from the hospital were positive for Lp 1, with concentrations up to 640,000 cfu/L. Water samples from regional storage tanks were negative. Positivity in homes and the hospital suggested inadequate maintenance measures. Enhanced surveillance combined with WGS was crucial in detecting this unusual LD outbreak related to domestic and hospital water systems.

Terpinen-4-ol, the Main Bioactive Component of Tea Tree Oil, as an Innovative Antimicrobial Agent against Legionella pneumophila

Legionella pneumophila (Lp), responsible for a severe pneumonia called Legionnaires’ disease, represents an important health burden in Europe. Prevention and control of Lp contamination in warm water systems is still a great challenge often due to the failure in disinfection procedures. The aim of this study was to evaluate the in vitro activity of Terpinen-4-ol (T-4-ol) as potential agent for Lp control, in comparison with the essential oil of Melaleuca alternifolia (tea tree) (TTO. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of T-4-ol were determined by broth micro-dilution and a micro-atmosphere diffusion method to investigate the anti-Lp effects of T-4-ol and TTO vapors. Scanning Electron Microscopy (SEM) was adopted to highlight the morphological changes and Lp damage following T-4-ol and TTO treatments. The greatest antimicrobial activity against Lp was shown by T-4-ol with a MIC range of 0.06–0.125% v/v and MBC range of 0.25–0.5% v/v. The TTO and T-4-ol MIC and MBC decreased with increasing temperature (36 °C to 45 ± 1 °C), and temperature also significantly influenced the efficacy of TTO and T-4-ol vapors. The time-killing assay showed an exponential trend of T-4-ol bactericidal activity at 0.5% v/v against Lp. SEM observations revealed a concentration- and temperature- dependent effect of T-4-ol and TTO on cell surface morphology with alterations. These findings suggest that T-4-ol is active against Lp and further studies may address the potential effectiveness of T-4-ol for control of water systems.

Case Report: First Report of Fatal Legionella pneumophila and Klebsiella pneumoniae Coinfection in a Kidney Transplant Recipient

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.