Searching for Activity Markers that Approximate (VBNC) Legionella pneumophila Infectivity in Amoeba after Ultraviolet (UV) Irradiation

Effects of Copper on Legionella pneumophila Revealed via Viability Assays and Proteomics

Cu is an antimicrobial that is commonly applied to premise (i.e., building) plumbing systems for Legionella control, but the precise mechanisms of inactivation are not well defined. Here, we applied a suite of viability assays and mass spectrometry-based proteomics to assess the mechanistic effects of Cu on L. pneumophila. Although a five- to six-log reduction in culturability was observed with 5 mg/L Cu2+ exposure, cell membrane integrity only indicated a <50% reduction. Whole-cell proteomic analysis revealed that AhpD, a protein related to oxidative stress, was elevated in Cu-exposed Legionella relative to culturable cells. Other proteins related to cell membrane synthesis and motility were also higher for the Cu-exposed cells relative to controls without Cu. While the proteins related to primary metabolism decreased for the Cu-exposed cells, no significant differences in the abundance of proteins related to virulence or infectivity were found, which was consistent with the ability of VBNC cells to cause infections. Whereas the cell-membrane integrity assay provided an upper-bound measurement of viability, an amoebae co-culture assay provided a lower-bound limit. The findings have important implications for assessing Legionella risk following its exposure to copper in engineered water systems.

Clinical and Environmental Surveillance for the Prevention of Legionellosis

Legionella is a Gram-negative bacterium whose natural hosts are aquatic protozoa, in which the microorganism replicates and is protected from adverse environmental conditions [...].

Emerging contaminants in the water environment: Disinfection-induced viable but non-culturable waterborne pathogens

Disinfection is essential for the control of waterborne pathogens (WPs), especially during the COVID-19 pandemic. WP can enter the viable but non-culturable (VBNC) state to evade disinfection, seriously threatening water safety. VBNC WPs should be considered as an emerging contaminant to ensure a higher level of safety of the water environment. Here, this study systematically reviewed the water disinfection methods that could induce WPs into the VBNC state, and clarified the risks of different species of VBNC WPs in the relevant water environment. The physicochemical and physiological properties of VBNC cells (e.g., morphology, physiology, and resuscitation potential) were then evaluated to better understand their potential health risks. In addition, the dominant detection methods of VBNC WPs were discussed, and real-time and label-free technologies were recommended for the study of VBNC WPs in the aquatic environment. The possible mechanisms of formation and persistence at the genetic level were highlighted. It concluded that the VBNC state has a deeper level of dormancy than the persistent state, which is associated with the general stress response and stringent response systems, and its persistence is also associated with the active efflux of harmful substances. Finally, the current shortcomings and research perspectives of VBNC bacteria were summarized. This review provides new insights into the characteristics, detection methods, persistence mechanisms, and potential health risks of VBNC WPs induced by water disinfection processes, and also serves as a basis for microbial risk control in the aquatic environment.

Inaccuracies of the ISO 11731 Method for Environmental Validation of Legionella in Building Water Systems: Opportunities to Improve Sensitivity and Detect Viable but Non-Culturable Legionella

Current environmental diagnostics for the detection of Legionella fail to detect viable but non-culturable Legionella, have sensitivity limitations and are time-consuming (10-14 days to results). The objective of this study was to compare Legionella detection results between the standard ISO 11731 and an innovative Legionella detection method that utilizes a hybrid methodology of traditional microbiology and molecular detection. In this study, four hundred and seventy-six (476) potable building water samples were analyzed with ISO 11731 and the novel method in parallel. Of the 476 total samples that were tested, a discrepancy of 21% was observed when comparing the ISO 11731 method to the novel method. Separating the samples based on hazard control methods yielded a 15.4% discrepancy for chlorinated systems (n = 284) and a 29% discrepancy for monochloraminated systems (n = 192). The data presented here conclusively show inaccuracies in environmental validation for building water systems based on results returned by the standard ISO 11731 method. This is especially evident in systems primarily disinfected with monochloramines. Overall, these data highlight the need for new and innovative methods to overcome the inaccuracies of the traditional ISO 11731 spread plates to prevent disease and injury caused by Legionella.

Differences in UV-C LED Inactivation of Legionella pneumophila Serogroups in Drinking Water

Legionella pneumophila (Lp) is an opportunistic pathogen that causes respiratory infections primarily through inhalation of contaminated aerosols. Lp can colonize premise plumbing systems due to favorable growth conditions (e.g., lower disinfectant residual, stagnation, warm temperatures). UV-C light-emitting diodes (UV-C LEDs) are an emerging water treatment technology and have been shown to effectively inactivate waterborne pathogens. In this study, the inactivation of four Lp strains (three clinical sg1, 4, and 6; and one sg1 drinking water (DW) isolate) was evaluated using a UV-C LED collimated beam at three wavelengths (255, 265, and 280 nm) and six fluence rates (0.5–34 mJ/cm²). Exposure to 255 nm resulted in higher log reductions at the lower fluences compared to exposures at 265 and 280 nm. Efficacy testing was also performed using a UV-C LED point-of-entry (POE) flow-through device. Based on the log inactivation curves, at 255 nm, the sg4 and sg6 clinical isolates were more susceptible to inactivation compared to the two sg1 isolates. However, at 265 and 280 nm, the sg1 and sg4 clinical isolates were more resistant to inactivation compared to the sg6 clinical and sg1 DW isolates. Differential log reductions were also observed using the POE device. Results indicate that although UV-C LED disinfection is effective, variations in Lp inactivation, wavelengths, and technology applications should be considered, especially when targeting specific isolates within premise plumbing systems.

Mechanistic insight of simultaneous removal of tetracycline and its related antibiotic resistance bacteria and genes by ferrate(VI)

The emergence of antibiotics and their corresponding antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) have posed great challenges to the public health. The paper demonstrates the removal of co-existing tetracycline (TC), its resistant Escherichia coli (E. coli), and ARGs (tetA and tetR) in a mixed system by applying ferrate(VI) (Fe^VIO₄^2-, Fe(VI)) at pH 7.0. TC was efficiently degraded by Fe(VI), and the rapid inactivation of the resistant E. coli was found with the complete loss of culturability. The results of flow cytometry suggested that the damage of membrane integrity and respiratory activity were highly correlated with the Fe(VI) dosages. Moreover, high-dose Fe(VI) eliminates 6 log₁₀ viable but non-culturable (VBNC) cells and even breaks the cells into fragments. ARGs in extracellular form (e-ARGs) exhibited a high sensitivity of 4.44 log₁₀ removal to Fe(VI). Comparatively, no removal of intracellular ARGs (i-ARGs) was observed due to the multi-protection of cellular structure and rapid decay of Fe(VI). The oxidized products of TC were assessed to be less toxic than the parent compound. Overall, this study demonstrated the superior efficiency and great promise of Fe(VI) on simultaneous removal of antibiotics and their related ARB and ARGs in water.

Natural Organic Matter, Orthophosphate, pH, and Growth Phase Can Limit Copper Antimicrobial Efficacy for Legionella in Drinking Water

Copper (Cu) is a promising antimicrobial for premise plumbing, where ions can be dosed directly via copper silver ionization or released naturally via corrosion of Cu pipes, but Cu sometimes inhibits and other times stimulates Legionella growth. Our overarching hypothesis was that water chemistry and growth phase control the net effect of Cu on Legionella. The combined effects of pH, phosphate concentration, and natural organic matter (NOM) were comprehensively examined over a range of conditions relevant to drinking water in bench-scale pure culture experiments, illuminating the effects of Cu speciation and precipitation. It was found that cupric ions (Cu²⁺) were drastically reduced at pH > 7.0 or in the presence of ligand-forming phosphates or NOM. Further, exponential phase L. pneumophila were 2.5× more susceptible to Cu toxicity relative to early stationary phase cultures. While Cu²⁺ ion was the most effective biocidal form of Cu, other inorganic ligands also had some biocidal impacts. A comparison of 33 large drinking water utilities' field-data from 1990 and 2018 showed that Cu²⁺ levels likely decreased more dramatically (>10×) than did the total or soluble Cu (2×) over recent decades. The overall findings aid in improving the efficacy of Cu as an actively dosed or passively released antimicrobial against L. pneumophila.

Critical Review: Propensity of Premise Plumbing Pipe Materials to Enhance or Diminish Growth of Legionella and Other Opportunistic Pathogens

Growth of Legionella pneumophila and other opportunistic pathogens (OPs) in drinking water premise plumbing poses an increasing public health concern. Premise plumbing is constructed of a variety of materials, creating complex environments that vary chemically, microbiologically, spatially, and temporally in a manner likely to influence survival and growth of OPs. Here we systematically review the literature to critically examine the varied effects of common metallic (copper, iron) and plastic (PVC, cross-linked polyethylene (PEX)) pipe materials on factors influencing OP growth in drinking water, including nutrient availability, disinfectant levels, and the composition of the broader microbiome. Plastic pipes can leach organic carbon, but demonstrate a lower disinfectant demand and fewer water chemistry interactions. Iron pipes may provide OPs with nutrients directly or indirectly, exhibiting a high disinfectant demand and potential to form scales with high surface areas suitable for biofilm colonization. While copper pipes are known for their antimicrobial properties, evidence of their efficacy for OP control is inconsistent. Under some circumstances, copper's interactions with premise plumbing water chemistry and resident microbes can encourage growth of OPs. Plumbing design, configuration, and operation can be manipulated to control such interactions and health outcomes. Influences of pipe materials on OP physiology should also be considered, including the possibility of influencing virulence and antibiotic resistance. In conclusion, all known pipe materials have a potential to either stimulate or inhibit OP growth, depending on the circumstances. This review delineates some of these circumstances and informs future research and guidance towards effective deployment of pipe materials for control of OPs.

Can incorporation of UVC LEDs into showerheads prevent opportunistic respiratory pathogens? - Microbial behavior and device design considerations

Respiratory infections from opportunistic bacterial pathogens (OBPs) have heightened research interests in drinking water distribution systems, premise plumbing, and point-of-use technologies. In particular, biofilm growth in showerheads increases OBP content, and inhalation of shower aerosols is a major exposure route for Legionellae and Mycobacteria infections. Incorporation of UVC LEDs into showerheads has thus been proposed as a point-of-use option for healthcare facilities. Herein we have examined incongruities between the nature of OBP contamination in shower water and the hypothetical application of conventional UV disinfection engineering concepts. Effective UV dosing within showerheads must overcome significant shielding effects imparted by the biological matrices in which common OBPs reside, including biofilm particles and protozoan hosts. Furthermore, prevention of biofilm growth in showerhead interiors requires a different UV irradiation approach and is lacking in established design parameters. Development of showerhead devices is also likely to face a trade-off between bathing functionality and simpler form factors that are more conducive to internal UV irradiation.