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Seto J, Takahashi J, Sampei M, Ikeda T, Mizuta K. A Case of Legionella pneumophila Serogroup 13 Pneumonia Based on the Detection of Serogroup-Specific Genes in Culture-Negative Sputum. Jpn J Infect Dis 2024; 77:118-120. [PMID: 38030269 DOI: 10.7883/yoken.jjid.2023.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Legionella pneumophila serogroup (SG) 1, the main cause of Legionnaires' disease, can be diagnosed using urinary antigen testing kits. However, lower respiratory tract specimen cultures are required to identify L. pneumophila SG 2-15. We attempted to detect L. pneumophila SG-specific genes in a culture-negative sputum specimen from a patient with pneumonia who was suspected to have Legionnaires' disease. Two multiplex PCR methods targeting L. pneumophila were modified and amplicons considered to be SG13 specific were detected. Direct sequencing revealed that the amplicons were identical to the nucleotide sequence of L. pneumophila SG13. Based on the presentation and clinical course (fever, muscle pain, disturbance of consciousness, high C-reactive protein titer, rhabdomyolysis, hypophosphatemia, and symptomatic improvement with levofloxacin treatment), in combination with the detection of L. pneumophila SG-specific genes, we suspected L. pneumophila SG13 pneumonia. L. pneumophila non-SG1 pneumonia is thought to be underestimated because of its difficult laboratory diagnosis. The modified multiplex PCR system for lower respiratory tract specimens revealed in this study is likely to improve the diagnosis of Legionnaires' disease caused by L. pneumophila SG13 and other SGs.
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Affiliation(s)
- Junji Seto
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
| | - Jun Takahashi
- Department of General Medicine, Okitama Public General Hospital, Japan
| | - Mika Sampei
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
| | - Tatsuya Ikeda
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
| | - Katsumi Mizuta
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Japan
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Glažar Ivče D, Rončević D, Šantić M, Cenov A, Tomić Linšak D, Mićović V, Lušić D, Glad M, Ljubas D, Vukić Lušić D. Is a Proactive Approach to Controlling Legionella in the Environment Justified? Food Technol Biotechnol 2021; 59:314-324. [PMID: 34759763 PMCID: PMC8542184 DOI: 10.17113/ftb.59.03.21.7016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/24/2021] [Indexed: 11/29/2022] Open
Abstract
Research background Legionella are Gram-negative bacteria that are ubiquitous in the natural environment. Contaminated water in man-made water systems is a potential source of transmission of legionnaires’ disease. The aim of this study is to explore the prevalence of Legionella pneumophila in the drinking water distribution system (DWDS) of Primorje-Gorski Kotar (PGK) County, Croatia, for the period 2013-2019, coupled with the incidence of legionnaires’ disease. A number of L. pneumophila-positive samples (>100 CFU/L), serogroup distribution and the degree of contamination of specific facilities (health and aged care, tourism, and sports) were assessed. Based on the obtained results, the reasoning for the implementation of a mandatory Legionella environmental surveillance program was assessed. Experimental approach Sample testing for Legionella was carried out according to the standard method for enumeration of this bacterium. A heterotrophic plate count (HPC) and Pseudomonas aeruginosa number were analysed along with the basic physicochemical indicators of drinking water quality. The research period was divided into two parts, namely, the 2013-2018 period (before implementation of the prevention program, after the outbreak of legionnaires’ disease), and the year 2019 (proactive approach, no disease cases recorded). Results and conclusion During the 7-year observation period in PGK County, an increase in the number of samples tested for Legionella was found. An increase in Legionella-positive samples (particularly pronounced during the warmer part of the year) was recorded, along with a growing trend in the number of reported legionnaires’ disease cases. In addition to hot water systems, the risk of Legionella colonisation also applies to cold water systems. Health and aged care facilities appear to be at highest risk. In addition to the higher proportion of positive samples and a higher degree of microbiological load in these facilities, the highest proportion of L. pneumophila SGs 2-14 was identified. Due to the diagnostic limitations of the applied tests, the number of legionnaires’ disease cases is underdiagnosed. Novelty and scientific contribution The introduction of a mandatory preventive approach to monitoring Legionella in DWDS water samples, along with the definition of national criteria for the interpretation of the results will create the preconditions for diagnosis and adequate treatment of larger numbers of legionnaires’ disease cases.
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Affiliation(s)
- Daniela Glažar Ivče
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Dobrica Rončević
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia
| | - Marina Šantić
- Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Arijana Cenov
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Dijana Tomić Linšak
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Vladimir Mićović
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
| | - Dražen Lušić
- Faculty of Health Studies, Viktora cara Emina 5, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.,Center for Advanced Computing and Modelling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
| | - Marin Glad
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
| | - Davor Ljubas
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, Zagreb, Croatia
| | - Darija Vukić Lušić
- Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia.,Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia.,Center for Advanced Computing and Modelling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
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Abstract
A 53-year-old man with alcoholism and a three-day history of diarrhea and abdominal pain was hospitalized with mild acute kidney injury (AKI) and rhabdomyolysis after a fall where he was down for a short duration. Subsequent testing revealed patchy right lower lobe infiltrates on chest X-ray and a positive urinary Legionella antigen test. Creatinine phosphokinase (CPK) peaked at 85,780 U/L (normal 0-250) on hospital day two and remained markedly elevated for five days despite aggressive intravenous (IV) hydration and appropriate antibiotic treatment. When the patient defervesced and showed clinical signs of resolution of pneumonia, the CPK level declined rapidly, and renal function returned to baseline. Rhabdomyolysis with AKI is a rare but serious complication of Legionella pneumonia, with most patients requiring dialysis. Our patient’s complete recovery without renal replacement therapy can probably be attributed to his normal baseline renal function, timely diagnosis of his Legionella-associated rhabdomyolysis, and prompt treatment with aggressive IV hydration and appropriate antibiotics. Legionella infection should be considered in acutely ill patients with rhabdomyolysis of unclear etiology.
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Affiliation(s)
- Joshua W Buzzard
- Miscellaneous, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Zachary Zuzek
- Internal Medicine, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, USA
| | - Ben P Alencherry
- Internal Medicine, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, USA
| | - Clifford D Packer
- Internal Medicine, Case Western Reserve University School of Medicine, Cleveland, USA
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Abstract
CONTEXT The incidence of legionellosis has sharply increased in the United States as a result of contaminated water systems. Jurisdictions across the country are considering whether to develop and implement regulations to protect individuals against Legionnaires' disease with its associated high morbidity and mortality. OBJECTIVE This article sheds light on the implementation and effectiveness of a 2005 citywide Legionella testing mandate of multifamily housing cooling towers in Garland, Texas. This ordinance has been in place for more than 10 years and represents the first of its kind in the United States to mandate routine testing of cooling towers for Legionella in multifamily housing. DESIGN, SETTING, AND POPULATION We utilized a mix of both qualitative and quantitative methods to explore the development, adoption, and implementation of the ordinance. Phone interviews were conducted with individuals from the City of Garland Health Department and apartment managers. Quantitative data included public health surveillance data on legionellosis. MAIN OUTCOME MEASURES Barriers and facilitators of implementation, number and percentage of cooling towers from multifamily housing units that tested positive for Legionella by year, and number of legionellosis cases by year in Garland, Texas. RESULTS Study outcomes highlight key themes that facilitated the successful implementation of the Legionella testing mandate, including the importance of timing, leadership support, stakeholder engagement, and education and outreach. The number of contaminated cooling towers was reduced over time. CONCLUSION Mandatory monitoring for legionella in a local jurisdiction may result in reduced risk of legionellosis from cooling towers through raising awareness and education of building owners and managers about the need to prevent, detect, and remediate legionella contamination in their building water systems. Garland, Texas, broke new ground in the United States in moving toward primary prevention of legionellosis. The ordinance may be useful both in serving to educate and increase awareness about the need for Legionella prevention and to monitor effectiveness of maintenance procedures.
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Affiliation(s)
- Ellen A. Whitney
- International Association of National Public Health Institutes, Global Health Institute (Ms Whitney), Department of Health Policy and Management, Rollins School of Public Health (Dr Blake), and Center for Public Health Preparedness and Research, Rollins School of Public Health (Dr Berkelman), Emory University, Atlanta, Georgia
| | - Sarah Blake
- International Association of National Public Health Institutes, Global Health Institute (Ms Whitney), Department of Health Policy and Management, Rollins School of Public Health (Dr Blake), and Center for Public Health Preparedness and Research, Rollins School of Public Health (Dr Berkelman), Emory University, Atlanta, Georgia
| | - Ruth L. Berkelman
- International Association of National Public Health Institutes, Global Health Institute (Ms Whitney), Department of Health Policy and Management, Rollins School of Public Health (Dr Blake), and Center for Public Health Preparedness and Research, Rollins School of Public Health (Dr Berkelman), Emory University, Atlanta, Georgia
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Wong K, Perpich JD, Kozlov G, Cygler M, Abu Kwaik Y, Gehring K. Structural Mimicry by a Bacterial F Box Effector Hijacks the Host Ubiquitin-Proteasome System. Structure 2017; 25:376-383. [PMID: 28111017 DOI: 10.1016/j.str.2016.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/24/2016] [Accepted: 12/21/2016] [Indexed: 02/04/2023]
Abstract
Ankyrin B (AnkB/LegAU13) is a translocated F box effector essential for the intracellular replication of the pathogen Legionella pneumophila. AnkB co-opts a host ubiquitin ligase to decorate the pathogen-containing vacuole with K48-linked polyubiquitinated proteins and degrade host proteins as a source of energy. Here, we report that AnkB commandeers the host ubiquitin-proteasome system through mimicry of two eukaryotic protein domains. Using X-ray crystallography, we determined the 3D structure of AnkB in complex with Skp1, a component of the human SCF ubiquitination ligase. The structure confirms that AnkB contains an N-terminal F box similar to Skp2 and a C-terminal substrate-binding domain similar to eukaryotic ankyrin repeats. We identified crucial amino acids in the substrate-binding domain of AnkB and showed them to be essential for the function of AnkB in L. pneumophila intracellular proliferation. The study reveals how Legionella uses molecular mimicry to manipulate the host ubiquitination pathway and proliferate intracellularly.
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Affiliation(s)
- Kathy Wong
- Department of Biochemistry and Groupe de recherche axé sur la structure des protéines, McGill University, Montreal, QC H3G 0B1, Canada
| | - John D Perpich
- Department of Microbiology and Immunology, University of Louisville College of Medicine, Louisville, KY 40202, USA
| | - Guennadi Kozlov
- Department of Biochemistry and Groupe de recherche axé sur la structure des protéines, McGill University, Montreal, QC H3G 0B1, Canada
| | - Miroslaw Cygler
- Department of Biochemistry, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Yousef Abu Kwaik
- Department of Microbiology and Immunology, University of Louisville College of Medicine, Louisville, KY 40202, USA
| | - Kalle Gehring
- Department of Biochemistry and Groupe de recherche axé sur la structure des protéines, McGill University, Montreal, QC H3G 0B1, Canada.
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Yamakuchi H, Hamada Y, Urakami T, Aoki Y. Discrimination between Legionnaires' Disease and Pneumococcal Pneumonia Based on the Clinical and Laboratory Features: A Quantitative Approach Using the Modified Winthrop-University Hospital Weighted Point System. Intern Med 2017; 56:487-491. [PMID: 28250292 PMCID: PMC5399197 DOI: 10.2169/internalmedicine.56.7399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Legionnaires' disease (LD) is a common form of lobar pneumonia, but the optimum diagnostic modality has long been a subject of debate due to incomplete sensitivity and specificity. A delay in the initiation of specific therapy for LD is associated with increased mortality. The decision to treat a patient for Legionella must be made quickly. The purpose of this study was to evaluate the ability of the modified Winthrop-University Hospital WUH system to identify LD while discriminating against pneumococcal pneumonia at the time of hospitalization for community-acquired pneumonia. Methods Five patients with LD and 13 patients with pneumococcal pneumonia were retrospectively analyzed. Results The WUH system identified 4 of 5 patients with LD (sensitivity, 80%) while excluding legionellosis in 12 of 13 patients with pneumococcal pneumonia (specificity, 92%). The positive and negative likelihood ratios were 10.4 and 0.2. The area under the receiver operating characteristic curve was 0.969. Conclusion The WUH system is useful for obtaining a rapid presumptive clinical diagnosis of LD. Further investigation with a larger number of patients is strongly recommended.
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Affiliation(s)
- Hiroki Yamakuchi
- Infectious Disease and Hospital Epidemiology, Kagoshima Seikyou Hospital, Japan
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Abstract
The most significant outbreak of Legionella pneumophila, or Legionnaires’ Disease, ever registered in Portugal occurred in 2014, and was considered one of the largest in European history. This relatively rare infection has a dire prognosis if not timely identified and correctly treated, presenting with a high lethality rate. We describe a case of infection by Legionella pneumophila in a previously healthy individual during an outbreak that originated 300 kilometers away from our hospital. The patient presented to the Emergency Department and after an initial assessment, was admitted to the Intensive Care Unit (ICU). He underwent supportive treatment with invasive mechanical ventilation and antibiotic therapy, having been discharged with functional improvement 21 days after admission. During follow-up, the patient presented well without residual clinical or radiological findings. Prompt management following established guidelines allowed for the appropriate treatment and a favorable prognosis. This case serves as a reminder that early management is important, healthy individuals without known risk factors may present with severe infection, and there is the possibility for individual cases of Legionellosis to present far from the outbreak source.
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Affiliation(s)
- Miguel Jacob
- Department of Biomedical Sciences and Medicine, University of Algarve
| | | | - Bruno Morgado
- Department of Biomedical Sciences and Medicine, University of Algarve
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Abstract
CONTEXT Reported cases of legionellosis more than tripled between 2001 and 2012 in the United States. The disease results primarily from exposure to aerosolized water contaminated with Legionella. OBJECTIVE To identify and describe policies and guidelines for the primary prevention of legionellosis in the US. DESIGN An Internet search for Legionella prevention guidelines in the United States at the federal and state levels was conducted from March to June 2012. Local government agency guidelines and guidelines from professional organizations that were identified in the initial search were also included. SETTING Federal, state, and local governing bodies and professional organizations. RESULTS Guidelines and regulations for the primary prevention of legionellosis (ie, Legionnaires' disease and Pontiac fever) have been developed by various public health and other government agencies at the federal, state, and local levels as well as by professional organizations. These guidelines are similar in recommending maintenance of building water systems; federal and other guidelines differ in the population/institutions targeted, the extent of technical detail, and support of monitoring water systems for levels of Legionella contamination. CONCLUSIONS Legionellosis deserves a higher public health priority for research and policy development. Guidance across public health agencies for the primary prevention of legionellosis requires strengthening as this disease escalates in importance as a cause of severe morbidity and mortality. We recommend a formal and comprehensive review of national public health guidelines for prevention of legionellosis.
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Affiliation(s)
- Alyssa Parr
- Center for Public Health Preparedness and Research, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Burdet C, Lepeule R, Duval X, Caseris M, Rioux C, Lucet JC, Yazdanpanah Y. Quinolones versus macrolides in the treatment of legionellosis: a systematic review and meta-analysis. J Antimicrob Chemother 2014; 69:2354-60. [PMID: 24827889 DOI: 10.1093/jac/dku159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Legionellosis is a life-threatening disease. The clinical superiority of quinolones or macrolides for treating patients with legionellosis has not been established. METHODS We performed a systematic review and meta-analysis of studies reporting data that allowed the comparison of quinolones versus macrolides in the treatment of proven legionellosis published from 1 January 1985 to 31 January 2013. We collected baseline aggregate patient characteristics. Studied outcomes included mortality, clinical cure, time to apyrexia, length of hospital stay and occurrence of complications in each treatment group. Treatment effect was assessed using a Mantel-Haenszel random effects model. RESULTS Among 1005 abstracts reviewed, 12 studies were selected (n=879 patients). No randomized controlled trial was performed directly comparing quinolone and macrolide efficacy in legionellosis. Mean age was 58.3 years, 27.7% were women and Fine score was ≥ 4 in 35.8%. Among 253 patients who received quinolone monotherapy, 10 died (4.0%). Among 211 patients who received macrolide monotherapy, 23 died (10.9%). The pooled OR of death for treatment with a quinolone versus a macrolide was 0.5 (95% CI 0.2-1.3, n=8 studies, 464 patients). Length of stay was significantly shorter in the quinolone monotherapy group. The difference was 3.0 days (95% CI 0.7-5.3, P=0.001, n=3 studies, 263 patients). Neither of two tests for heterogeneity was significant (I (2)=0% for both, P=1). Other studied outcomes were not significantly different among treatment groups. CONCLUSIONS Few clinical data on legionellosis treatment are available. This first meta-analysis showed a trend toward a lower mortality rate and a significant decrease in length of hospital stay among patients receiving quinolones. These results must be confirmed by a randomized controlled trial.
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Affiliation(s)
- C Burdet
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France APHP, Bichat Hospital, Biostatistics Department, Paris, France INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France
| | - R Lepeule
- APHP, Beaujon Hospital, Internal Medicine Department, Clichy, France
| | - X Duval
- INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France INSERM CIC 1425, APHP, Bichat Hospital, Paris, France
| | - M Caseris
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France
| | - C Rioux
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France
| | - J-C Lucet
- INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France APHP, Bichat Hospital, Infection Control Unit, Paris, France
| | - Y Yazdanpanah
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France
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Affiliation(s)
- Christopher Ellis
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital.
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