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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 DOI: 10.1128/spectrum.03459-23] [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] [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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Tarabay J, Varkey JB. The potential risks of Legionella arising from ligature-resistant fixtures. Am J Infect Control 2024; 52:344-348. [PMID: 37604209 DOI: 10.1016/j.ajic.2023.08.007] [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] [Received: 06/24/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
To provide a safe environment, behavioral health settings must adhere to "ligature-resistant" protocols for patients at risk of harm to themselves or others. However, certain bathroom ligature-resistant fixtures alter environmental controls, such as sinks and showerheads, and increase the risk of water-borne pathogens due to low water output settings, highlighting the importance of an interdisciplinary water management program. We describe how ligature-resistant water fixtures may have been associated with a possible case of hospital-associated Legionellosis.
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Affiliation(s)
- Jessica Tarabay
- Department of Quality and Infection Prevention, Emory University Hospital, Emory Healthcare, Atlanta, GA.
| | - Jay B Varkey
- Department of Quality and Infection Prevention, Emory University Hospital, Emory Healthcare, Atlanta, GA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Adams-Ward X, Chapalain A, Ginevra C, Jarraud S, Doublet P, Gilbert C. Bacterial persistence in Legionella pneumophila clinical isolates from patients with recurring legionellosis. Front Cell Infect Microbiol 2023; 13:1219233. [PMID: 37600942 PMCID: PMC10434508 DOI: 10.3389/fcimb.2023.1219233] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Bacterial persisters are a transient subpopulation of non-growing, antibiotic-tolerant cells. There is increasing evidence that bacterial persisters play an important role in treatment failure leading to recurring infections and promoting the development of antibiotic resistance. Current research reveals that recurring legionellosis is often the result of relapse rather than reinfection and suggests that the mechanism of bacterial persistence may play a role. The development of single-cell techniques such as the Timerbac system allows us to identify potential persister cells and investigate their physiology. Here, we tested the persister forming capacity of 7 pairs of Legionella pneumophila (Lp) clinical isolates, with isolate pairs corresponding to two episodes of legionellosis in the same patient. We distinguished non-growing subpopulations from their replicating counterparts during infection in an amoeba model. Imaging flow cytometry allowed us to identify single non-growing bacteria within amoeba cells 17 h post-infection, thus corresponding to this subpopulation of potential persister cells. Interestingly the magnitude of this subpopulation varies between the 7 pairs of Lp clinical isolates. Biphasic killing kinetics using ofloxacin stress confirmed the persister development capacity of ST1 clinical isolates, highlighting enhanced persister formation during the host cell infection. Thus, persister formation appears to be strain or ST (sequence type) dependent. Genome sequence analysis was carried out between ST1 clinical isolates and ST1 Paris. No genetic microevolution (SNP) linked to possible increase of persistence capacity was revealed among all the clones tested, even in clones issued from two persistence cycle experiments, confirming the transient reversible phenotypic status of persistence. Treatment failure in legionellosis is a serious issue as infections have a 5-10% mortality rate, and investigations into persistence in a clinical context and the mechanisms involved may allow us to combat this issue.
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Affiliation(s)
- Xanthe Adams-Ward
- Centre International De Recherche En Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, École normale supérieure (ENS) Lyon, Centre national de la recherche scientifique (CNRS) UMR5308, Université Lyon 1, Université De Lyon, Lyon, France
| | - Annelise Chapalain
- Centre International De Recherche En Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, École normale supérieure (ENS) Lyon, Centre national de la recherche scientifique (CNRS) UMR5308, Université Lyon 1, Université De Lyon, Lyon, France
| | - Christophe Ginevra
- Centre International De Recherche En Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, École normale supérieure (ENS) Lyon, Centre national de la recherche scientifique (CNRS) UMR5308, Université Lyon 1, Université De Lyon, Lyon, France
- Hospices Civils De Lyon, Institut Des Agents Infectieux, Centre National De Référence Des Légionelles, Lyon, France
| | - Sophie Jarraud
- Centre International De Recherche En Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, École normale supérieure (ENS) Lyon, Centre national de la recherche scientifique (CNRS) UMR5308, Université Lyon 1, Université De Lyon, Lyon, France
- Hospices Civils De Lyon, Institut Des Agents Infectieux, Centre National De Référence Des Légionelles, Lyon, France
| | - Patricia Doublet
- Centre International De Recherche En Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, École normale supérieure (ENS) Lyon, Centre national de la recherche scientifique (CNRS) UMR5308, Université Lyon 1, Université De Lyon, Lyon, France
| | - Christophe Gilbert
- Centre International De Recherche En Infectiologie (CIRI), Institut national de la santé et de la recherche médicale (INSERM) U1111, École normale supérieure (ENS) Lyon, Centre national de la recherche scientifique (CNRS) UMR5308, Université Lyon 1, Université De Lyon, Lyon, France
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Wilson AM, Canter K, Abney SE, Gerba CP, Myers ER, Hanlin J, Reynolds KA. An application for relating Legionella shower water monitoring results to estimated health outcomes. Water Res 2022; 221:118812. [PMID: 35816914 DOI: 10.1016/j.watres.2022.118812] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
Exposure models are useful tools for relating environmental monitoring data to expected health outcomes. The objective of this study was to (1) compare two Legionella shower exposure models, and (2) develop a risk calculator tool for relating environmental monitoring data to estimated Legionella infection risks and Legionnaires' Disease (LD) illness risks. Legionella infection risks for a single shower event were compared using two shower Legionella exposure models. These models varied in their description of partitioning of Legionella in aerosols and aerosol deposition in the lung, where Model 1 had larger and fewer aerosol ranges than Model 2. Model 2 described conventional vs. water efficient showers separately, while Model 1 described exposure for an unspecified shower type (did not describe it as conventional or water efficient). A Monte Carlo approach was used to account for variability and uncertainty in these aerosolization and deposition parameters, Legionella concentrations, and the dose-response parameter. Methods for relating infection risks to illness risks accounting for demographic differences were used to inform the risk calculator web application ("app"). Model 2 consistently estimated higher infection risks than Model 1 for the same Legionella concentration in water and estimated deposited doses with less variability. For a 7.8-min shower with a Legionella concentration of 0.1 CFU/mL, the average infection risks estimated using Model 2 were 4.8 × 10-6 (SD=3.0 × 10-6) (conventional shower) and 2.3 × 10-6 (SD=1.7 × 10-6) (water efficient). Average infection risk estimated by Model 1 was 1.1 × 10-6 (SD=9.7 × 10-7). Model 2 was used for app development due to more conservative risk estimates and less variability in estimated dose. While multiple Legionella shower models are available for quantitative microbial risk assessments (QMRAs), they may yield notably different infection risks for the same environmental microbial concentration. Model comparisons will inform decisions regarding their integration with risk assessment tools. The development of risk calculator tools for relating environmental microbiology data to infection risks will increase the impact of exposure models for informing water treatment decisions and achieving risk targets.
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Affiliation(s)
- Amanda M Wilson
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, PO Box: 245210, Tucson, AZ 85724, United States; Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT, United States
| | - Kelly Canter
- Ecolab Research, Development & Engineering, Eagan, MN, United States
| | - Sarah E Abney
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, PO Box: 245210, Tucson, AZ 85724, United States; Department of Soil, Water, and Environmental Science, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Charles P Gerba
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, PO Box: 245210, Tucson, AZ 85724, United States; Department of Soil, Water, and Environmental Science, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Eric R Myers
- Nalco Water, An Ecolab Company, Naperville, IL, United States
| | - John Hanlin
- Ecolab Research, Development & Engineering, Eagan, MN, United States
| | - Kelly A Reynolds
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, PO Box: 245210, Tucson, AZ 85724, United States.
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Niculita-Hirzel H, Vanhove AS, Leclerc L, Girardot F, Pourchez J, Allegra S. Risk Exposure to Legionella pneumophila during Showering: The Difference between a Classical and a Water Saving Shower System. Int J Environ Res Public Health 2022; 19:ijerph19063285. [PMID: 35328980 PMCID: PMC8955837 DOI: 10.3390/ijerph19063285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023]
Abstract
The increase in legionellosis incidence in the general population in recent years calls for a better characterization of the sources of infection, such as showering. Water-efficient shower systems that use water-atomizing technology have been shown to emit slightly more inhalable particles in the range of bacterial sizes than the traditional systems; however, the actual rate of bacterial emission remains poorly documented. The aim of this study was to assess the aerosolisation rate of the opportunistic water pathogen Legionella pneumophila during showering with one shower system representative of each technology. To achieve this objective, we performed controlled experiments inside a glove box and determined the emitted dose and viability of airborne Legionella. The bioaerosols were sampled with a Coriolis® Delta air sampler and the total number of viable (cultivable and noncultivable) Legionella was determined by flow cytometry and culture. We found that the rate of viable and cultivable Legionella aerosolized from the water jet was similar between the two showerheads: the viable fraction represents 0.02% of the overall bacteria present in water, while the cultivable fraction corresponds to only 0.0005%. The two showerhead models emitted a similar ratio of airborne Legionella viable and cultivable per volume of water used. Therefore, the risk of exposure to Legionella is not expected to increase significantly with the new generation of water-efficient showerheads.
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Affiliation(s)
- Hélène Niculita-Hirzel
- Department Work, Heath & Environment, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Route de la Corniche 2, CH-1066 Epalinges-Lausanne, Switzerland
- Correspondence:
| | - Audrey S. Vanhove
- EVS-ISTHME UMR 5600, CNRS, University Jean Monnet of Saint-Etienne, F-42023 Saint-Etienne, France; (A.S.V.); (F.G.); (S.A.)
| | - Lara Leclerc
- Mines Saint-Etienne, University of Lyon, University Jean Monnet of Saint-Etienne, INSERM, U 1059 Sainbiose, Centre CIS, F-42023 Saint-Etienne, France; (L.L.); (J.P.)
| | - Françoise Girardot
- EVS-ISTHME UMR 5600, CNRS, University Jean Monnet of Saint-Etienne, F-42023 Saint-Etienne, France; (A.S.V.); (F.G.); (S.A.)
| | - Jérémie Pourchez
- Mines Saint-Etienne, University of Lyon, University Jean Monnet of Saint-Etienne, INSERM, U 1059 Sainbiose, Centre CIS, F-42023 Saint-Etienne, France; (L.L.); (J.P.)
| | - Séverine Allegra
- EVS-ISTHME UMR 5600, CNRS, University Jean Monnet of Saint-Etienne, F-42023 Saint-Etienne, France; (A.S.V.); (F.G.); (S.A.)
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Sabatini L, Sisti M, Campana R. Isolation and identification of Legionella spp. from non-hospital facilities: a preliminary one-year surveillance study in the urban area of Pesaro-Urbino (Central Italy). Ann Ig 2022; 34:177-183. [PMID: 35088824 DOI: 10.7416/ai.2022.2477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Legionella is considered one of the most important causes of potentially preventable morbid-ity and mortality. These microorganisms are ubiquitous, but incomplete information is available on the geographic distribution of Legionella species in our region. STUDY DESIGN For the mentioned reasons, in this work the distribution of Legionella spp. in non-hospital facilities of the urban area of Pesaro-Urbino (Central Italy), including public fountains, residential build-ings, public and private offices and retirement homes, was investigated. METHODS A total of 298 water samples were collected from the different facilities and subjected to standard Legionella isolation and identification protocols. RESULTS As reported, 17.8% of the collected water samples resulted positive for Legionella spp. (28.6% from retirement homes, 21.3% from residential buildings, 15.3% from private and public offices). The highest per-centage of positive samples (14.4%) was found in hot water from retirements homes (58.8%) and residential buildings (31.8%); the most frequent isolated serogroups were L. pneumophila 2-14 (71.7%). CONCLUSIONS This work is the first describing the distribution of Legionella spp. in non-hospital facilities in the province of Pesaro-Urbino, and highlights a condition of potential risk for susceptible categories. From our data, we can point that a regular and constant control to prevent microbiological risk from legionellosis, particularly in facilities housing the elderly, is recommended.
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Affiliation(s)
- L Sabatini
- Department of Biomolecular Sciences, Division of Pharmacology and Hygiene, "Carlo Bo" University, Urbino, Italy
| | - M Sisti
- Department of Biomolecular Sciences, Division of Pharmacology and Hygiene, "Carlo Bo" University, Urbino, Italy
| | - R Campana
- Department of Biomolecular Sciences, Division of Pharmacology and Hygiene, "Carlo Bo" University, Urbino, Italy
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Steen TW, Eggemoen ÅR, Andersen M, Christiansen T, Eika F, Haakerud I, Spæren KH. Legionella transmission from an outdoor fountain in Oslo, Norway. Tidsskr Nor Laegeforen 2021; 141:21-0092. [PMID: 34423959 DOI: 10.4045/tidsskr.21.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Most cases of legionellosis in Norway are acquired outside the country. This was a domestic case from an unusual source. CASE PRESENTATION A man in his thirties was admitted with pneumonia early in the summer. He developed respiratory failure before recovering. Cultures from his lower airways grew Legionella pneumophila serogroup 1. Samples from his home and workplace did not identify Legionella. On further questioning it was discovered that the patient regularly sat beside an outdoor fountain during his breaks from work. Samples from the fountain identified high numbers of L. pneumophila serogroup 1, sequence type 256. Full genome sequencing showed that isolates from the patient and fountain were identical. The fountain used recirculated water with small amounts of chlorine. High outdoor temperatures in Oslo may have facilitated growth of Legionella in the fountain. INTERPRETATION To our knowledge, this is the first published case of Legionella transmission from an outdoor fountain.
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De Giglio O, Napoli C, Apollonio F, Brigida S, Marzella A, Diella G, Calia C, Scrascia M, Pacifico C, Pazzani C, Uricchio VF, Montagna MT. Occurrence of Legionella in groundwater used for sprinkler irrigation in Southern Italy. Environ Res 2019; 170:215-221. [PMID: 30594053 DOI: 10.1016/j.envres.2018.12.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Legionellae are opportunistic bacteria that cause various conditions after exposure to contaminated aerosols, ranging from a serious type of pneumonia to a mild case of an influenza-like illness. Despite the risks of exposure, little is known about the occurrence of Legionella in natural environments and, even though studies have shown that there is a potential risk of transmission via inhalation, it does not have to be detected in groundwater that is used for irrigation. The culture methods traditionally used to detect Legionella have several limits that can be partly solved by applying molecular techniques. Samples from 177 wells in Apulia, Southern Italy, were collected twice, in winter and in summer, and analyzed. When compared with the guidelines, 145 (81.9%) of the sampled wells were suitable for irrigation use. The culture-based method highlighted the presence of different species and serogroups of Legionella in 31 (21.2%) of the 145 wells that were shown to be suitable for irrigation use. A greater number of wells returned positive results for Legionella in summer than in winter (p = 0.023), and the median concentrations were mostly higher in summer (500 CFU/L) than in winter (300 CFU/L). The median temperature in the Legionella positive well waters was significantly higher than that in the negative ones, both in winter and in summer (p < 0.001). Using molecular techniques, Legionella non-pneumophila was found in 37 of the 114 wells earlier detected as suitable for irrigation use but negative for Legionella by the culture-based methods. The distribution of Legionella differ significantly in porous aquifers compared to the karst-fissured ones both with quantitative polymerase chain reaction (qPCR) (p = 0.0004) and viable cells by propidium monoazide (PMA-qPCR) (p = 0.0000). Legionella concentrations were weakly correlated with temperature of water both with qPCR (ρ = 0.47, p = 0.0033) and PMA-qPCR (ρ = 0.41, p = 0.0126). Our data suggest that water that aerosolizes when sprinkled on plants represents a potential source of Legionellosis, with a higher risk from exposure in summer. On a practical level, this finding is important for workers (farmers and gardeners) who are in contact with waters used for irrigation.
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Affiliation(s)
- Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Christian Napoli
- Department of Medical and Surgical sciences and translational Medicine, Sapienza University of Rome, Italy.
| | - Francesca Apollonio
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Silvia Brigida
- Water Research Institute, National Research Council, Bari, Italy.
| | - Angelo Marzella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Carla Calia
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
| | - Maria Scrascia
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy.
| | - Claudia Pacifico
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Carlo Pazzani
- Department of Biology, University of Bari "Aldo Moro", Bari, Italy.
| | | | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy.
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Żak J, Orlińska K, Koperny M, Foremny J, Bandoła K, Bała M. Legionella sp. in water systems in public teaching and education facilities in Małopolskie voivodeship in 2016. Przegl Epidemiol 2019; 73:227-237. [PMID: 31385680 DOI: 10.32394/pe.73.21] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Bacteria Legionella sp. found in water distribution systems, especially warm, transferred to water spray devices for aerators and showers in the form of aerosols infected with them become a threat to the human inhaler. OBJECTIVE Assessment of colonization of the water supply network with Legionella bacteria in teaching and education facilities in Małopolska in 2016 year. MATERIAL AND METHODS The results of water samples taken from plumbing installations were analyzed in teaching and education facilities by employees of the State Sanitary Inspection of the Lesser Poland Voivodeship. RESULTS The results of 366 testing hot water samples in 111 teaching and education centers in Małopolska have shown that in 123 testing samples (33,6%) in 48 centers (43,2%) the water sample was colonized with Legionella sp. and the water quality did not meet the requirements of the current ordinance of the Minister of Health. CONCLUSIONS It is justified to periodically monitor the presence of Legionella sp. in water supply installations in teaching and education centers and taking action to reduce the colonization of these bacteria.
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Affiliation(s)
- Jacek Żak
- Provincial Sanitary and Epidemiological Station in Krakow
| | | | - Magdalena Koperny
- Department of Health Care Benefits The Agency for Health Technology Assessment and Tariff System
| | | | | | - Małgorzata Bała
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College in Krakow
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Dietersdorfer E, Kirschner A, Schrammel B, Ohradanova-Repic A, Stockinger H, Sommer R, Walochnik J, Cervero-Aragó S. Starved viable but non-culturable (VBNC) Legionella strains can infect and replicate in amoebae and human macrophages. Water Res 2018; 141:428-438. [PMID: 29409685 DOI: 10.1016/j.watres.2018.01.058] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 05/22/2023]
Abstract
Legionella infections are among the most important waterborne infections with constantly increasing numbers of cases in industrialized countries, as a result of aging populations, rising numbers of immunocompromised individuals and increased need for conditioned water due to climate change. Surveillance of water systems is based on microbiological culture-based techniques; however, it has been shown that high percentages of the Legionella populations in water systems are not culturable. In the past two decades, the relevance of such viable but non-culturable (VBNC) legionellae has been controversially discussed, and whether VBNC legionellae can directly infect human macrophages, the primary targets of Legionella infections, remains unclear. In this study, it was demonstrated for the first time that several starved VBNC Legionella strains (four L. pneumophila serogroup 1 strains, a serogroup 6 strain and a L. micdadei strain) can directly infect different types of human macrophages and amoebae even after one year of starvation in ultrapure water. However, under these conditions, the strains caused infection with reduced efficacy, as represented by the lower percentages of infected cells, prolonged time in co-culture and higher multiplicities of infection required. Interestingly, the VBNC cells remained mostly non-culturable even after multiplication within the host cells. Amoebal infection by starved VBNC Legionella, which likely occurs in oligotrophic biofilms, would result in an increase in the bacterial concentration in drinking-water systems. If cells remain in the VBNC state, the real number of active legionellae will be underestimated by the use of culture-based standard techniques. Thus, further quantitative research is needed in order to determine, whether and how many starved VBNC Legionella cells are able to cause disease in humans.
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Affiliation(s)
- Elisabeth Dietersdorfer
- Medical University of Vienna, Institute of Specific Prophylaxis and Tropical Medicine, Department of Medical Parasitology, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Alexander Kirschner
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria.
| | - Barbara Schrammel
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Anna Ohradanova-Repic
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Lazarettgasse 19, A-1090 Vienna, Austria
| | - Hannes Stockinger
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Lazarettgasse 19, A-1090 Vienna, Austria
| | - Regina Sommer
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria
| | - Julia Walochnik
- Medical University of Vienna, Institute of Specific Prophylaxis and Tropical Medicine, Department of Medical Parasitology, Kinderspitalgasse 15, A-1090, Vienna, Austria.
| | - Sílvia Cervero-Aragó
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria
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11
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Hamilton KA, Hamilton MT, Johnson W, Jjemba P, Bukhari Z, LeChevallier M, Haas CN. Health risks from exposure to Legionella in reclaimed water aerosols: Toilet flushing, spray irrigation, and cooling towers. Water Res 2018; 134:261-279. [PMID: 29428779 DOI: 10.1016/j.watres.2017.12.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 05/05/2023]
Abstract
The use of reclaimed water brings new challenges for the water industry in terms of maintaining water quality while increasing sustainability. Increased attention has been devoted to opportunistic pathogens, especially Legionella pneumophila, due to its growing importance as a portion of the waterborne disease burden in the United States. Infection occurs when a person inhales a mist containing Legionella bacteria. The top three uses for reclaimed water (cooling towers, spray irrigation, and toilet flushing) that generate aerosols were evaluated for Legionella health risks in reclaimed water using quantitative microbial risk assessment (QMRA). Risks are compared using data from nineteen United States reclaimed water utilities measured with culture-based methods, quantitative PCR (qPCR), and ethidium-monoazide-qPCR. Median toilet flushing annual infection risks exceeded 10-4 considering multiple toilet types, while median clinical severity infection risks did not exceed this value. Sprinkler and cooling tower risks varied depending on meteorological conditions and operational characteristics such as drift eliminator performance. However, the greatest differences between risk scenarios were due to 1) the dose response model used (infection or clinical severity infection) 2) population at risk considered (residential or occupational) and 3) differences in laboratory analytical method. Theoretical setback distances necessary to achieve a median annual infection risk level of 10-4 are proposed for spray irrigation and cooling towers. In both cooling tower and sprinkler cases, Legionella infection risks were non-trivial at potentially large setback distances, and indicate other simultaneous management practices could be needed to manage risks. The sensitivity analysis indicated that the most influential factors for variability in risks were the concentration of Legionella and aerosol partitioning and/or efficiency across all models, highlighting the importance of strategies to manage Legionella occurrence in reclaimed water.
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Affiliation(s)
- Kerry A Hamilton
- Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA.
| | | | - William Johnson
- American Water Research Laboratory, 213 Carriage Lane, Delran, New Jersey 08075, USA
| | - Patrick Jjemba
- American Water Research Laboratory, 213 Carriage Lane, Delran, New Jersey 08075, USA
| | - Zia Bukhari
- American Water Research Laboratory, 213 Carriage Lane, Delran, New Jersey 08075, USA
| | - Mark LeChevallier
- American Water Research Laboratory, 213 Carriage Lane, Delran, New Jersey 08075, USA
| | - Charles N Haas
- Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
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12
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Petti S. From ' Legionellosis acquired through a dental unit' to 'Was Legionellosis acquired through a dental unit?'. J Hosp Infect 2017; 96:204-205. [PMID: 28457583 DOI: 10.1016/j.jhin.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
- S Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
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13
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Flannery J. Legionellosis protection requirements. How to comply with ASHRAE's standard for building water systems. Health Facil Manage 2016; 29:42-44. [PMID: 27323504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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14
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Broadbent C. Legionnaire's disease avoidance planning. Health Estate 2007; 61:45-7. [PMID: 17892058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Hospital-acquired infection is the cause of about 5,000 deaths a year in the UK. In New Zealand, there are more than three times as many such deaths as from the annual road toll. The costs in loss of income, in pain and suffering and in direct costs to hospitals are staggering.
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15
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Yoshida SI. [Legionella and its infection]. Fukuoka Igaku Zasshi 2006; 97:192-9. [PMID: 17025234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Shin-ichi Yoshida
- Department of Bacteriology, Faculty of Medical Sciences, Kyushu University
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16
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Freije M. Ebb & flow. Ten ways to minimize stagnation in domestic water systems. Health Facil Manage 2006; 19:19-22. [PMID: 16499188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Matt Freije
- HC Information Resources Inc, Fallbrook, CA, USA.
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17
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Trerotoli P, Montagna MT, Borella P, Romano Spica V, Stancanelli G, Triassi M, Serio G, Napoli C, Soldano S, Tatò D, Vercilli F, Gentile C, Quaranta G, Volpe M, Ambrosio A, Santarpia R, Montegrosso S. [The discharge form: advantages and limits legionellosis cases individuation]. Ann Ig 2003; 15:817-24. [PMID: 15049538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Despite legionellosis surveillance is active in Italy since many years, the disease notification appears still undervalued. A multicentric survey was carried out among 5 big Italian hospitals. It examined 11,435 discharge forms (1999-2001), reporting pneumonia diagnosis. Legionellosis (II class of notify system for infectious disease) was studied among pneumonia diagnosis by discharge forms. According to the ICD9-CM, there's no specific code for legionellosis (this disease is included among "others gram-negative pneumonia"). So the presumed pneumonia imputable to Legionella spp were the 2.7% of the whole number of analyzed discharge forms. Besides, the data regarding the other pneumonia showed that the etiological agent was specified only in the 11.2% of the case. This situation could be rectified both introducing adequate discharge forms codes and promoting the etiological diagnosis during the hospital stay.
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Affiliation(s)
- P Trerotoli
- Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Igiene, Università degli Studi di Bari
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18
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Saito A. [Characteristics of legionellosis in Japan and its worldwide trends]. Nihon Naika Gakkai Zasshi 2003; 92:1662-72. [PMID: 14560600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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19
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Koide M, Saito A. [Legionella infection]. Nihon Naika Gakkai Zasshi 2002; 91:2960-4. [PMID: 12451655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Abstract
A 56-year-old Japanese male was admitted to Toyohashi Municipal Hospital because of fever, cough, and dyspnea. Chest X-ray film showed bilateral alveolar infiltrates. He suffered from severe hypoxemia and was given a diagnosis of acute respiratory distress syndrome. He was also complicated with disseminated intravascular coagulation and pseudomembranous colitis. He fully recovered by intensive treatment with antibiotics, mechanical ventilation and endotoxin eliminating therapy. Legionella longbeachae was isolated from his respiratory specimens and was regarded as the etiologic agent of his pneumonia.
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21
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Matsubara S, Akashi S, Naitoh K, Nakahara Y, Hayashi S. [Severe Legionella micdadei pneumonia effectively treated with hemofiltration therapy]. Nihon Kokyuki Gakkai Zasshi 1998; 36:886-90. [PMID: 9893432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A 42-year-old man was admitted because of fever, productive cough, and progressive dyspnea. Chest x-ray films and computed tomographic scans disclosed dense consolidation in the left and right lung fields. No pathogenic agent was found despite extensive bacteriological examinations. Based on serological findings, the patient was given a diagnosis of acute pneumonia caused by Legionella micdadei. It has been reported that Legionnaire's disease is easily complicated by fatal systemic illnesses such as disseminated intravascular coagulation (DIC) and multiple organ failure. In fact, the patient suffered from severe hypotension and DIC on admission. Treatments against systemic complications were started together with intravenous administration of antibiotics including erythromycin. Continuous intravenous cathecolamin, however, failed to alleviate the patient's shock. We therefore applied endotoxin eliminating therapy using a polymyxin-B-column (PMX) and continuous hemofiltration (CHF). The patient recovered from critical shock immediately after the start of PMX, which together with CHF, alleviated his systemic complications. Although the factors responsible for fatal systemic complications in Legionnare's disease are not well-documented, our findings suggested that some substances removable by PMX and CHF play an important role in pathogenesis.
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Affiliation(s)
- S Matsubara
- Department of Medicine, Saga Medical School, Japan
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Affiliation(s)
- J Roig
- Servei de Pneumologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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23
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Abstract
Three cases of pulmonary Legionella bozemanii infection in immunocompromised patients are described. The diagnosis was made by culture in each case and would not otherwise have been made, and it is recommended that a culture specific for Legionella species should be included in the investigation of patients with suspected opportunist pulmonary infections.
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Affiliation(s)
- C R Swinburn
- Regional Cardiothoracic Unit, Freeman Hospital, Newcastle upon Tyne
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24
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Zazzo JF, Mercat A, Wolff M, Letulzo Y, Regnier B. ARDS associated with nosocomial legionellosis: dramatic effect of indomethacin. Intensive Care Med 1988; 14:679-80. [PMID: 3183201 DOI: 10.1007/bf00256784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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25
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Fumarola D, Munno I, Longo-Papadia L. Legionellosis in infants. Eur J Epidemiol 1988; 4:129-30. [PMID: 3356230 DOI: 10.1007/bf00152707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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26
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Legionella, man and environment. Third international symposium, 4-8 May 1986, Jerusalem, Israel. Part Two. Proceedings and abstracts. Isr J Med Sci 1986; 22:697-759. [PMID: 3793429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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27
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Legionella, man and environment. Third international symposium, 4-8 May, 1986, Jerusalem, Israel. Part One. Proceedings. Isr J Med Sci 1986; 22:619-95. [PMID: 3793443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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