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Colautti A, Civilini M, Franchi M, Felice A, De Martin S, De Paoli E, Vidotto M, Iacumin L. Draft genome sequences from 127 Legionella spp. strains isolated in water systems linked to legionellosis outbreaks. Microbiol Resour Announc 2024:e0115423. [PMID: 38690889 DOI: 10.1128/mra.01154-23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/13/2024] [Indexed: 05/03/2024] Open
Abstract
Legionnaires' disease is a severe form of pneumonia caused by Legionella spp. bacteria. According to the European Centre for Disease Prevention and Control, problems related to this pathogen showed a significant surge in recent years, making its monitoring critical.
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Affiliation(s)
- Andrea Colautti
- Department of Agricultural, Food, Environmental and Animal Science (Di4A), University of Udine, Udine, Italy
| | - Marcello Civilini
- Department of Agricultural, Food, Environmental and Animal Science (Di4A), University of Udine, Udine, Italy
| | - Marinella Franchi
- Laboratory of Microbiology, ARPA-Regional Agency for Environmental Protection Friuli Venezia Giulia, Udine, Italy
| | - Antonella Felice
- Laboratory of Microbiology, ARPA-Regional Agency for Environmental Protection Friuli Venezia Giulia, Udine, Italy
| | - Stefano De Martin
- Laboratory of Microbiology, ARPA-Regional Agency for Environmental Protection Friuli Venezia Giulia, Udine, Italy
| | - Emanuele De Paoli
- Department of Agricultural, Food, Environmental and Animal Science (Di4A), University of Udine, Udine, Italy
| | | | - Lucilla Iacumin
- Department of Agricultural, Food, Environmental and Animal Science (Di4A), University of Udine, Udine, Italy
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Thizy G, Flahault A, Scemla A, Roux O, Jarraud S, Lebeaux D, Pouchot J, Gautier-Vargas G, Malvezzi P, Murris M, Vuotto F, Girerd S, Pansu N, Antonini T, Elkrief L, Barrou B, Besch C, Blot M, Boignard A, Brenier H, Coilly A, Gouezel C, Hannah K, Housssel-Debry P, Jouan J, Lecuyer H, Limelette A, Luyt CE, Melloni B, Pison C, Rafat C, Rebibou JM, Savier E, Schvartz B, Scatton O, Toure F, Varnous S, Vidal P, Savoye E, Ader F, Lortholary O, Lanternier F, Lafont E. Legionnaires Disease in Solid Organ Transplant Recipients: A Decade-Long Nationwide Study in France. Chest 2024; 165:507-520. [PMID: 37839586 DOI: 10.1016/j.chest.2023.09.033] [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: 05/19/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ transplant recipients. However, the epidemiologic features, clinical presentation, and outcomes of LD in this population are poorly described. RESEARCH QUESTION What are the clinical manifestations, radiologic presentation, risk factors for severity, treatment, and outcome of LD in solid organ transplant recipients? STUDY DESIGN AND METHODS In this 10-year multicenter retrospective cohort study in France, where LD notification is mandatory, patients were identified by hospital discharge databases. Diagnosis of LD relied on positive culture findings from any respiratory sample, positive urinary antigen test (UAT) results, positive specific serologic findings, or a combination thereof. Severe LD was defined as admission to the ICU. RESULTS One hundred one patients from 51 transplantation centers were eligible; 64 patients (63.4%) were kidney transplant recipients. Median time between transplantation and LD was 5.6 years (interquartile range, 1.5-12 years). UAT results were positive in 92% of patients (89/97). Among 31 patients with positive culture findings in respiratory samples, Legionella pneumophila serogroup 1 was identified in 90%. Chest CT imaging showed alveolar consolidation in 98% of patients (54 of 57), ground-glass opacity in 63% of patients (36 of 57), macronodules in 21% of patients (12 of 57), and cavitation in 8.8% of patients (5 of 57). Fifty-seven patients (56%) were hospitalized in the ICU. In multivariate analysis, severe LD was associated with negative UAT findings at presentation (P = .047), lymphopenia (P = .014), respiratory symptoms (P = .010), and pleural effusion (P = .039). The 30-day and 12-month mortality rates were 8% (8 of 101) and 20% (19 of 97), respectively. In multivariate analysis, diabetes mellitus was the only factor associated with 12-month mortality (hazard ratio, 3.2; 95% OR, 1.19-8.64; P = .022). INTERPRETATION LD is a late and severe complication occurring in solid organ transplant recipients that may present as pulmonary nodules on which diabetes impacts its long-term prognosis.
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Affiliation(s)
- Guillaume Thizy
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Adrien Flahault
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Anne Scemla
- Service de Transplantation Rénale, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivier Roux
- Service d'Hépatologie, Hôpital Beaujon, Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
| | - Sophie Jarraud
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France
| | - David Lebeaux
- Unité Mobile d'Infectiologie, Service de Microbiologie, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gabriela Gautier-Vargas
- Service de Néphrologie et Transplantation, Hôpital Civil, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Paolo Malvezzi
- Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Université de Grenoble, la Tronche, France
| | - Marlene Murris
- Service de Pneumologie-Consultation Mucoviscidose, Pôle Voies Respiratoires, CHU de Toulouse-Hôpital Larrey, Université de Toulouse, Toulouse, France
| | - Fanny Vuotto
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Lille, Université de Lille, Lille, France
| | - Sophie Girerd
- Service de Néphrologie et Transplantation Rénale, CHRU Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Nathalie Pansu
- Service de Maladies Infectieuses et Tropicales, CHU Gui de Chauliac, Université de Montpellier, Montpellier, France
| | - Teresa Antonini
- Service d'Hépatologie, Hôpital Universitaire Croix-Rousse, Lyon, France; Cancer Research Center of Lyon, INSERM U1052, Lyon, France
| | - Laure Elkrief
- Service d'Hépatologie, CHRU de Tours, Hôpital Trousseau, Université de Tours, Chambray-lès-Tours, France
| | - Benoit Barrou
- Département d'Urologie, Néphrologie et Transplantation, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Camille Besch
- Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, CHRU Hautepierre, Université de Strasbourg, Strasbourg, France
| | - Mathieu Blot
- Département de Maladies Infectieuses, Centre Hospitalo-Universitaire de Dijon-Bourgogne, Université de Bourgogne, France
| | - Aude Boignard
- Service de Cardiologie, CHU de Grenoble, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Henri Brenier
- Service de Néphrologie, Centre Hospitalier Universitaire Pontchaillou, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AP-HP Hôpital Paul-Brousse, Université Paris-Saclay, Villejuif, France
| | - Corentin Gouezel
- Service d'Anesthésie et Réanimation de Chirurgie Cardiaque, Hôpital Bichat, Université Paris Cité, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Kaminski Hannah
- Service de Néphrologie, Transplantation Dialyse, Aphérèses, CHU de Bordeaux, Hôpital Pellegrin, Université de Bordeaux, Bordeaux, France
| | - Pauline Housssel-Debry
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Universitaire de Pontchaillou, Université de Rennes, Rennes, France
| | - Jerome Jouan
- Service de Chirurgie Cardiaque, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Hervé Lecuyer
- Service de Microbiologie Clinique, Hôpital Necker Enfants-Malades, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Limelette
- Laboratoire de Microbiologie, Hôpital Robert Debré, CHU de Reims, Université de Reims, Reims, France
| | - Charles Edouard Luyt
- Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Boris Melloni
- Service de Pathologie Respiratoire, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Christophe Pison
- Service de Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université de Grenoble, Grenoble, France
| | - Cédric Rafat
- Service de Soins Intensifs Néphrologique et Rein Aigu, Hôpital Tenon, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Michel Rebibou
- Service de Néphrologie, Transplantation Hémodialyse, CHU, Université de Dijon, Dijon, France
| | - Eric Savier
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Transplantation Hépatique, CHU Pitié-Salpêtriere, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Betoul Schvartz
- Service de Néphrologie, Hémodialyse, Transplantation Rénale, CHU de Reims, Université de Reims, Reims, France
| | - Olivier Scatton
- Service de Chirurgie Digestive Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fatouma Toure
- Service Néphrologie, CHU Limoges, Centre Hospitalier et Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Shaida Varnous
- Service de Chirurgie Cardiaque et Thoracique, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Vidal
- Laboratoire de Bactériologie-Hygiène, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emilie Savoye
- Organ and Tissue Procurement and Transplantation Department, French Biomedicine Agency, Saint Denis La Plaine, France
| | - Florence Ader
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, France; Centre International de Recherche en Infectiologie, Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Université de Lyon, France; Service de Maladies Infectieuses et Tropicales, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital Universitaire Croix-Rousse, Lyon, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuel Lafont
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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Yu F, Nair AA, Lauper U, Luo G, Herb J, Morse M, Savage B, Zartarian M, Wang M, Lin S. Mysteriously rapid rise in Legionnaires' disease incidence correlates with declining atmospheric sulfur dioxide. PNAS Nexus 2024; 3:pgae085. [PMID: 38476666 PMCID: PMC10929586 DOI: 10.1093/pnasnexus/pgae085] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/09/2024] [Indexed: 03/14/2024]
Abstract
Legionnaires' disease (LD) is a severe form of pneumonia (∼10-25% fatality rate) caused by inhalation of aerosols containing Legionella, a pathogenic gram-negative bacteria. These bacteria can grow, spread, and aerosolize through building water systems. A recent dramatic increase in LD incidence has been observed globally, with a 9-fold increase in the United States from 2000 to 2018, and with disproportionately higher burden for socioeconomically vulnerable subgroups. Despite the focus of decades of research since the infamous 1976 outbreak, substantial knowledge gaps remain with regard to source of exposure and the reason(s) for the dramatic increase in LD incidence. Here, we rule out factors indicated in literature to contribute to its long-term increases and identify a hitherto unexplored explanatory factor. We also provide an epidemiological demonstration that the occurrence of LD is linked with exposure to cooling towers (CTs). Our results suggest that declining sulfur dioxide air pollution, which has many well-established health benefits, results in reduced acidity of aerosols emitted from CTs, which may prolong the survival duration of Legionella in contaminated CT droplets and contribute to the increase in LD incidence. Mechanistically associating decreasing aerosol acidity with this respiratory disease has implications for better understanding its transmission, predicting future risks, and informed design of preventive and interventional strategies that consider the complex impacts of continued sulfur dioxide changes.
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Affiliation(s)
- Fangqun Yu
- Atmospheric Sciences Research Center, University at Albany, State University of New York, Albany, NY 12226, USA
| | - Arshad A Nair
- Atmospheric Sciences Research Center, University at Albany, State University of New York, Albany, NY 12226, USA
| | - Ursula Lauper
- New York State Department of Health, Bureau of Water Supply Protection, Albany, NY 12223, USA
| | - Gan Luo
- Atmospheric Sciences Research Center, University at Albany, State University of New York, Albany, NY 12226, USA
| | - Jason Herb
- Atmospheric Sciences Research Center, University at Albany, State University of New York, Albany, NY 12226, USA
| | - Matthew Morse
- New York State Department of Health, Bureau of Water Supply Protection, Albany, NY 12223, USA
| | - Braden Savage
- New York State Department of Health, Bureau of Water Supply Protection, Albany, NY 12223, USA
| | - Martin Zartarian
- New York State Department of Health, Bureau of Water Supply Protection, Albany, NY 12223, USA
| | - Meng Wang
- School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
| | - Shao Lin
- School of Public Health, University at Albany, State University of New York, Albany, NY 12144, USA
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Palusińska-Szysz M, Simões M. Editorial: Legionella pneumophila-transmission, pathogenesis, host-pathogen interaction, prevention and treatment. Front Microbiol 2024; 15:1364620. [PMID: 38357354 PMCID: PMC10864628 DOI: 10.3389/fmicb.2024.1364620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
| | - Manuel Simões
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Porto, Portugal
- ALiCE—Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal
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Donovan CV, MacFarquhar JK, Wilson E, Sredl M, Tanz LJ, Mullendore J, Fleischauer A, Smith JC, Lucas C, Kunz J, Moore Z. Legionnaires' Disease Outbreak Associated With a Hot Tub Display at the North Carolina Mountain State Fair, September 2019. Public Health Rep 2024; 139:79-87. [PMID: 36971250 PMCID: PMC10905752 DOI: 10.1177/00333549231159159] [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: 12/29/2023] Open
Abstract
OBJECTIVES On September 23, 2019, the North Carolina Division of Public Health identified a legionellosis increase in western North Carolina; most patients had recently attended the North Carolina Mountain State Fair. We conducted a source investigation. METHODS Cases were fair attendees with laboratory-confirmed legionellosis and symptom onset within 2 to 14 days (Legionnaires' disease) or ≤3 days (Pontiac fever). We conducted a case-control study matching cases to non-ill fair attendees as control participants and an environmental investigation, and we performed laboratory testing (Legionella bacteria culture and polymerase chain reaction) of 27 environmental samples from fairgrounds and hot tubs and 14 specimens from case patients. We used multivariable unconditional logistic regression models to calculate adjusted odds ratios for potential Legionella exposure sources and risk factors. RESULTS Of 136 people identified with fair-associated legionellosis, 98 (72%) were hospitalized and 4 (3%) died. Case patients were more likely than control participants to report walking by hot tub displays (adjusted odds ratio = 10.0; 95% CI, 4.2-24.1). Complete hot tub water treatment records were not kept, precluding evaluation of water maintenance conducted on display hot tubs. Legionella pneumophila sequence types (STs) were consistent among 10 typed clinical specimens (ST224) but distinct from the only positive environmental sample from the fair (ST7 and ST8). CONCLUSIONS Hot tub displays were identified as the most likely outbreak source, making this the largest hot tub-associated Legionnaires' disease outbreak worldwide. Following the investigation, the North Carolina Division of Public Health and the Centers for Disease Control and Prevention released guidance on mitigating risk of Legionella exposure from hot tub displays. Results highlight the importance of properly maintaining equipment that aerosolizes water, including hot tubs intended for display purposes only.
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Affiliation(s)
- Catherine V. Donovan
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Now with the Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer K. MacFarquhar
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erica Wilson
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Megan Sredl
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Lauren J. Tanz
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Aaron Fleischauer
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
- Division of State and Local Readiness, Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica C. Smith
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claressa Lucas
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jasen Kunz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zack Moore
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
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Gea-Izquierdo E, Gil-Prieto R, Hernández-Barrera V, Rodríguez-Caravaca G, Gil-de-Miguel Á. Legionellosis-Associated Hospitalization in Spain from 2002 to 2021. Microorganisms 2023; 11:1693. [PMID: 37512866 PMCID: PMC10385138 DOI: 10.3390/microorganisms11071693] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Legionellosis is a respiratory disease of bacterial and environmental origin that usually presents two distinct clinical entities, "Legionnaires' disease" (LD) and "Pontiac fever". LD is an important cause of hospital-acquired pneumonia (HAP). The objective of this study is to describe the epidemiology of legionellosis-associated hospitalization (L-AH) in Spain from 2002 to 2021 and the burden of hospitalization due to legionellosis. Discharge reports from the Minimum Basic Data Set (MBDS) were used to retrospectively analyze hospital discharge data with a diagnosis of legionellosis, based on the ICD-9-CM and ICD-10-CM diagnosis codes, from 2002 to 2021. 21,300 L-AH occurred throughout the year during 2002-2021. The incidence of hospitalization associated per 100,000 inhabitants by month showed a similar trend for the 2002-2011, 2012-2021, and 2002-2021 periods. In Spain, during 2002-2021, the hospitalization rate (HR) in the autonomous communities ranged from 4.57 (2002-2011) to 0.24 (2012-2021) cases per 100,000 inhabitants. The HR of legionellosis in Spain has substantially increased across the 2002-2021 period, and the estimate is consistent with available European data. It is considered that in-depth epidemiological surveillance studies of legionellosis and improvements in the prevention and control of the disease are required in Spain.
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Affiliation(s)
- Enrique Gea-Izquierdo
- Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Madrid, Spain
- María Zambrano Program, European Union, Spain
| | - Ruth Gil-Prieto
- Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Madrid, Spain
| | | | - Gil Rodríguez-Caravaca
- Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Madrid, Spain
- Department of Preventive Medicine, Hospital Universitario Fundación Alcorcón, Rey Juan Carlos University, 28922 Madrid, Spain
| | - Ángel Gil-de-Miguel
- Preventive Medicine and Public Health, Rey Juan Carlos University, 28922 Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Graham FF, Harte D, Zhang J, Fyfe C, Baker MG. Increased Incidence of Legionellosis after Improved Diagnostic Methods, New Zealand, 2000-2020. Emerg Infect Dis 2023; 29:1173-1182. [PMID: 37209673 DOI: 10.3201/eid2906.221598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
Legionellosis, notably Legionnaires' disease, is recognized globally and in New Zealand (Aotearoa) as a major cause of community-acquired pneumonia. We analyzed the temporal, geographic, and demographic epidemiology and microbiology of Legionnaires' disease in New Zealand by using notification and laboratory-based surveillance data for 2000‒2020. We used Poisson regression models to estimate incidence rate ratios and 95% CIs to compare demographic and organism trends over 2 time periods (2000-2009 and 2010-2020). The mean annual incidence rate increased from 1.6 cases/100,000 population for 2000-2009 to 3.9 cases/100,000 population for 2010-2020. This increase corresponded with a change in diagnostic testing from predominantly serology with some culture to almost entirely molecular methods using PCR. There was also a marked shift in the identified dominant causative organism, from Legionella pneumophila to L. longbeachae. Surveillance for legionellosis could be further enhanced by greater use of molecular typing of isolates.
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Capon A, Cains T, Draper J, Sintchenko V, Ferson M, Sheppeard V. Investigation of a legionellosis outbreak in Sydney CBD - a brief report. Aust N Z J Public Health 2023; 47:100018. [PMID: 36965315 DOI: 10.1016/j.anzjph.2023.100018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE To identify and control a source of Legionella in Sydney CBD. METHODS Clinical, epidemiological, environmental and genomic techniques were employed to identify cases and the source of Legionella. RESULTS Eleven legionellosis cases were linked to Sydney CBD with a median age of 69 years. All were hospitalised and had risk factors for Legionella infection. Eight of 11 cases identified as male. Genomic analysis linked three cases to a contaminated cooling water source in Sydney CBD, with a further case infected with a similar strain to that found in Sydney CBD. Another case, although epidemiologically linked to Sydney CBD, was infected with a genomically different strain to that found in Sydney CBD. Six other cases had no viable sample for genomic analysis. CONCLUSION/IMPLICATIONS FOR PUBLIC HEALTH An outbreak of legionellosis is a serious public health threat that requires rapid investigation and environmental control. We were able to identify a source in Sydney CBD through the application of clinical, epidemiological, environmental and genomic techniques. Genomic analysis is a powerful tool that can be used to confirm the source location but requires close collaboration between clinicians, public health units and microbiologists to recover viable sputum cultures from cases diagnosed with legionellosis.
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Affiliation(s)
- Adam Capon
- South Eastern Sydney Local Health District, Public Health Unit, New South Wales, Australia; School of Public Health, The University of Sydney, New South Wales, Australia.
| | - Toni Cains
- South Eastern Sydney Local Health District, Public Health Unit, New South Wales, Australia
| | - Jenny Draper
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology - Institute of Clinical Pathology and Medical Research, New South Wales, Australia
| | - Vitali Sintchenko
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology - Institute of Clinical Pathology and Medical Research, New South Wales, Australia; School of Medicine, The University of Sydney, New South Wales, Australia
| | - Mark Ferson
- South Eastern Sydney Local Health District, Public Health Unit, New South Wales, Australia; School of Population Health, University of New South Wales, New South Wales, Australia
| | - Vicky Sheppeard
- South Eastern Sydney Local Health District, Public Health Unit, New South Wales, Australia; School of Public Health, The University of Sydney, New South Wales, Australia
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Malik MA, Shaukat F, Malik A, Kaifee S, Eid M. A Case of Legionnaires' Disease Manifesting as Heat Exhaustion. Cureus 2023; 15:e35099. [PMID: 36938252 PMCID: PMC10023067 DOI: 10.7759/cureus.35099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
A 69-year-old male with a history of prior admissions of heat exhaustion presented with non-specific symptoms including fatigue, diarrhea, and dehydration. The workup revealed a positive legionella urine antigen. He was treated with levofloxacin with symptom resolution within 48 hours.
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Affiliation(s)
| | - Fahd Shaukat
- Medicine, Rochester Regional Health, Rochester, USA
| | - Aqsa Malik
- Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, PAK
| | - Syeda Kaifee
- Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Mohamed Eid
- Medicine, Rochester Regional Health, Rochester, USA
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10
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Czerwiński M, Księżak E, Piekarska K. Legionellosis in Poland in 2018-2021. Przegl Epidemiol 2023; 77:241-250. [PMID: 37861069 DOI: 10.32394/pe.77.23] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Objectives The aim of this study is to compare the epidemiological situation of legionellosis in Poland in 2018-2021 to prior years, taking into account the impact of the COVID-19 pandemic in 2020-2021. Material and methods The assessment is based on national surveillance data published in the annual bulletin "Infectious Diseases and Poisons in Poland" from 2013 to 2021, as well as data from Legionnaires' disease case reports collected and sent to the Department of Epidemiology of Infectious Diseases and Surveillance NIPH NIH - NRI by sanitary and epidemiological stations or submitted to EpiBase. Results In Poland, both Legionnaires' disease (an acute infection that progresses to pneumonia) and Pontiac fever (a mild, flu-like sickness) are reported. In 2018-2021, a total of 255 cases of legionellosis were registered, including 236 cases of Legionnaires' disease and 19 cases of Pontiac fever. Each year, there was an increase in the number of notifications compared to the annual median number of cases from 2013-2017. The annual incidence rate in 2019 (0.23 per 100,000 population) was the highest since the start of legionellosis case registration in Poland. It declined again during the years of the COVID-19 pandemic. The notifications occurred throughout the country, but the highest notification rate was observed in the western belt of voivodeships. Pomorskie reported the highest incidence, accounting for more than 20% of all registered cases. The median incidence of Legionnaires' disease in men (0.23 per 100,000) was more than twice that of women (0.10), with the highest incidence (0.58) recorded in men 65 years of age or older. All indigenous cases of Legionnaires' disease were sporadic; all but three patients were hospitalized. State Sanitary Inspection reported 26 fatal cases of Legionnaires' disease (mortality = 11%). Twenty-four cases were linked to contaminated water systems in health-care settings, and 21 cases were likely associated with travel abroad. Summary and conclusions Although the number of notifications has increased in recent years, Legionnaires' disease is still an infrequently diagnosed respiratory infection in Poland, and the reported incidence remains one of the lowest in the entire EU. The most affected demographic group is men aged 65 and older. Improving the early diagnosis of Legionnaires' disease in healthcare settings remains a priority.
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Affiliation(s)
- Michał Czerwiński
- National Institute of Public Health NIH - National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance
| | - Ewelina Księżak
- National Institute of Public Health NIH - National Research Institute, Department of Epidemiology of Infectious Diseases and Surveillance
| | - Katarzyna Piekarska
- National Institute of Public Health NIH - National Research Institute, Department of Bacteriology and Biocontamination Control
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11
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Gamage SD, Jinadatha C, Coppin JD, Kralovic SM, Bender A, Ambrose M, Decker BK, DeVries AS, Goto M, Kowalskyj O, Maistros AL, Rizzo V, Simbartl LA, Watson RJ, Roselle GA. Factors That Affect Legionella Positivity in Healthcare Building Water Systems from a Large, National Environmental Surveillance Initiative. Environ Sci Technol 2022; 56:11363-11373. [PMID: 35929739 DOI: 10.1021/acs.est.2c02194] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/15/2023]
Abstract
Legionella growth in healthcare building water systems can result in legionellosis, making water management programs (WMPs) important for patient safety. However, knowledge is limited on Legionella prevalence in healthcare buildings. A dataset of quarterly water testing in Veterans Health Administration (VHA) healthcare buildings was used to examine national environmental Legionella prevalence from 2015 to 2018. Bayesian hierarchical logistic regression modeling assessed factors influencing Legionella positivity. The master dataset included 201,146 water samples from 814 buildings at 168 VHA campuses. Overall Legionella positivity over the 4 years decreased from 7.2 to 5.1%, with the odds of a Legionella-positive sample being 0.94 (0.90-0.97) times the odds of a positive sample in the previous quarter for the 16 quarters of the 4 year period. Positivity varied considerably more at the medical center campus level compared to regional levels or to the building level where controls are typically applied. We found higher odds of Legionella detection in older buildings (OR 0.92 [0.86-0.98] for each more recent decade of construction), in taller buildings (OR 1.20 [1.13-1.27] for each additional floor), in hot water samples (O.R. 1.21 [1.16-1.27]), and in samples with lower residual biocide concentrations. This comprehensive healthcare building review showed reduced Legionella detection in the VHA healthcare system over time. Insights into factors associated with Legionella positivity provide information for healthcare systems implementing WMPs and for organizations setting standards and regulations.
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Affiliation(s)
- Shantini D Gamage
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, United States
| | - Chetan Jinadatha
- Department of Medicine, Central Texas Veterans Health Care System, Temple, Texas 76504, United States
- College of Medicine, Texas A&M University, Bryan, Texas 77807, United States
| | - John D Coppin
- Department of Research, Central Texas Veterans Health Care System, Temple, Texas 76504, United States
| | - Stephen M Kralovic
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, United States
- Cincinnati VA Medical Center, Cincinnati, Ohio 45220, United States
| | - Alan Bender
- Booz Allen Hamilton, McLean, Virginia 22102, United States
| | - Meredith Ambrose
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
| | - Brooke K Decker
- Division of Infectious Diseases, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, United States
| | - Aaron S DeVries
- Minneapolis VA Healthcare System, Minneapolis, Minnesota 55417, United States
| | - Michihiko Goto
- Iowa City VA Health Care System, Iowa City, Iowa 52246, United States
- University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, United States
| | - Oleh Kowalskyj
- Office of Healthcare Engineering, Healthcare Environment and Facilities Program, Veterans Health Administration, VA, Washington, D.C. 20571, United States
| | - Angela L Maistros
- VA Capitol Health Care Network, Veterans Integrated Service Network (VISN) 5, Linthicum, Maryland 21090, United States
| | - Vincent Rizzo
- Office of Healthcare Engineering, Healthcare Environment and Facilities Program, Veterans Health Administration, VA, Washington, D.C. 20571, United States
| | - Loretta A Simbartl
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
| | - Richard J Watson
- Occupational Health and Safety Program Office, Veterans Health Administration, VA, Washington, D.C. 20571, United States
| | - Gary A Roselle
- National Infectious Diseases Service, Specialty Care Program Office, Veterans Health Administration, Department of Veterans Affairs (VA), Washington, D.C. 20571, United States
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, United States
- Cincinnati VA Medical Center, Cincinnati, Ohio 45220, United States
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12
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Abstract
Reported Legionnaires' disease (LD) cases began increasing in the United States in 2003 after relatively stable numbers for >10 years; reasons for the rise are unclear. We compared epidemiologic patterns associated with cases reported to the Centers for Disease Control and Prevention before and during the rise. The age-standardized average incidence was 0.48 cases/100,000 population during 1992-2002 compared with 2.71 cases/100,000 in 2018. Reported LD incidence increased in nearly every demographic, but increases tended to be larger in demographic groups with higher incidence. During both periods, the largest number of cases occurred among White persons, but the highest incidence was in Black or African American persons. Incidence and increases in incidence were generally largest in the East North Central, Middle Atlantic, and New England divisions. Seasonality was more pronounced during 2003-2018, especially in the Northeast and Midwest. Rising incidence was most notably associated with increasing racial disparities, geographic focus, and seasonality.
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De Giglio O, Diella G, Lopuzzo M, Triggiano F, Calia C, Pousis C, Fasano F, Calabrese G, Rafaschieri V, Carpagnano LF, Carlucci M, Gesualdo L, Ricci ML, Scaturro M, Rota MC, Bonadonna L, Lucentini L, Montagna MT. Management of Microbiological Contamination of the Water Network of a Newly Built Hospital Pavilion. Pathogens 2021; 10:75. [PMID: 33467059 DOI: 10.3390/pathogens10010075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/28/2022] Open
Abstract
The good installation, as well as commissioning plan, of a water network is a crucial step in reducing the risk of waterborne diseases. The aim of this study was to monitor the microbiological quality of water from a newly built pavilion before it commenced operation. Overall, 91 water samples were tested for coliforms, Escherichia coli, enterococci, Pseudomonas aeruginosa and Legionella at three different times: T0 (without any water treatment), T1 (after treatment with hydrogen peroxide and silver ions at initial concentration of 20 mg/L and after flushing of water for 20 min/day for seven successive days) and T2 (15 days later). Coliforms were detected in 47.3% of samples at T0, 36.3% at T1 and 4.4% at T2. E. coli was isolated in 4.4% of the samples only at T1, while enterococci appeared in 12.1% of the samples at T1 and in 2.2% at T2. P. aeruginosa was isolated in 50.5% of the samples at T0, 29.7% at T1 and 1.1% at T2. Legionella pneumophila serogroup 8 was isolated in 80.2% of the samples at T0, 36.3% at T1 and 2.2% at T2. Our results confirmed the need for a water safety plan in new hospital pavilions to prevent the risk of waterborne diseases.
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14
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Abstract
Legionellosis is a serious bacterial infection characterized by atypical pneumonia primarily due to infection with Legionella pneumophila, and bathing can be a potential cause of this infection. Legionellosis was first identified in 1977, and it is caused by Gram-negative bacteria belonging to the genus Legionella. Legionellosis remains an important public health threat, particularly in Japan, where the population is rapidly aging, thereby becoming more at risk of developing severe disease and accompanying life-threatening pneumonia. The bacteria are most commonly transmitted via the inhalation of contaminated aerosols produced and broadcast via water sprays, jets or mists. Infection can also occur via the aspiration of contaminated water or ice, or through inhalation of contaminated dust. Because the signs and symptoms of Legionnaires' disease (LD), as well as radiographic imaging are similar to pneumonia caused by other pathogens, a specific diagnostic test is required, such as a urine antigen detection test. Six clinical and laboratory parameters, a high body temperature, a non-productive cough, low serum sodium and platelet counts, and high lactate dehydrogenase (LDH) and c-reactive protein concentrations can be used to reliably predict the likelihood of LD. The first choices for chemotherapy are fluoroquinolone and macrolide antibiotic drugs. The main goals of LD prevention measures are 1) the prevention of microbial growth and biofilm formation, 2) the removal of all biofilm formed on equipment and in facilities, 3) minimizing aerosol splash and spread, and 4) minimizing bacterial contamination from external sources. It is apparent that, in Japan, where hot spring (onsen) bathing is common among aged people, strict regulations need to be in place - and enforced - to ensure that all Japanese onsens and spas provide a safe environment and undertake regular, effective infection control practices.
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15
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Sreenath K, Chaudhry R, Vinayaraj EV, Dey AB, Kabra SK, Thakur B, Guleria R. Distribution of Virulence Genes and Sequence-Based Types Among Legionella pneumophila Isolated From the Water Systems of a Tertiary Care Hospital in India. Front Public Health 2020; 8:596463. [PMID: 33330340 PMCID: PMC7719716 DOI: 10.3389/fpubh.2020.596463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/19/2020] [Accepted: 10/12/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Legionnaires' disease (LD) is a potentially fatal pneumonia predominantly caused by infection due to Legionella pneumophila although more than 50 other Legionella species are described. Water systems contaminated with Legionella spp. are the implicated sources of Legionnaires' disease. In this study, we aimed to assess Legionella contamination in the water sources of a tertiary care hospital and to determine the virulence properties and molecular characteristics of L. pneumophila environmental isolates. Methods: During May 2015 through August 2018, a total of 201 hospital water samples were tested for L. pneumophila by standardized culture procedures; environmental isolates were examined for the presence of two virulence genes: Legionella vir homolog (lvh) and repeats in structural toxin (rtxA) by PCR. The genotyping of isolates was performed by sequence-based typing (SBT) according to the protocol of the European Study Group for Legionella Infections (ESGLI). Results:L. pneumophila was isolated from 38/201 (18.9%) water samples; among the 46 isolates, the lvh locus was present in 45 (97.8%), the rtxA locus was found in 45 (97.8%), and both loci were found in 44 (95.7%) isolates. A total of 23 sequence types (STs) were identified among the 44 isolates (index of discrimination [IOD] of 0.929), and 11/23 (47.8%) STs were new to the ESGLI database. Conclusions: The study results showed genetic diversity in L. pneumophila isolates from the hospital environment along with a high percentage of pathogenicity loci. Besides, certain STs may have an increased ability to cause legionellosis, thus requires specific infection control and prevention strategies whenever identified.
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Affiliation(s)
- K Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - E V Vinayaraj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - A B Dey
- Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Thakur
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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16
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Dey R, Mameri MR, Trajkovic-Bodennec S, Bodennec J, Pernin P. Impact of inter-amoebic phagocytosis on the L. pneumophila growth. FEMS Microbiol Lett 2020; 367:5899054. [PMID: 32860684 DOI: 10.1093/femsle/fnaa147] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/25/2020] [Indexed: 01/21/2023] Open
Abstract
Free-living amoebae are known to act as replication niches for the pathogenic bacterium Legionella pneumophila in freshwater environments. However, we previously reported that some strains of the Willaertia magna species are more resistant to L. pneumophila infection and differ in their ability to support its growth. From this observation, we hypothesize that L. pneumophila growth in environment could be partly dependent on the composition of amoebic populations and on the possible interactions between different amoebic species. We tested this hypothesis by studying the growth of L. pneumophila and of a permissive free-living amoeba, Vermamoeba vermiformis (formerly named Hartmannella vermiformis), in co-culture with or without other free-living amoebae (Acanthamoeba castellanii and W. magna). We demonstrate the occurrence of inter-amoebic phagocytosis with A. castellanii and W. magna being able to ingest V. vermiformis infected or not infected with L. pneumophila. We also found that L. pneumophila growth is strongly impacted by the permissiveness of each interactive amoeba demonstrating that L. pneumophila proliferation and spread are controlled, at least in part, by inter-amoebic interactions.
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Affiliation(s)
- Rafik Dey
- Université claude Bernard Lyon I, 43 boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.,Université Lyon 1; ISPB-Faculté de Pharmacie Laboratoire de Biologie Cellulaire, 8, Avenue Rockefeller, F-69373, France.,School of public health. University of Alberta, Edmonton AB, Canada
| | - Mouh Rayane Mameri
- Amoeba R & D Center, 38 Av des Frères Montgolfier, Chassieu F-69680, France.,Université Lyon 1; ISPB-Faculté de Pharmacie Laboratoire de Biologie Cellulaire, 8, Avenue Rockefeller, F-69373, France
| | | | - Jacques Bodennec
- Université claude Bernard Lyon I, 43 boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.,Université Lyon 1, Lyon Neuroscience Research Center CNRS, UMR 5292, Villeurbanne, F-69622, France.,Université Lyon 1, INSERM, U1028, Tiger Team, Bron, F-69500, France
| | - Pierre Pernin
- Université claude Bernard Lyon I, 43 boulevard du 11 Novembre 1918, 69100 Villeurbanne, France.,Université Lyon 1; ISPB-Faculté de Pharmacie Laboratoire de Biologie Cellulaire, 8, Avenue Rockefeller, F-69373, France
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17
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Abstract
We reviewed findings of clinical, epidemiologic, and environmental investigations for 288 confirmed case-patients with Legionnaires’ disease reported in Hong Kong, China, during January 2005−December 2015. We found that chronic renal failure/impairment (adjusted odds ratio [aOR] 4.09), chronic pulmonary diseases (aOR 3.22), malignancy (aOR 3.04), and heart diseases (aOR 2.15) were independently associated with a higher risk for severe Legionnaires’ disease. However, patients with hyperlipidemia had a lower risk for severe outcome (aOR 0.17). Legionella positivity rate was 22% for 1,904 water samples collected. We found a higher positivity rate in summer months (28%−30%), which corroborated with months of highest rainfalls. Our novel finding that Legionnaires’ disease patients with hyperlipidemia had a lower risk for severe outcome deserves further study to confirm the observation and ascertain the underlying reason.
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18
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Nisar MA, Ross KE, Brown MH, Bentham R, Whiley H. Legionella pneumophila and Protozoan Hosts: Implications for the Control of Hospital and Potable Water Systems. Pathogens 2020; 9:pathogens9040286. [PMID: 32326561 PMCID: PMC7238060 DOI: 10.3390/pathogens9040286] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/21/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
Legionella pneumophila is an opportunistic waterborne pathogen of public health concern. It is the causative agent of Legionnaires’ disease (LD) and Pontiac fever and is ubiquitous in manufactured water systems, where protozoan hosts and complex microbial communities provide protection from disinfection procedures. This review collates the literature describing interactions between L. pneumophila and protozoan hosts in hospital and municipal potable water distribution systems. The effectiveness of currently available water disinfection protocols to control L. pneumophila and its protozoan hosts is explored. The studies identified in this systematic literature review demonstrated the failure of common disinfection procedures to achieve long term elimination of L. pneumophila and protozoan hosts from potable water. It has been demonstrated that protozoan hosts facilitate the intracellular replication and packaging of viable L. pneumophila in infectious vesicles; whereas, cyst-forming protozoans provide protection from prolonged environmental stress. Disinfection procedures and protozoan hosts also facilitate biogenesis of viable but non-culturable (VBNC) L. pneumophila which have been shown to be highly resistant to many water disinfection protocols. In conclusion, a better understanding of L. pneumophila-protozoan interactions and the structure of complex microbial biofilms is required for the improved management of L. pneumophila and the prevention of LD.
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Carlson KM, Boczek LA, Chae S, Ryu H. Legionellosis and Recent Advances in Technologies for Legionella Control in Premise Plumbing Systems: A Review. Water (Basel) 2020; 12:1-676. [PMID: 32704396 PMCID: PMC7377215 DOI: 10.3390/w12030676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review discusses Legionella, among the most prolific and publicly well-known waterborne pathogens, and advances in potential treatment technologies. The number of cases associated with Legionella continues to rise, as does its public awareness. Currently, cases associated with premise plumbing account for the largest number of legionellosis cases in the United States. So, while it is important to understand Legionella as such, it is also important to investigate how to treat drinking water in premise plumbing for Legionella and other waterborne pathogens. While there are currently several methods recognized as potential means of inactivating waterborne pathogens, several shortcomings continue to plague its implementation. These methods are generally of two types. Firstly, there are chemical treatments such as chlorine, chlorine dioxide, monochloramine, ozone, and copper-silver ionization. Secondly, there are physical treatments such as thermal inactivation and media filtration. Their shortcomings range from being labor-intensive and costly to having negative health effects if not properly operated. Recently developed technologies including ultraviolet (UV) irradiation using light emitting diodes (LEDs) and innovative carbon nanotube (CNT) filters can better control waterborne pathogens by allowing for the simultaneous use of different treatment measures in plumbing systems.
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Affiliation(s)
- Kelsie M. Carlson
- United States Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA
- Department of Chemical and Environmental Engineering, University of Cincinnati, Cincinnati, OH 45268, USA
| | - Laura A. Boczek
- United States Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA
| | - Soryong Chae
- Department of Chemical and Environmental Engineering, University of Cincinnati, Cincinnati, OH 45268, USA
| | - Hodon Ryu
- United States Environmental Protection Agency, Office of Research and Development, 26 W. Martin Luther King Dr., Cincinnati, OH 45268, USA
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20
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Abstract
OBJECTIVE The aim of this study is to assess the epidemiological situation of legionellosis in Poland in 2017 in comparison with previous years. MATERIAL AND METHODS The analysis is based on national surveillance data published in the annual bulletin: “Infectious diseases and poisonings in Poland in 2017” and bulletins from previous years along with data from legionellosis case reports collected and sent to the Department of Epidemiology of Infectious Diseases and Surveillance NIPH – NIH by Sanitary and Epidemiological Stations. RESULTS In Poland, both cases of Legionnaires’ disease (an acute form of infection with pneumonia) and Pontiac fever (a mild, influenza-like form of infection) are routinely reported to the surveillance system. In 2017, a total of 39 cases of legionellosis were registered, including 38 cases of Legionnaires’ disease and 1 case of Pontiac fever; the annual incidence rate 0.102 (per 100,000 population) has increased by almost 50 percent since previous year (0.070) and is almost three times higher than the median incidence (0.036) for 2011-2015.
The infections were reported in fourteen voivodeships; only one voivodeship (Świętokrzyskie) did not register any case in last years. The incidence in men (0.129 per 100,000) was higher compared to women (0.076); the highest incidence (0.323) was noted in men aged 50-59. All reported cases were sporadic and were hospitalised. The Sanitary Inspection reported nine fatal cases – 6 women and 3 men. Thirty three cases were autochthonous including four cases linked with contaminated water systems in health-care settings. Six cases were associated with travels abroad (to Egypt, Albania, Italy and Crete). SUMMARY AND CONCLUSIONS Although in recent years number of reported cases continues to rise, the incidence of legionellosis in Poland remains one of the lowest in the entire EU. Also draws attention variation of incidence between provinces and a high mortality among reported cases. Our data suggest significant under-diagnosis of legionellosis. A priority remains to improve early diagnosis of Legionnaires’ disease in health care settings.
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Affiliation(s)
| | - Michał Czerwiński
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health – National Institute of Hygiene in Warsaw
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21
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Han XY. Solar and Climate Effects Explain the Wide Variation in Legionellosis Incidence Rates in the United States. Appl Environ Microbiol 2019; 85:e01776-19. [PMID: 31519664 DOI: 10.1128/AEM.01776-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
Legionellosis, an infection caused by the environmental bacteria Legionella spp., has become a significant public health problem in the United States in recent years; however, among the states, the incidence rates vary widely without a clear explanation. This study examined environmental effects on the 2014-to-2016 average annual legionellosis incidence rates in the U.S. states through correlative analyses with long-term precipitation, temperature, solar UV radiation, and sunshine hours. The continental states west of ∼95°W showed low incidence rates of 0.51 to 1.20 cases per 100,000 population, which corresponded to low precipitation, below 750 mm annually. For the eastern states, where precipitation was higher, solar effects were prominent and mixed, leading to wide incidence variation. Robust regressions suggested a dividing line at 40°N: north of this line, rising temperature, mainly from solar heat, raised legionellosis incidence to a peak of 4.25/100,000 in Ohio; south of the line, intensifying sunlight in terms of high UV indices and long sunshine hours prevailed to limit incidence gradually to 0.99/100,000 in Louisiana. On or near the 40°N line were 15 eastern states that had leading legionellosis incidence rates of >2.0/100,000. These states all showed modest environmental parameters. In contrast, the frigid climate in Alaska and the strong year-round solar UV in Hawaii explained the lowest U.S. incidences, 0.14/100,000 and 0.47/100,000, respectively, in these states. The findings of solar and climate effects explain the wide variation of legionellosis incidence rates in the United States and may offer insights into the potential exposure to and prevention of infection.IMPORTANCE Legionellosis, caused by the environmental bacteria Legionella spp., has become a significant public health problem in the United States in recent years, with ∼6,000 cases annually. The present study showed, through a series of correlative analyses with long-term precipitation, temperature, solar UV radiation, and sunshine hours, that these environmental conditions strongly influence the legionellosis incidence rates across the United States in mixed and dynamic fashions. The incidence rates varied remarkably by region, with the highest in Ohio and New York and the lowest in Alaska. A precipitation threshold above 750 mm was required for elevated legionellosis activity. Regression models and dividing lines between regions were established to show the promotive effect of temperature, as well as the inhibitive effects of solar UV and sunshine hours. These findings explain the wide variation of legionellosis incidence rates in the United States. They may also offer insights into potential exposure to and prevention of infection.
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22
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Lampl BMJ, Strigl W, Winner D, Pawlik MT. Case report: 38-year-old female patient with severe legionellosis but no source of infection. GMS Hyg Infect Control 2019; 14:Doc13. [PMID: 31728267 PMCID: PMC6838731 DOI: 10.3205/dgkh000329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report about a 38-year-old female patient with an extremely severe case of legionellosis. The patient had to be treated in the intensive care unit for more than a month. Extracorporeal membrane oxygenation (ECMO) had to be established in order to save the patient's life. The patient did not belong to any risk group (i.e., age >50, smoker, immunosuppression, chronic disease, male sex). Infection control investigations carried out by the Public Health Department could not reveal concrete exposures likely to cause the infection. The serotypes in the patient material (Legionella pneumophila serotype 2-14) and in the samples taken from the showerhead in the patient's apartment (Legionella pneumophila serotype 1) were not identical. Results of the examination performed according to the German Drinking Water Ordinance (Trinkwasserverordnung, TrinkwV) carried out in 2017 in the patient's apartment, showed that the technical measures limit (Technischer Maßnahmenwert, TMW) was not exceeded. The patient has survived through the extensive use and efforts of intensive care measures. In general, a concrete exposure to Legionella is often not ascertainable, as in the case presented. This raises the question of how and whether such cases of legionellosis are preventable.
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Affiliation(s)
- Benedikt M. J. Lampl
- Public Health Department Regensburg, Germany,*To whom correspondence should be addressed: Benedikt M. J. Lampl, Gesundheitsamt Regensburg, Altmühlstr. 3, 93059 Regensburg, Phone: +49 941 4009-523, E-mail:
| | | | - Dieter Winner
- Caritas-Krankenhaus St. Josef, Department of Anesthesiology, Regensburg, Germany
| | - Michael T. Pawlik
- Caritas-Krankenhaus St. Josef, Department of Anesthesiology, Regensburg, Germany
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Cassell K, Gacek P, Rabatsky-Ehr T, Petit S, Cartter M, Weinberger DM. Estimating the True Burden of Legionnaires' Disease. Am J Epidemiol 2019; 188:1686-1694. [PMID: 31225857 DOI: 10.1093/aje/kwz142] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 10/13/2018] [Revised: 05/25/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022] Open
Abstract
Over the past decade, the reported incidence of Legionnaires' disease (LD) in the northeastern United States has increased, reaching 1-3 cases per 100,000 population. There is reason to suspect that this is an underestimate of the true burden, since LD cases may be underdiagnosed. In this analysis of pneumonia and influenza (P&I) hospitalizations, we estimated the percentages of cases due to Legionella, influenza, and respiratory syncytial virus (RSV) by age group. We fitted mixed-effects models to estimate attributable percents using weekly time series data on P&I hospitalizations in Connecticut from 2000 to 2014. Model-fitted values were used to calculate estimates of numbers of P&I hospitalizations attributable to Legionella (and influenza and RSV) by age group, season, and year. Our models estimated that 1.9%, 8.8%, and 5.1% of total (all-ages) inpatient P&I hospitalizations could be attributed to Legionella, influenza, and RSV, respectively. Only 10.6% of total predicted LD cases had been clinically diagnosed as LD during the study period. The observed incidence rate of 1.2 cases per 100,000 population was substantially lower than our estimated rate of 11.6 cases per 100,000 population. Our estimates of numbers of P&I hospitalizations attributable to Legionella are comparable to those provided by etiological studies of community-acquired pneumonia and emphasize the potential for underdiagnosis of LD in clinical settings.
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Affiliation(s)
- Kelsie Cassell
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
| | - Paul Gacek
- Connecticut Department of Public Health, Hartford, Connecticut
| | | | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Matthew Cartter
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut
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Laganà P, Facciolà A, Palermo R, Delia S. Environmental Surveillance of Legionellosis within an Italian University Hospital-Results of 15 Years of Analysis. Int J Environ Res Public Health 2019; 16:E1103. [PMID: 30925660 PMCID: PMC6480113 DOI: 10.3390/ijerph16071103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
Legionnaires' disease is normally acquired by inhalation of legionellae from a contaminated environmental source. Water systems of large and old buildings, such as hospitals, can be contaminated with legionellae and therefore represent a potential risk for the hospital population. In this study, we demonstrated the constant presence of Legionella in water samples from the water system of a large university hospital in Messina (Sicily, Italy) consisting of 11 separate pavilions during a period of 15 years (2004⁻2018). In total, 1346 hot water samples were collected between January 2004 and December 2018. During this period, to recover Legionella spp. from water samples, the standard procedures reported by the 2000 Italian Guidelines were adopted; from May 2015 to 2018 Italian Guidelines revised in 2015 (ISS, 2015) were used. Most water samples (72%) were positive to L. pneumophila serogroups 2⁻14, whereas L. pneumophila serogroup 1 accounted for 18% and non-Legionellapneumophila spp. Accounted for 15%. Most of the positive samples were found in the buildings where the following critical wards are situated: (Intensive Care Unit) ICU, Neurosurgery, Surgeries, Pneumology, and Neonatal Intensive Unit Care. This study highlights the importance of the continuous monitoring of hospital water samples to prevent the potential risk of nosocomial legionellosis.
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Affiliation(s)
- Pasqualina Laganà
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Branch of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Torre Biologica 3p, AOU 'G. Martino, Via C. Valeria, s.n.c., 98125 Messina, Italy.
| | - Alessio Facciolà
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy.
| | - Roberta Palermo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy.
| | - Santi Delia
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Branch of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Torre Biologica 3p, AOU 'G. Martino, Via C. Valeria, s.n.c., 98125 Messina, 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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Abstract
Respiratory tract infections (RTIs) are a common health problem of international travelers. Travelers may be at increased risk of RTIs due to travel itself (mingling and close quarters in airports, airplanes, cruise ships, and hotels), and due to unique exposure at travel destinations. The clinical spectrum of RTIs in travelers is broad and includes upper RTIs, pharyngitis, otitis, laryngitis, bronchitis, and pneumonia. Most travelers who acquire an RTI only develop mild disease, and only a minority seek medical attention. All travelers should be up to date on any indicated vaccines based on age and medical condition that prevent RTIs, including influenza, measles, pneumococcal diseases, Haemophilus influenzae b, Neisseria meningitidis, diphtheria, and pertussis. Respiratory tract infections (RTIs) are among the most common illnesses reported by travelers. Most RTIs are viral, involve the upper respiratory tract, and do not require specific diagnosis or treatment. Influenza is often considered the most important travel-related infection. Travelers play an integral role in the yearly and global spread of influenza. Lower RTIs, including pneumonia, often require antimicrobial therapy. High-risk groups such as infants, small children, the elderly, and subjects with chronic tracheobronchial or pulmonary disease are at increased risk of developing severe clinical consequences should infection occur. All international travelers should be immunized for seasonal influenza unless otherwise contraindicated, and travelers should be instructed in hand hygiene and sneeze and cough hygiene. All travelers should be up to date on any indicated vaccines that prevent RTIs, including measles, pneumococcal diseases, Haemophilus influenzae b (Hib), meningococcal disease, diphtheria, and pertussis. Travelers may be at increased risk of geographically restricted RTIs, and clinicians should be familiar with the major manifestations of these illnesses.
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Amemura-Maekawa J, Kura F, Chida K, Ohya H, Kanatani JI, Isobe J, Tanaka S, Nakajima H, Hiratsuka T, Yoshino S, Sakata M, Murai M, Ohnishi M; Working Group for Legionella in Japan. Legionella pneumophila and Other Legionella Species Isolated from Legionellosis Patients in Japan between 2008 and 2016. Appl Environ Microbiol 2018; 84:e00721-18. [PMID: 29980559 DOI: 10.1128/AEM.00721-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/27/2018] [Indexed: 12/13/2022] Open
Abstract
The Legionella Reference Center in Japan collected 427 Legionella clinical isolates between 2008 and 2016, including 7 representative isolates from corresponding outbreaks. The collection included 419 Legionella pneumophila isolates, of which 372 belonged to serogroup 1 (SG1) (87%) and the others belonged to SG2 to SG15 except for SG7 and SG11, and 8 isolates of other Legionella species (Legionella bozemanae, Legionella dumoffii, Legionella feeleii, Legionella longbeachae, Legionella londiniensis, and Legionella rubrilucens). L. pneumophila isolates were genotyped by sequence-based typing (SBT) and represented 187 sequence types (STs), of which 126 occurred in a single isolate (index of discrimination of 0.984). These STs were analyzed using minimum spanning tree analysis, resulting in the formation of 18 groups. The pattern of overall ST distribution among L. pneumophila isolates was diverse. In particular, some STs were frequently isolated and were suggested to be related to the infection sources. The major STs were ST23 (35 isolates), ST120 (20 isolates), and ST138 (16 isolates). ST23 was the most prevalent and most causative ST for outbreaks in Japan and Europe. ST138 has been observed only in Japan, where it has caused small-scale outbreaks; 81% of those strains (13 isolates) were suspected or confirmed to infect humans through bath water sources. On the other hand, 11 ST23 strains (31%) and 5 ST120 strains (25%) were suspected or confirmed to infect humans through bath water. These findings suggest that some ST strains frequently cause legionellosis in Japan and are found under different environmental conditions.IMPORTANCELegionella pneumophila serogroup 1 (SG1) is the most frequent cause of legionellosis. Our previous genetic analysis indicated that SG1 environmental isolates represented 8 major clonal complexes, consisting of 3 B groups, 2 C groups, and 3 S groups, which included major environmental isolates derived from bath water, cooling towers, and soil and puddles, respectively. Here, we surveyed clinical isolates collected from patients with legionellosis in Japan between 2008 and 2016. Most strains belonging to the B group were isolated from patients for whom bath water was the suspected or confirmed source of infection. Among the isolates derived from patients whose suspected infection source was soil or dust, most belonged to the S1 group and none belonged to the B or C groups. Additionally, the U group was discovered as a new group, which mainly included clinical isolates with unknown infection sources.
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Jaber L, Amro M, Tair HA, Bahader SA, Alalam H, Butmeh S, Hilal DA, Brettar I, Höfle MG, Bitar DM. Comparison of in situ sequence type analysis of Legionella pneumophila in respiratory tract secretions and environmental samples of a hospital in East Jerusalem. Epidemiol Infect 2018; 146:2116-21. [PMID: 30157982 DOI: 10.1017/S0950268818002340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Legionella pneumophila genotyping is important for epidemiological investigation of nosocomial and community-acquired outbreaks of legionellosis. The prevalence of legionellosis in pneumonia patients in the West Bank was monitored for the first time, and the sequence types (STs) from respiratory samples were compared with STs of environmental samples from different wards of the hospital. Sputum (n = 121) and bronchoalveolar lavage (BAL) (n = 74) specimens were cultured for L. pneumophila; genomic DNA was tested by 16S rRNA polymerase chain reaction (PCR) amplification. Nested PCR sequence-based typing (NPSBT) was implemented on DNA of the respiratory and environmental PCR-positive samples. Only one respiratory specimen was positive for L. pneumophila by culture. BAL gave a higher percentage of L. pneumophila-positive samples, 35% (26/74) than sputum, 15% (18/121) by PCR. NPSBT revealed the following STs: ST 1 (29%, 7/24), ST 461 (21%, 5/24), ST 1037 (4%, 1/24) from respiratory samples, STs from environmental samples: ST 1 (28.5%, 4/14), ST 187 (21.4%, 3/14) and ST 2070, ST 461, ST 1482 (7.1%, 1/14) each. This study emphasises the advantage of PCR over culture for the detection of L. pneumophila in countries where antibiotics are indiscriminately used prior to hospital admission. ST 1 was the predominant ST in both respiratory and environmental samples.
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Abstract
Using the Nationwide Inpatient Sample and US weather data, we estimated the probability of community-acquired pneumonia (CAP) being diagnosed as Legionnaires’ disease (LD). LD risk increases when weather is warm and humid. With warm weather, we found a dose-response relationship between relative humidity and the odds for LD. When the mean temperature was 60°–80°F with high humidity (>80.0%), the odds for CAP being diagnosed with LD were 3.1 times higher than with lower levels of humidity (<50.0%). Thus, in some regions (e.g., the Southwest), LD is rarely the cause of hospitalizations. In other regions and seasons (e.g., the mid-Atlantic in summer), LD is much more common. Thus, suspicion for LD should increase when weather is warm and humid. However, when weather is cold, dry, or extremely hot, empirically treating all CAP patients for LD might contribute to excessive antimicrobial drug use at a population level.
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Fitzhenry R, Weiss D, Cimini D, Balter S, Boyd C, Alleyne L, Stewart R, McIntosh N, Econome A, Lin Y, Rubinstein I, Passaretti T, Kidney A, Lapierre P, Kass D, Varma JK. Legionnaires' Disease Outbreaks and Cooling Towers, New York City, New York, USA. Emerg Infect Dis 2018; 23. [PMID: 29049017 PMCID: PMC5652439 DOI: 10.3201/eid2311.161584] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Surveillance will determine whether a new law regulating cooling towers reduces the incidence of Legionnaires’ disease. The incidence of Legionnaires’ disease in the United States has been increasing since 2000. Outbreaks and clusters are associated with decorative, recreational, domestic, and industrial water systems, with the largest outbreaks being caused by cooling towers. Since 2006, 6 community-associated Legionnaires’ disease outbreaks have occurred in New York City, resulting in 213 cases and 18 deaths. Three outbreaks occurred in 2015, including the largest on record (138 cases). Three outbreaks were linked to cooling towers by molecular comparison of human and environmental Legionella isolates, and the sources for the other 3 outbreaks were undetermined. The evolution of investigation methods and lessons learned from these outbreaks prompted enactment of a new comprehensive law governing the operation and maintenance of New York City cooling towers. Ongoing surveillance and program evaluation will determine if enforcement of the new cooling tower law reduces Legionnaires’ disease incidence in New York City.
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Chaudhry R, Sreenath K, Arvind V, Vinayaraj EV, Tanu S. Legionella pneumophila Serogroup 1 in the Water Facilities of a Tertiary Healthcare Center, India. Emerg Infect Dis 2018; 23:1924-1925. [PMID: 29048287 PMCID: PMC5652427 DOI: 10.3201/eid2311.171071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Proactive environmental surveillance for Legionella pneumophila in hospitals that treat immunocompromised patients is a useful strategy for preventing nosocomial Legionnaires’ disease. We report the presence of L. pneumophila serogroup 1 in 15.2% of the water systems of our tertiary healthcare center, which should prompt health officials to formulate mitigation policies.
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Lapierre P, Nazarian E, Zhu Y, Wroblewski D, Saylors A, Passaretti T, Hughes S, Tran A, Lin Y, Kornblum J, Morrison SS, Mercante JW, Fitzhenry R, Weiss D, Raphael BH, Varma JK, Zucker HA, Rakeman JL, Musser KA. Legionnaires' Disease Outbreak Caused by Endemic Strain of Legionella pneumophila, New York, New York, USA, 2015. Emerg Infect Dis 2018; 23:1784-1791. [PMID: 29047425 PMCID: PMC5652421 DOI: 10.3201/eid2311.170308] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
During the summer of 2015, New York, New York, USA, had one of the largest and deadliest outbreaks of Legionnaires’ disease in the history of the United States. A total of 138 cases and 16 deaths were linked to a single cooling tower in the South Bronx. Analysis of environmental samples and clinical isolates showed that sporadic cases of legionellosis before, during, and after the outbreak could be traced to a slowly evolving, single-ancestor strain. Detection of an ostensibly virulent Legionella strain endemic to the Bronx community suggests potential risk for future cases of legionellosis in the area. The genetic homogeneity of the Legionella population in this area might complicate investigations and interpretations of future outbreaks of Legionnaires’ disease.
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Gomaa F, Gersh M, Cavanaugh CM. Diverse Legionella-Like Bacteria Associated with Testate Amoebae of the Genus Arcella (Arcellinida: Amoebozoa). J Eukaryot Microbiol 2018; 65:661-668. [PMID: 29443446 DOI: 10.1111/jeu.12511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/03/2018] [Accepted: 02/03/2018] [Indexed: 12/11/2022]
Abstract
Diverse species of Legionella and Legionella-like amoebal pathogens (LLAPs) have been identified as intracellular bacteria in many amoeboid protists. There are, however, other amoeboid groups such as testate amoeba for which we know little about their potential to host such bacteria. In this study, we assessed the occurrence and diversity of Legionella spp. in cultures and environmental isolates of freshwater arcellinid testate amoebae species, Arcella hemispherica, Arcella intermedia, and Arcella vulgaris, via 16S rRNA gene sequence analyses and fluorescent in situ hybridization (FISH). Analysis of the 16S rRNA gene sequences indicated that A. hemispherica, A. intermedia, and A. vulgaris host Legionella-like bacteria with 94-98% identity to other Legionella spp. based on NCBI BLAST search. Phylogenetic analysis placed Legionella-like Arcella-associated bacteria (LLAB) in three different clusters within a tree containing all other members of Legionella and LLAPs. The intracellular localization of the Legionella within Arcella hosts was confirmed using FISH with a Legionella-specific probe. This study demonstrates that the host range of Legionella and Legionella-like bacteria in the Amoebozoa extends beyond members of "naked" amoebae species, with members of the testate amoebae potentially serving an ecological role in the dispersal, protection, and replication of Legionella spp. in natural environments.
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Affiliation(s)
- Fatma Gomaa
- Department of Organismic and Evolutionary Biology, Biological Laboratory, Harvard University, Cambridge, Massachusetts, 02138, USA
| | - Maxim Gersh
- Department of Organismic and Evolutionary Biology, Biological Laboratory, Harvard University, Cambridge, Massachusetts, 02138, USA
| | - Colleen M Cavanaugh
- Department of Organismic and Evolutionary Biology, Biological Laboratory, Harvard University, Cambridge, Massachusetts, 02138, USA
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Greene SK, Peterson ER, Kapell D, Fine AD, Kulldorff M. Daily Reportable Disease Spatiotemporal Cluster Detection, New York City, New York, USA, 2014-2015. Emerg Infect Dis 2018; 22:1808-12. [PMID: 27648777 PMCID: PMC5038417 DOI: 10.3201/eid2210.160097] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Each day, the New York City Department of Health and Mental Hygiene uses the free SaTScan software to apply prospective space–time permutation scan statistics to strengthen early outbreak detection for 35 reportable diseases. This method prompted early detection of outbreaks of community-acquired legionellosis and shigellosis.
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Picard-Masson M, Lajoie É, Lord J, Lalancette C, Marchand G, Levac É, Lemieux MA, Hudson P, Lajoie L. Two Related Occupational Cases of Legionella longbeachae Infection, Quebec, Canada. Emerg Infect Dis 2018; 22:1289-91. [PMID: 27314946 PMCID: PMC4918178 DOI: 10.3201/eid2207.160184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Two patients with no exposure to gardening compost had related Legionella longbeachae infections in Quebec, Canada. Epidemiologic investigation and laboratory results from patient and soil samples identified the patients’ workplace, a metal recycling plant, as the likely source of infection, indicating a need to suspect occupational exposure for L. longbeachae infections.
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Stypułkowska-Misiurewicz H, Czerwiński M. Legionellosis in Poland in 2016. Przegl Epidemiol 2018; 72:143-147. [PMID: 30111084] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of the study was to assess the epidemiological situation of legionellosis in Poland in 2016 in comparison to the preceding years. MATERIAL AND METHODS The assessment was based on national surveillance data published in the annual bulletin: “Infectious diseases and poisonings in Poland in 2016” and its prior versions along with data from legionellosis case reports sent from Sanitary-Epidemiological Stations to the Department of Epidemiology of NIPH - NIH. RESULTS In Poland, both two main forms of legionellosis - Legionnaires’ disease and Pontiac fever are routinely reported to the surveillance system. In 2016, a total of 27 cases of legionellosis were registered, including 25 cases of Legionnaires’ disease and 2 cases of Pontiac fever; in 2016, a total of 27 cases of legionellosis have been reported, including 25 cases of Legionnaires’ disease and 2 cases of Pontiac fever; the annual incidence rate 0.070 (per 100,000 population) was comparable to previous year (0.060) but almost twice as high as the median (incidence) for 2010-2014. The infections were reported in 11 provinces, including two, which in previous years usually did not register any cases; only two provinces (out of 16 in the country) have reported no cases in recent years. The incidence in men (0.080 per 100,000) was higher compared to women (0.055). All reported cases were sporadic and, except for one mild case of Legionnaires’ disease, required hospitalization. The Sanitary Inspection reported two fatal cases – both women aged 59 and 69. Twenty cases were autochthonous including four cases linked with contaminated water systems in hospitals. Seven cases were associated with travel abroad (to Germany, Russia, Greece, Australia, USA and Thailand). SUMMARY AND CONCLUSIONS Despite the increase in the number of cases in recent years as well as number of provinces, which detected cases, the annual incidence of legionellosis in Poland remains one of the lowest in the EU, which suggests that this infection is likely under-recognized and underdiagnosed in all provinces of the country.
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Affiliation(s)
| | - Michał Czerwiński
- National Institute of Public Health – National Institute of Hygiene in Warsaw, Department of Epidemiology and Surveillance
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Abstract
Legionellaceae are composed of a single genus, Legionella, which is currently comprised of over 52 species. L. pneumophila, L. micdadei, L. longbeachae, and L. dumoffi are clinically considered the most important, with L. pneumophila causing >90%1,7 of cases of legionnaires disease (LD). Since LD's recognition in 1976 following an outbreak of pneumonia involving delegates of an American Legion convention in Philadelphia, there has been increased awareness and importance of the isolation, detection, and reporting of these cases. Herein we describe the unfortunate case of a 7 month old boy with undiagnosed LD that lead to respiratory insufficiency, sepsis, multisystem organ failure and death. Laboratory investigation methods, and clinical and pathological findings are discussed.
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Affiliation(s)
- Adam M Szewc
- Microbiology/Molecular Department, Phoenix Children's Hospital, Phoenix, AZ
| | - Steve Taylor
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, AZ
| | - Gary D Cage
- Microbiology/Molecular Department, Phoenix Children's Hospital, Phoenix, AZ
| | - Daphne de Mello
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, AZ
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Bacigalupe R, Lindsay D, Edwards G, Fitzgerald JR. Population Genomics of Legionella longbeachae and Hidden Complexities of Infection Source Attribution. Emerg Infect Dis 2017; 23:750-757. [PMID: 28418314 PMCID: PMC5403047 DOI: 10.3201/eid2305.161165] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Legionella longbeachae is the primary cause of legionellosis in Australasia and Southeast Asia and an emerging pathogen in Europe and the United States; however, our understanding of the population diversity of L. longbeachae from patient and environmental sources is limited. We analyzed the genomes of 64 L. longbeachae isolates, of which 29 were from a cluster of legionellosis cases linked to commercial growing media in Scotland in 2013 and 35 were non–outbreak-associated isolates from Scotland and other countries. We identified extensive genetic diversity across the L. longbeachae species, associated with intraspecies and interspecies gene flow, and a wide geographic distribution of closely related genotypes. Of note, we observed a highly diverse pool of L. longbeachae genotypes within compost samples that precluded the genetic establishment of an infection source. These data represent a view of the genomic diversity of L. longbeachae that will inform strategies for investigating future outbreaks.
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Patiño-Barbosa AM, Gil-Restrepo AF, Restrepo-Montoya V, Villamil-Gomez WE, Cardona-Ospina JA, Rodriguez-Morales AJ. Is Legionellosis Present and Important in Colombia? An Analyses of Cases from 2009 to 2013. Cureus 2017; 9:e1123. [PMID: 28465870 PMCID: PMC5409816 DOI: 10.7759/cureus.1123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/06/2022] Open
Abstract
Infection due to Legionella pneumophila has been not studied in Colombia, although it is present. The observational, retrospective study in which the incidence of legionellosis in Colombia, 2009-2013, was estimated based on data extracted from the personal health records system (Registro Individual de Prestación de Servicios, RIPS) using the ICD-10 codes A48.1 (Legionnaires' disease) and A48.2 (Pontiac Fever). Using official population estimates of the National Administrative Department of Statistics (DANE), crude and adjusted incidence rates were estimated (cases / 100,000 pop). During the period, 206 cases were reported (mean of 41.2 per year) for the cumulated national rate of 0.45 cases / 100,000 pop. The clinical form of legionellosis with the highest incidence rates was the non-pneumonic Legionnaires' disease (0.39 cases / 100,000 pop) with women being the main affected (0.42 cases / 100,000 pop). The territory with the highest incidence rate was Bolivar department (1.94 cases / 100,000 pop), followed by La Guajira (1.7 cases / 100,000 pop). Finally, age groups with the highest morbidity were 0-9.999 years old (1.16 cases / 100,000 pop) and system of identification for social subsidies beneficiaries (SISBEN) category with the highest number of total cases was level one (88 cases). According to these results, we can show that legionellosis in Colombia is more common than it could be thought. Nevertheless, cross-sectional and prospective studies should be conducted in our country in order to improve the knowledge of incidence, prevalence, and burden of disease.
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Affiliation(s)
| | | | | | - Wilmer E Villamil-Gomez
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo
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Abstract
Legionella pneumophila, the causative agent of Legionnaires' disease, is a Gram-negative gammaproteobacterial pathogen that infects and intracellularly replicates in human macrophages and a variety of protozoa. L. pneumophila encodes an orphan biosynthetic gene cluster (BGC) that contains isocyanide-associated biosynthetic genes and is upregulated during infection. Because isocyanide-functionalized metabolites are known to harbor invertebrate innate immunosuppressive activities in bacterial pathogen-insect interactions, we used pathway-targeted molecular networking and tetrazine-based chemoseletive ligation chemistry to characterize the metabolites from the orphan pathway in L. pneumophila. We also assessed their intracellular growth contributions in an amoeba and in murine bone-marrow-derived macrophages. Unexpectedly, two distinct groups of aromatic amino acid-derived metabolites were identified from the pathway, including a known tyrosine-derived isocyanide and a family of new N-acyl-l-histidine metabolites.
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Affiliation(s)
- Thomas Tørring
- Interdiscplinary Nanoscience Center, Aarhus University, Gustav Wieds Vej 14, 8000, Aarhus C, Denmark
| | - Stephanie R Shames
- Department of Microbial Pathogenesis, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Wooyoung Cho
- Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA.,Chemical Biology Institute, Yale University, 600 West Campus Drive, West Haven, CT, 06516, USA
| | - Craig R Roy
- Department of Microbial Pathogenesis, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Jason M Crawford
- Department of Microbial Pathogenesis, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.,Department of Chemistry, Yale University, 225 Prospect Street, New Haven, CT, 06511, USA.,Chemical Biology Institute, Yale University, 600 West Campus Drive, West Haven, CT, 06516, USA
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Stypułkowska-Misiurewicz H, Czerwiński M. Legionellosis in Poland in 2015. Przegl Epidemiol 2017; 71:333-337. [PMID: 29181967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of the study was to assess the epidemiological situation of legionellosis in Poland in 2015 in comparison to the preceding years. MATERIAL AND METHODS We reviewed data published in the annual bulletin: “Infectious diseases and poisonings in Poland in 2015” and its prior versions along with the legionellosis case reports sent from Sanitary- Epidemiological Stations to the Department of Epidemiology of NIPH - NIH. RESULTS In Poland, both two forms of legionellosis - Legionnaires’ disease (a severe form of disease accompanied by pneumonia) and Pontiac fever (mild, influenza-like form of infection) - are notifiable. In 2015, a total of 23 cases of Legionnaires’ disease have been reported (there were no reports of Pontiac fever). The annual incidence rate 0.060 (per 100,000 population) slightly increased when compared to previous year as well as to the median (incidence) for 2009-2013. The infections were reported in 10 provinces, including five, which in previous years usually did not register any cases; however, there is a number of provinces that did not identify any LD cases in recent years. The incidence in males (0.097 per 100,000) was almost 4-times higher compared to females (0.025). Except for one cluster of two, all cases were sporadic; All patients required hospitalization. The Sanitary Inspection reported four fatal cases – all men 43- 67 years/old. Eighteen cases were likely acquired in the country, including a cluster of two cases linked with contaminated building water system. Four cases were associated with travels abroad (to Russia, Croatia, United Arab Emirates and USA) and in one case the exposure occurred during the transport of goods (lorry driver). SUMMARY AND CONCLUSIONS This study suggests, that legionellosis is likely under recognized and under diagnosed in all provinces of the country. Geographical variations in incidence may reflect local differences in availability of laboratory tests for LD. Number of detected cases - without information on the number of laboratory tests performed - do not appear to be sufficient to fully assess the epidemiological situation.
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Hampton LM, Garrison L, Kattan J, Brown E, Kozak-Muiznieks NA, Lucas C, Fields B, Fitzpatrick N, Sapian L, Martin-Escobar T, Waterman S, Hicks LA, Alpuche-Aranda C, Lopez-Gatell H. Legionnaires' Disease Outbreak at a Resort in Cozumel, Mexico. Open Forum Infect Dis 2016; 3:ofw170. [PMID: 27704023 PMCID: PMC5047414 DOI: 10.1093/ofid/ofw170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 06/05/2016] [Accepted: 08/05/2016] [Indexed: 11/24/2022] Open
Abstract
An investigation of a Legionnaires' disease outbreak at a Cozumel Island resort identified the source of the first reported Legionnaires' disease outbreak in Mexico and highlighted the need for all countries to make Legionnaires' disease a reportable disease. Background. A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease. Methods. Reports of LD among travelers were solicited from US health departments and the European Working Group for Legionella Infections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possible Legionella exposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested for Legionella. Results. Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers. Legionellae were found to have extensively colonized the resort's potable water system. Legionellae matching a case isolate were found in the resort's potable water system. Conclusions. Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so.
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Affiliation(s)
- Lee M Hampton
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Laurel Garrison
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Jessica Kattan
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office; Connecticut Department of Public Health, Hartford
| | - Ellen Brown
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | | | - Claressa Lucas
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Barry Fields
- Division of Global Health Protection, Center for Global Health
| | - Nicole Fitzpatrick
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Luis Sapian
- Instituto de Diagnóstico y Referencia Epidemiologicos , Ciudad de Mexico, Distrito Federal
| | | | - Stephen Waterman
- Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases , Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Lauri A Hicks
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases
| | - Celia Alpuche-Aranda
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos , Mexico
| | - Hugo Lopez-Gatell
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública , Cuernavaca, Morelos , Mexico
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Bédard E, Boppe I, Kouamé S, Martin P, Pinsonneault L, Valiquette L, Racine J, Prévost M. Combination of Heat Shock and Enhanced Thermal Regime to Control the Growth of a Persistent Legionella pneumophila Strain. Pathogens 2016; 5:E35. [PMID: 27092528 DOI: 10.3390/pathogens5020035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022] Open
Abstract
Following nosocomial cases of Legionella pneumophila, the investigation of a hot water system revealed that 81.5% of sampled taps were positive for L. pneumophila, despite the presence of protective levels of copper in the water. A significant reduction of L. pneumophila counts was observed by culture after heat shock disinfection. The following corrective measures were implemented to control L. pneumophila: increasing the hot water temperature (55 to 60 °C), flushing taps weekly with hot water, removing excess lengths of piping and maintaining a water temperature of 55 °C throughout the system. A gradual reduction in L. pneumophila counts was observed using the culture method and qPCR in the 18 months after implementation of the corrective measures. However, low level contamination was retained in areas with hydraulic deficiencies, highlighting the importance of maintaining a good thermal regime at all points within the system to control the population of L. pneumophila.
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Abstract
We report a rare case of cutaneous Legionella longbeachae infection in a patient receiving long-term corticosteroids for immune thrombocytopenia. Such infections cannot be identified by using Legionella urinary antigen testing but are commonly seen after exposure to commercial potting compost, particularly in immunocompromised patients.
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Smith SS, Ritger K, Samala U, Black SR, Okodua M, Miller L, Kozak-Muiznieks NA, Hicks LA, Steinheimer C, Ewaidah S, Presser L, Siston AM. Legionellosis Outbreak Associated With a Hotel Fountain. Open Forum Infect Dis 2015; 2:ofv164. [PMID: 26716104 PMCID: PMC4692259 DOI: 10.1093/ofid/ofv164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 07/27/2015] [Accepted: 09/30/2015] [Indexed: 12/04/2022] Open
Abstract
Background. In August 2012, the Chicago Department of Public Health (CDPH) was notified of acute respiratory illness, including 1 fatality, among a group of meeting attendees who stayed at a Chicago hotel during July 30–August 3, 2012. Suspecting Legionnaires' disease (LD), CDPH advised the hotel to close their swimming pool, spa, and decorative lobby fountain and began an investigation. Methods. Case finding included notification of individuals potentially exposed during July 16–August 15, 2012. Individuals were interviewed using a standardized questionnaire. An environmental assessment was performed. Results. One hundred fourteen cases were identified: 11 confirmed LD, 29 suspect LD, and 74 Pontiac fever cases. Illness onsets occurred July 21–August 22, 2012. Median age was 48 years (range, 22–82 years), 64% were male, 59% sought medical care (15 hospitalizations), and 3 died. Relative risks for hotel exposures revealed that persons who spent time near the decorative fountain or bar, both located in the lobby were respectively 2.13 (95%, 1.64–2.77) and 1.25 (95% CI, 1.09–1.44) times more likely to become ill than those who did not. Legionella pneumophila serogroup 1 was isolated from samples collected from the fountain, spa, and women's locker room fixtures. Legionella pneumophila serogroup 1 environmental isolates and a clinical isolate had matching sequence-based types. Hotel maintenance records lacked a record of regular cleaning and disinfection of the fountain. Conclusions. Environmental testing identified Legionella in the hotel's potable water system. Epidemiologic and laboratory data indicated the decorative fountain as the source. Poor fountain maintenance likely created favorable conditions for Legionella overgrowth.
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Affiliation(s)
| | | | - Usha Samala
- Chicago Department of Public Health, Illinois
| | | | | | | | | | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia
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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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Pancer KW. Cross-reactions in IgM ELISA tests to Legionella pneumophila sg1 and Bordetella pertussis among children suspected of legionellosis; potential impact of vaccination against pertussis? Cent Eur J Immunol 2015; 40:180-7. [PMID: 26557032 PMCID: PMC4637393 DOI: 10.5114/ceji.2015.52832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/16/2015] [Accepted: 04/03/2015] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was preliminary evaluation of IgM cross-reaction in sera collected from children hospitalized because of suspected legionellosis. Sera with positive IgM results to L. pneumophila sgs1-7, B. pertussis or with simultaneous detection of IgM antibodies to L. pneumophila sgs1-7 and B. pertussis, or IgM to L. pneumophila sgs1-7 and M. pneumoniae in routine tests, were selected. In total, an adapted pre-absorption test was used for the serological confirmation of legionellosis in the sera of 19 children suspected of legionellosis, and also in 3 adult persons with confirmed Legionnaires' disease. Sera were pre-absorbed with antigens of L. pneumophila sg1, B. pertussis or both, and tested by ELISA tests. The reduction of IgM antibody level by pre-absorption with antigen/antigens was determined. Reduction of anti-Lpsgs1-7 IgM by pre-absorption with L.pneumophila sg1 antigen ranged from 1.5 to 80, and reduction of anti-Bp IgM by pre-absorption with B. pertussis ranged from 2.0 to 23.8. Reduction by both antigens varied depending on the age of the patients: among children <4 yrs.old, the reduction of anti-B. pertussis IgM by both antigens was higher than for B. pertussis antigen alone. Based on the high difference (≥ 2 times) between reduction by L.pneumophila sg1 and by B. pertussis antigen, legionellosis was confirmed in 8/19 children. The majority of them also indicated IgM positive/borderline results for B. pertussis or M.pneumoniae in routine ELISA tests. As a preliminary, we posed a hypothesis of a potential impact of an anti-pertussis vaccination on the results obtained in anti-L. pneumophila ELISA IgM tests among young children.
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Pancer KW. Problem of immunoglobulin M co-detection in serological response to bacterial and viral respiratory pathogens among children suspected of legionellosis. Cent Eur J Immunol 2015; 40:174-9. [PMID: 26557031 DOI: 10.5114/ceji.2015.52831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/03/2015] [Indexed: 11/17/2022] Open
Abstract
The objective of this research was an analysis of the serological response to respiratory bacterial and viral pathogens, in 156 children admitted to hospital in Warsaw with a suspicion of legionellosis. Levels of immunoglobulin (Ig) M to Bordetella pertussis, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), adenoviruses, human parainfluenza virus (HPIV) t. 1-4 and influenza t. A + B viruses were determined retrospectively by ELISAs. In the prospective examinations (only Legionella pneumophila sg1), a positive level of IgM was found in 35 patients, but in 59 children together with retrospective tests. There were positive results for B. pertussis (21 children), followed by HPIV (10 children), M. pneumoniae (5 patients), RSV (4 persons), adenoviruses (3 children), and influenza A + B virus (3 persons). Positive results for > 1 agent were found in 16 children. The most often co-detected IgM were to L. pneumophila sg1 and B. pertussis (9 children) and L. pneumophila sg1 and M. pneumoniae (5 patients). The distribution of IgM to L. pneumophila sg1, B. pertussis and HPIV among children ≤ 4 years differed significantly from IgM specific to other pathogens. A high number of HPIV infections, mainly single, was found among infants. Positive results of IgM to L. pneumophila sg1 were mainly found in children aged 4-5 years. and the oldest children (over 10 years.). However, among the oldest children, anti-L. pneumophila sg1 antibodies were often found together with IgM to B. pertussis. Infections due to more than 2 pathogens were only observed among patients with pneumonia, especially due to L. pneumophila sg1 and/or B. pertussis. Conversely, co-detection of IgM ELISA for L. pneumophila and M. pneumoniae were mainly detected among patients hospitalized without pneumonia.
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McCoy WF, Rosenblatt AA. HACCP-Based Programs for Preventing Disease and Injury from Premise Plumbing: A Building Consensus. Pathogens 2015; 4:513-28. [PMID: 26184325 PMCID: PMC4584270 DOI: 10.3390/pathogens4030513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 03/31/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 12/22/2022] Open
Abstract
Thousands of preventable injuries and deaths are annually caused by microbial, chemical and physical hazards from building water systems. Water is processed in buildings before use; this can degrade the quality of the water. Processing steps undertaken on-site in buildings often include conditioning, filtering, storing, heating, cooling, pressure regulation and distribution through fixtures that restrict flow and temperature. Therefore, prevention of disease and injury requires process management. A process management framework for buildings is the hazard analysis and critical control point (HACCP) adaptation of failure mode effects analysis (FMEA). It has been proven effective for building water system management. Validation is proof that hazards have been controlled under operating conditions and may include many kinds of evidence including cultures of building water samples to detect and enumerate potentially pathogenic microorganisms. However, results from culture tests are often inappropriately used because the accuracy and precision are not sufficient to support specifications for control limit or action triggers. A reliable negative screen is based on genus-level Polymerase Chain Reaction (PCR) for Legionella in building water systems; however, building water samples with positive results from this test require further analysis by culture methods.
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Affiliation(s)
- William F McCoy
- Phigenics, LLC, 1701 Quincy Ave., Suite 32, Naperville, IL 60540, USA.
| | - Aaron A Rosenblatt
- Gordon & Rosenblatt, LLC, 45 Rockefeller Plaza, 20th Floor, New York, NY 10111, USA.
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Waldron PR, Martin BA, Ho DY. Mistaken identity: Legionella micdadei appearing as acid-fast bacilli on lung biopsy of a hematopoietic stem cell transplant patient. Transpl Infect Dis 2015; 17:89-93. [PMID: 25573597 DOI: 10.1111/tid.12334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 05/20/2014] [Revised: 09/09/2014] [Accepted: 10/21/2014] [Indexed: 11/28/2022]
Abstract
Legionella micdadei is a potential cause of invasive lung infections in immunocompromised hosts. On biopsy specimens, it can appear as an acid-fast bacillus (AFB) and can be mistaken for a member of genus Mycobacterium. As Legionella requires selective media to grow in culture, and the commonly used, commercially available urine antigen test for Legionella only detects Legionella pneumophila serogroup-1, but not L. micdadei, it is important to consider this organism in the differential diagnosis for AFB in immunocompromised hosts. We report a case of L. micdadei infection, which was initially treated empirically for non-tuberculous mycobacteria based on AFB staining of biopsy tissue before the final diagnosis was made.
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Affiliation(s)
- P R Waldron
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
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