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de Miguel-Balsa E, Jaimez Navarro E, Cascajero A, González-Camacho F, González-Rubio JM. Fulminant septic shock due to community-acquired pneumonia caused by Legionella pneumophila SG1 Olda OLDA ST1. Case report. J Infect Public Health 2024; 17:1047-1049. [PMID: 38678725 DOI: 10.1016/j.jiph.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024] Open
Abstract
Legionellers' desease accounts for 1-8 % of cases of severe community-acquired pneumonia (CAP). Legionella spp. Is the causative organism that can result in respiratory failure, multi-organ dysfunction, sepsis, and death. Therefore, rapid diagnosis and efficient treatment are crucial. We report the clinical and microbiology study of a patient with community-acquired pneumonia caused by Legionella pneumophila, with fatal outcome. After death, the strain causing the infection was identified as Legionella pneumophila serogroup 1, Olda OLDA phenotype and sequence-type 1. This is the first reported case of septic shock and death associated with an isolate of these characteristics.
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Affiliation(s)
- Eva de Miguel-Balsa
- Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, Spain; Department of Clinical Medicine, Faculty of Medicine. Miguel Hernández University, Alicante, Spain
| | - Enrique Jaimez Navarro
- Servicio de Medicina Intensiva, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Almudena Cascajero
- Legionella Reference Laboratory, National Centre for Microbiology, Instituto de Salud, Carlos III, 28220 Majadahonda, Spain
| | - Fernando González-Camacho
- Legionella Reference Laboratory, National Centre for Microbiology, Instituto de Salud, Carlos III, 28220 Majadahonda, Spain.
| | - Juana María González-Rubio
- Legionella Reference Laboratory, National Centre for Microbiology, Instituto de Salud, Carlos III, 28220 Majadahonda, Spain.
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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] [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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Gumá M, Drasar V, Santandreu B, Cano R, Afshar B, Nicolau A, Bennassar M, del Barrio J, Crespi P, Crespi S. A community outbreak of Legionnaires' disease caused by outdoor hot tubs for private use in a hotel. Front Microbiol 2023; 14:1137470. [PMID: 37180254 PMCID: PMC10167275 DOI: 10.3389/fmicb.2023.1137470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/30/2023] [Indexed: 05/16/2023] Open
Abstract
During the period October-November 2017, an outbreak of Legionnaires' disease involving 27 cases occurred in the tourist area of Palmanova (Mallorca, Spain). The majority of cases were reported by the European Centre of Disease Prevention and Control (ECDC) as travel associated cases of Legionnaires' disease (TALD). Most cases belonged to different hotel cluster alerts. No cases were reported among the local population residing in the area. All tourist establishments associated with one or more TALD cases were inspected and sampled by public health inspectors. All relevant sources of aerosol emission detected were investigated and sampled. The absence of active cooling towers in the affected area was verified, by documents and on-site. Samples from hot tubs for private use located on the terraces of the penthouse rooms of a hotel in the area were included in the study. Extremely high concentrations (> 106 CFU/l) of Legionella pneumophila, including the outbreak strain, were found in the hot tubs of vacant rooms of this hotel thus identifying the probable source of infection. Meteorological situation may have contributed to the geographical distribution pattern of this outbreak. In conclusion, hot tubs for private use located outdoors should be considered when investigating community outbreaks of Legionnaires' disease of unclear origin.
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Affiliation(s)
- Mercedes Gumá
- Conselleria de Salut i Consum, Govern Balear, Palma de Mallorca, Spain
| | - Vladimir Drasar
- Public Health Institute Ostrava, National Legionella Reference Laboratory, Ostrava, Czechia
| | - Beatriz Santandreu
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Rosa Cano
- Centro Nacional de Epidemiología and CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Baharak Afshar
- Respiratory and Vaccine Preventable Bacteria Reference Unit (RVPBRU), UK Health Security Agency (UKHSA), London, United Kingdom
| | - Antonio Nicolau
- Conselleria de Salut i Consum, Govern Balear, Palma de Mallorca, Spain
| | - Magdalena Bennassar
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Jorge del Barrio
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Pau Crespi
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
| | - Sebastian Crespi
- Environmental Health and Laboratory Services, Biolinea Int., Palma de Mallorca, Spain
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Nilsen NS, Uldum SA. Legionella colonisation in hot water systems in care homes from two Danish municipalities. JOURNAL OF WATER AND HEALTH 2022; 20:1393-1404. [PMID: 36170193 DOI: 10.2166/wh.2022.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Legionnaires' disease is a serious health risk among the elderly. Water systems in care homes are therefore of particular interest. We investigated the levels of culturable Legionella in the hot water systems in care homes in two Danish municipalities. Two hundred and sixty-eight water samples from 98 care homes were evaluated. Contents of culturable Legionella counts were calculated, and correlations between temperature and colony-forming units (CFU/L) were analysed. Seventy-seven and 81%, respectively, of the care homes were colonised with Legionella in the two municipalities. Most care homes had less than 1,000 CFU/L, but 13 and 16% had more than 10,000 CFU/L. When including first flush samples, 27% of the care homes in Municipality 1 had Legionella levels above 10,000 CFU/L. Temperatures of ≥50 °C in Municipality 1 and ≥55 °C in Municipality 2 correlated with low levels of Legionella. The content of Legionella colonies was significantly higher in care homes in Municipality 1. However, a significantly higher proportion of taps in Municipality 2 had Legionella colonies. In conclusion, temperatures should be raised to 55 °C to avoid high Legionella levels. Test procedures should be evaluated, and the regular use of taps and routine testing for Legionella should be taken into consideration.
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Affiliation(s)
- Niss Skov Nilsen
- Danish Building Research Institute (Build), Division of Sustainability, Energy and Indoor Environment in Buildings, Aalborg University, A.C. Meyers Vaenge 15, 2450 Copenhagen SV, Denmark E-mail:
| | - Søren Anker Uldum
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut (SSI), Artillerivej 5, 2300 Copenhagen S, Denmark
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Girolamini L, Pascale MR, Mazzotta M, Spiteri S, Marino F, Salaris S, Grottola A, Orsini M, Cristino S. Combining Traditional and Molecular Techniques Supports the Discovery of a Novel Legionella Species During Environmental Surveillance in a Healthcare Facility. Front Microbiol 2022; 13:900936. [PMID: 35770167 PMCID: PMC9234573 DOI: 10.3389/fmicb.2022.900936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
Legionella surveillance plays a significant role not only to prevent the risk of infection but also to study the ecology of isolates, their characteristics, and how their prevalence changes in the environment. The difficulty in Legionella isolation, identification, and typing results in a low notification rate; therefore, human infection is still underestimated. In addition, during Legionella surveillance, the special attention given to Legionella pneumophila leads to an underestimation of the prevalence and risk of infection for other species. This study describes the workflow performed during environmental Legionella surveillance that resulted in the isolation of two strains, named 8cVS16 and 9fVS26, associated with the genus Legionella. Traditional and novel approaches such as standard culture technique, MALDI-TOF MS, gene sequencing, and whole-genome sequencing (WGS) analysis were combined to demonstrate that isolates belong to a novel species. The strain characteristics, the differences between macrophage infectivity potential (mip), RNA polymerase β subunit (rpoB), and reference gene sequences, the average nucleotide identity (ANI) of 90.4%, and the DNA–DNA digital hybridization (dDDH) analysis of 43% demonstrate that these isolates belong to a new Legionella species. The finding suggests that, during the culture technique, special attention should be paid to the characteristics of the isolates that are less associated with the Legionella genus in order to investigate the differences found using more sensitive methods. The characterization of the two newly discovered isolates based on morphological, biochemical, and microscopic characteristics is currently underway and will be described in another future study.
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Affiliation(s)
- Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Civil, Chemical, Environmental, and Materials Engineering, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Simona Spiteri
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Silvano Salaris
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Antonella Grottola
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Regional Reference Laboratory for Clinical Diagnosis of Legionellosis, Molecular Microbiology and Virology Unit, University Hospital-Policlinico Modena, Modena, Italy
| | - Massimiliano Orsini
- Laboratory of Microbial Ecology and Genomics of Microorganisms, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- *Correspondence: Sandra Cristino
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Scaturro M, Girolamini L, Pascale MR, Mazzotta M, Marino F, Errico G, Monaco M, Girolamo A, Rota MC, Ricci ML, Cristino S. Case Report: First Report of Fatal Legionella pneumophila and Klebsiella pneumoniae Coinfection in a Kidney Transplant Recipient. Front Med (Lausanne) 2022; 9:912649. [PMID: 35770012 PMCID: PMC9234666 DOI: 10.3389/fmed.2022.912649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
A very rare case of pulmonary Klebsiella pneumoniae-Legionella pneumophila coinfection in a double kidney transplanted man affected by the chronic renal disease is described. Cases of Legionnaires' disease with an incubation period of 14 days have rarely been documented. Despite the long period of hospitalization, typing of clinical and environmental L. pneumophila strains demonstrated that the patient's home water distribution system was the source of infection, highlighting that Legionella house contamination can be a hidden risk, especially for immune-compromised people.
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Affiliation(s)
- Maria Scaturro
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Luna Girolamini
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Giulia Errico
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonietta Girolamo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Luisa Ricci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sandra Cristino
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella Infections (ESGLI), Basel, Switzerland
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
- *Correspondence: Sandra Cristino
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7
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Pascale MR, Bisognin F, Mazzotta M, Girolamini L, Marino F, Dal Monte P, Cordovana M, Scaturro M, Ricci ML, Cristino S. Use of Fourier-Transform Infrared Spectroscopy With IR Biotyper® System for Legionella pneumophila Serogroups Identification. Front Microbiol 2022; 13:866426. [PMID: 35558114 PMCID: PMC9090449 DOI: 10.3389/fmicb.2022.866426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/11/2022] [Indexed: 01/09/2023] Open
Abstract
Legionella spp. are Gram-negative bacteria that inhabit freshwater environments representing a serious risk for human health. Legionella pneumophila (Lp) is the species most frequently responsible for a severe pneumonia known as Legionnaires' disease. Lp consists of 15 serogroups (Sgs), usually identified by monoclonal or polyclonal antibodies. With regard to Lp serogrouping, it is well known that phenotyping methods do not have a sufficiently high discriminating power, while genotypic methods although very effective, are expensive and laborious. Recently, mass spectrometry and infrared spectroscopy have proved to be rapid and successful approaches for the microbial identification and typing. Different biomolecules (e.g., lipopolysaccharides) adsorb infrared radiation originating from a specific microbial fingerprint. The development of a classification system based on the intra-species identification features allows a rapid and reliable typing of strains for diagnostic and epidemiological purposes. The aim of the study was the evaluation of Fourier Transform Infrared Spectroscopy using the IR Biotyper® system (Bruker Daltonik, Germany) for the identification of Lp at the serogroup (Sg) level for diagnostic purposes as well as in outbreak events. A large dataset of Lp isolates (n = 133) and ATCC reference strains representing the 15 Lp serogroups were included. The discriminatory power of the instrument's classifier, was tested by Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA). All isolates were classified as follows: 12/133 (9.0%) as Lp Sg1 and 115/133 (86.5%) as Lp Sg 2-15 (including both ATCC and environmental Lp serogroup). Moreover, a mis-classification for 2/133 (1.5%) isolates of Lp Sg 2-15 that returned as Lp Sg1 was observed, and 4/133 (3.0%) isolates were not classified. An accuracy of 95.49% and an error rate of 4.51% were calculated. IR Biotyper® is able provide a quick and cost-effective reliable Lp classification with advantages compared with agglutination tests that show ambiguous and unspecific results. Further studies including a larger number of isolates could be useful to implement the classifier obtaining a robust and reliable tool for the routine Lp serogrouping. IR Biotyper® could be a powerful and easy-to-use tool to identify Lp Sgs, especially during cluster/outbreak investigations, to trace the source of the infection and promptly adopt preventive and control strategies.
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Affiliation(s)
- Maria Rosaria Pascale
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Francesco Bisognin
- Microbiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Federica Marino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - Paola Dal Monte
- Microbiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Maria Scaturro
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Luisa Ricci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
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8
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Courboules C, Dournon N, Lawrence C, Noussair L, Descours G, Sivadon-Tardy V, Jarraud S, Herrmann JL, Gaillard JL, Espinasse F, El Sayed F, Roux AL. Non- Legionella pneumophila serogroup 1 pneumonia: Diagnosis of a nosocomial legionellosis with the Biofire Pneumonia plus panel. IDCases 2022; 28:e01487. [PMID: 35369568 PMCID: PMC8967999 DOI: 10.1016/j.idcr.2022.e01487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
We report a nosocomial case of Legionella pneumophila pneumonia caused by a serogroup 10 strain diagnosed with the Biofire® Pneumonia plus panel. Molecular investigations of the environment of the patient allowed us to identify the source of contamination.
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Affiliation(s)
- Camille Courboules
- Laboratoire de Microbiologie, APHP, CHU Ambroise Paré, Boulogne Billancourt, France
| | - Nathalie Dournon
- Equipe Mobile d'Infectiologie, APHP, CHU Ambroise Paré, Boulogne Billancourt, France
| | - Christine Lawrence
- Equipe Opérationnelle d'Hygiène, APHP, CHU Raymond Poincaré, Garches, France
| | - Latifa Noussair
- Laboratoire de Microbiologie, APHP, CHU Raymond Poincaré, Garches, France
| | - Ghislaine Descours
- Centre National de Référence des Legionella, Université de Lyon, INSERME U851, et Hospices Civils de Lyon, Lyon, France
| | | | - Sophie Jarraud
- Centre National de Référence des Legionella, Université de Lyon, INSERME U851, et Hospices Civils de Lyon, Lyon, France
| | | | - Jean-Louis Gaillard
- Laboratoire de Microbiologie, APHP, CHU Ambroise Paré, Boulogne Billancourt, France
| | - Florence Espinasse
- Equipe Opérationnelle d'Hygiène, APHP, CHU Ambroise Paré, Boulogne Billancourt, France
| | - Faten El Sayed
- Laboratoire de Microbiologie, APHP, CHU Ambroise Paré, Boulogne Billancourt, France
| | - Anne-Laure Roux
- Laboratoire de Microbiologie, APHP, CHU Ambroise Paré, Boulogne Billancourt, France
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9
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Ricci ML, Fillo S, Ciammaruconi A, Lista F, Ginevra C, Jarraud S, Girolamo A, Barbanti F, Rota MC, Lindsay D, Gorzynski J, Uldum SA, Baig S, Foti M, Petralito G, Torri S, Faccini M, Bonini M, Gentili G, Senatore S, Lamberti A, Carrico JA, Scaturro M. Genome analysis of Legionella pneumophila ST23 from various countries reveals highly similar strains. Life Sci Alliance 2022; 5:5/6/e202101117. [PMID: 35236759 PMCID: PMC8899845 DOI: 10.26508/lsa.202101117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/30/2022] Open
Abstract
ST23 isolated in Italy are analysed by cgMLST and SNP approaches and they are also compared with ST23 from other countries. They are found to be phylogenetically related independently on year, town, or country of isolation. Legionella pneumophila serogroup 1 (Lp1) sequence type (ST) 23 is one of the most commonly detected STs in Italy where it currently causes all investigated outbreaks. ST23 has caused both epidemic and sporadic cases between 1995 and 2018 and was analysed at genomic level and compared with ST23 isolated in other countries to determine possible similarities and differences. A core genome multi-locus sequence typing (cgMLST), based on a previously described set of 1,521 core genes, and single-nucleotide polymorphisms (SNPs) approaches were applied to an ST23 collection including genomes from Italy, France, Denmark and Scotland. DNAs were automatically extracted, libraries prepared using NextEra library kit and MiSeq sequencing performed. Overall, 63 among clinical and environmental Italian Lp1 isolates and a further seven and 11 ST23 from Denmark and Scotland, respectively, were sequenced, and pangenome analysed. Both cgMLST and SNPs analyses showed very few loci and SNP variations in ST23 genomes. All the ST23 causing outbreaks and sporadic cases in Italy and elsewhere, were phylogenetically related independent of year, town or country of isolation. Distances among the ST23s were further shortened when SNPs due to horizontal gene transfers were removed. The Lp1 ST23 isolated in Italy have kept their monophyletic origin, but they are phylogenetically close also to ST23 from other countries. The ST23 are quite widespread in Italy, and a thorough epidemiological investigation is compelled to determine sources of infection when this ST is identified in both LD sporadic cases and outbreaks.
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Affiliation(s)
- Maria Luisa Ricci
- Department of Infectious Diseases Istituto Superiore di Sanità, Rome, Italy.,ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Silvia Fillo
- Scientific Department, Army Medical Center, Rome, Italy
| | | | | | - Christophe Ginevra
- CIRI, Centre International de Recherche en Infectiologie, Legionella Pathogenesis Team, University of Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France; National Reference Centre of Legionella, Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France.,ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sophie Jarraud
- Universitè Lyon 1, CNR Legionella, Lyon, France.,ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | | | - Fabrizio Barbanti
- Department of Infectious Diseases Istituto Superiore di Sanità, Rome, Italy
| | | | - Diane Lindsay
- Scottish Microbiology Reference Laboratories, Glasgow, Scotland.,ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Jamie Gorzynski
- Scottish Microbiology Reference Laboratories, Glasgow, Scotland
| | - Søren A Uldum
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen S, Denmark.,ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Sharmin Baig
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen S, Denmark
| | - Marina Foti
- Agency for Health Protection of Metropolitan Area of Milan (ATS), Milan, Italy
| | | | - Stefania Torri
- Department of Laboratory of Medicine, Hospital Niguarda, Ca' Granda, Milan, Italy
| | - Marino Faccini
- Agency for Health Protection of Metropolitan Area of Milan (ATS), Milan, Italy
| | - Maira Bonini
- Agency for Health Protection of Metropolitan Area of Milan (ATS), Milan, Italy
| | - Gabriella Gentili
- Agency for Health Protection of Metropolitan Area of Milan (ATS), Milan, Italy
| | - Sabrina Senatore
- Agency for Health Protection of Metropolitan Area of Milan (ATS), Milan, Italy
| | - Anna Lamberti
- Agency for Health Protection of Metropolitan Area of Milan (ATS), Milan, Italy
| | - Joao André Carrico
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
| | - Maria Scaturro
- Department of Infectious Diseases Istituto Superiore di Sanità, Rome, Italy .,ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
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10
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Krøvel AV, Bernhoff E, Austerheim E, Soma MA, Romstad MR, Löhr IH. Legionella pneumophila in Municipal Shower Systems in Stavanger, Norway; A Longitudinal Surveillance Study Using Whole Genome Sequencing in Risk Management. Microorganisms 2022; 10:microorganisms10030536. [PMID: 35336109 PMCID: PMC8954845 DOI: 10.3390/microorganisms10030536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 12/10/2022] Open
Abstract
Following an incidence of Legionnaires disease (LD) in 2007, where a municipal shower system was the likely source of infection, Stavanger municipality initiated a surveillance program for Legionella as part of establishing internal risk evaluation and prevention routines. More than 250 shower systems were examined for cultivatable Legionella pneumophila. The prevalence and diversity of serogroups (sg) and sequence types (STs) of L. pneumophila were mapped using available typing techniques over a period of more than 10 years (2010–2021). The surveillance showed an overall reduction in the L. pneumophila colonisation rate in municipal systems from 11 to 4.5% following prevention measures during the period, with the highest colonisation rate in complex systems (e.g., larger nursing homes and sports complexes). Further, an approximately even distribution between sg1 and 2–14 was seen. Whole genome sequencing (WGS) revealed that only a limited number of STs were detected, and they were consistent at specific locations over time. This study showed that environmental surveillance data in combination with available typing techniques and WGS can give the municipality a better tool for risk management and an overview of ST distributions that can be a valuable asset in future source investigations.
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Affiliation(s)
- Anne Vatland Krøvel
- NORCE—Norwegian Research Centre, Environment Department, Professor Olav Hansenssvei 15, N-4021 Stavanger, Norway;
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
- Correspondence:
| | - Eva Bernhoff
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
| | - Elin Austerheim
- NORCE—Norwegian Research Centre, Environment Department, Professor Olav Hansenssvei 15, N-4021 Stavanger, Norway;
| | - Markus André Soma
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
| | - Monica Regine Romstad
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
| | - Iren Høyland Löhr
- National Reference Laboratory for Legionella, Department of Medical Microbiology, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway; (E.B.); (M.A.S.); (M.R.R.); (I.H.L.)
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11
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A Tale of Four Danish Cities: Legionella pneumophila Diversity in Domestic Hot Water and Spatial Variations in Disease Incidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052530. [PMID: 35270223 PMCID: PMC8909801 DOI: 10.3390/ijerph19052530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023]
Abstract
Denmark has one of the highest Legionnaires' disease notification rates within Europe, averaging 4.7 cases per 100,000 population annually (2017 to 2020). The relatively high incidence of disease is not uniform across the country, and approximately 70% of all domestically acquired cases in Denmark are caused by Legionella pneumophila (LP) strains that are considered less virulent. The aim of this study was to investigate if colonization rates, levels of colonization, and/or types of LP present in hot water systems were associated with geographic differences in Legionnaires' disease incidence. Domestic water systems from four cities in Denmark were analyzed via culture and qPCR. Serogrouping and sequence typing was performed on randomly selected isolates. Single nucleotide polymorphism was used to identify clonal relationship among isolates from the four cities. The results revealed a high LP colonization rate from 68% to 87.5% among systems, composed primarily of non-serogroup 1. LP serogroup 1 reacting with the monoclonal antibody (MAb) 3/1 was not identified in any of the systems tested, while MAb 3/1 negative serogroup 1 strains were isolated from 10 systems (9.6%). We hypothesize that a combination of factors influences the incidence rate of LD in each city, including sequence type and serogroup distribution, colonization rate, concentration of Legionella in Pre-flush and Flush samples, and potentially building characteristics such as water temperature measured at the point of use.
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12
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Knežević M, Rončević D, Vukić Lušić D, Mihelčić M, Kogoj R, Keše D, Glad M, Cenov A, Ožanič M, Glažar Ivče D, Šantić M. Decreasing Pasteurization Treatment Efficiency against Amoeba-Grown Legionella pneumophila—Recognized Public Health Risk Factor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031099. [PMID: 35162120 PMCID: PMC8834526 DOI: 10.3390/ijerph19031099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/16/2022]
Abstract
Legionellae are gram-negative bacteria most commonly found in freshwater ecosystems and purpose-built water systems. In humans, the bacterium causes Legionnaires’ disease (LD) or a Pontiac fever. In this study, the different waters (drinking water, pool water, cooling towers) in which Legionella pneumophila has been isolated were studied to assess the possible risk of bacterial spreading in the population. The influence of physical and chemical parameters, and interactions with Acanthamoeba castellanii on L. pneumophila, were analyzed by Heterotrophic Plate Count, the Colony-forming units (CFU) methods, transmission electron microscopy (TEM), and Sequence-Based Typing (SBT) analysis. During the study period (2013–2019), a total of 1932 water samples were analyzed, with the average annual rate of Legionella-positive water samples of 8.9%, showing an increasing trend. The largest proportion of Legionella-positive samples was found in cooling towers and rehabilitation centers (33.9% and 33.3%, respectively). Among the isolates, L. pneumophila SGs 2–14 was the most commonly identified strain (76%). The survival of Legionella was enhanced in the samples with higher pH values, while higher electrical conductivity, nitrate, and free residual chlorine concentration significantly reduced the survival of Legionella. Our results show that growth in amoeba does not affect the allelic profile, phenotype, and morphology of the bacterium but environmental L. pneumophila becomes more resistant to pasteurization treatment.
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Affiliation(s)
- Maša Knežević
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
| | - Dobrica Rončević
- Department of Epidemiology, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia;
- Department of Public Health, Faculty of Health Studies, Viktora Cara Emina 5, 51000 Rijeka, Croatia
| | - Darija Vukić Lušić
- Department of Environmental Health, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
- Department of Environmental Health, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia; (M.G.); (A.C.)
- Center for Advanced Computing and Modeling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
- Correspondence: ; Tel.: +385-(0)51-358-755
| | - Mirna Mihelčić
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
| | - Rok Kogoj
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloska 4, 1000 Ljubljana, Slovenia; (R.K.); (D.K.)
| | - Darja Keše
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloska 4, 1000 Ljubljana, Slovenia; (R.K.); (D.K.)
| | - Marin Glad
- Department of Environmental Health, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia; (M.G.); (A.C.)
| | - Arijana Cenov
- Department of Environmental Health, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia; (M.G.); (A.C.)
| | - Mateja Ožanič
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
| | - Daniela Glažar Ivče
- Branch Office Rab, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Palit 143a, 51280 Rab, Croatia;
| | - Marina Šantić
- Department of Microbiology and Parasitology, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia; (M.K.); (M.M.); (M.O.); (M.Š.)
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13
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Trousil J, Frgelecová L, Kubíčková P, Řeháková K, Drašar V, Matějková J, Štěpánek P, Pavliš O. Acute Pneumonia Caused by Clinically Isolated Legionella pneumophila Sg 1, ST 62: Host Responses and Pathologies in Mice. Microorganisms 2022; 10:microorganisms10010179. [PMID: 35056629 PMCID: PMC8781576 DOI: 10.3390/microorganisms10010179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Legionnaires’ disease is a severe form of lung infection caused by bacteria belonging to the genus Legionella. The disease severity depends on both host immunity and L. pneumophila virulence. The objective of this study was to describe the pathological spectrum of acute pneumonia caused by a virulent clinical isolate of L. pneumophila serogroup 1, sequence type 62. In A/JOlaHsd mice, we compared two infectious doses, namely, 104 and 106 CFU, and their impact on the mouse status, bacterial clearance, lung pathology, and blood count parameters was studied. Acute pneumonia resembling Legionnaires’ disease has been described in detail.
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Affiliation(s)
- Jiří Trousil
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Heyrovského nám. 2, 162 00 Prague, Czech Republic;
- Correspondence: or
| | - Lucia Frgelecová
- Department of Pathological Morphology and Parasitology, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic;
| | - Pavla Kubíčková
- Military Health Institute, Military Medical Agency, Tychonova 1, 160 00 Prague, Czech Republic; (P.K.); (O.P.)
| | - Kristína Řeháková
- Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Palackého tř. 1946/1, 612 42 Brno, Czech Republic;
| | - Vladimír Drašar
- National Legionella Reference Laboratory, Public Health Institute Ostrava, Masarykovo náměstí 16, 682 01 Vyškov, Czech Republic;
| | - Jana Matějková
- Department of Medical Microbiology, Second Faculty of Medicine, Charles University, Motol University Hospital, V Úvalu 84, 150 06 Prague, Czech Republic;
| | - Petr Štěpánek
- Institute of Macromolecular Chemistry, Czech Academy of Sciences, Heyrovského nám. 2, 162 00 Prague, Czech Republic;
| | - Oto Pavliš
- Military Health Institute, Military Medical Agency, Tychonova 1, 160 00 Prague, Czech Republic; (P.K.); (O.P.)
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14
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Wee BA, Alves J, Lindsay DSJ, Klatt AB, Sargison FA, Cameron RL, Pickering A, Gorzynski J, Corander J, Marttinen P, Opitz B, Smith AJ, Fitzgerald JR. Population analysis of Legionella pneumophila reveals a basis for resistance to complement-mediated killing. Nat Commun 2021; 12:7165. [PMID: 34887398 PMCID: PMC8660822 DOI: 10.1038/s41467-021-27478-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022] Open
Abstract
Legionella pneumophila is the most common cause of the severe respiratory infection known as Legionnaires' disease. However, the microorganism is typically a symbiont of free-living amoeba, and our understanding of the bacterial factors that determine human pathogenicity is limited. Here we carried out a population genomic study of 902 L. pneumophila isolates from human clinical and environmental samples to examine their genetic diversity, global distribution and the basis for human pathogenicity. We find that the capacity for human disease is representative of the breadth of species diversity although some clones are more commonly associated with clinical infections. We identified a single gene (lag-1) to be most strongly associated with clinical isolates. lag-1, which encodes an O-acetyltransferase for lipopolysaccharide modification, has been distributed horizontally across all major phylogenetic clades of L. pneumophila by frequent recent recombination events. The gene confers resistance to complement-mediated killing in human serum by inhibiting deposition of classical pathway molecules on the bacterial surface. Furthermore, acquisition of lag-1 inhibits complement-dependent phagocytosis by human neutrophils, and promoted survival in a mouse model of pulmonary legionellosis. Thus, our results reveal L. pneumophila genetic traits linked to disease and provide a molecular basis for resistance to complement-mediated killing.
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Affiliation(s)
- Bryan A. Wee
- grid.4305.20000 0004 1936 7988The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland UK
| | - Joana Alves
- grid.4305.20000 0004 1936 7988The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland UK
| | - Diane S. J. Lindsay
- Bacterial Respiratory Infections Service (Ex Mycobacteria), Scottish Microbiology Reference Laboratory, Glasgow, Scotland UK
| | - Ann-Brit Klatt
- grid.6363.00000 0001 2218 4662Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fiona A. Sargison
- grid.4305.20000 0004 1936 7988The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland UK
| | - Ross L. Cameron
- grid.413893.40000 0001 2232 4338NHS National Services Scotland, Health Protection Scotland, Glasgow, Scotland UK
| | - Amy Pickering
- grid.4305.20000 0004 1936 7988The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland UK
| | - Jamie Gorzynski
- grid.4305.20000 0004 1936 7988The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland UK
| | - Jukka Corander
- grid.7737.40000 0004 0410 2071Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland ,grid.5510.10000 0004 1936 8921Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Pekka Marttinen
- grid.500231.50000 0004 0530 9461Helsinki Institute for Information Technology, Department of Computer Science, Aalto University, Aalto, Finland
| | - Bastian Opitz
- grid.6363.00000 0001 2218 4662Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew J. Smith
- Bacterial Respiratory Infections Service (Ex Mycobacteria), Scottish Microbiology Reference Laboratory, Glasgow, Scotland UK ,grid.8756.c0000 0001 2193 314XCollege of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow, UK
| | - J. Ross Fitzgerald
- grid.4305.20000 0004 1936 7988The Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, Scotland UK
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15
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Kao AS, Myer S, Wickrama M, Ismail R, Hettiarachchi M. Multidisciplinary Management of Legionella Disease in Immunocompromised Patients. Cureus 2021; 13:e19214. [PMID: 34873543 PMCID: PMC8638927 DOI: 10.7759/cureus.19214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 12/26/2022] Open
Abstract
Legionella pneumonia is a gram-negative bacterial infection commonly associated with aerosol transmission from contaminated water sources. Impaired immunity leads to delayed clearance of infection and further predisposes individuals with Legionella pneumonia at risk of developing complications. We present a case report on a renal transplant patient with comorbid cardiac and renal dysfunction who developed community-acquired Legionella pneumonia. The case emphasizes the importance of adopting a multidisciplinary approach when managing Legionella infection in patients with multiple comorbidities and immunosuppressive states.
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Affiliation(s)
- Andrew S Kao
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Stephanie Myer
- Internal Medicine, Detroit Medical Center Sinai Grace Hospital, Detroit, USA
| | - Madappuli Wickrama
- Internal Medicine, Detroit Medical Center Sinai Grace Hospital, Detroit, USA
| | - Rana Ismail
- Medicine, Detroit Medical Center Sinai Grace Hospital, Detroit, USA
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16
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Scaturro M, Rota MC, Caporali MG, Girolamo A, Magoni M, Barberis D, Romano C, Cereda D, Gramegna M, Piro A, Corbellini S, Giagulli C, Rezza G, Caruso A, Ricci ML. A community-acquired Legionnaires' disease outbreak caused by Legionella pneumophila serogroup 2: an uncommon event, Italy, August to October 2018. ACTA ACUST UNITED AC 2021; 26. [PMID: 34169820 PMCID: PMC8229375 DOI: 10.2807/1560-7917.es.2021.26.25.2001961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In September 2018 in Brescia province, northern Italy, an outbreak of Legionnaires' disease (LD) caused by Legionella pneumophila serogroup 2 (Lp2) occurred. The 33 cases (two fatal) resided in seven municipalities along the Chiese river. All cases were negative by urinary antigen test (UAT) and most were diagnosed by real-time PCR and serology. In only three cases, respiratory sample cultures were positive, and Lp2 was identified and typed as sequence type (ST)1455. In another three cases, nested sequence-based typing was directly applied to respiratory samples, which provided allelic profiles highly similar to ST1455. An environmental investigation was undertaken immediately and water samples were collected from private homes, municipal water systems, cooling towers and the river. Overall, 533 environmental water samples were analysed and 34 were positive for Lp. Of these, only three samples, all collected from the Chiese river, were Lp2 ST1455. If and how the river water could have been aerosolised causing the LD cases remains unexplained. This outbreak, the first to our knowledge caused by Lp2, highlights the limits of UAT for LD diagnosis, underlining the importance of adopting multiple tests to ensure that serogroups other than serogroup 1, as well as other Legionella species, are identified.
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Affiliation(s)
- Maria Scaturro
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | | | - Michele Magoni
- Agency for Health Protection of Metropolitan Area of Milan, Milan, Italy
| | - Daria Barberis
- Public Health Laboratory, Agency for Health Protection of Brescia, Brescia, Italy
| | - Chiara Romano
- Public Health Laboratory, Agency for Health Protection of Brescia, Brescia, Italy
| | - Danilo Cereda
- Public Health Managment of Welfare, Lombardy Region, Milan, Italy
| | - Maria Gramegna
- Public Health Managment of Welfare, Lombardy Region, Milan, Italy
| | - Antonio Piro
- Agency for Health Protection of Valpadana, Mantova, Italy
| | - Silvia Corbellini
- Microbiology and Virology unit, Spedali Civili Brescia Hospital, Brescia, Italy
| | - Cinzia Giagulli
- Department of Molecular and Translational Medicine, Microbiology unit, University of Brescia, Brescia, Italy
| | - Giovanni Rezza
- Department of Health Prevention, Ministery of Health, Ministry of Health, Rome, Italy
| | - Arnaldo Caruso
- Department of Experimental and Applied Medicine, Section of Microbiology, Spedali Civili Hospital, Brescia, Italy
| | - Maria Luisa Ricci
- Department Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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17
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A Legionnaires' Disease Cluster in a Private Building in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136922. [PMID: 34203343 PMCID: PMC8297097 DOI: 10.3390/ijerph18136922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/18/2022]
Abstract
Legionnaires’ disease (LD) is a severe pneumonia caused by bacteria belonging to the genus Legionella. This is a major public health concern and infections are steadily increasing worldwide. Several sources of infection have been identified, but they have not always been linked to human isolates by molecular match. The well-known Legionella contamination of private homes has rarely been associated with the acquisition of the disease, although some patients never left their homes during the incubation period. This study demonstrated by genomic matching between clinical and environmental Legionella isolates that the source of an LD cluster was a private building. Monoclonal antibodies and sequence-based typing were used to type the isolates, and the results clearly demonstrated the molecular relationship between the strains highlighting the risk of contracting LD at home. To contain this risk, the new European directive on the quality of water intended for human consumption has introduced for the first time Legionella as a microbiological parameter to be investigated in domestic water systems. This should lead to a greater attention to prevention and control measures for domestic Legionella contamination and, consequently, to a possible reduction in community acquired LD cases.
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18
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Beauté J, Plachouras D, Sandin S, Giesecke J, Sparén P. Healthcare-Associated Legionnaires' Disease, Europe, 2008-2017. Emerg Infect Dis 2021; 26:2309-2318. [PMID: 32946366 PMCID: PMC7510712 DOI: 10.3201/eid2610.181889] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Healthcare-associated Legionnaires’ disease (HCA LD) can cause nosocomial outbreaks with high death rates. We compared community-acquired LD cases with HCA LD cases in Europe during 2008−2017 using data from The European Surveillance System. A total of 29 countries reported 40,411 community-acquired and 4,315 HCA LD cases. Of the HCA LD cases, 2,937 (68.1%) were hospital-acquired and 1,378 (31.9%) were linked to other healthcare facilities. The odds of having HCA LD were higher for women, children and persons <20 years of age, and persons >60 years of age. Out of the cases caused by Legionella pneumophila with a known serotype, community-acquired LD was more likely to be caused by L. pneumophila serogroup 1 (92.3%) than was HCA LD (85.1%). HCA LD patients were more likely to die. HCA LD is associated with specific patient demographics, causative strains, and outcomes. Healthcare facilities should consider these characteristics when designing HCA LD prevention strategies.
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19
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Cytotoxicity, Intracellular Replication, and Contact-Dependent Pore Formation of Genotyped Environmental Legionella pneumophila Isolates from Hospital Water Systems in the West Bank, Palestine. Pathogens 2021; 10:pathogens10040417. [PMID: 33915921 PMCID: PMC8066006 DOI: 10.3390/pathogens10040417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/15/2021] [Accepted: 03/28/2021] [Indexed: 12/02/2022] Open
Abstract
Legionella pneumophila is the causative agent of Legionnaires’ disease. Due to the hot climate and intermittent water supply, the West Bank, Palestine, can be considered a high-risk area for this often fatal atypical pneumonia. L. pneumophila occurs in biofilms of natural and man-made freshwater environments, where it infects and replicates intracellularly within protozoa. To correlate the genetic diversity of the bacteria in the environment with their virulence properties for protozoan and mammalian host cells, 60 genotyped isolates from hospital water systems in the West Bank were analyzed. The L. pneumophila isolates were previously genotyped by high resolution Multi Locus Variable Number of Tandem Repeat Analysis (MLVA-8(12)) and sorted according to their relationship in clonal complexes (VACC). Strains of relevant genotypes and VACCs were compared according to their capacity to infect Acanthamoeba castellanii and THP-1 macrophages, and to mediate pore-forming cytotoxicity in sheep red blood cells (sRBCs). Based on a previous detailed analysis of the biogeographic distribution and abundance of the MLVA-8(12)-genotypes, the focus of the study was on the most abundant L. pneumophila- genotypes Gt4(17), Gt6 (18) and Gt10(93) and the four relevant clonal complexes [VACC1, VACC2, VACC5 and VACC11]. The highly abundant genotypes Gt4(17) and Gt6(18) are affiliated with VACC1 and sequence type (ST)1 (comprising L. pneumophila str. Paris), and displayed seroroup (Sg)1. Isolates of these two genotypes exhibited significantly higher virulence potentials compared to other genotypes and clonal complexes in the West Bank. Endemic for the West Bank was the clonal complex VACC11 (affiliated with ST461) represented by three relevant genotypes that all displayed Sg6. These genotypes unique for the West Bank showed a lower infectivity and cytotoxicity compared to all other clonal complexes and their affiliated genotypes. Interestingly, the L. pneumophila serotypes ST1 and ST461 were previously identified by in situ-sequence based typing (SBT) as main causative agents of Legionnaires’ disease (LD) in the West Bank at a comparable level. Overall, this study demonstrates the site-specific regional diversity of L. pneumophila genotypes in the West Bank and suggests that a combination of MLVA, cellular infection assays and hierarchical agglomerative cluster analysis allows an improved genotype-based risk assessment.
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20
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Ito A, Yamamoto Y, Ishii Y, Okazaki A, Ishiura Y, Kawagishi Y, Takiguchi Y, Kishi K, Taguchi Y, Shinzato T, Okochi Y, Hayashi R, Nakamori Y, Kichikawa Y, Murata K, Takeda H, Higa F, Miyara T, Saito K, Ishikawa T, Ishida T, Tateda K. Evaluation of a novel urinary antigen test kit for diagnosing Legionella pneumonia. Int J Infect Dis 2020; 103:42-47. [PMID: 33176204 DOI: 10.1016/j.ijid.2020.10.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic utility of a novel test kit that could theoretically detect all serogroups of Legionella pneumophila for diagnosing Legionella pneumonia, in comparison with existing kits. METHODS This study was conducted in 16 hospitals in Japan from April 2016 to December 2018. Three urinary antigen test kits were used: the novel kit (LAC-116), BinaxNOW Legionella (Binax), and Q-line Kyokutou Legionella (Q-line). In addition, sputum culture and nucleic acid detection tests and serum antibody tests were performed where possible. The diagnostic accuracy and correlations of the novel kit with the two existing kits were analyzed. RESULTS In total, 56 patients were diagnosed with Legionella pneumonia. The sensitivities of LAC-116, Binax, and Q-line were 79%, 84%, and 71%, respectively. The overall match rate between LAC-116 and Binax was 96.8% and between LAC-116 and Q-line was 96.4%. One patient had L. pneumophila serogroup 2, and only LAC-116 showed a positive result, whereas Binax and Q-line did not. CONCLUSIONS The novel Legionella urinary antigen test kit was useful for diagnosing Legionella pneumonia. In addition, it could detect Legionella pneumonia caused by non-L. pneumophila serogroup 1.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.
| | - Yoshikazu Ishii
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan.
| | - Akihito Okazaki
- Department of Respiratory Medicine, Koseiren Takaoka Hospital, 5-10 Eirakumachi, Takaoka, Toyama 933-8555, Japan.
| | - Yoshihisa Ishiura
- First Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Yukio Kawagishi
- Department of Internal Medicine, Kurobe City Hospital, 1108-1 Mikkaichi, Kurobe, Toyama 938-8502, Japan.
| | - Yasuo Takiguchi
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, 1273-2 Aoba-chou, Chuo-ku, Chiba, Chiba 260-0852, Japan.
| | - Kazuma Kishi
- Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan.
| | - Takashi Shinzato
- Department of Infectious Diseases and Internal Medicine, Nakagami General Hospital, 610 Noborikawa, Okinawa, Okinawa 904-2195, Japan.
| | - Yasumi Okochi
- Department of Respiratory Medicine, Japan Community Health Care Organization, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0073, Japan.
| | - Ryuji Hayashi
- Clinical Oncology, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.
| | - Yoshitaka Nakamori
- Division of Respiratory Medicine, Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
| | - Yoshiko Kichikawa
- Division of Respiratory Medicine, Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
| | - Kengo Murata
- Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan.
| | - Hiroaki Takeda
- Department of Respiratory Medicine, Yamagata Saisei Hospital, 79-1 Okimachi, Yamagata, Yamagata 990-8545, Japan.
| | - Futoshi Higa
- Department of Internal Medicine, National Hospital Organization Okinawa Hospital, 3-20-14 Ganeko, Ginowan, Okinawa 901-2214, Japan.
| | - Takayuki Miyara
- Department of Infection Prevention and Control, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
| | - Keisuke Saito
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan.
| | - Takeo Ishikawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo 201-8601, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan.
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21
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Zayed AR, Pecellin M, Salah A, Alalam H, Butmeh S, Steinert M, Lesnik R, Brettar I, Höfle MG, Bitar DM. Characterization of Legionella pneumophila Populations by Multilocus Variable Number of Tandem Repeats (MLVA) Genotyping from Drinking Water and Biofilm in Hospitals from Different Regions of the West Bank. Pathogens 2020; 9:E862. [PMID: 33105606 PMCID: PMC7690423 DOI: 10.3390/pathogens9110862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 01/26/2023] Open
Abstract
The West Bank can be considered a high-risk area for Legionnaires' disease (LD) due to its hot climate, intermittent water supply and roof storage of drinking water. Legionella, mostly L. pneumophila, are responsible for LD, a severe, community-acquired and nosocomial pneumonia. To date, no extensive assessment of Legionella spp and L. pneumophila using cultivation in combination with molecular approaches in the West Bank has been published. Two years of environmental surveillance of Legionella in water and biofilms in the drinking water distribution systems (DWDS) of eight hospitals was carried out; 180 L. pneumophila strains were isolated, mostly from biofilms in DWDS. Most of the isolates were identified as serogroup (Sg) 1 (60%) and 6 (30%), while a minor fraction comprised Sg 8 and 10. Multilocus Variable number of tandem repeats Analysis using 13 loci (MLVA-8(12)) was applied as a high-resolution genotyping method and compared to the standard Sequence Based Typing (SBT). The isolates were genotyped in 27 MLVA-8(12) genotypes (Gt), comprising four MLVA clonal complexes (VACC 1; 2; 5; 11). The major fraction of isolates constituted Sequence Type (ST)1 and ST461. Most of the MLVA-genotypes were highly diverse and often unique. The MLVA-genotype composition showed substantial regional variability. In general, the applied MLVA-method made it possible to reproducibly genotype the isolates, and was consistent with SBT but showed a higher resolution. The advantage of the higher resolution was most evident for the subdivision of the large strain sets of ST1 and ST461; these STs were shown to be highly pneumonia-relevant in a former study. This shows that the resolution by MLVA is advantageous for back-tracking risk sites and for the avoidance of outbreaks of L. pneumophila. Overall, our results provide important insights into the detailed population structure of L. pneumophila, allowing for better risk assessment for DWDS.
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Affiliation(s)
- Ashraf R. Zayed
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany; (A.R.Z.); (M.P.); (R.L.); (I.B.)
- Department of Microbiology and Immunology, Al-Quds University, Abu-Dies, East Jerusalem 19356, Palestine; (A.S.); (H.A.); (S.B.); (D.M.B.)
| | - Marina Pecellin
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany; (A.R.Z.); (M.P.); (R.L.); (I.B.)
| | - Alaa Salah
- Department of Microbiology and Immunology, Al-Quds University, Abu-Dies, East Jerusalem 19356, Palestine; (A.S.); (H.A.); (S.B.); (D.M.B.)
| | - Hanna Alalam
- Department of Microbiology and Immunology, Al-Quds University, Abu-Dies, East Jerusalem 19356, Palestine; (A.S.); (H.A.); (S.B.); (D.M.B.)
| | - Suha Butmeh
- Department of Microbiology and Immunology, Al-Quds University, Abu-Dies, East Jerusalem 19356, Palestine; (A.S.); (H.A.); (S.B.); (D.M.B.)
| | - Michael Steinert
- Department of Life Sciences, Institute of Microbiology, Technical University of Braunschweig, Universitätsplatz 2, 38106 Braunschweig, Germany;
| | - Rene Lesnik
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany; (A.R.Z.); (M.P.); (R.L.); (I.B.)
| | - Ingrid Brettar
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany; (A.R.Z.); (M.P.); (R.L.); (I.B.)
| | - Manfred G. Höfle
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstrasse 7, 38124 Braunschweig, Germany; (A.R.Z.); (M.P.); (R.L.); (I.B.)
| | - Dina M. Bitar
- Department of Microbiology and Immunology, Al-Quds University, Abu-Dies, East Jerusalem 19356, Palestine; (A.S.); (H.A.); (S.B.); (D.M.B.)
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22
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Miyashita N, Higa F, Aoki Y, Kikuchi T, Seki M, Tateda K, Maki N, Uchino K, Ogasawara K, Kiyota H, Watanabe A. Distribution of Legionella species and serogroups in patients with culture-confirmed Legionella pneumonia. J Infect Chemother 2020; 26:411-417. [PMID: 32081644 DOI: 10.1016/j.jiac.2019.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/04/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Legionella species are consistently identified as some of the most common causative agents of severe community-acquired pneumonia (CAP) or nosocomial pneumonia. Although the number of reported Legionella infection cases is gradually increasing in Japan, most cases are diagnosed by a urinary antigen test, which identifies only L. pneumophila serogroup 1. Therefore, assessment of pneumonia-causing Legionella species and serogroups would be important. The Japan Society for Chemotherapy Legionella committee has collected the isolates and clinical information on cases of sporadic community-acquired Legionella pneumonia throughout Japan. Between December 2006 and March 2019, totally 140 sporadic cases were identified, in which L. pneumophila was the most frequently isolated species (90.7%) followed by L. bozemanae (3.6%), L. dumofii (3.6%), L. micdadei (1.4%), and L. longbeachae (0.7%). Among 127 isolates of L. pneumophila, 111 isolates were of serogroup 1, two of serogroup 2, four of serogroup 3, one of serogroup 4, one of serogroup 5, seven of serogroup 6, and one was of serogroup 10. We also assessed in vitro activity of antibiotics against these isolates and showed that quinolones and macrolides have potent anti-Legionella activity. Our study showed that pneumonia-causing Legionella species and serogroup distribution was comparable to that reported in former surveillances. L. pneumophila was the most common etiologic agent in patients with community-acquired Legionella pneumonia, and L. pneumophila serogroup 1 was the predominant serogroup.
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Affiliation(s)
- Naoyuki Miyashita
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan.
| | - Futoshi Higa
- National Hospital Organization Okinawa National Hospital, Japan
| | - Yosuke Aoki
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Masafumi Seki
- Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan
| | - Nobuko Maki
- Taisho Toyama Pharmaceutical Co., Ltd, Japan
| | | | | | - Hiroshi Kiyota
- Department of Urology, The Jikei University Katsushika Medical Center, Japan
| | - Akira Watanabe
- Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Japan
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23
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Community Acquired Legionnaire's Disease in a Kidney Transplant Patient. ACTA ACUST UNITED AC 2019; 39:45-49. [PMID: 30864362 DOI: 10.2478/prilozi-2018-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This case report details the clinical picture of a renal transplant recipient infected with community acquired Legionella pneumonia. While it is more commonly associated as a nosocomial infection due to pathogenic organisms in a hospital's water supply, this case serves as a reminder to consider the patient's impaired cellular immune function when trying to diagnose community acquired pneumonia.
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24
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Jiang L, Amemura-Maekawa J, Ren H, Li Y, Sakata M, Zhou H, Murai M, Chang B, Ohnishi M, Qin T. Distribution of lag-1 Alleles, ORF7, and ORF8 Genes of Lipopolysaccharide and Sequence-Based Types Among Legionella pneumophila Serogroup 1 Isolates in Japan and China. Front Cell Infect Microbiol 2019; 9:274. [PMID: 31448241 PMCID: PMC6691400 DOI: 10.3389/fcimb.2019.00274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/17/2019] [Indexed: 01/08/2023] Open
Abstract
Approximately 85% of cases of Legionnaires' disease are caused by Legionella pneumophila serogroup 1. In this study, we analyzed the distribution of lag-1 alleles, ORF 7 and ORF 8 genes of lipopolysaccharide (LPS) and sequence-based types of 616 L. pneumophila serogroup 1 strains isolated in Japan (206 clinical, 225 environmental) and China (13 clinical and 172 environmental). The lag-1 gene was harbored by significantly more of the clinical isolates compared with the environmental isolates (90.3 vs. 19.1% and 61.6 vs. 3.0%, respectively; both P < 0.001). ORF 7 genes were detected in 51.0% of Japanese clinical and 36.0% of Japanese environmental (P = 0.001) isolates, as well as 15.3% of Chinese clinical and 9.9% of Chinese environmental isolates (P = 0.544). ORF 8 genes were detected in 12.1% of Japanese clinical and 5.8% of Japanese environmental (P = 0.017) isolates, as well as 7.7% of Chinese clinical and 3.4% of Chinese environmental isolates (P = 0.388). The Japanese and Chinese isolates were assigned to 203 and 36 different sequence-types (ST), respectively. ST1 was predominant. Most isolates with the same ST also had the same lag-1, ORF 7, and ORF 8 gene subgroups. In conclusion, the lag-1 was present in most of the clinical isolates, but was absent from most of the environmental isolates from both China and Japan, regardless of the water source and SBT type. PCR-based serotyping and subgrouping methods can be used to define a hierarchy of virulence genotypes that require stringent surveillance to prevent human disease.
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Affiliation(s)
- Luxi Jiang
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China.,Department of Respiratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Junko Amemura-Maekawa
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hongyu Ren
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China
| | - Yinan Li
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China
| | - Miho Sakata
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Miyo Murai
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tian Qin
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centre for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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25
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Sharaby Y, Rodríguez-Martínez S, Höfle MG, Brettar I, Halpern M. Quantitative microbial risk assessment of Legionella pneumophila in a drinking water supply system in Israel. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 671:404-410. [PMID: 30933796 DOI: 10.1016/j.scitotenv.2019.03.287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
Legionella pneumophila cause human infections via inhalation of contaminated water aerosols, resulting in severe pneumonia. Legionella spp. prevalence was monitored in a drinking-water distribution system (DWDS) in Northern Israel. Five points (toilet faucets and showers) were sampled seasonally along a three years period. Toilet faucets and shower use, both generating aerosols, are known transmission routes for this pathogen and thus, present a potential health risk. Quantitative Microbial Risk Assessment (QMRA) was applied in order to assess the health risks posed by Legionella for these two exposure scenarios, while considering Legionella seasonality. The obtained results were compared with estimated tolerable risk levels of infection and of disease set by the USEPA and WHO. Both limits were expressed as Disability-Adjusted Life Years index (DALY) being 1 × 10-4 and 1 × 10-6, respectively. The QMRA revealed that the annual risk levels for both faucets and showers use exceeded the acceptable risk of infection with an average of 5.52 × 10-4 and 2.37 × 10-3 DALY'S per person per year, respectively. Annual risk levels were stable with no significant differences between the three years. Risk levels varied significantly between seasons by up to three orders of magnitude. Risk levels were highest during summer, autumn, and lowest during winter. The highest seasonal infection risk values were found in summer for both faucets and showers, which corresponded to 8.09 × 10-4 and 2.75 × 10-3 DALY'S per person per year, respectively. In conclusion, during summer and autumn there is a significant increase of the infection risk associated with exposure to Legionella-contaminated aerosols, in the studied water system. Public health assessment and prevention measures should focus on these seasons.
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Affiliation(s)
- Y Sharaby
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel.
| | - S Rodríguez-Martínez
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
| | - M G Höfle
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - I Brettar
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - M Halpern
- Department of Evolutionary and Environmental Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel; Department of Biology and Environment, Faculty of Natural Sciences, University of Haifa, Oranim, Tivon, Israel
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26
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Cluster of Legionnaires' Disease in an Italian Prison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112062. [PMID: 31212678 PMCID: PMC6604178 DOI: 10.3390/ijerph16112062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Legionella pneumophila (Lp) is the most common etiologic agent causing Legionnaires' Disease (LD). Water systems offer the best growth conditions for Lp and support its spread by producing aerosols. From 2015 to 2017, the Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis of Palermo monitored the presence of Lp in nine prisons in Western Sicily. During this investigation, we compared Lp isolates from environmental samples in a prison located in Palermo with isolates from two prisoners in the same prison. METHODS We collected 93 water samples from nine Sicilian prisons and the bronchoalveolar lavages (BALs) of two prisoners considered cases of LD. These samples were processed following the procedures described in the Italian Guidelines for the Prevention and Control of Legionellosis of 2015. Then, genotyping was performed on 19 Lp colonies (17 from water samples and 2 from clinical samples) using the Sequence-Based Typing (SBT) method, according to European Study Group for Legionella Infections (ESGLI) protocols. RESULTS Lp serogroup (sg) 6 was the most prevalent serogroup isolated from the prisons analyzed (40%), followed by Lp sg 1 (16%). Most of all, in four penitentiary institutions, we detected a high concentration of Lp >104 Colony Forming Unit/Liter (CFU/L). The environmental molecular investigation found the following Sequence Types (STs) in Lp sg 6: ST 93, ST 292, ST 461, ST 728, ST 1317 and ST 1362, while most of the isolates in sg 1 belonged to ST 1. We also found a new ST that has since been assigned the number 2451 in the ESGLI-SBT database. From the several Lp sg 1 colonies isolated from the two BALs, we identified ST 2451. CONCLUSIONS In this article, we described the results obtained from environmental and epidemiological investigations of Lp isolated from prisons in Western Sicily. Furthermore, we reported the first cluster of Legionnaires' in an Italian prison and the molecular typing of Lp sg 1 from one prison's water system and two BALs, identified the source of the contamination, and discovered a new ST.
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Natås OB, Brekken AL, Bernhoff E, Hetland MAK, Löhr IH, Lindemann PC. Susceptibility of Legionella pneumophila to antimicrobial agents and the presence of the efflux pump LpeAB. J Antimicrob Chemother 2019; 74:1545-1550. [DOI: 10.1093/jac/dkz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Olav Bjarte Natås
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Anita Løvås Brekken
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Eva Bernhoff
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Iren Høyland Löhr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Paul Christoffer Lindemann
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Quero S, Párraga-Niño N, Sabria M, Barrabeig I, Sala MR, Jané M, Mateu L, Sopena N, Pedro-Botet ML, Garcia-Nuñez M. Legionella SBT applied directly to respiratory samples as a rapid molecular epidemiological tool. Sci Rep 2019; 9:623. [PMID: 30679570 PMCID: PMC6346096 DOI: 10.1038/s41598-018-36924-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/29/2018] [Indexed: 11/09/2022] Open
Abstract
Legionnaires' disease (LD) is an atypical pneumonia caused by the inhalation of Legionella. The methods used for the diagnosis of LD are direct culture of respiratory samples and urinary antigen detection. However, the sensitivity of culture is low, and the urinary antigen test is specific only for L. pneumophila sg1. Moreover, as no isolates are obtained, epidemiological studies cannot be performed. The implementation of Nested-sequence-based typing (Nested-SBT) makes it possible to carry out epidemiological studies while also confirming LD, especially in cases caused by non-sg 1. Sixty-two respiratory samples from patients with Legionella clinically confirmed by positive urinary antigen tests were cultured and tested by Nested-SBT, following the European Study Group for Legionella Infections (ESGLI) protocol. Only 2/62 (3.2%) respiratory samples were culture-positive. Amplification and sequencing of Nested-SBT genes were successfully performed in 57/62 samples (91.9%). The seven target genes were characterised in 39/57 (68.4%) respiratory samples, and the complete sequence type (ST) was obtained. The mip gene was the most frequently amplified and sequenced. Nested-SBT is a useful method for epidemiological studies in culture-negative samples, achieving a 28.7-fold improvement over the results of culture studies and reducing the time needed to obtain molecular epidemiological results.
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Affiliation(s)
- Sara Quero
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | - Noemí Párraga-Niño
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Miquel Sabria
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain. .,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Irene Barrabeig
- Vigilància Epidemiològica i Resposta a Emergències de Salut Pública, Agencia de Salut Pública de Catalunya, Barcelona, Spain
| | - Maria Rosa Sala
- Vigilància Epidemiològica i Resposta a Emergències de Salut Pública, Agencia de Salut Pública de Catalunya, Barcelona, Spain
| | - Mireia Jané
- Vigilància Epidemiològica i Resposta a Emergències de Salut Pública, Agencia de Salut Pública de Catalunya, Barcelona, Spain
| | - Lourdes Mateu
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Nieves Sopena
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria Luisa Pedro-Botet
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Marian Garcia-Nuñez
- Infectious Diseases Unit, Fundació Institut d'Investigació Germans Trias i Pujol, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain. .,Hospital Universitari Parc Taulí, Sabadell, Spain.
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David S, Mentasti M, Lai S, Vaghji L, Ready D, Chalker VJ, Parkhill J. Spatial structuring of a Legionella pneumophila population within the water system of a large occupational building. Microb Genom 2018; 4. [PMID: 30312149 PMCID: PMC6249432 DOI: 10.1099/mgen.0.000226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The diversity of Legionella pneumophila populations within single water systems is not well understood, particularly in those unassociated with cases of Legionnaires’ disease. Here, we performed genomic analysis of 235 L. pneumophila isolates obtained from 28 water samples in 13 locations within a large occupational building. Despite regular treatment, the water system of this building is thought to have been colonized by L. pneumophila for at least 30 years without evidence of association with Legionnaires’ disease cases. All isolates belonged to one of three sequence types (STs), ST27 (n=81), ST68 (n=122) and ST87 (n=32), all three of which have been recovered from Legionnaires’ disease patients previously. Pairwise single nucleotide polymorphism differences amongst isolates of the same ST were low, ranging from 0 to 19 in ST27, from 0 to 30 in ST68 and from 0 to 7 in ST87, and no homologous recombination was observed in any lineage. However, there was evidence of horizontal transfer of a plasmid, which was found in all ST87 isolates and only one ST68 isolate. A single ST was found in 10/13 sampled locations, and isolates of each ST were also more similar to those from the same location compared with those from different locations, demonstrating spatial structuring of the population within the water system. These findings provide the first insights into the diversity and genomic evolution of a L. pneumophila population within a complex water system not associated with disease.
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Affiliation(s)
- Sophia David
- 1Pathogen Genomics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK.,2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK.,†Present address: The Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Cambridge, UK
| | - Massimo Mentasti
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK.,‡Present address: Microbiology Cardiff, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - Sandra Lai
- 3Food, Water and Environmental Laboratory, Public Health England, Colindale, London, UK
| | - Lalita Vaghji
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK
| | - Derren Ready
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK
| | - Victoria J Chalker
- 2Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Colindale, London, UK
| | - Julian Parkhill
- 1Pathogen Genomics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
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30
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Montagna MT, De Giglio O, Napoli C, Diella G, Rutigliano S, Agodi A, Auxilia F, Baldovin T, Bisetto F, Arnoldo L, Brusaferro S, Busetti M, Calagreti G, Casini B, Cristina ML, Di Luzio R, Fiorio M, Formoso M, Liguori G, Martini E, Molino A, Mondello P, Mura I, Novati R, Orsi GB, Patroni A, Poli A, Privitera G, Ripabelli G, Rocchetti A, Rose F, Sarti M, Savini S, Silvestri A, Sodano L, Spagnolo AM, Tardivo S, Teti V, Torregrossa MV, Torri E, Veronesi L, Zarrilli R, Pacifico C, Goglio A, Moro M, Pasquarella C. Control and prevention measures for legionellosis in hospitals: A cross-sectional survey in Italy. ENVIRONMENTAL RESEARCH 2018; 166:55-60. [PMID: 29864633 DOI: 10.1016/j.envres.2018.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
Risk assessment, environmental monitoring, and the disinfection of water systems are the key elements in preventing legionellosis risk. The Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine, and Public Health and the Italian Multidisciplinary Society for the Prevention of Health Care-Associated Infections carried out a national cross-sectional survey to investigate the measures taken to prevent and control legionellosis in Italian hospitals. A multiple-choice questionnaire was developed, comprising 71 questions regarding hospital location, general characteristics, clinical and environmental surveillance, and control and preventive measures for legionellosis in 2015. Overall, 739 hospitals were enrolled from February to June 2017, and 178 anonymous questionnaires were correctly completed and evaluated (response rate: 24.1%). The survey was conducted using the SurveyMonkey® platform, and the data were analyzed using Stata 12 software. Of the participating hospitals, 63.2% reported at least one case of legionellosis, of which 28.2% were of proven nosocomial origin. The highest case numbers were reported in the Northern Italy, in hospitals with a pavilion structure or cooling towers, and in hospitals with higher numbers of beds, wards and operating theaters. Laboratory diagnosis was performed using urinary antigen testing alone (31.9%), both urinary antigen testing and single antibody titer (17.8%), or with seroconversion also added (21.5%). Culture-based or molecular investigations were performed in 28.8% and 22.1% of the clinical specimens, respectively. The water systems were routinely tested for Legionella in 97.4% of the hospitals, 62% of which detected a positive result (> 1000 cfu/L). Legionella pneumophila serogroup 2-15 was the most frequently isolated species (58.4%). The most common control measures were the disinfection of the water system (73.7%), mostly through thermal shock (37.4%) and chlorine dioxide (34.4%), and the replacement (69.7%) or cleaning (70.4%) of faucets and showerheads. A dedicated multidisciplinary team was present in 52.8% of the hospitals, and 73% of the hospitals performed risk assessment. Targeted training courses were organized in 36.5% of the hospitals, involving nurses (30.7%), physicians (28.8%), biologists (21.5%), technicians (26.4%), and cleaners (11%). Control and prevention measures for legionellosis are present in Italian hospitals, but some critical aspects should be improved. More appropriate risk assessment is necessary, especially in large facilities with a high number of hospitalizations. Moreover, more sensitive diagnostic tests should be used, and dedicated training courses should be implemented.
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Affiliation(s)
- Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy.
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Christian Napoli
- Department of Medical and S urgical Sciences and Translational Medicine, Sapienza University of Roma, Square A. Moro 5, 00185 Roma, Italy
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Square G. Cesare 11, 70124 Bari, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', University of Catania, Str. S. Sofia, 87, Comparto 10 Edificio C, 95123 Catania, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milano, Str. Pascal 36, 20133 Milano, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Hygiene and Public Health Unit, Str. Loredan, 18.35131 Padova, Italy
| | - Francesco Bisetto
- Presidio Ospedaliero di Camposampiero, AULss6 Euganea Str. P. Cosma 1, 35012 Camposampiero, PD, Italy
| | - Luca Arnoldo
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Silvio Brusaferro
- Department of Medicine, University of Udine, Str. Colugna 50, 33100 Udine, Italy
| | - Marina Busetti
- University Hospital ASUITS, Microbiology Unit, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Gioia Calagreti
- Hospital "Alto Tevere", AUSL Umbria 1, Città di Castello, PG, Italy
| | - Beatrice Casini
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | | | | | - Maurizio Formoso
- Hospital "Miulli", Str. 127 km 4.1, Santeramo-Acquaviva delle Fonti, BA, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University "Parthenope", Napoli, Italy
| | - Enrica Martini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Andrea Molino
- Hospital "Madonna delle Grazie", Contrada Cattedra Ambulante s.nc. 75100 Matera, Italy
| | | | - Ida Mura
- Department of Biomedical Science, University of Sassari, Sassari, Italy
| | | | - Giovanni Battista Orsi
- Department of Public Health and Infectious Disease, Sapienza University of Roma, Roma, Italy
| | - Andrea Patroni
- ASST Valcamonica, Str. Manzoni 142, 25040 Esine, BS, Italy
| | - Anna Poli
- Hospital "San Giovanni di Dio", Str. Torre Galli 3, 50143 Firenze, Italy
| | - Gaetano Privitera
- Department of Translational Research, N.T.M.S. - Hygiene and Epidemiology Unit, University of Pisa, Str. S. Zeno 35-39, 56127 Pisa, Italy
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Andrea Rocchetti
- ASO "SS. Antonio, Biagio and C. Arrigo", Str. Venezia 17, 15121 Alessandria, Italy
| | | | - Mario Sarti
- Hospital "OCSAE", Str. Giardini 1355, Baggiovara, MO, Italy
| | - Sandra Savini
- AOU "Ospedali Riuniti", Str. Conca, 71, 60126 Ancona, Italy
| | - Antonio Silvestri
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Luisa Sodano
- Hospital "San Camillo Forlanini", Circonvallazione Gianicolense 87, 00152 Roma, Italy
| | - Anna Maria Spagnolo
- Department of Health Sciences, University of Genova, Str. A. Pastore 1, 16132 Genova, Italy
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University of Verona, Str. Le Grazie 8, 37134 Verona, Italy
| | | | - Maria Valeria Torregrossa
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Str. Vespro, 133, 90127 Palermo, Italy
| | - Emanuele Torri
- Department of Health ans Social Policy, Str. Gilli 4, 38123 Trento, Italy
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
| | - Raffaele Zarrilli
- Department of Public Health, University of Napoli "Federico II", Str. S. Pansini, 5, Napoli, Italy
| | - Claudia Pacifico
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Matteo Moro
- Hospital "San Raffaele", Str. Olgettina 60, 20132 Milano, Italy
| | - Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, Str. Volturno 39, Parma, Italy
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Schrammel B, Cervero-Aragó S, Dietersdorfer E, Walochnik J, Lück C, Sommer R, Kirschner A. Differential development of Legionella sub-populations during short- and long-term starvation. WATER RESEARCH 2018; 141:417-427. [PMID: 29685632 DOI: 10.1016/j.watres.2018.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
Legionellae are among the most important waterborne pathogens in industrialized countries. Monitoring and surveillance of Legionella in engineered water systems is usually performed with culture-based methods. Since the advent of culture-independent techniques, it has become clear that Legionella concentrations are often several orders of magnitude higher than those measured by culture-based techniques and that a variable proportion of these non-culturable cells are viable. In engineered water systems, the formation of these viable but non-culturable (VBNC) cells can be caused by different kinds of stress, such as, and most importantly, nutrient starvation, oxidative stress and heat. In this study, the formation of VBNC cells of six Legionella strains under conditions of starvation was monitored in mono-species microcosms for up to one year using a combination of different viability indicators. Depending on the strain, complete loss of culturability was observed from 11 days to 8 weeks. During the starvation process, three distinct phases and different sub-populations of VBNC cells were identified. Until complete loss of culturability, the number of membrane-intact cells decreased rapidly to 5.5-69% of the initial cell concentration. The concentration of the sub-population with low esterase activity dropped to 0.03-55%, and the concentration of the highly esterase-active sub-population dropped to 0.01-1.2% of the initial concentration; these sub-populations remained stable for several weeks to months. Only after approximately 200 days of starvation, the number of VBNC cells started to decrease below detection limits. The most abundant VBNC sub-populations were characterized by partially damaged membranes and low esterase-activity. With this study, we showed that upon starvation, a stable VBNC Legionella community may be present over several months in a strain-dependent manner even under harsh conditions. Even after one year of starvation, a small proportion of L. pneumophila cells with high esterase-activity was detected. We speculate that this highly active VBNC subpopulation is able to infect amoebae and human macrophages.
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Affiliation(s)
- Barbara Schrammel
- Institute for Hygiene and Applied Immunology, Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Sílvia Cervero-Aragó
- Institute for Hygiene and Applied Immunology, Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria; Interuniversity Cooperation Centre for Water and Health, Austria
| | - Elisabeth Dietersdorfer
- Institute for Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Julia Walochnik
- Institute for Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Christian Lück
- Institute for Medical Microbiology and Hygiene, Medical Faculty "Carl Gustav Carus", Technical University Dresden, Germany
| | - Regina Sommer
- Institute for Hygiene and Applied Immunology, Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria; Interuniversity Cooperation Centre for Water and Health, Austria
| | - Alexander Kirschner
- Institute for Hygiene and Applied Immunology, Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria; Interuniversity Cooperation Centre for Water and Health, Austria.
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Dietersdorfer E, Kirschner A, Schrammel B, Ohradanova-Repic A, Stockinger H, Sommer R, Walochnik J, Cervero-Aragó S. Starved viable but non-culturable (VBNC) Legionella strains can infect and replicate in amoebae and human macrophages. WATER RESEARCH 2018; 141:428-438. [PMID: 29409685 DOI: 10.1016/j.watres.2018.01.058] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 05/22/2023]
Abstract
Legionella infections are among the most important waterborne infections with constantly increasing numbers of cases in industrialized countries, as a result of aging populations, rising numbers of immunocompromised individuals and increased need for conditioned water due to climate change. Surveillance of water systems is based on microbiological culture-based techniques; however, it has been shown that high percentages of the Legionella populations in water systems are not culturable. In the past two decades, the relevance of such viable but non-culturable (VBNC) legionellae has been controversially discussed, and whether VBNC legionellae can directly infect human macrophages, the primary targets of Legionella infections, remains unclear. In this study, it was demonstrated for the first time that several starved VBNC Legionella strains (four L. pneumophila serogroup 1 strains, a serogroup 6 strain and a L. micdadei strain) can directly infect different types of human macrophages and amoebae even after one year of starvation in ultrapure water. However, under these conditions, the strains caused infection with reduced efficacy, as represented by the lower percentages of infected cells, prolonged time in co-culture and higher multiplicities of infection required. Interestingly, the VBNC cells remained mostly non-culturable even after multiplication within the host cells. Amoebal infection by starved VBNC Legionella, which likely occurs in oligotrophic biofilms, would result in an increase in the bacterial concentration in drinking-water systems. If cells remain in the VBNC state, the real number of active legionellae will be underestimated by the use of culture-based standard techniques. Thus, further quantitative research is needed in order to determine, whether and how many starved VBNC Legionella cells are able to cause disease in humans.
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Affiliation(s)
- Elisabeth Dietersdorfer
- Medical University of Vienna, Institute of Specific Prophylaxis and Tropical Medicine, Department of Medical Parasitology, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Alexander Kirschner
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria.
| | - Barbara Schrammel
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Anna Ohradanova-Repic
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Lazarettgasse 19, A-1090 Vienna, Austria
| | - Hannes Stockinger
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Lazarettgasse 19, A-1090 Vienna, Austria
| | - Regina Sommer
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria
| | - Julia Walochnik
- Medical University of Vienna, Institute of Specific Prophylaxis and Tropical Medicine, Department of Medical Parasitology, Kinderspitalgasse 15, A-1090, Vienna, Austria.
| | - Sílvia Cervero-Aragó
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090, Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Vienna, Austria
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Valavane A, Chaudhry R, Malhotra P. Multiplex polymerase chain reaction of genetic markers for detection of potentially pathogenic environmental Legionella pneumophila isolates. Indian J Med Res 2018; 146:392-400. [PMID: 29355148 PMCID: PMC5793476 DOI: 10.4103/ijmr.ijmr_623_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background & objectives: Genomic constitution of the bacterium Legionella pneumophila plays an important role in providing them a pathogenic potential. Here, we report the standardization and application of multiplex polymerase chain reaction (PCR) for the detection of molecular markers of pathogenic potential in L. pneumophila in hospital environment. Methods: Culture of the standard strains of L. pneumophila was performed in buffered charcoal-yeast extract agar with L-cysteine at pH 6.9. Primers were designed for multiplex PCR, and standardization for the detection of five markers annotated to L. pneumophila plasmid pLPP (11A2), lipopolysaccharide synthesis (19H4), CMP-N-acetylneuraminic acid synthetase (10B12), conjugative coupling factor (24B1) and hypothetical protein (8D6) was done. A total of 195 water samples and 200 swabs were collected from the hospital environment. The bacterium was isolated from the hospital environment by culture and confirmed by 16S rRNA gene PCR and restriction enzyme analysis. A total of 45 L. pneumophila isolates were studied using the standardized multiplex PCR. Results: The PCR was sensitive to detect 0.1 ng/μl DNA and specific for the two standard strains used in the study. Of the 45 hospital isolates tested, 11 isolates had four markers, 12 isolates had three markers, 10 isolates had two markers, nine isolates had one marker and three isolates had none of the markers. None of the isolates had all the five markers. Interpretation & conclusions: The findings of this study showed the presence of gene markers of pathogenic potential of the bacterium L. pneumophila. However, the genomic constitution of the environmental isolates should be correlated with clinical isolates to prove their pathogenic potential. Rapid diagnostic methods such as multiplex PCR reported here, for elucidating gene markers, could help in future epidemiological studies of bacterium L. pneumophila.
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Affiliation(s)
- Arvind Valavane
- 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
| | - Pawan Malhotra
- International Centre for Genetic Engineering & Biotechnology, New Delhi, India
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Schrammel B, Petzold M, Cervero-Aragó S, Sommer R, Lück C, Kirschner A. Persistent presence of outer membrane epitopes during short- and long-term starvation of five Legionella pneumophila strains. BMC Microbiol 2018; 18:75. [PMID: 30016940 PMCID: PMC6050704 DOI: 10.1186/s12866-018-1220-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/29/2018] [Indexed: 11/25/2022] Open
Abstract
Background Legionella pneumophila, the causative agent of Legionnaire’s disease, may enter a viable but non-culturable (VBNC) state triggered by environmental stress conditions. Specific outer-membrane epitopes of L. pneumophila are used in many diagnostic applications and some of them are linked to important virulence-related factors or endotoxins. However, it is not clear how the presence and status of these epitopes are influenced by environmental stress conditions. In this study, changes of outer membrane epitopes for monoclonal antibodies (mAb) from the Dresden panel and the major outer membrane protein MOMP were analysed for five L. pneumophila strains during short- and long-term starvation in ultrapure water. Results With ELISA and single cell immuno-fluorescence analysis, we could show that for most of the investigated mAb-strain combinations the total number of mAb-stained Legionella cells stayed constant for up to 400 days. Especially the epitopes of mAb 3/1, 8/5, 26/1 and 20/1, which are specific for L. pneumophila serogroup 1 subtypes, and the mAb 9/1, specific for serogroup 6, showed long-term persistence. For most mAb- stained cells, a high percentage of viable cells was observed at least until 118 days of starvation. At the same time, we observed a reduction of the fluorescence intensity of the stained cells during starvation indicating a loss of epitopes from the cell surface. However, most of the epitopes, including the virulence-associated mAb 3/1 epitope were still present with high fluorescence intensity after 400 days of starvation in up to 50% of the starved L. pneumophila population. Conclusions The results demonstrate the continuous presence of outer membrane epitopes of L. pneumophila during short-term and long-term starvation. Thus, culture-independent mAb-based diagnostic and detection tools, such as immuno-magnetic separation and microarray techniques are applicable for both L. pneumophila in the culturable and the VBNC state even after long-term starvation but nevertheless require careful testing before application. However, the mere presence of those epitopes is not necessarily an indication of viability or infectivity. Electronic supplementary material The online version of this article (10.1186/s12866-018-1220-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barbara Schrammel
- Institute for Hygiene and Applied Immunology - Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090, Vienna, Austria
| | - Markus Petzold
- Institute for Medical Microbiology and Hygiene, Medical Faculty "Carl Gustav Carus", University of Technology Dresden, Dresden, Germany
| | - Sílvia Cervero-Aragó
- Institute for Hygiene and Applied Immunology - Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090, Vienna, Austria.,Interuniversity Cooperation Centre for Water and Health, Vienna, Austria
| | - Regina Sommer
- Institute for Hygiene and Applied Immunology - Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090, Vienna, Austria.,Interuniversity Cooperation Centre for Water and Health, Vienna, Austria
| | - Christian Lück
- Institute for Medical Microbiology and Hygiene, Medical Faculty "Carl Gustav Carus", University of Technology Dresden, Dresden, Germany
| | - Alexander Kirschner
- Institute for Hygiene and Applied Immunology - Water Hygiene, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090, Vienna, Austria. .,Interuniversity Cooperation Centre for Water and Health, Vienna, Austria.
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Torre I, Alfano R, Borriello T, De Giglio O, Iervolino C, Montagna MT, Scamardo MS, Pennino F. Environmental surveillance and in vitro activity of antimicrobial agents against Legionella pneumophila isolated from hospital water systems in Campania, South Italy: a 5-year study. ENVIRONMENTAL RESEARCH 2018; 164:574-579. [PMID: 29625340 DOI: 10.1016/j.envres.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/26/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Legionellosis' treatment failures have been recently reported showing the possibility of resistance development to traditional therapy, especially in healthcare related disease cases. Environmental impact of antibiotic residues, especially in hospital waters, may act on the resistome of Legionella resulting in developing resistance mechanisms. OBJECTIVES In this study we investigate the antibiotic susceptibility of environmental Legionella pneumophila (Lpn) strains isolated from hospital water systems in Campania, a region located in Southwest Italy. METHODS 5321 hospital water samples were investigated for the presence of Lpn. Among positive samples, antibiotic susceptibility was tested for a random subset of 125 Lpn strains (25 Lpn isolates from each of the following serogroups: 1, 3, 5, 6, 8). Susceptibility testing was performed, using the E-test on buffered charcoal yeast extract agar supplemented with α-ketoglutarate, for 10 antimicrobial drugs: azithromycin, cefotaxime, clarithromycin, doxycycline, erythromycin, rifampicin, tigecycline, ciprofloxacin, levofloxacin and moxifloxacin. Non parametric tests were used to determine and assess the significant differences in susceptibility to the different antimicrobics between the serogroups. RESULTS Among the isolated strains, none showed resistance to the antibiotics tested. Rifampicin was the most active antibiotic against overall Legionella strains, followed by levofloxacin. Between the macrolides the clarithromycin was overall the most active drug, instead the azithromycin was the less active. Analyzing the different serogroups a significant difference was found between serogroup 1 and non-1 serogroup isolates for doxycycline and tigecycline. CONCLUSIONS Antibiotic susceptibility of environmental isolates of Legionella spp. might be useful for the early detection of resistance to antibiotics that directly impacts on mortality and length of hospital stay.
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Affiliation(s)
- Ida Torre
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
| | - Rossella Alfano
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Tonia Borriello
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Carmela Iervolino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Marina Silvia Scamardo
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Francesca Pennino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
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Hamilton KA, Prussin AJ, Ahmed W, Haas CN. Outbreaks of Legionnaires’ Disease and Pontiac Fever 2006–2017. Curr Environ Health Rep 2018; 5:263-271. [DOI: 10.1007/s40572-018-0201-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Virulence Traits of Environmental and Clinical Legionella pneumophila Multilocus Variable-Number Tandem-Repeat Analysis (MLVA) Genotypes. Appl Environ Microbiol 2018. [PMID: 29523542 DOI: 10.1128/aem.00429-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Legionella pneumophila causes water-based infections resulting in severe pneumonia. Recently, we showed that different MLVA-8 (multilocus variable-number tandem-repeat analysis using 8 loci) genotypes dominated different sites of a drinking-water distribution system. Each genotype displayed a unique temperature-dependent growth behavior. Here we compared the pathogenicity potentials of different MLVA-8 genotypes of environmental and clinical strains. The virulence traits studied were hemolytic activity and cytotoxicity toward amoebae and macrophages. Clinical strains were significantly more hemolytic than environmental strains, while their cytotoxicity toward amoebae was significantly lower at 30°C. No significant differences were detected between clinical and environmental strains in cytotoxicity toward macrophages. Significant differences in virulence were observed between the environmental genotypes (Gt). Gt15 strains showed a significantly higher hemolytic activity. In contrast, Gt4 and Gt6 strains were more infective toward Acanthamoeba castellanii Moreover, Gt4 strains exhibited increased cytotoxicity toward macrophages and demonstrated a broader temperature range of amoebal lysis than Gt6 and Gt15 strains. Understanding the virulence traits of Legionella genotypes may improve the assessment of public health risks of Legionella in drinking water.IMPORTANCELegionella pneumophila is the causative agent of a severe form of pneumonia. Here we demonstrated that clinical strains were significantly more cytotoxic toward red blood cells than environmental strains, while their cytotoxicity toward macrophages was similar. Genotype 4 (Gt4) strains were highly cytotoxic toward amoebae and macrophages and lysed amoebae in a broader temperature range than to the other studied genotypes. The results can explain the relatively high success of Gt4 in the environment and in clinical samples; thus, Gt4 strains should be considered a main factor for the assessment of public health risks of Legionella in drinking water. Our findings shed light on the ecology, virulence, and pathogenicity potential of different L. pneumophila genotypes, which can be a valuable parameter for future modeling and quantitative microbial risk assessment of Legionella in drinking-water systems.
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Population structure of Environmental and Clinical Legionella pneumophila isolates in Catalonia. Sci Rep 2018; 8:6241. [PMID: 29674708 PMCID: PMC5908911 DOI: 10.1038/s41598-018-24708-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 04/09/2018] [Indexed: 11/13/2022] Open
Abstract
Legionella is the causative agent of Legionnaires’ disease (LD). In Spain, Catalonia is the region with the highest incidence of LD cases. The characterisation of clinical and environmental isolates using molecular epidemiology techniques provides epidemiological data for a specific geographic region and makes it possible to carry out phylogenetic and population-based analyses. The aim of this study was to describe and compare environmental and clinical isolates of Legionella pneumophila in Catalonia using sequence-based typing and monoclonal antibody subgrouping. A total of 528 isolates were characterised. For data analysis, the isolates were filtered to reduce redundancies, and 266 isolates (109 clinical and 157 environmental) were finally included. Thirty-two per cent of the clinical isolates were ST23, ST37 and ST1 while 40% of the environmental isolates were ST284 and ST1. Although the index of diversity was higher in clinical than in environmental ST isolates, we observed that clinical STs were similar to those recorded in other regions but that environmental STs were more confined to particular study areas. This observation supports the idea that only certain STs trigger cases or outbreaks in humans. Therefore, comparison of the genomes of clinical and environmental isolates could provide important information about the traits that favour infection or environmental persistence.
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Petzold M, Prior K, Moran-Gilad J, Harmsen D, Lück C. Epidemiological information is key when interpreting whole genome sequence data - lessons learned from a large Legionella pneumophila outbreak in Warstein, Germany, 2013. ACTA ACUST UNITED AC 2018; 22. [PMID: 29162202 PMCID: PMC5718391 DOI: 10.2807/1560-7917.es.2017.22.45.17-00137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Whole genome sequencing (WGS) is increasingly used in Legionnaires’ disease (LD) outbreak investigations, owing to its higher resolution than sequence-based typing, the gold standard typing method for Legionella pneumophila, in the analysis of endemic strains. Recently, a gene-by-gene typing approach based on 1,521 core genes called core genome multilocus sequence typing (cgMLST) was described that enables a robust and standardised typing of L. pneumophila. Methods: We applied this cgMLST scheme to isolates obtained during the largest outbreak of LD reported so far in Germany. In this outbreak, the epidemic clone ST345 had been isolated from patients and four different environmental sources. In total 42 clinical and environmental isolates were retrospectively typed. Results: Epidemiologically unrelated ST345 isolates were clearly distinguishable from the epidemic clone. Remarkably, epidemic isolates split up into two distinct clusters, ST345-A and ST345-B, each respectively containing a mix of clinical and epidemiologically-related environmental samples. Discussion/conclusion: The outbreak was therefore likely caused by both variants of the single sequence type, which pre-existed in the environmental reservoirs. The two clusters differed by 40 alleles located in two neighbouring genomic regions of ca 42 and 26 kb. Additional analysis supported horizontal gene transfer of the two regions as responsible for the difference between the variants. Both regions comprise virulence genes and have previously been reported to be involved in recombination events. This corroborates the notion that genomic outbreak investigations should always take epidemiological information into consideration when making inferences. Overall, cgMLST proved helpful in disentangling the complex genomic epidemiology of the outbreak.
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Affiliation(s)
- Markus Petzold
- The ESCMID Study Group for Legionella infections (ESGLI).,These authors contributed equally to the work.,Institute of Medical Microbiology and Hygiene, Dresden University of Technology, Dresden, Germany
| | - Karola Prior
- Department for Periodontology and Restorative Dentistry, University Hospital Muenster, Muenster, Germany.,These authors contributed equally to the work
| | - Jacob Moran-Gilad
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Public Health Services, Ministry of Health, Jerusalem, Israel.,The ESCMID Study Group for Legionella infections (ESGLI)
| | - Dag Harmsen
- Department for Periodontology and Restorative Dentistry, University Hospital Muenster, Muenster, Germany
| | - Christian Lück
- The ESCMID Study Group for Legionella infections (ESGLI).,Institute of Medical Microbiology and Hygiene, Dresden University of Technology, Dresden, Germany
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Wilmes D, Coche E, Rodriguez-Villalobos H, Kanaan N. Bacterial pneumonia in kidney transplant recipients. Respir Med 2018; 137:89-94. [PMID: 29605219 DOI: 10.1016/j.rmed.2018.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/06/2018] [Accepted: 02/26/2018] [Indexed: 12/16/2022]
Abstract
Bacterial pathogens are the most frequent cause of pneumonia after transplantation. Early after transplantation, recipients are at higher risk for nosocomial infections. The most commonly encountered pathogens during this period are gram-negative bacilli (Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa …), but gram-positive coccus such as Staphylococcus aureus or Streptococcus pneumoniae and anaerobic bacteria can also be found. Empirical antibiotic therapy should be guided by previous colonisation of the recipient and bacterial resistance pattern in the hospital. Six months after transplantation, pneumonias are mostly due to community-acquired bacteria (S. pneumonia, H. influenza, Mycoplasma, Chlamydia and others). Opportunistic pathogens take advantage of the state of immunosuppression which is usually highest from one to six months after transplantation. During this period, but also occurring many years later in the setting of a chronically depressed immune system, bacterial pathogens with low intrinsic virulence can cause pneumonia. The diagnosis of pneumonia caused by opportunistic pathogens can be challenging. The delay in diagnosis preventing the early instauration of adequate treatment in kidney transplant recipients with a depressed immune system, frequently coupled with co-morbid conditions and a state of frailty, will affect prognosis and outcome, increasing morbidity and mortality. This review will focus on the most common opportunistic bacterial pathogens causing pneumonia in kidney transplant recipients: Legionella, Nocardia, Mycobacterium tuberculosis/nontuberculous, and Rhodococcus. Recognition of their specificities in the setting of immunosuppression will allow early diagnosis, crucial for initiation of effective therapy and successful outcome. Interactions with immunosuppressive therapy should be considered as well as reducing immunosuppression if necessary.
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Affiliation(s)
- D Wilmes
- Division of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - E Coche
- Division of Radiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - H Rodriguez-Villalobos
- Division of Microbiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - N Kanaan
- Division of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
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Schjørring S, Stegger M, Kjelsø C, Lilje B, Bangsborg JM, Petersen RF, David S, Uldum SA. Genomic investigation of a suspected outbreak of Legionella pneumophila ST82 reveals undetected heterogeneity by the present gold-standard methods, Denmark, July to November 2014. ACTA ACUST UNITED AC 2017; 22:30558. [PMID: 28662761 PMCID: PMC5490456 DOI: 10.2807/1560-7917.es.2017.22.25.30558] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/16/2016] [Indexed: 12/20/2022]
Abstract
Between July and November 2014, 15 community-acquired cases of Legionnaires´ disease (LD), including four with Legionella pneumophila serogroup 1 sequence type (ST) 82, were diagnosed in Northern Zealand, Denmark. An outbreak was suspected. No ST82 isolates were found in environmental samples and no external source was established. Four putative-outbreak ST82 isolates were retrospectively subjected to whole genome sequencing (WGS) followed by phylogenetic analyses with epidemiologically unrelated ST82 sequences. The four putative-outbreak ST82 sequences fell into two clades, the two clades were separated by ca 1,700 single nt polymorphisms (SNP)s when recombination regions were included but only by 12 to 21 SNPs when these were removed. A single putative-outbreak ST82 isolate sequence segregated in the first clade. The other three clustered in the second clade, where all included sequences had < 5 SNP differences between them. Intriguingly, this clade also comprised epidemiologically unrelated isolate sequences from the UK and Denmark dating back as early as 2011. The study confirms that recombination plays a major role in L. pneumophila evolution. On the other hand, strains belonging to the same ST can have only few SNP differences despite being sampled over both large timespans and geographic distances. These are two important factors to consider in outbreak investigations.
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Affiliation(s)
- Susanne Schjørring
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.,European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Charlotte Kjelsø
- Department of Infectious Disease Epidemiology and prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Berit Lilje
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Jette M Bangsborg
- Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Denmark
| | - Randi F Petersen
- Department of Virus and Microbiological Special Diagnostics; Statens Serum Institut, Copenhagen, Denmark
| | - Sophia David
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom
| | - Søren A Uldum
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
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Ito A, Ishida T, Washio Y, Yamazaki A, Tachibana H. Legionella pneumonia due to non-Legionella pneumophila serogroup 1: usefulness of the six-point scoring system. BMC Pulm Med 2017; 17:211. [PMID: 29246145 PMCID: PMC5732474 DOI: 10.1186/s12890-017-0559-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background Because of a limited number of reports, we aimed to investigate the clinical characteristics of patients with Legionella pneumonia due to non-Legionella pneumophila serogroup 1 and the diagnostic usefulness of the six-point scoring system for such patients compared with patients with pneumonia caused by L. pneumophila serogroup 1. Methods We retrospectively analysed patients diagnosed with Legionella pneumonia due to non-L. pneumophila serogroup 1 between March 2001 and June 2016. We examined the clinical characteristics, including symptoms, laboratory findings, radiologic findings, pneumonia severity, initial treatment and prognosis. We also calculated scores using the six-point scoring system in these patients. Furthermore, we compared the clinical characteristics and six-point scores between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients among hospitalized community-acquired pneumonia patients enrolled prospectively between October 2010 and July 2016. Results Eleven patients had pneumonia due to non-L. pneumophila serogroup 1; their median age was 66 years and 8 patients (72.7%) were male. The most common pathogen was L. pneumophila serogroup 3 (6/11), followed by L. pneumophila serogroup 9 (3/11), L. pneumophila serogroup 6 (1/11) and L. longbeachae (1/11). Non-specific symptoms, such as fever and cough, were common. Six patients (54.5%) had liver enzyme elevation, but no patient developed hyponatraemia at <130 mEq/L. Nine patients (81.8%) showed lobar pneumonia and 7 patients (63.6%) manifested with consolidation and ground-glass opacity. Patients with mild to moderate severity comprised 10 (90.9%) by CURB-65 and 5 (45.5%) by the Pneumonia Severity Index. Of all patients, 4 were admitted to the intensive care unit and 3 died despite appropriate empiric therapy. The clinical characteristics were not significantly different between non-L. pneumophila serogroup 1 patients and L. pneumophila serogroup 1 patients (n = 23). At a cut-off value of ≥ 2 points, the sensitivity of the six-point scoring system was 54.5% (6/11) for non-L. pneumophila serogroup 1 patients and 95.7% (22/23) for L. pneumophila serogroup 1 patients. Conclusions Cases of non-L. pneumophila serogroup 1 pneumonia varied in severity from mild to severe and the clinical characteristics were often non-specific. The six-point scoring system was not useful in predicting such Legionella pneumonia cases. Electronic supplementary material The online version of this article (10.1186/s12890-017-0559-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan
| | - Yasuyoshi Washio
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan.,Department of Respiratory Medicine, Saiseikai Fukuoka General Hospital, Tenjinn 1-3-46, Chuoku, Fukuoka, Fukuoka, 810-0001, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki, Okayama, 710-8602, Japan.,Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, Nakaashihara 11, Joyo, Kyoto, 610-0113, Japan
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Ranc AG, Carpentier M, Beraud L, Descours G, Ginevra C, Maisonneuve E, Verdon J, Berjeaud JM, Lina G, Jarraud S. Legionella pneumophila LPS to evaluate urinary antigen tests. Diagn Microbiol Infect Dis 2017; 89:89-91. [DOI: 10.1016/j.diagmicrobio.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/16/2017] [Accepted: 06/17/2017] [Indexed: 11/25/2022]
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Ito A, Ishida T, Tachibana H, Ito Y, Takaiwa T, Fujii H, Hashimoto T, Nakajima H, Amemura-Maekawa J. A Case of Community-Acquired Pneumonia Due to Legionella pneumophila Serogroup 9 Wherein Initial Treatment with Single-Dose Oral Azithromycin Appeared Useful. Jpn J Infect Dis 2017; 70:660-662. [PMID: 28890505 DOI: 10.7883/yoken.jjid.2016.548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Legionella species are important causative pathogens for severe community-acquired pneumonia (CAP). Most cases of Legionella pneumonia are due to Legionella pneumophila serogroup 1, and CAP due to L. pneumophila serogroup 9 is rare. A fourth case of CAP due to L. pneumophila serogroup 9 has been reported, and initial treatment using single-dose oral azithromycin appeared useful. Azithromycin or fluoroquinolone injection is usually recommended for the treatment of Legionella pneumonia, and no previous reports have shown the effectiveness of single-dose oral azithromycin. This case report is therefore valuable from the perspective of possible treatment for mild to moderate Legionella pneumonia using single-dose oral azithromycin.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Kurashiki Central Hospital
| | - Tadashi Ishida
- Department of Respiratory Medicine, Kurashiki Central Hospital
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital
| | - Yuhei Ito
- Department of Respiratory Medicine, Kurashiki Central Hospital
| | - Takuya Takaiwa
- Department of Respiratory Medicine, Sakai City Medical Center
| | - Hiroyuki Fujii
- Department of Clinical Laboratory Examination, Ohara Healthcare Foundation, Kurashiki Central Hospital
| | - Toru Hashimoto
- Department of Clinical Laboratory Examination, Ohara Healthcare Foundation, Kurashiki Central Hospital
| | - Hiroshi Nakajima
- Department of Bacteriology, Okayama Prefectural Institute for Environmental Science and Public Health
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Burillo A, Pedro-Botet ML, Bouza E. Microbiology and Epidemiology of Legionnaire's Disease. Infect Dis Clin North Am 2017; 31:7-27. [PMID: 28159177 DOI: 10.1016/j.idc.2016.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Legionnaire's disease (LD) is the pneumonic form of legionellosis caused by aerobic gram-negative bacilli of the genus Legionella. Individuals become infected when they inhale aerosolized water droplets contaminated with Legionella species. Forty years after the identification of Legionella pneumophila as the cause of the 1976 pneumonia outbreak in a hotel in Philadelphia, we have non-culture-based diagnostic tests, effective antibiotics, and preventive measures to handle LD. With a mortality rate still around 10%, underreporting, and sporadic outbreaks, there is still much work to be done. In this article, the authors review the microbiology, laboratory diagnosis, and epidemiology of LD.
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Affiliation(s)
- Almudena Burillo
- Division of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - María Luisa Pedro-Botet
- Infectious Diseases Unit, Hospital Universitario German Trías i Pujol, Carretera de Canyet s/n, 08916 Badalona, Spain; Departamento de Medicina, Area de Medicina, Universidad Autónoma de Barcelona, Plaza Cívica, Campus de la UAB, 08193 Bellaterra, Sardañola del Vallés (Barcelona), Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/1089), Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Emilio Bouza
- Division of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain.
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46
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Schönning C, Jernberg C, Klingenberg D, Andersson S, Pääjärvi A, Alm E, Tano E, Lytsy B. Legionellosis acquired through a dental unit: a case study. J Hosp Infect 2017; 96:89-92. [PMID: 28228245 DOI: 10.1016/j.jhin.2017.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
In 2012, an elderly immunocompromised man died from legionellosis at a hospital in Uppsala, Sweden. The patient had visited a dental ward at the hospital during the incubation period. Legionella spp. at a concentration of 2000 colony-forming units/L were isolated from the cupfiller outlet providing water for oral rinsing. Isolates from the patient and the dental unit were Legionella pneumophila serogroup 1, subgroup Knoxville and ST9. Pulsed-field gel electrophoresis and whole-genome sequencing strongly suggested that the isolates were of common origin. This report presents one of few documented cases of legionellosis acquired through a dental unit.
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Affiliation(s)
- C Schönning
- Department of Surveillance and Coordination, Public Health Agency of Sweden, Sweden.
| | - C Jernberg
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - D Klingenberg
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - S Andersson
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - A Pääjärvi
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - E Alm
- Department of Microbiology, Public Health Agency of Sweden, Sweden
| | - E Tano
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Sweden
| | - B Lytsy
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, Sweden
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47
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Walser SM, Brenner B, Wunderlich A, Tuschak C, Huber S, Kolb S, Niessner R, Seidel M, Höller C, Herr CEW. Detection of Legionella-contaminated aerosols in the vicinity of a bio-trickling filter of a breeding sow facility - A pilot study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 575:1197-1202. [PMID: 27692939 DOI: 10.1016/j.scitotenv.2016.09.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
The urbanization of agricultural areas results in a reduction of distances between residential buildings and livestock farms. In the public debate, livestock farming is increasingly criticized due to environmental disturbance and odor nuisance originating from such facilities. One method to reduce odor and ammonia is by exhaust air treatment, for example, by biological exhaust air purification processes with bio-trickling filters filled with tap water. Higher temperatures in the summer time and the generation of biofilms are ideal growth conditions for Legionella. However, there are no studies on the presence of Legionella in the water of bio-trickling filters and the release of Legionella-containing aerosols. Therefore, the aim of this study was to investigate Legionella in wash water and emitted bioaerosols of a bio-trickling filter system of a breeding sow facility. For this purpose, measurements were carried out using a cyclone sampler. In addition, samples of wash water were taken. Legionella were not found by culture methods. However, using molecular biological methods, Legionella spp. could be detected in wash water as well as in bioaerosol samples. With antibody-based methods, Legionella pneumophila were identified. Further studies are needed to investigate the environmental health relevance of Legionella-containing aerosols emitted by such exhaust air purification systems.
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Affiliation(s)
- Sandra M Walser
- Bavarian Health and Food Safety Authority, Occupational and Environmental Health, Epidemiology, Munich, Germany.
| | - Bernhard Brenner
- Bavarian Health and Food Safety Authority, Occupational and Environmental Health, Epidemiology, Munich, Germany
| | - Anika Wunderlich
- Technical University of Munich, Analytical Chemistry & Institute of Hydrochemistry, Munich, Germany
| | - Christian Tuschak
- Bavarian Health and Food Safety Authority, Hygiene, Oberschleissheim, Germany
| | - Stefanie Huber
- Bavarian Health and Food Safety Authority, Hygiene, Oberschleissheim, Germany
| | - Stefanie Kolb
- Bavarian Health and Food Safety Authority, Occupational and Environmental Health, Epidemiology, Munich, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Centre of the Ludwig-Maximilians-Universität, Munich, Germany
| | - Reinhard Niessner
- Technical University of Munich, Analytical Chemistry & Institute of Hydrochemistry, Munich, Germany
| | - Michael Seidel
- Technical University of Munich, Analytical Chemistry & Institute of Hydrochemistry, Munich, Germany
| | - Christiane Höller
- Bavarian Health and Food Safety Authority, Hygiene, Oberschleissheim, Germany
| | - Caroline E W Herr
- Bavarian Health and Food Safety Authority, Occupational and Environmental Health, Epidemiology, Munich, Germany; University of Munich, Germany
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48
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Answer to January 2017 Photo Quiz. J Clin Microbiol 2017; 55:349-350. [DOI: 10.1128/jcm.03512-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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49
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Multiplication of Legionella pneumophila Sequence Types 1, 47, and 62 in Buffered Yeast Extract Broth and Biofilms Exposed to Flowing Tap Water at Temperatures of 38°C to 42°C. Appl Environ Microbiol 2016; 82:6691-6700. [PMID: 27613680 DOI: 10.1128/aem.01107-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/01/2016] [Indexed: 12/11/2022] Open
Abstract
Legionella pneumophila proliferates in freshwater environments at temperatures ranging from 25 to 45°C. To investigate the preference of different sequence types (ST) for a specific temperature range, growth of L. pneumophila serogroup 1 (SG1) ST1 (environmental strains), ST47, and ST62 (disease-associated strains) was measured in buffered yeast extract broth (BYEB) and biofilms grown on plasticized polyvinyl chloride in flowing heated drinking water originating from a groundwater supply. The optimum growth temperatures in BYEB were approximately 37°C (ST1), 39°C (ST47), and 41°C (ST62), with maximum growth temperatures of 42°C (ST1) and 43°C (ST47 and ST62). In the biofilm at 38°C, the ST47 and ST62 strains multiplied equally well compared to growth of the environmental ST1 strain and an indigenous L. pneumophila non-SG1 strain, all attaining a concentration of approximately 107 CFU/cm-2 Raising the temperature to 41°C did not impact these levels within 4 weeks, but the colony counts of all strains tested declined (at a specific decline rate of 0.14 to 0.41 day-1) when the temperature was raised to 42°C. At this temperature, the concentration of Vermamoeba vermiformis in the biofilm, determined with quantitative PCR (qPCR), was about 2 log units lower than the concentration at 38°C. In columns operated at a constant temperature, ranging from 38 to 41°C, none of the tested strains multiplied in the biofilm at 41°C, in which also V. vermiformis was not detected. These observations suggest that strains of ST47 and ST62 did not multiply in the biofilm at a temperature of ≥41°C because of the absence of a thermotolerant host. IMPORTANCE Growth of Legionella pneumophila in tap water installations is a serious public health concern. The organism includes more than 2,100 varieties (sequence types). More than 50% of the reported cases of Legionnaires' disease are caused by a few sequence types which are very rarely detected in the environment. Strains of selected virulent sequence types proliferated in biofilms on surfaces exposed to warm (38°C) tap water to the same level as environmental varieties and multiplied well as pure culture in a nutrient-rich medium at temperatures of 42 and 43°C. However, these organisms did not grow in the biofilms at temperatures of ≥41°C. Typical host amoebae also did not multiply at these temperatures. Apparently, proliferation of thermotolerant host amoebae is needed to enable multiplication of the virulent L. pneumophila strains in the environment at elevated temperatures. The detection of these amoebae in water installations therefore is a scientific challenge with practical implications.
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50
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Unusual Legionnaires' outbreak in cool, dry Western Canada: an investigation using genomic epidemiology. Epidemiol Infect 2016; 145:254-265. [PMID: 27760576 PMCID: PMC5197926 DOI: 10.1017/s0950268816001965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An outbreak of Legionnaires' disease occurred in an inner city district in Calgary, Canada. This outbreak spanned a 3-week period in November-December 2012, and a total of eight cases were identified. Four of these cases were critically ill requiring intensive care admission but there was no associated mortality. All cases tested positive for Legionella pneumophila serogroup 1 (LP1) by urinary antigen testing. Five of the eight patients were culture positive for LP1 from respiratory specimens. These isolates were further identified as Knoxville monoclonal subtype and sequence subtype ST222. Whole-genome sequencing revealed that the isolates differed by no more than a single vertically acquired single nucleotide variant, supporting a single point-source outbreak. Hypothesis-based environmental investigation and sampling was conducted; however, a definitive source was not identified. Geomapping of case movements within the affected urban sector revealed a 1·0 km common area of potential exposure, which coincided with multiple active construction sites that used water spray to minimize transient dust. This community point-source Legionnaires' disease outbreak is unique due to its ST222 subtype and occurrence in a relatively dry and cold weather setting in Western Canada. This report suggests community outbreaks of Legionella should not be overlooked as a possibility during late autumn and winter months in the Northern Hemisphere.
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