Mechanisms of infection in the respiratory tract

Assessment of the risk of Legionella pneumophila in water distribution systems in hospitals of Tehran city

When a sensitive host inhales aerosols containing these bacteria, Legionella infection occurs. Therefore, monitoring and assessing Legionella in the environment and water distribution systems of such places are critical due to the prone population in hospitals. However, the health risks of Legionella bacteria in the environment are not adequately evaluated. In this study, for hospitalized patients, we performed a quantitative health risk assessment of Legionella in selected hospitals in Tehran city using two scenarios of shower and toilet faucet exposure. This study identified Legionella in 38 cases (38%) out of 100 samples collected from toilet faucets and showers in 8 hospitals. The information gathered was used for quantitative microbial risk assessment (QMRA). The microbial load transmitted by inhalation was calculated using the concentration of Legionella in water. Other exposure parameters (inhalation rate and exposure time) were obtained using information from other studies and the median length of hospital stay (3.6 days). The exponential model was used to estimate the risk of infection (γ = 0.06) due to Legionella pneumophila (L. pneumophila) inhalation for each exposure event. For the mean concentration obtained for Legionella (10³ CFU/L), the risk of infection for toilet faucets and showers was in the range of 0.23-2.3 and 3.5-21.9, respectively, per 10,000 hospitalized patients. The results were compared with the tolerable risk level of infection determined by the US EPA and WHO. The risk values exceeded the WHO values for waterborne pathogens in hospitals in both exposure scenarios. As a result, our QMRA results based on monitoring data showed that despite using treated water (from distribution networks in the urban areas) by hospitals, 38% of the samples were contaminated with Legionella, and faucets and showers can be sources of Legionella transmission. Hence, to protect the health of hospitalized patients, the risk of Legionella infection should be considered.

Quantitative microbial risk assessment of Legionella pneumophila in a drinking water supply system in Israel

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.

Airborne Microorganisms From Livestock Production Systems and Their Relation to Dust

Large amounts of airborne microorganisms are emitted from livestock production. These emitted microorganisms may associate with dust, and are suspected to pose a risk of airborne infection to humans in vicinity and to animals on other farms. However, the extent to which airborne transmission may play a role in the epidemic, and how dust acts as a carrier of microorganisms in the transmission processes is unknown. The authors present the current knowledge of the entire process of airborne transmission of microorganisms-from suspension and transportation until deposition and infection-and their relation to dust. The sampling and the mitigation techniques of airborne microorganisms and dust in livestock production systems are introduced as well.

Isolation of Pasteurella haemolytica from the nasal cavity of goats

Twenty transport-stressed goats were divided into two groups. The first group was further stressed with steroid. Pasteurella haemolytica was found at various sites in the nasal cavity of goats in this group as early as 2 weeks post-transportation. The successful isolations continued consistently with more goats having pure growth of P. haemolytica at later stages. Mild catarrh rhinitis, loss of epithelial cilia and erosions were the main lesions observed in the nasal cavity. Goats in the second group that were not given steroid injections had inconsistent bacterial isolation and less severe pathological lesions.

Differentiation between five types of pneumonia distribution pattern in pigs

Five types of lesion distribution pattern in pig pneumonia were described through gravity point calculation on the lesions of abattoir samples of pig lungs, using the gravity points as the matrix for a statistical characterisation of the type. The pneumonia types studied were: bronchopneumonia, pleuropneumonia, secondary disseminated bronchopneumonia, vermoid disseminated pneumonia and haematogenically disseminated (embolic) pneumonia. A qualitative approach to pneumonia type designation by pathological and microbiological examination was not consistent with the quantitative description, as the pathological features and the isolated microorganisms varied between cases of a type. Of the five types studied only two types (pleuropneumonia and vermoid pneumonia) were not distinguishable from each other in a type to type comparison. The patterns observed reflect two main pathways of disease dispersion in pulmonary disease, bronchogenic and haematogenic. The haematogenically dispersed pneumonia had a random lesion distribution pattern, while the bronchogenic type patterns were skewed. Some patterns were shown to reflect properties of the dispersive system and vehicle, while the lesion distribution determinants of pleuropneumonia and vermoid pneumonia need further study. The two major dispersion pathways could be distinguished with high levels of confidence from each other by a simple calculation: the number of lesions in the lobi apicales et cardiaci expressed as a percentage of the total number of lesions.