1
|
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.
Collapse
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
| |
Collapse
|
2
|
Kauppinen A, Siponen S, Pitkänen T, Holmfeldt K, Pursiainen A, Torvinen E, Miettinen IT. Phage Biocontrol of Pseudomonas aeruginosa in Water. Viruses 2021; 13:928. [PMID: 34067885 PMCID: PMC8156286 DOI: 10.3390/v13050928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022] Open
Abstract
Bacteriophage control of harmful or pathogenic bacteria has aroused growing interest, largely due to the rise of antibiotic resistance. The objective of this study was to test phages as potential agents for the biocontrol of an opportunistic pathogen Pseudomonas aeruginosa in water. Two P. aeruginosa bacteriophages (vB_PaeM_V523 and vB_PaeM_V524) were isolated from wastewater and characterized physically and functionally. Genomic and morphological characterization showed that both were myoviruses within the Pbunavirus genus. Both had a similar latent period (50-55 min) and burst size (124-134 PFU/infected cell), whereas there was variation in the host range. In addition to these environmental phages, a commercial Pseudomonas phage, JG003 (DSM 19870), was also used in the biocontrol experiments. The biocontrol potential of the three phages in water was tested separately and together as a cocktail against two P. aeruginosa strains; PAO1 and the environmental strain 17V1507. With PAO1, all phages initially reduced the numbers of the bacterial host, with phage V523 being the most efficient (>2.4 log10 reduction). For the environmental P. aeruginosa strain (17V1507), only the phage JG003 caused a reduction (1.2 log10) compared to the control. The cocktail of three phages showed a slightly higher decrease in the level of the hosts compared to the use of individual phages. Although no synergistic effect was observed in the host reduction with the use of the phage cocktail, the cocktail-treated hosts did not appear to acquire resistance as rapidly as hosts treated with a single phage. The results of this study provide a significant step in the development of bacteriophage preparations for the control of pathogens and harmful microbes in water environments.
Collapse
Affiliation(s)
- Ari Kauppinen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, FI-70701 Kuopio, Finland; (S.S.); (T.P.); (A.P.); (I.T.M.)
| | - Sallamaari Siponen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, FI-70701 Kuopio, Finland; (S.S.); (T.P.); (A.P.); (I.T.M.)
- Department of Environmental and Biological Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland;
| | - Tarja Pitkänen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, FI-70701 Kuopio, Finland; (S.S.); (T.P.); (A.P.); (I.T.M.)
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, FI-00014 Helsinki, Finland
| | - Karin Holmfeldt
- Centre for Ecology and Evolution in Microbial Model Systems (EEMiS), Department of Biology and Environmental Sciences, Linnaeus University, SE-39231 Kalmar, Sweden;
| | - Anna Pursiainen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, FI-70701 Kuopio, Finland; (S.S.); (T.P.); (A.P.); (I.T.M.)
| | - Eila Torvinen
- Department of Environmental and Biological Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland;
| | - Ilkka T. Miettinen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, FI-70701 Kuopio, Finland; (S.S.); (T.P.); (A.P.); (I.T.M.)
| |
Collapse
|
3
|
Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR. Pathogens 2020; 9:pathogens9110978. [PMID: 33238543 PMCID: PMC7700499 DOI: 10.3390/pathogens9110978] [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: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence to date indicates that heater-cooler units (HCUs) and heater units (HUs) can generate potentially infectious aerosols containing a range of opportunistic pathogens such as Mycobacterium chimaera, other non-tuberculous mycobacterial (NTM) species, Pseudomonas aeruginosa and Legionella spp. Our purpose was to determine the extent of Legionella contamination and total viable count (TVC) in HCUs and HUs and to analyze the relationship by water system design of devices of two different brands (LivaNova vs. Maquet). METHODS Legionella spp. were detected and quantified by our optimized PMA-qPCR protocol; TVCs were assessed according to ISO protocol 6222. Analyses were performed in the first sampling round and after six months of surveillance. RESULTS Overall, Legionella spp. was detected in 65.7% of devices. In the second sampling round, Legionella positivity rates were significantly lower in water samples from the Maquet devices compared to the LivaNova ones (27.3% vs. 61.5%). LivaNova HCUs also yielded more Legionella, and aquatic bacteria counts than Maquet in both first and second-round samples. CONCLUSIONS We recommend that all surgical patients and staff exposed to aerosols from thermoregulatory devices should be followed up for Legionella infection and that microbiological surveillance on such devices should be conducted regularly as precautionary principle.
Collapse
|
4
|
Boamah DK, Zhou G, Ensminger AW, O'Connor TJ. From Many Hosts, One Accidental Pathogen: The Diverse Protozoan Hosts of Legionella. Front Cell Infect Microbiol 2017; 7:477. [PMID: 29250488 PMCID: PMC5714891 DOI: 10.3389/fcimb.2017.00477] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/31/2017] [Indexed: 01/03/2023] Open
Abstract
The 1976 outbreak of Legionnaires' disease led to the discovery of the intracellular bacterial pathogen Legionella pneumophila. Given their impact on human health, Legionella species and the mechanisms responsible for their replication within host cells are often studied in alveolar macrophages, the primary human cell type associated with disease. Despite the potential severity of individual cases of disease, Legionella are not spread from person-to-person. Thus, from the pathogen's perspective, interactions with human cells are accidents of time and space—evolutionary dead ends with no impact on Legionella's long-term survival or pathogenic trajectory. To understand Legionella as a pathogen is to understand its interaction with its natural hosts: the polyphyletic protozoa, a group of unicellular eukaryotes with a staggering amount of evolutionary diversity. While much remains to be understood about these enigmatic hosts, we summarize the current state of knowledge concerning Legionella's natural host range, the diversity of Legionella-protozoa interactions, the factors influencing these interactions, the importance of avoiding the generalization of protozoan-bacterial interactions based on a limited number of model hosts and the central role of protozoa to the biology, evolution, and persistence of Legionella in the environment.
Collapse
Affiliation(s)
- David K Boamah
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Guangqi Zhou
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Alexander W Ensminger
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Tamara J O'Connor
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
5
|
Bédard E, Prévost M, Déziel E. Pseudomonas aeruginosa in premise plumbing of large buildings. Microbiologyopen 2016; 5:937-956. [PMID: 27353357 PMCID: PMC5221438 DOI: 10.1002/mbo3.391] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/27/2022] Open
Abstract
Pseudomonas aeruginosa is an opportunistic bacterial pathogen that is widely occurring in the environment and is recognized for its capacity to form or join biofilms. The present review consolidates current knowledge on P. aeruginosa ecology and its implication in healthcare facilities premise plumbing. The adaptability of P. aeruginosa and its capacity to integrate the biofilm from the faucet and the drain highlight the role premise plumbing devices can play in promoting growth and persistence. A meta‐analysis of P. aeruginosa prevalence in faucets (manual and electronic) and drains reveals the large variation in device positivity reported and suggest the high variability in the sampling approach and context as the main reason for this variation. The effects of the operating conditions that prevail within water distribution systems (disinfection, temperature, and hydraulic regime) on the persistence of P. aeruginosa are summarized. As a result from the review, recommendations for proactive control measures of water contamination by P. aeruginosa are presented. A better understanding of the ecology of P. aeruginosa and key influencing factors in premise plumbing are essential to identify culprit areas and implement effective control measures.
Collapse
Affiliation(s)
- Emilie Bédard
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC, Canada.,INRS-Institut Armand-Frappier, Laval, QC, Canada
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Eric Déziel
- INRS-Institut Armand-Frappier, Laval, QC, Canada
| |
Collapse
|
6
|
Leoni E, Sanna T, Zanetti F, Dallolio L. Controlling Legionella and Pseudomonas aeruginosa re-growth in therapeutic spas: implementation of physical disinfection treatments, including UV/ultrafiltration, in a respiratory hydrotherapy system. JOURNAL OF WATER AND HEALTH 2015; 13:996-1005. [PMID: 26608761 DOI: 10.2166/wh.2015.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The study aimed to assess the efficacy of an integrated water safety plan (WSP) in controlling Legionella re-growth in a respiratory hydrotherapy system located in a spa centre, supplied with sulphurous water, which was initially colonized by Legionella pneumophila. Heterotrophic plate counts, Pseudomonas aeruginosa, Legionella spp. were detected in water samples taken 6-monthly from the hydrotherapy equipment (main circuit, entry to benches, final outlets). On the basis of the results obtained by the continuous monitoring and the changes in conditions, the original WSP, including physical treatments of water and waterlines, environmental surveillance and microbiological monitoring, was integrated introducing a UV/ultrafiltration system. The integrated treatment applied to the sulphurous water (microfiltration/UV irradiation/ultrafiltration), waterlines (superheated stream) and distal outlets (descaling/disinfection of nebulizers and nasal irrigators), ensured the removal of Legionella spp. and P. aeruginosa and a satisfactory microbiological quality over time. The environmental surveillance was successful in evaluating the hazard and identifying the most suitable preventive strategies to avoid Legionella re-growth. Ultrafiltration is a technology to take into account in the control of microbial contamination of therapeutic spas, since it does not modify the chemical composition of the water, thus allowing it to retain its therapeutic properties.
Collapse
Affiliation(s)
- E Leoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistic, University of Bologna, via S. Giacomo 12, Bologna 40126, Italy E-mail:
| | - T Sanna
- Department of Biomedical and Neuromotor Sciences, School of Hygiene and Preventive Medicine, University of Bologna, via S. Giacomo 12, Bologna 40126, Italy
| | - F Zanetti
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistic, University of Bologna, via S. Giacomo 12, Bologna 40126, Italy E-mail:
| | - L Dallolio
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistic, University of Bologna, via S. Giacomo 12, Bologna 40126, Italy E-mail:
| |
Collapse
|
7
|
Kobayashi M, Oana K, Kawakami Y. Bath water contamination with Legionella and nontuberculous mycobacteria in 24-hour home baths, hot springs, and public bathhouses of Nagano Prefecture, Japan. Jpn J Infect Dis 2015; 67:276-81. [PMID: 25056073 DOI: 10.7883/yoken.67.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bath water samples were collected from 116 hot springs, 197 public bathhouses, and 38 24-hour home baths in Nagano Prefecture, Japan, during the period of April 2009 to November 2011, for determining the presence and extent of contamination with Legionella and nontuberculous mycobacteria. Cultures positive for Legionella were observed in 123 of the 3,314 bath water samples examined. The distribution and abundance of Legionella and/or combined contamination with Legionella and nontuberculous mycobacteria were investigated to clarify the contamination levels. The abundance of Legionella was demonstrated to correlate considerably with the levels of combined contamination with Legionella and nontuberculous mycobacteria. Legionella spp. were obtained from 61% of the water samples from 24-hour home baths, but only from 3% of the samples from public bathhouses and hot springs. This is despite the fact that a few outbreaks of Legionnaires' disease in Nagano Prefecture as well as other regions of Japan have been traced to bath water contamination. The comparatively higher rate of contamination of the 24-hour home baths is a matter of concern. It is therefore advisable to routinely implement good maintenance of the water basins, particularly of the 24-hour home baths.
Collapse
Affiliation(s)
- Michiko Kobayashi
- Division of Infection Control and Microbiological Regulation, Department of Health and Medical Sciences, Shinshu University Graduate School of Medicine
| | | | | |
Collapse
|
8
|
Hsu CS, Huang DJ. Disinfection of herbal spa pool using combined chlorine dioxide and sodium hypochlorite treatment. ENVIRONMENTAL MONITORING AND ASSESSMENT 2015; 187:34. [PMID: 25632897 DOI: 10.1007/s10661-014-4242-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 12/17/2014] [Indexed: 06/04/2023]
Abstract
The presence of pathogenic microorganisms in public spa pools poses a serious threat to human health. The problem is particularly acute in herbal spas, in which the herbs and microorganisms may interact and produce undesirable consequences. Accordingly, the present study investigated the effectiveness of a combined disinfectant containing chlorine dioxide and sodium hypochlorite in improving the water quality of a public herbal spa in Taiwan. Water samples were collected from the spa pool and laboratory tests were then performed to measure the variation over time of the microorganism content (total CFU and total coliforms) and residual disinfectant content given a single disinfection mode (SDM) with disinfectant concentrations of 5.2 × 10, 6.29 × 10, 7.4 × 10, and 11.4 × 10(-5) N, respectively. Utilizing the experience gained from the laboratory tests, a further series of on-site investigations was performed using three different disinfection modes, namely SDM, 3DM (once every 3 h disinfection mode), and 2DM (once every 2 h disinfection mode). The laboratory results showed that for all four disinfectant concentrations, the CFU concentration reduced for the first 6 h following SDM treatment, but then increased. Moreover, the ANOVA results showed that the sample treated with the highest disinfectant concentration (11.4 × 10(-5) N) exhibited the lowest rate of increase in the CFU concentration. In addition, the on-site test results showed that 3DM and 2DM treatments with disinfectant concentrations in excess of 9.3 × 10 and 5.5 × 10(-5) N, respectively, provided an effective reduction in the total CFU concentration. In conclusion, the experimental results presented in this study provide a useful source of reference for spa businesses seeking to improve the water quality of their spa pools.
Collapse
Affiliation(s)
- Ching-Shan Hsu
- Department of Environmental Resource Management, Chia-Nan University of Pharmacy and Science, Tainan, 71710, Taiwan,
| | | |
Collapse
|
9
|
Aerosolization of respirable droplets from a domestic spa pool and the use of MS-2 coliphage and Pseudomonas aeruginosa as markers for Legionella pneumophila. Appl Environ Microbiol 2014; 81:555-61. [PMID: 25381233 DOI: 10.1128/aem.02912-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Legionnaires' disease can result when droplets or aerosols containing legionella bacteria are inhaled and deposited in the lungs. A number of outbreaks have been associated with the use of a spa pool where aeration, a high water temperature, and a large and variable organic load make disinfectant levels difficult to maintain. Spa pool ownership is increasing, and the aim of this study, using two surrogate organisms (MS-2 coliphage and Pseudomonas aeruginosa [a natural contaminant]), was to assess the potential risk to domestic users when disinfection fails. A representative "entry level" domestic spa pool was installed in an outdoor courtyard. The manufacturer's instructions for spa pool maintenance were not followed. A cyclone sampler was used to sample the aerosols released from the spa pool with and without activation of the air injection system. Samples were taken at increasing heights and distances from the pool. An aerodynamic particle sizer was used to measure the water droplet size distribution at each sample point. When the air injection system was inactivated, neither surrogate organism was recovered from the air. On activation of the air injection system, the mean mass of droplets within the respirable range (10 cm above the water line) was 36.8 μg cm(-3). This corresponded to a mean air concentration of P. aeruginosa of 350 CFU m(-3). From extrapolation from animal data, the estimated risk of infection from aerosols contaminated with similar concentrations of Legionella pneumophila was 0.76 (males) and 0.65 (females). At 1 m above and/or beyond the pool, the mean aerosol mass decreased to 0.04 μg cm(-3) and corresponded to a 100-fold reduction in mean microbial air concentration. The estimated risk of infection at this distance was negligible.
Collapse
|
10
|
Mansi A, Amori I, Marchesi I, Marcelloni A, Proietto A, Ferranti G, Magini V, Valeriani F, Borella P. Legionella spp. survival after different disinfection procedures: Comparison between conventional culture, qPCR and EMA–qPCR. Microchem J 2014. [DOI: 10.1016/j.microc.2013.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|