1
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Toplitsch D, Platzer S, Zehner R, Maitz S, Mascher F, Kittinger C. Comparison of Updated Methods for Legionella Detection in Environmental Water Samples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105436. [PMID: 34069615 PMCID: PMC8161308 DOI: 10.3390/ijerph18105436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/04/2022]
Abstract
The difficulty of cultivation of Legionella spp. from water samples remains a strenuous task even for experienced laboratories. The long incubation periods for Legionellae make isolation difficult. In addition, the water samples themselves are often contaminated with accompanying microbial flora, and therefore require complex cultivation methods from diagnostic laboratories. In addition to the recent update of the standard culture method ISO 11731:2017, new strategies such as quantitative PCR (qPCR) are often discussed as alternatives or additions to conventional Legionella culture approaches. In this study, we compared ISO 11731:2017 with qPCR assays targeting Legionella spp., Legionella pneumophila, and Legionella pneumophila serogroup 1. In samples with a high burden of accompanying microbial flora, qPCR shows an excellent negative predictive value for Legionella pneumophila, thus making qPCR an excellent tool for pre-selection of negative samples prior to work-intensive culture methods. This and its low limit of detection make qPCR a diagnostic asset in Legionellosis outbreak investigations, where quick-risk assessments are essential, and are a useful method for monitoring risk sites.
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2
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Legionella Detection in Environmental Samples as an Example for Successful Implementation of qPCR. WATER 2018. [DOI: 10.3390/w10081012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Waterborne diseases are a serious threat because of their ability to infect a high number of individuals in a short time span, such as during outbreaks of Legionellosis. This significantly highlights the need for the rapid detection and quantification of bacteria in environmental water samples. The aim of this study was to investigate the feasibility of quantitative Polymerase Chain Reaction (qPCR) for the detection of Legionellapneumophila (L. pneumophila) in environmental water samples and comparison of standard culture methods for Legionella detection with qPCR. Our study reached a negative predictive value (NPV) for L. pneumophila of 80.7% and for L. pneumophila serogroup 1 (sg1) the calculated NPV was 87.0%. The positive predictive value (PPV) for L. pneumophila was 53.9% and for L. pneumophila sg1 PPV was 21.4%. Results showed a correlation between qPCR and culture with an R2 value of 0.8973 for L. pneumophila, whereas no correlation was observed for the detection of L. pneumophila sg1. In our study, qPCR proved useful for the identification of L. pneumophila negative samples. However, despite the obvious benefits (sample handling, rapid generation of results), qPCR needs to be improved regarding the PPV before it can replace culture in water quality assessment.
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3
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Prussin AJ, Schwake DO, Marr LC. Ten Questions Concerning the Aerosolization and Transmission of Legionella in the Built Environment. BUILDING AND ENVIRONMENT 2017; 123:684-695. [PMID: 29104349 PMCID: PMC5665586 DOI: 10.1016/j.buildenv.2017.06.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Legionella is a genus of pathogenic Gram-negative bacteria responsible for a serious disease known as legionellosis, which is transmitted via inhalation of this pathogen in aerosol form. There are two forms of legionellosis: Legionnaires' disease, which causes pneumonia-like symptoms, and Pontiac fever, which causes influenza-like symptoms. Legionella can be aerosolized from various water sources in the built environment including showers, faucets, hot tubs/swimming pools, cooling towers, and fountains. Incidence of the disease is higher in the summertime, possibly because of increased use of cooling towers for air conditioning systems and differences in water chemistry when outdoor temperatures are higher. Although there have been decades of research related to Legionella transmission, many knowledge gaps remain. While conventional wisdom suggests that showering is an important source of exposure in buildings, existing measurements do not provide strong support for this idea. There has been limited research on the potential for Legionella transmission through heating, ventilation, and air conditioning (HVAC) systems. Epidemiological data suggest a large proportion of legionellosis cases go unreported, as most people who are infected do not seek medical attention. Additionally, controlled laboratory studies examining water-to-air transfer and source tracking are still needed. Herein, we discuss ten questions that spotlight current knowledge about Legionella transmission in the built environment, engineering controls that might prevent future disease outbreaks, and future research that is needed to advance understanding of transmission and control of legionellosis.
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Affiliation(s)
- Aaron J. Prussin
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
- Corresponding Author:
| | - David Otto Schwake
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Linsey C. Marr
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
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4
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Wang H, Bédard E, Prévost M, Camper AK, Hill VR, Pruden A. Methodological approaches for monitoring opportunistic pathogens in premise plumbing: A review. WATER RESEARCH 2017; 117:68-86. [PMID: 28390237 PMCID: PMC5693313 DOI: 10.1016/j.watres.2017.03.046] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/19/2017] [Accepted: 03/22/2017] [Indexed: 05/06/2023]
Abstract
Opportunistic premise (i.e., building) plumbing pathogens (OPPPs, e.g., Legionella pneumophila, Mycobacterium avium complex, Pseudomonas aeruginosa, Acanthamoeba, and Naegleria fowleri) are a significant and growing source of disease. Because OPPPs establish and grow as part of the native drinking water microbiota, they do not correspond to fecal indicators, presenting a major challenge to standard drinking water monitoring practices. Further, different OPPPs present distinct requirements for sampling, preservation, and analysis, creating an impediment to their parallel detection. The aim of this critical review is to evaluate the state of the science of monitoring OPPPs and identify a path forward for their parallel detection and quantification in a manner commensurate with the need for reliable data that is informative to risk assessment and mitigation. Water and biofilm sampling procedures, as well as factors influencing sample representativeness and detection sensitivity, are critically evaluated with respect to the five representative bacterial and amoebal OPPPs noted above. Available culturing and molecular approaches are discussed in terms of their advantages, limitations, and applicability. Knowledge gaps and research needs towards standardized approaches are identified.
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Affiliation(s)
- Hong Wang
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China.
| | - Emilie Bédard
- Department of Civil Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Anne K Camper
- Center for Biofilm Engineering and Department of Civil Engineering, Montana State University, Bozeman, MT 59717, USA
| | - Vincent R Hill
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Amy Pruden
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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5
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Collins S, Stevenson D, Walker J, Bennett A. Evaluation ofLegionellareal-time PCR against traditional culture for routine and public health testing of water samples. J Appl Microbiol 2017; 122:1692-1703. [DOI: 10.1111/jam.13461] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/25/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S. Collins
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
| | - D. Stevenson
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
| | - J. Walker
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
| | - A. Bennett
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
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6
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Lu J, Buse H, Struewing I, Zhao A, Lytle D, Ashbolt N. Annual variations and effects of temperature on Legionella spp. and other potential opportunistic pathogens in a bathroom. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:2326-2336. [PMID: 27815848 PMCID: PMC6155451 DOI: 10.1007/s11356-016-7921-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/16/2016] [Indexed: 05/22/2023]
Abstract
Opportunistic pathogens (OPs) in drinking water, like Legionella spp., mycobacteria, Pseudomonas aeruginosa, and free-living amobae (FLA) are a risk to human health, due to their post-treatment growth in water systems. To assess and manage these risks, it is necessary to understand their variations and environmental conditions for the water routinely used. We sampled premise tap (N cold = 26, N hot = 26) and shower (N shower = 26) waters in a bathroom and compared water temperatures to levels of OPs via qPCR and identified Legionella spp. by 16S ribosomal RNA (rRNA) gene sequencing. The overall occurrence and cell equivalent quantities (CE L-1) of Mycobacterium spp. were highest (100 %, 1.4 × 105), followed by Vermamoeba vermiformis (91 %, 493), Legionella spp. (59 %, 146), P. aeruginosa (14 %, 10), and Acanthamoeba spp. (5 %, 6). There were significant variations of OP's occurrence and quantities, and water temperatures were associated with their variations, especially for Mycobacterium spp., Legionella spp., and V. vermiformis. The peaks observed for Legionella, mainly consisted of Legionella pneumophila sg1 or Legionella anisa, occurred in the temperature ranged from 19 to 49 °C, while Mycobacterium spp. and V. vermiformis not only co-occurred with Legionella spp. but also trended to increase with increasing temperatures. There were higher densities of Mycobacterium in first than second draw water samples, indicating their release from faucet/showerhead biofilm. Legionella spp. were mostly at detectable levels and mainly consisted of L. pneumophila, L. anisa, Legionella donaldsonii, Legionella tunisiensis, and an unknown drinking water isolate based on sequence analysis. Results from this study suggested potential health risks caused by opportunistic pathogens when exposed to warm shower water with low chlorine residue and the use of Mycobacterium spp. as an indicator of premise pipe biofilm and the control management of those potential pathogens.
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Affiliation(s)
- Jingrang Lu
- US EPA, Office of Research and Development, 26W Martin Luther King Dr., Cincinnati, OH, 45268, USA.
| | - Helen Buse
- Pegasus Technical Services, Inc., Cincinnati, OH,, USA
| | - Ian Struewing
- Pegasus Technical Services, Inc., Cincinnati, OH,, USA
| | - Amy Zhao
- US EPA, Office of Research and Development, 26W Martin Luther King Dr., Cincinnati, OH, 45268, USA
| | - Darren Lytle
- US EPA, Office of Research and Development, 26W Martin Luther King Dr., Cincinnati, OH, 45268, USA
| | - Nicholas Ashbolt
- School of Public Health, University of Alberta, Edmonton, Canada
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7
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Edagawa A, Kimura A, Kawabuchi-Kurata T, Adachi S, Furuhata K, Miyamoto H. Investigation of Legionella Contamination in Bath Water Samples by Culture, Amoebic Co-Culture, and Real-Time Quantitative PCR Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13118-30. [PMID: 26492259 PMCID: PMC4627020 DOI: 10.3390/ijerph121013118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022]
Abstract
We investigated Legionella contamination in bath water samples, collected from 68 bathing facilities in Japan, by culture, culture with amoebic co-culture, real-time quantitative PCR (qPCR), and real-time qPCR with amoebic co-culture. Using the conventional culture method, Legionella pneumophila was detected in 11 samples (11/68, 16.2%). Contrary to our expectation, the culture method with the amoebic co-culture technique did not increase the detection rate of Legionella (4/68, 5.9%). In contrast, a combination of the amoebic co-culture technique followed by qPCR successfully increased the detection rate (57/68, 83.8%) compared with real-time qPCR alone (46/68, 67.6%). Using real-time qPCR after culture with amoebic co-culture, more than 10-fold higher bacterial numbers were observed in 30 samples (30/68, 44.1%) compared with the same samples without co-culture. On the other hand, higher bacterial numbers were not observed after propagation by amoebae in 32 samples (32/68, 47.1%). Legionella was not detected in the remaining six samples (6/68, 8.8%), irrespective of the method. These results suggest that application of the amoebic co-culture technique prior to real-time qPCR may be useful for the sensitive detection of Legionella from bath water samples. Furthermore, a combination of amoebic co-culture and real-time qPCR might be useful to detect viable and virulent Legionella because their ability to invade and multiply within free-living amoebae is considered to correlate with their pathogenicity for humans. This is the first report evaluating the efficacy of the amoebic co-culture technique for detecting Legionella in bath water samples.
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Affiliation(s)
- Akiko Edagawa
- Division of Environment Health, Osaka Prefectural Institute of Public Health, Osaka 537-0025, Japan.
- Division of Microbiology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
| | - Akio Kimura
- Division of Planning and Coordination, Osaka Prefectural Institute of Public Health, Osaka 537-0025, Japan.
| | | | - Shinichi Adachi
- Division of Environment Health, Osaka Prefectural Institute of Public Health, Osaka 537-0025, Japan.
| | - Katsunori Furuhata
- School of Life and Environmental Science, Azabu University, Kanagawa 252-5201, Japan.
| | - Hiroshi Miyamoto
- Division of Microbiology, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
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8
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Mendis N, McBride P, Faucher SP. Short-Term and Long-Term Survival and Virulence of Legionella pneumophila in the Defined Freshwater Medium Fraquil. PLoS One 2015; 10:e0139277. [PMID: 26406895 PMCID: PMC4583229 DOI: 10.1371/journal.pone.0139277] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/09/2015] [Indexed: 12/03/2022] Open
Abstract
Legionella pneumophila (Lp) is the etiological agent responsible for Legionnaires’ disease, a potentially fatal pulmonary infection. Lp lives and multiplies inside protozoa in a variety of natural and man-made water systems prior to human infection. Fraquil, a defined freshwater medium, was used as a highly reproducible medium to study the behaviour of Lp in water. Adopting a reductionist approach, Fraquil was used to study the impact of temperature, pH and trace metal levels on the survival and subsequent intracellular multiplication of Lp in Acanthamoeba castellanii, a freshwater protozoan and a natural host of Legionella. We show that temperature has a significant impact on the short- and long-term survival of Lp, but that the bacterium retains intracellular multiplication potential for over six months in Fraquil. Moreover, incubation in Fraquil at pH 4.0 resulted in a rapid decline in colony forming units, but was not detrimental to intracellular multiplication. In contrast, variations in trace metal concentrations had no impact on either survival or intracellular multiplication in amoeba. Our data show that Lp is a resilient bacterium in the water environment, remaining infectious to host cells after six months under the nutrient-deprived conditions of Fraquil.
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Affiliation(s)
- Nilmini Mendis
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Peter McBride
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Sébastien P. Faucher
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
- * E-mail:
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9
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Hsu TK, Wu SF, Hsu BM, Kao PM, Tao CW, Shen SM, Ji WT, Huang WC, Fan CW. Surveillance of parasitic Legionella in surface waters by using immunomagnetic separation and amoebae enrichment. Pathog Glob Health 2015; 109:328-35. [PMID: 26373823 DOI: 10.1179/2047773215y.0000000034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Free-living amoebae (FLA) are potential reservoirs of Legionella in aquatic environments. However, the parasitic relationship between various Legionella and amoebae remains unclear. In this study, surface water samples were gathered from two rivers for evaluating parasitic Legionella. Warmer water temperature is critical to the existence of Legionella. This result suggests that amoebae may be helpful in maintaining Legionella in natural environments because warmer temperatures could enhance parasitisation of Legionella in amoebae. We next used immunomagnetic separation (IMS) to identify extracellular Legionella and remove most free Legionella before detecting the parasitic ones in selectively enriched amoebae. Legionella pneumophila was detected in all the approaches, confirming that the pathogen is a facultative amoebae parasite. By contrast, two obligate amoebae parasites, Legionella-like amoebal pathogens (LLAPs) 8 and 9, were detected only in enriched amoebae. However, several uncultured Legionella were detected only in the extracellular samples. Because the presence of potential hosts, namely Vermamoeba vermiformis, Acanthamoeba spp. and Naegleria gruberi, was confirmed in the samples that contained intracellular Legionella, uncultured Legionella may survive independently of amoebae. Immunomagnetic separation and amoebae enrichment may have referential value for detecting parasitic Legionella in surface waters.
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Affiliation(s)
- Tsui-Kang Hsu
- Department of Ophthalmology, Cheng Hsin General Hospital , Taipei, Taiwan, Republic of China
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10
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Collins S, Jorgensen F, Willis C, Walker J. Real-time PCR to supplement gold-standard culture-based detection of Legionella
in environmental samples. J Appl Microbiol 2015. [DOI: 10.1111/jam.12911] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Collins
- Public Health England; Biosafety Investigation Unit; Salisbury UK
- Public Health England; Food, Water and Environmental Microbiology Laboratory; Salisbury UK
| | - F. Jorgensen
- Public Health England; Food, Water and Environmental Microbiology Laboratory; Salisbury UK
| | - C. Willis
- Public Health England; Food, Water and Environmental Microbiology Laboratory; Salisbury UK
| | - J. Walker
- Public Health England; Biosafety Investigation Unit; Salisbury UK
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11
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Omiccioli E, Schiavano GF, Ceppetelli V, Amagliani G, Magnani M, Brandi G. Validation according to ISO/TS 12869:2012 of a molecular method for the isolation and quantification of Legionella spp. in water. Mol Cell Probes 2015; 29:86-91. [DOI: 10.1016/j.mcp.2014.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 12/19/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
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12
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Mercante JW, Winchell JM. Current and emerging Legionella diagnostics for laboratory and outbreak investigations. Clin Microbiol Rev 2015; 28:95-133. [PMID: 25567224 PMCID: PMC4284297 DOI: 10.1128/cmr.00029-14] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic "blind spot" for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.
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Affiliation(s)
- Jeffrey W Mercante
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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Ji WT, Hsu BM, Chang TY, Hsu TK, Kao PM, Huang KH, Tsai SF, Huang YL, Fan CW. Surveillance and evaluation of the infection risk of free-living amoebae and Legionella in different aquatic environments. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 499:212-219. [PMID: 25192927 DOI: 10.1016/j.scitotenv.2014.07.116] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 06/03/2023]
Abstract
Free-living amoebae (FLA) are ubiquitous in various aquatic environments. Several amoebae species are pathogenic and host other pathogens such as Legionella, but the presence of FLA and its parasites as well as the related infection risk are not well known. In this study, the presence of pathogenic FLA and Legionella in various water bodies was investigated. Water samples were collected from a river, intake areas of drinking water treatment plants, and recreational hot spring complexes in central and southern Taiwan. A total of 140 water samples were tested for the presence of Acanthamoeba spp., Naegleria spp., Vermamoeba vermiformis, and Legionella. In addition, phylogenetic characteristics and water quality parameters were also assessed. The pathogenic genotypes of FLA included Acanthamoeba T4 and Naegleria australiensis, and both were abundant in the hot spring water. In contrast, Legionella pneumophila was detected in different aquatic environments. Among the FLA assessed, V. vermiformis was most likely to coexist with Legionella spp. The total bacteria level was associated with the presence of FLA and Legionella especially in hot spring water. Taken together, FLA contamination in recreational hot springs and drinking water source warrants more attention on potential legionellosis and amoebae infections.
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Affiliation(s)
- Wen-Tsai Ji
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
| | - Bing-Mu Hsu
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC.
| | - Tien-Yu Chang
- Department of Radiology, Taipei Medical University Hospital, 252 Wu Hsing Street, Taipei, Taiwan, ROC
| | - Tsui-Kang Hsu
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan, ROC; Department of Life Science, Institute of Molecular Biology and Institute of Biomedical Science, National Chung Cheng University, Min-Hsiung, Chiayi, Taiwan, ROC
| | - Po-Min Kao
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
| | - Kuan-Hao Huang
- Department of Life Science, Institute of Molecular Biology and Institute of Biomedical Science, National Chung Cheng University, Min-Hsiung, Chiayi, Taiwan, ROC
| | - Shiou-Feng Tsai
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
| | - Yu-Li Huang
- Department of Safety Health and Environmental Engineering, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Cheng-Wei Fan
- Department of Earth and Environmental Sciences, National Chung Cheng University, Chiayi, Taiwan, ROC
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14
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Lévesque S, Plante PL, Mendis N, Cantin P, Marchand G, Charest H, Raymond F, Huot C, Goupil-Sormany I, Desbiens F, Faucher SP, Corbeil J, Tremblay C. Genomic characterization of a large outbreak of Legionella pneumophila serogroup 1 strains in Quebec City, 2012. PLoS One 2014; 9:e103852. [PMID: 25105285 PMCID: PMC4126679 DOI: 10.1371/journal.pone.0103852] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/02/2014] [Indexed: 11/20/2022] Open
Abstract
During the summer of 2012, a major Legionella pneumophila serogroup 1 outbreak occurred in Quebec City, Canada, which caused 182 declared cases of Legionnaire's disease and included 13 fatalities. Legionella pneumophila serogroup 1 isolates from 23 patients as well as from 32 cooling towers located in the vicinity of the outbreak were recovered for analysis. In addition, 6 isolates from the 1996 Quebec City outbreak and 4 isolates from patients unrelated to both outbreaks were added to allow comparison. We characterized the isolates using pulsed-field gel electrophoresis, sequence-based typing, and whole genome sequencing. The comparison of patients-isolated strains to cooling tower isolates allowed the identification of the tower that was the source of the outbreak. Legionella pneumophila strain Quebec 2012 was identified as a ST-62 by sequence-based typing methodology. Two new Legionellaceae plasmids were found only in the epidemic strain. The LVH type IV secretion system was found in the 2012 outbreak isolates but not in the ones from the 1996 outbreak and only in half of the contemporary human isolates. The epidemic strains replicated more efficiently and were more cytotoxic to human macrophages than the environmental strains tested. At least four Icm/Dot effectors in the epidemic strains were absent in the environmental strains suggesting that some effectors could impact the intracellular replication in human macrophages. Sequence-based typing and pulsed-field gel electrophoresis combined with whole genome sequencing allowed the identification and the analysis of the causative strain including its likely environmental source.
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Affiliation(s)
- Simon Lévesque
- Laboratoire de Santé Publique du Québec (LSPQ)/Institut National de Santé Publique du Québec, Québec, Canada
- * E-mail:
| | - Pier-Luc Plante
- Université Laval, Department of Molecular Medicine, Québec, Canada
| | - Nilmini Mendis
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Québec, Canada
| | - Philippe Cantin
- Centre d'Expertise en Analyse Environnementale du Québec, Québec, Canada
| | - Geneviève Marchand
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Québec, Canada
| | - Hugues Charest
- Laboratoire de Santé Publique du Québec (LSPQ)/Institut National de Santé Publique du Québec, Québec, Canada
- Département de Microbiologie, Immunologie et Infectiologie, Université de Montréal, Québec, Canada
| | - Frédéric Raymond
- Université Laval, Department of Molecular Medicine, Québec, Canada
| | - Caroline Huot
- Direction Régionale de Santé Publique de la Capitale-Nationale, Québec, Canada
| | | | - François Desbiens
- Direction Régionale de Santé Publique de la Capitale-Nationale, Québec, Canada
| | - Sébastien P. Faucher
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Québec, Canada
| | - Jacques Corbeil
- Université Laval, Department of Molecular Medicine, Québec, Canada
| | - Cécile Tremblay
- Laboratoire de Santé Publique du Québec (LSPQ)/Institut National de Santé Publique du Québec, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Québec, Canada
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15
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Abstract
Legionella spp. are the causative agent of Legionnaire's disease and an opportunistic pathogen of significant public health concern. Identification and quantification from environmental sources is crucial for identifying outbreak origins and providing sufficient information for risk assessment and disease prevention. Currently there are a range of methods for Legionella spp. quantification from environmental sources, but the two most widely used and accepted are culture and real-time polymerase chain reaction (qPCR). This paper provides a review of these two methods and outlines their advantages and limitations. Studies from the last 10 years which have concurrently used culture and qPCR to quantify Legionella spp. from environmental sources have been compiled. 26/28 studies detected Legionella at a higher rate using qPCR compared to culture, whilst only one study detected equivalent levels of Legionella spp. using both qPCR and culture. Aggregating the environmental samples from all 28 studies, 2856/3967 (72%) tested positive for the presence of Legionella spp. using qPCR and 1331/3967 (34%) using culture. The lack of correlation between methods highlights the need to develop an acceptable standardized method for quantification that is sufficient for risk assessment and management of this human pathogen.
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Affiliation(s)
- Harriet Whiley
- a Department of Health and the Environment , Flinders University , Adelaide , Australia
| | - Michael Taylor
- a Department of Health and the Environment , Flinders University , Adelaide , Australia
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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]
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17
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Brousseau N, Lévesque B, Guillemet TA, Cantin P, Gauvin D, Giroux JP, Gingras S, Proulx F, Côté PA, Dewailly E. Contamination of public whirlpool spas: factors associated with the presence of Legionella spp., Pseudomonas aeruginosa and Escherichia coli. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2012; 23:1-15. [PMID: 22731241 DOI: 10.1080/09603123.2012.678001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This work explores the factors associated with contamination of public spas by Legionella spp., Pseudomonas aeruginosa and Escherichia coli. Physicochemical and microbiological parameters were measured in water samples from 95 spas inQuébec, Canada. Spa maintenance was documented by a questionnaire. Legionella spp. were detected in 23% of spas, P. aeruginosa in 41% and E. coli in 2%. Bacteria were found in concerning concentrations (Legionella spp. ≥ 500 CFU/l, P. aeruginosa ≥ 51 CFU/100 ml or E. coli ≥ 1 CFU/100 ml) in 26% ofspas. Observed physicochemical parameters frequently differed from recommended guidelines. The following factors decreased the prevalence of concerning microbial contamination: a free chlorine concentration ≥ 2 mg/l or total bromine ≥ 3 mg/l (p = 0.001), an oxidation-reduction potential (ORP) > 650 mV (p = 0.001), emptying and cleaning the spa at least monthly (p = 0.019) and a turbidity ≤ 1 NTU (p = 0.013). Proper regulations and training of spa operators are critical for better maintenance of these increasingly popular facilities.
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18
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