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Pijnacker R, Brandsema P, Euser S, Vahidnia A, Kuiter A, Limaheluw J, Schout C, Haj Mohammad G, Raven S. An outbreak of Legionnaires' disease linked to a municipal and industrial wastewater treatment plant, The Netherlands, September-October 2022. Euro Surveill 2024; 29:2300506. [PMID: 38757288 PMCID: PMC11100293 DOI: 10.2807/1560-7917.es.2024.29.20.2300506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/19/2024] [Indexed: 05/18/2024] Open
Abstract
Wastewater treatment plants (WWTPs) are increasingly identified as Legionnaires' disease (LD) sources. An outbreak investigation was initiated following five LD cases reported in September 2022 in Houten, the Netherlands. Case identification was based on the European LD case definition, with symptom onset from 1 September 2022, residence in or within 5 km of Houten, or visit to Houten within the incubation period, without other likely sources. We sampled potential sources and genotyped environmental and clinical isolates. We identified 15 LD cases with onset between 13 September and 23 October 2022. A spatial source identification and wind direction model suggested an industrial (iWWTP) and a municipal WWTP (mWWTP) as potential sources, with the first discharging water into the latter. Both tested positive for Legionella pneumophila serogroups 1 and 6 with multiple sequence types (ST). We detected L. pneumophila sg1 ST42 in the mWWTP, matching with one of three available clinical isolates. Following control measures at the WWTPs, no further cases were observed. This outbreak underlines that municipal and industrial WWTPs can play an important role in community LD cases and outbreaks, especially those with favourable conditions for Legionella growth and dissemination, or even non-favourable conditions for growth but with the influx of contaminated water.
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Affiliation(s)
- Roan Pijnacker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Infectious Diseases, Public Health Service region Utrecht (GGD), Zeist, the Netherlands
| | - Petra Brandsema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sjoerd Euser
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Ali Vahidnia
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Arnold Kuiter
- Environmental Services Regarding Authorization and Enforcement (RUD Utrecht), Utrecht, the Netherlands
| | - Jesse Limaheluw
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Christine Schout
- Department of Infectious Diseases, Public Health Service region Utrecht (GGD), Zeist, the Netherlands
| | - Gaaled Haj Mohammad
- Department of Infectious Diseases, Public Health Service region Utrecht (GGD), Zeist, the Netherlands
| | - Stijn Raven
- Department of Infectious Diseases, Public Health Service region Utrecht (GGD), Zeist, the Netherlands
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Sakhaee F, Mafi S, Zargar M, Vaziri F, Hajiesmaeili M, Siadat SD, Fateh A. Correlation between Legionella pneumophila serogroups isolated from patients with ventilator-associated pneumonia and water resources: a study of four hospitals in Tehran, Iran. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:41368-41374. [PMID: 35089517 PMCID: PMC8796176 DOI: 10.1007/s11356-022-18867-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/21/2022] [Indexed: 05/08/2023]
Abstract
Legionella pneumophila (L. pneumophila) is one of the main pathogens, causing pneumonia and respiratory tract infections, especially in patients with ventilator-associated pneumonia (VAP). This study aimed to approve the hypothesis that the serogroup distribution of L. pneumophila isolates from patients is correlated with Legionella strains in the environment. A total of 280 bronchoalveolar lavage (BAL) samples from VAP patients admitted to the intensive care unit (ICU) as well as 116 water samples from different sources in four hospitals in Tehran, Iran, were evaluated for the presence of L. pneumophila infection by culture, nested polymerase chain reaction (PCR), real-time PCR, and sequencing for genetic diversity. The molecular and culture methods found 24 (8.6%) and 5 (1.8%) samples to be positive for L. pneumophila in VAP patients, while they found 23 (19.8%) and 8 (6.9%) positive samples in water resources, respectively. The sequencing results indicated that all positive clinical samples and 14 (60.8%) environmental samples were belonged to L. pneumophila serogroup 1. Smoking, age, length of ICU stay, and duration of ventilator use had strong relationship with L. pneumophila infectivity. In conclusion, this is the first report from Iran to determine minor differences in the serogroup distribution of environmental and clinical strains. However, further studies are needed to confirm this relationship in different regions of Iran.
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Affiliation(s)
- Fatemeh Sakhaee
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
| | - Shirin Mafi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohsen Zargar
- Department of Microbiology, Qom Branch, Islamic Azad University, Qom, Iran
| | - Farzam Vaziri
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Mohammadreza Hajiesmaeili
- Critical Care Quality Improvement Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Davar Siadat
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran
| | - Abolfazl Fateh
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran.
- Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran.
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Masaka E, Reed S, Davidson M, Oosthuizen J. Opportunistic Premise Plumbing Pathogens. A Potential Health Risk in Water Mist Systems Used as a Cooling Intervention. Pathogens 2021; 10:pathogens10040462. [PMID: 33921277 PMCID: PMC8068904 DOI: 10.3390/pathogens10040462] [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] [Received: 03/03/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Water mist systems (WMS) are used for evaporative cooling in public areas. The health risks associated with their colonization by opportunistic premise plumbing pathogens (OPPPs) is not well understood. To advance the understanding of the potential health risk of OPPPs in WMS, biofilm, water and bioaerosol samples (n = 90) from ten (10) WMS in Australia were collected and analyzed by culture and polymerase chain reaction (PCR) methods to detect the occurrence of five representative OPPPs: Legionella pneumophila, Pseudomonas aeruginosa, Mycobacterium avium, Naegleria fowleri and Acanthamoeba. P. aeruginosa (44%, n = 90) occurred more frequently in samples, followed by L. pneumophila serogroup (Sg) 2–14 (18%, n = 90) and L. pneumophila Sg 1 (6%, n = 90). A negative correlation between OPPP occurrence and residual free chlorine was observed except with Acanthamoeba, rs (30) = 0.067, p > 0.05. All detected OPPPs were positively correlated with total dissolved solids (TDS) except with Acanthamoeba. Biofilms contained higher concentrations of L. pneumophila Sg 2–14 (1000–3000 CFU/mL) than water samples (0–100 CFU/mL). This study suggests that WMS can be colonized by OPPPs and are a potential health risk if OPPP contaminated aerosols get released into ambient atmospheres.
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Barskey AE, Lackraj D, Tripathi PS, Lee S, Smith J, Edens C. Travel-associated cases of Legionnaires' disease in the United States, 2015-2016. Travel Med Infect Dis 2020; 40:101943. [PMID: 33279632 DOI: 10.1016/j.tmaid.2020.101943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Recent travel is associated with ~20% of reported Legionnaires' disease (LD) cases worldwide. METHODS We analyzed LD cases reported to the Centers for Disease Control and Prevention (CDC) during 2015-2016. Travel-associated cases met case criteria for confirmed LD in someone who spent ≥1 night away from home during the 10 days before symptom onset. Most analyses were limited to travel-associated, public accommodation stay (TAPAS) cases. We used reported travel dates to estimate the number of TAPAS cases acquired during travel. RESULTS Of 12,200 LD cases reported among U.S. residents, 12.3% were travel-associated; 8.7% were TAPAS. Median patient age for TAPAS cases was 61 years; 64.4% were male; 67.3% were white; 77.9% were non-Hispanic; 96.1% were hospitalized; 4.5% died. Among 887 TAPAS cases involving U.S. destinations, an estimated 29.8% were acquired during travel; 4.28 TAPAS cases were reported, and an estimated 1.10 TAPAS cases were acquired during travel, per 10,000,000 hotel room nights booked. Sixty-eight U.S. TAPAS clusters were detected. CONCLUSIONS While acquisition during travel accounted for a relatively small proportion of all LD cases, clusters of TAPAS cases were frequently detected. Prompt notification of these cases to CDC facilitates cluster detection and expedites intervention.
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Affiliation(s)
- Albert E Barskey
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | - Jessica Smith
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chris Edens
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Paniagua AT, Paranjape K, Hu M, Bédard E, Faucher SP. Impact of temperature on Legionella pneumophila, its protozoan host cells, and the microbial diversity of the biofilm community of a pilot cooling tower. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 712:136131. [PMID: 31931228 DOI: 10.1016/j.scitotenv.2019.136131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
Legionella pneumophila is a waterborne bacterium known for causing Legionnaires' Disease, a severe pneumonia. Cooling towers are a major source of outbreaks, since they provide ideal conditions for L. pneumophila growth and produce aerosols. In such systems, L. pneumophila typically grow inside protozoan hosts. Several abiotic factors such as water temperature, pipe material and disinfection regime affect the colonization of cooling towers by L. pneumophila. The local physical and biological factors promoting the growth of L. pneumophila in water systems and its spatial distribution are not well understood. Therefore, we built a lab-scale cooling tower to study the dynamics of L. pneumophila colonization in relationship to the resident microbiota and spatial distribution. The pilot was filled with water from an operating cooling tower harboring low levels of L. pneumophila. It was seeded with Vermamoeba vermiformis, a natural host of L. pneumophila, and then inoculated with L. pneumophila. After 92 days of operation, the pilot was disassembled, the water was collected, and biofilm was extracted from the pipes. The microbiome was studied using 16S rRNA and 18S rRNA genes amplicon sequencing. The communities of the water and of the biofilm were highly dissimilar. The relative abundance of Legionella in water samples reached up to 11% whereas abundance in the biofilm was extremely low (≤0.5%). In contrast, the host cells were mainly present in the biofilm. This suggests that L. pneumophila grows in host cells associated with biofilm and is then released back into the water following host cell lysis. In addition, water temperature shaped the bacterial and eukaryotic community of the biofilm, indicating that different parts of the systems may have different effects on Legionella growth.
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Affiliation(s)
- Adriana Torres Paniagua
- Department of Natural Resource Sciences, McGill University, 21111 Lakeshore Drive, Ste-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Kiran Paranjape
- Department of Natural Resource Sciences, McGill University, 21111 Lakeshore Drive, Ste-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Mengqi Hu
- Department of Natural Resource Sciences, McGill University, 21111 Lakeshore Drive, Ste-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Emilie Bédard
- Department of Natural Resource Sciences, McGill University, 21111 Lakeshore Drive, Ste-Anne-de-Bellevue, Quebec, H9X 3V9, Canada; Department of Civil Engineering, Polytechnique Montreal, P.O. Box 6079, Station Centre-Ville, Montreal, Quebec H3C 3A7, Canada.
| | - Sébastien P Faucher
- Department of Natural Resource Sciences, McGill University, 21111 Lakeshore Drive, Ste-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.
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Villanueva D, Schepanski K. Investigation of atmospheric conditions fostering the spreading of legionnaires' disease in outbreaks related to cooling towers. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1347-1356. [PMID: 31342243 DOI: 10.1007/s00484-019-01751-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
Legionnaires' disease (LD) is a severe lung infection caused by the bacteria Legionella pneumophila which is usually associated with water managing installations like cooling towers. Several outbreaks of LD have been linked to individual sources of bioaerosol in the past. However, the transmission pathways as well as the influence of meteorological factors in the spreading of such bioaerosols remain unclear. Using the meteorological data near 12 LD outbreaks in Europe for the period 2000-2016, the correlation between key meteorological factors and the occurrence of LD was assessed. Temperature, humidity, atmospheric pressure, wind speed, precipitation, cloud cover and, for the first time, fog occurrence were included as potential risk factors. It was found that the occurrence of fog was related to four of the LD outbreaks, suggesting that the presence of fog droplets and/or the thermal inversions associated with fog may play a role in the disease spreading. This finding can contribute to outbreak investigations and to the prevention of future outbreaks.
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Affiliation(s)
- Diego Villanueva
- Leibniz Institute for Tropospheric Research, Permoser Str. 15, 04318, Leipzig, Germany.
| | - Kerstin Schepanski
- Leibniz Institute for Tropospheric Research, Permoser Str. 15, 04318, Leipzig, Germany
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Baskaran V, Murray RL, Hunter A, Lim WS, McKeever TM. Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS One 2019; 14:e0220204. [PMID: 31318967 PMCID: PMC6638981 DOI: 10.1371/journal.pone.0220204] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/10/2019] [Indexed: 01/19/2023] Open
Abstract
Aim To summarise and quantify the effect of tobacco smoking on the risk of developing community acquired pneumonia (CAP) in adults. Methods We systematically searched MEDLINE, Embase, CINAHL, PsychINFO and Web of Science, from inception to October 2017, to identify case-control and cohort studies and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The review protocol was registered with the PROSPERO database (CRD42018093943). Study quality was assessed by the Newcastle-Ottawa Scale. Pooled odds ratios (ORs) or hazard ratios (HRs) were estimated using a random-effects model. Results Of 647 studies identified, 27 studies were included (n = 460,592 participants) in the systematic review. Most of the included studies were of moderate quality with a median score of six (IQR 6–7). Meta-analysis showed that current smokers (pooled OR 2.17, 95% CI 1.70–2.76, n = 13 studies; pooled HR 1.52, 95% CI 1.13–2.04, n = 7 studies) and ex-smokers (pooled OR 1.49, 95% CI 1.26–1.75, n = 8 studies; pooled HR 1.18, 95% CI 0.91–1.52, n = 6 studies) were more likely to develop CAP compared to never smokers. Although the association between passive smoking and risk of CAP in adults of all ages was not statistically significant (pooled OR 1.13, 95% CI 0.94–1.36, n = 5 studies), passive smoking in adults aged ≥65 years was associated with a 64% increased risk of CAP (pooled OR 1.64; 95% CI 1.17–2.30, n = 2 studies). Dose-response analyses of data from five studies revealed a significant trend; current smokers who smoked higher amount of tobacco had a higher risk of CAP. Conclusion Tobacco smoke exposure is significantly associated with the development of CAP in current smokers and ex-smokers. Adults aged > 65 years who are passive smokers are also at higher risk of CAP. For current smokers, a significant dose-response relationship is evident.
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Affiliation(s)
- Vadsala Baskaran
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- * E-mail:
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Tricia M. McKeever
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
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Edens C, Alden NB, Danila RN, Fill MMA, Gacek P, Muse A, Parker E, Poissant T, Ryan PA, Smelser C, Tobin-D’Angelo M, Schrag SJ. Multistate analysis of prospective Legionnaires' disease cluster detection using SaTScan, 2011-2015. PLoS One 2019; 14:e0217632. [PMID: 31145765 PMCID: PMC6542510 DOI: 10.1371/journal.pone.0217632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/15/2019] [Indexed: 01/09/2023] Open
Abstract
Detection of clusters of Legionnaires’ disease, a leading waterborne cause of pneumonia, is challenging. Clusters vary in size and scope, are associated with a diverse range of aerosol-producing devices, including exposures such as whirlpool spas and hotel water systems typically associated with travel, and can occur without an easily identified exposure source. Recently, jurisdictions have begun to use SaTScan spatio-temporal analysis software prospectively as part of routine cluster surveillance. We used data collected by the Active Bacterial Core surveillance platform to assess the ability of SaTScan to detect Legionnaires’ disease clusters. We found that SaTScan analysis using traditional surveillance data and geocoded residential addresses was unable to detect many common Legionnaires’ disease cluster types, such as those associated with travel or a prolonged time between cases. Additionally, signals from an analysis designed to simulate a real-time search for clusters did not align with clusters identified by traditional surveillance methods or a retrospective SaTScan analysis. A geospatial analysis platform better tailored to the unique characteristics of Legionnaires’ disease epidemiology would improve cluster detection and decrease time to public health action.
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Affiliation(s)
- Chris Edens
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, United States of America
| | - Richard N. Danila
- Minnesota Department of Health, St. Paul, Minnesota, United States of America
| | | | - Paul Gacek
- Connecticut Department of Public Health, Hartford, Connecticut, United States of America
| | - Alison Muse
- New York State Department of Health, Albany, New York, United States of America
| | - Erin Parker
- California Emerging Infections Program, Oakland, California, United States of America
| | - Tasha Poissant
- Oregon Health Authority, Portland, Oregon, United States of America
| | - Patricia A. Ryan
- Maryland Department of Health, Baltimore, Maryland, United States of America
| | - Chad Smelser
- New Mexico Department of Health, Santa Fe, New Mexico, United States of America
| | | | - Stephanie J. Schrag
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Facciponte DN, Bough MW, Seidler D, Carroll JL, Ashare A, Andrew AS, Tsongalis GJ, Vaickus LJ, Henegan PL, Butt TH, Stommel EW. Identifying aerosolized cyanobacteria in the human respiratory tract: A proposed mechanism for cyanotoxin-associated diseases. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 645:1003-1013. [PMID: 30248825 PMCID: PMC6159226 DOI: 10.1016/j.scitotenv.2018.07.226] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/12/2018] [Accepted: 07/17/2018] [Indexed: 05/10/2023]
Abstract
Cyanobacteria produce harmful toxins that have been associated with several acute conditions and chronic human diseases, like gastroenteritis, non-alcoholic liver disease, and amyotrophic lateral sclerosis. Aerosol from waterbodies appears to be a likely mechanism for exposure. We conducted a study of human biospecimens focused on the cyanobacterial aerosilization process by evaluating the extent to which cyanobacteria can invade the human respiratory tract. Our study suggests that humans routinely inhale aerosolized cyanobacteria, which can be harbored in the nostrils and the lungs. Using PCR, cyanobacteria were found at high frequencies in the upper respiratory tract (92.20%) and central airway (79.31%) of our study subjects. Nasal swabs were not predictive of bronchoalveolar lavage (BAL) when detecting inhaled cyanobacteria. Interestingly, we found no evidence that time of year was a significant factor for cyanobacteria positivity (BAL cytology p = 1.0 and PCR p = 1.0); (nasal swab cytology p = 0.051 and PCR p = 0.65). Additionally, we found that proximity to a waterbody was not a significant factor for cyanobacteria positivity in BAL and nasal swabs collected during cyanobacteria bloom season [May-October] (p = 0.46 and p = 0.38). These data suggest that cyanobacteria exposure may be a prevalent and chronic phenomenon not necessarily restricted to waterbodies alone. Sources of indoor exposure warrant future investigation. Given the widespread prevalence of cyanobacterial exposure in the airway, investigation of the aerosol spread of cyanotoxins, more specifically, is warranted. Our findings are consistent with the hypothesis that aerosol is a significant route for cyanobacteria exposure, and thus a likely route of transmission for cyanotoxin-associated human diseases.
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Affiliation(s)
- Dominic N Facciponte
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA.
| | - Matthew W Bough
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA; Dartmouth College, Hanover, NH 03755, USA
| | - Darius Seidler
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - James L Carroll
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Alix Ashare
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Angeline S Andrew
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Gregory J Tsongalis
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Louis J Vaickus
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA
| | - Patricia L Henegan
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA
| | - Tanya H Butt
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA
| | - Elijah W Stommel
- Dartmouth-Hitchcock Medical Center, Department of Neurology, One Medical Center Dr., Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Rd., Hanover, NH 03755, USA.
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Differential Susceptibility of Male Versus Female Laboratory Mice to Anaplasma phagocytophilum Infection. Trop Med Infect Dis 2018; 3:tropicalmed3030078. [PMID: 30274474 PMCID: PMC6161277 DOI: 10.3390/tropicalmed3030078] [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] [Received: 06/27/2018] [Revised: 07/07/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022] Open
Abstract
Human granulocytic anaplasmosis (HGA) is a debilitating, non-specific febrile illness caused by the granulocytotropic obligate intracellular bacterium called Anaplasma phagocytophilum. Surveillance studies indicate a higher prevalence of HGA in male versus female patients. Whether this discrepancy correlates with differential susceptibility of males and females to A. phagocytophilum infection is unknown. Laboratory mice have long been used to study granulocytic anaplasmosis. Yet, sex as a biological variable (SABV) in this model has not been evaluated. In this paper, groups of male and female C57Bl/6 mice that had been infected with A. phagocytophilum were assessed for the bacterial DNA load in the peripheral blood, the percentage of neutrophils harboring bacterial inclusions called morulae, and splenomegaly. Infected male mice exhibited as much as a 1.85-fold increase in the number of infected neutrophils, which is up to a 1.88-fold increase in the A. phagocytophilum DNA load, and a significant increase in spleen size when compared to infected female mice. The propensity of male mice to develop a higher level of A. phagocytophilum infection is relevant for studies utilizing the mouse model. This stresses the importance of including SABV and aligns with the observed higher incidence of infection in male versus female patients.
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Russo A, Gouveia CM, Soares PMM, Cardoso RM, Mendes MT, Trigo RM. The unprecedented 2014 Legionnaires' disease outbreak in Portugal: atmospheric driving mechanisms. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1167-1179. [PMID: 29572569 DOI: 10.1007/s00484-018-1520-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
A large outbreak of Legionnaires' disease occurred in November 2014 nearby Lisbon, Portugal. This epidemic infected 377 individuals by the Legionella pneumophila bacteria, resulting in 14 deaths. The primary source of transmission was contaminated aerosolized water which, when inhaled, lead to atypical pneumonia. The unseasonably warm temperatures during October 2014 may have played a role in the proliferation of Legionella species in cooling tower systems. The episode was further exacerbated by high relative humidity and a thermal inversion which limited the bacterial dispersion. Here, we analyze if the Legionella outbreak event occurred during a situation of extreme potential recirculation and/or stagnation characteristics. In order to achieve this goal, the Allwine and Whiteman approach was applied for a hindcast simulation covering the affected area during a near 20-year long period (1989-2007) and then for an independent period covering the 2014 event (15 October to 13 November 2014). The results regarding the average daily critical transport indices for the 1989-2007 period clearly indicate that the airshed is prone to stagnation as these events have a dominant presence through most of the study period (42%), relatively to the occurrence of recirculation (18%) and ventilation (17%) events. However, the year of 2014 represents an exceptional year when compared to the 1989-2007 period, with 53 and 33% of the days being classified as under stagnation and recirculation conditions, respectively.
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Affiliation(s)
- Ana Russo
- Instituto Dom Luiz, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, Edifício C1, Piso 1, 1749-016, Lisbon, Portugal.
| | - Célia M Gouveia
- Instituto Dom Luiz, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, Edifício C1, Piso 1, 1749-016, Lisbon, Portugal
- Instituto Português do Mar e da Atmosfera, Rua C-Aeroporto, 1749-077, Lisbon, Portugal
| | - Pedro M M Soares
- Instituto Dom Luiz, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, Edifício C1, Piso 1, 1749-016, Lisbon, Portugal
| | - Rita M Cardoso
- Instituto Dom Luiz, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, Edifício C1, Piso 1, 1749-016, Lisbon, Portugal
| | - Manuel T Mendes
- Instituto Português do Mar e da Atmosfera, Rua C-Aeroporto, 1749-077, Lisbon, Portugal
| | - Ricardo M Trigo
- Instituto Dom Luiz, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, Edifício C1, Piso 1, 1749-016, Lisbon, Portugal
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Quantitative Microbial Risk Assessment and Opportunist Waterborne Infections⁻Are There Too Many Gaps to Fill? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061150. [PMID: 29865180 PMCID: PMC6025005 DOI: 10.3390/ijerph15061150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 01/14/2023]
Abstract
Quantitative microbial risk assessment (QMRA) is a relatively new approach in identifying health risks associated with the ubiquitous presence of pathogens and opportunists in the human environment. The methodology builds on experimental and meta-analytical data to identify measurable factors that contribute to, and can quantify, the likely extent of disease given a particular exposure. Early modelling was particularly focused on food-borne disease, and subsequently water-borne disease, with the emphasis focused on ingestion and its role in enteric disease. More recently, there has been a focus on translating these principles to opportunist waterborne infections (OWI) with primary focus on Legionella spp. Whereas dose and susceptibility are well documented via the ingestion route of exposure there is considerably less certainty regarding both factors when understanding Legionella spp. and other OWI. Many OWI can arise through numerous routes of transmission with greatly differing disease presentations. Routes of Legionella spp. infection do not include ingestion, but rather aspiration and inhalation of contaminated water are the routes of exposure. The susceptible population for OWI is a vulnerable sub-set of the population unlike those associated with enteric disease pathogens. These variabilities in dose, exposure and susceptibility call in to question whether QMRA can be a useful tool in managing risks associated with OWI. Consideration of Legionella spp. as a well-documented subject of research calls into question whether QMRA of OWI is likely to be a useful tool in developing risk management strategies.
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Pankhurst CL, Scully C, Samaranayake L. Dental Unit Water Lines and their Disinfection and Management: A Review. ACTA ACUST UNITED AC 2017; 44:284-5, 289-92. [PMID: 29172350 DOI: 10.12968/denu.2017.44.4.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The perceived threat to public health from dental unit water line (DUWL) contamination comes from opportunistic and respiratory pathogens such as Legionella spp, Nontuberculous Mycobacteria (NTM) and pseudomonads. These organisms can grow and multiply in the DUWL biofilm to reach infective concentrations, with the potential for inhalation leading to respiratory infections or direct contamination of surgical wounds. In this paper we discuss current legislation and practical methods for delivering water within the DUWL that meets the standards for safety. Clinical relevance: Understanding the clinical relevance and methods for decontaminating DUWL is essential to create a safe working environment in dentistry.
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A Supervised Statistical Learning Approach for Accurate Legionella pneumophila Source Attribution during Outbreaks. Appl Environ Microbiol 2017; 83:AEM.01482-17. [PMID: 28821546 DOI: 10.1128/aem.01482-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/11/2017] [Indexed: 01/12/2023] Open
Abstract
Public health agencies are increasingly relying on genomics during Legionnaires' disease investigations. However, the causative bacterium (Legionella pneumophila) has an unusual population structure, with extreme temporal and spatial genome sequence conservation. Furthermore, Legionnaires' disease outbreaks can be caused by multiple L. pneumophila genotypes in a single source. These factors can confound cluster identification using standard phylogenomic methods. Here, we show that a statistical learning approach based on L. pneumophila core genome single nucleotide polymorphism (SNP) comparisons eliminates ambiguity for defining outbreak clusters and accurately predicts exposure sources for clinical cases. We illustrate the performance of our method by genome comparisons of 234 L. pneumophila isolates obtained from patients and cooling towers in Melbourne, Australia, between 1994 and 2014. This collection included one of the largest reported Legionnaires' disease outbreaks, which involved 125 cases at an aquarium. Using only sequence data from L. pneumophila cooling tower isolates and including all core genome variation, we built a multivariate model using discriminant analysis of principal components (DAPC) to find cooling tower-specific genomic signatures and then used it to predict the origin of clinical isolates. Model assignments were 93% congruent with epidemiological data, including the aquarium Legionnaires' disease outbreak and three other unrelated outbreak investigations. We applied the same approach to a recently described investigation of Legionnaires' disease within a UK hospital and observed a model predictive ability of 86%. We have developed a promising means to breach L. pneumophila genetic diversity extremes and provide objective source attribution data for outbreak investigations.IMPORTANCE Microbial outbreak investigations are moving to a paradigm where whole-genome sequencing and phylogenetic trees are used to support epidemiological investigations. It is critical that outbreak source predictions are accurate, particularly for pathogens, like Legionella pneumophila, which can spread widely and rapidly via cooling system aerosols, causing Legionnaires' disease. Here, by studying hundreds of Legionella pneumophila genomes collected over 21 years around a major Australian city, we uncovered limitations with the phylogenetic approach that could lead to a misidentification of outbreak sources. We implement instead a statistical learning technique that eliminates the ambiguity of inferring disease transmission from phylogenies. Our approach takes geolocation information and core genome variation from environmental L. pneumophila isolates to build statistical models that predict with high confidence the environmental source of clinical L. pneumophila during disease outbreaks. We show the versatility of the technique by applying it to unrelated Legionnaires' disease outbreaks in Australia and the UK.
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Oder M, Fink R, Bohinc K, Torkar KG. The influence of shear stress on the adhesion capacity of Legionella pneumophila. Arh Hig Rada Toksikol 2017; 68:109-115. [DOI: 10.1515/aiht-2017-68-2904] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 05/01/2017] [Indexed: 12/16/2022] Open
Abstract
Abstract
Bacterial adhesion is a complex process influenced by many factors, including hydrodynamic conditions. They affect the transfer of oxygen, nutrients, and bacterial cells in a water supply and cooling systems. The aim of this study was to identify hydrodynamic effects on bacterial adhesion to and detachment from stainless steel surfaces. For this purpose we observed the behaviour of bacterium L. pneumophila in no-flow and laminar and turbulent flow conditions simulated in a fluid flow chamber. The bacterial growth in no-flow and laminar flow conditions was almost identical in the first 24 h, while at 48 and 72 h of incubation, the laminar flow stimulated bacterial growth. In the second part of this study we found that laminar flow accelerated bacterial adhesion in the first 48 h, but after 72 h the amount of bacterial cells exposed to the flow dropped, probably due to detachment. In the third part we found that the turbulent flow detached more bacterial cells than the laminar, which indicates that the strength of shear forces determines the rate of bacterial removal.
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Affiliation(s)
- Martina Oder
- Faculty of Health Sciences, University of Ljubljana, Ljubljana , Slovenia
| | - Rok Fink
- Faculty of Health Sciences, University of Ljubljana, Ljubljana , Slovenia
| | - Klemen Bohinc
- Faculty of Health Sciences, University of Ljubljana, Ljubljana , Slovenia
| | - Karmen Godič Torkar
- University of Ljubljana, Faculty of Health Sciences, Department for Sanitary Engineering, Zdravstvena pot 5, 1000 Ljubljana , Slovenia
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16
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The typical presentation of an atypical pathogen during an outbreak of Legionnaires' disease in Vila Franca de Xira, Portugal, 2014. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:117-123. [PMID: 28259636 DOI: 10.1016/j.rppnen.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires' disease (LD). METHODS We describe the clinical findings and diagnostic methods used among the 43 confirmed or probable cases admitted to our department. RESULTS 60.5% were male, mean age was 56.1±13.5 years and tobacco smoking was the most frequent risk factor (76.7%). All patients had fever, 62.8% ≥39.5°C, 72.1% had chills and myalgia/arthralgia and 62.8% had dry cough. Extra pulmonary symptoms were frequent: confusion and headache occurred in 34.9% and gastrointestinal symptoms in 20.9%. High C-Reactive Protein (55.8% ≥30mg/dL) and hyponatremia (62.8%) were the laboratorial abnormalities most commonly found. Hypoxemia occurred in 55.8% and hypocapnia in 93%. Urinary Antigen Test (UAT) was positive in 83.7% of the cases. CONCLUSIONS Although not specific, a combination of risk factors, symptoms and laboratory findings can be highly suggestive of LD, even in an outbreak. This should prompt diagnosis confirmation. Routine use of UAT in less severe cases of community acquired pneumonia might contribute to earlier diagnosis.
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17
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Prasad B, Hamilton KA, Haas CN. Incorporating Time-Dose-Response into Legionella Outbreak Models. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:291-304. [PMID: 27228068 DOI: 10.1111/risa.12630] [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: 05/26/2015] [Revised: 02/05/2016] [Accepted: 02/13/2016] [Indexed: 06/05/2023]
Abstract
A novel method was used to incorporate in vivo host-pathogen dynamics into a new robust outbreak model for legionellosis. Dose-response and time-dose-response (TDR) models were generated for Legionella longbeachae exposure to mice via the intratracheal route using a maximum likelihood estimation approach. The best-fit TDR model was then incorporated into two L. pneumophila outbreak models: an outbreak that occurred at a spa in Japan, and one that occurred in a Melbourne aquarium. The best-fit TDR from the murine dosing study was the beta-Poisson with exponential-reciprocal dependency model, which had a minimized deviance of 32.9. This model was tested against other incubation distributions in the Japan outbreak, and performed consistently well, with reported deviances ranging from 32 to 35. In the case of the Melbourne outbreak, the exponential model with exponential dependency was tested against non-time-dependent distributions to explore the performance of the time-dependent model with the lowest number of parameters. This model reported low minimized deviances around 8 for the Weibull, gamma, and lognormal exposure distribution cases. This work shows that the incorporation of a time factor into outbreak distributions provides models with acceptable fits that can provide insight into the in vivo dynamics of the host-pathogen system.
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Affiliation(s)
- Bidya Prasad
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA, USA
| | - Kerry A Hamilton
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA, USA
| | - Charles N Haas
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, PA, USA
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Bassett MT, Balter S. Regulating Cooling Towers to Prevent Outbreaks of Legionnaires' Disease. Public Health Rep 2017; 132:133-135. [PMID: 28147210 DOI: 10.1177/0033354916689612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mary T Bassett
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Sharon Balter
- 1 New York City Department of Health and Mental Hygiene, Queens, NY, USA
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A Case of Pulmonary-Renal Syndrome Leading to the Diagnosis of Legionnaires' Disease. Case Rep Nephrol 2016; 2016:4250819. [PMID: 27999694 PMCID: PMC5141308 DOI: 10.1155/2016/4250819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 51-year-old Caucasian man referred at our department due to acute renal failure (ARF) complicating respiratory failure during hospitalization in a regional hospital. The patient was previously started on steroids due to the suspicion of rapidly progressive glomerulonephritis (RPGN) in the context of Goodpasture syndrome. However, clinical and laboratory findings did not support this diagnosis; instead a careful evaluation limited differential diagnosis of the renal insult to acute tubular necrosis or acute interstitial nephritis (AIN) following respiratory infection. With lung function fully improved but renal function not recovering, a renal biopsy revealed AIN, a finding leading to further diagnostic testing and finally to the diagnosis of Legionnaires' disease as a cause of this patient's pulmonary-renal syndrome. The management consisted of progressive tapering of oral steroids associated with full recovery of the patient's renal function. This is a rare case of Legionnaires' disease causing immune-mediated AIN and highlights the possibility of Legionella infection as a cause of pulmonary-renal syndrome.
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20
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Lee EH, Chua B, Son A. Detection of airborne bacteria with disposable bio-precipitator and NanoGene assay. Biosens Bioelectron 2016; 83:205-12. [DOI: 10.1016/j.bios.2016.04.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
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22
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Qu PH, Li Y, Salam N, Chen SY, Liu L, Gu Q, Fang BZ, Xiao M, Li M, Chen C, Li WJ. Allofrancisella inopinata gen. nov., sp. nov. and Allofrancisella frigidaquae sp. nov., isolated from water-cooling systems, and transfer of Francisella guangzhouensis Qu et al. 2013 to the new genus as Allofrancisella guangzhouensis comb. nov. Int J Syst Evol Microbiol 2016; 66:4832-4838. [PMID: 27543089 DOI: 10.1099/ijsem.0.001437] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Five bacterial strains (SYSU YG23T, SYSU 10HL1970T, 10HP82-10, 10HL1938, 10HP457) isolated from water reservoirs of cooling systems were characterized using a polyphasic taxonomic approach. The isolates were Gram-stain-negative, strictly aerobic and non-motile. Growth was enhanced in the presence of l-cysteine. The major fatty acids (>5 %) for the five strains were C10 : 0, C16 : 0, C16 : 0 3-OH, C18 : 0 3-OH and C18 : 1ω9c. Ubiquinone-8 was detected as the respiratory quinone while the polar lipid profile consisted of phosphatidylethanolamine, diphosphatidylglycerol, phosphatidylglycerol, phosphatidylcholine, three unidentified phospholipids, two unidentified aminophospholipids and three unidentified glycolipids. The strains shared 16S rRNA gene sequence similarities of 99.0-99.2 % with Francisella guangzhouensis 08HL01032T but less than 95.2 % with other members of the family Francisellaceae. The phylogenetic dendrogram based on 16S rRNA gene sequences showed that these strains form a separate cluster along with Francisella guangzhouensis. This cluster was also confirmed from multilocus-sequence typing based on sequences of the mdhA, rpoB and sdhA genes. Matrix-assisted laser desorption ionization time-of-flight MS analyses of the strains along with closely and distantly related Francisella strains also showed a distinct cluster for these strains. Based on the findings from the polyphasic taxonomy studies, the strains were considered to represent two novel species of a new genus for which the names Allofrancisella inopinata gen. nov., sp. nov. (type strain SYSU YG23T=KCTC 42968T=DSM 101834T) and Allofrancisella frigidaquae sp. nov. (type strain SYSU 10HL1970T=KCTC 42969T=DSM 101835T) are proposed. In addition, Francisella guangzhouensisQu et al. 2013 is proposed to be transferred to this new genus as Allofrancisella guangzhouensis comb. nov.
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Affiliation(s)
- Ping-Hua Qu
- Department of Clinical Laboratory, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, PR China
| | - Ying Li
- Department of Clinical Laboratory, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, PR China
- School of Laboratory Medicine, Tianjin Medical University, Tianjin 300070, PR China
| | - Nimaichand Salam
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, PR China
| | - Shou-Yi Chen
- Department of Microbiological Laboratory, Guangzhou Center for Diseases Control and Prevention, Guangzhou 510440, PR China
| | - Lan Liu
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, PR China
| | - Quan Gu
- Department of Clinical Laboratory, Tangshan People's Hospital, Tangshan 063000, PR China
| | - Bao-Zhu Fang
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, PR China
| | - Min Xiao
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, PR China
| | - Mo Li
- Department of Clinical Laboratory, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, PR China
| | - Cha Chen
- Department of Clinical Laboratory, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510006, PR China
| | - Wen-Jun Li
- State Key Laboratory of Biocontrol and Guangdong Provincial Key Laboratory of Plant Resources, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, PR China
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Ahmadrajabi R, Shakibaie MR, Iranmanesh Z, Mollaei HR, Sobhanipoor MH. Prevalence of mip virulence gene and PCR-base sequence typing of Legionella pneumophila from cooling water systems of two cities in Iran. Virulence 2016; 7:602-9. [PMID: 27028760 DOI: 10.1080/21505594.2016.1170944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Legionella pneumophila is the primary respiratory pathogen and mostly transmitted to human through water cooling systems and cause mild to severe pneumonia with high mortality rate especially in elderly both in hospitals and community. However, current Legionella risk assessments may be compromised by uncertainties in Legionella detection methods. Here, we investigated the presence of L. pneumophila mip gene in water samples collected from different hospitals cooling towers, nursing homes and building/hotels water coolants from two geographical locations of Iran (Kerman and Bam cities) during summer season of 2015 by both nested and real-time PCR methods. Analysis of the 128 water samples for presence of the mip gene by nested-PCR revealed, 18 (23%) positive cases in Kerman and 7(14%) in Bam. However, when samples were tested by real-time PCR, we identified 4 more new cases of L. pneumophila in the hospitals as well as nursing homes water systems that were missed by nested-PCR. The highest rate of contamination was detected in water obtained from hospitals cooling towers in both the cities (p≤0.05). Dendrogram analysis and clonal relationship by PCR-base sequence typing (SBT) of the L. pneumophila genomic DNAs in Kerman water samples showed close clonal similarities among the isolates, in contrast, isolates identified from Bam city demonstrated two fingerprint patterns. The clones from hospital water samples were more related to the L. pneumophila serogroup- 1.
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Affiliation(s)
- Roya Ahmadrajabi
- a Faculty of Medicine, Microbiology Section, Bam University of Medical Sciences , Bam , Iran
| | - Mohammad Reza Shakibaie
- b Department of Microbiology and Virology , Kerman University of Medical Sciences , Kerman , Iran.,c Environmental Health and Engineering Research Center, Kerman University of Medical Sciences , Kerman , Iran
| | - Zahra Iranmanesh
- b Department of Microbiology and Virology , Kerman University of Medical Sciences , Kerman , Iran
| | - Hamid Reza Mollaei
- b Department of Microbiology and Virology , Kerman University of Medical Sciences , Kerman , Iran
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Evaluation of an Optimal Epidemiological Typing Scheme for Legionella pneumophila with Whole-Genome Sequence Data Using Validation Guidelines. J Clin Microbiol 2016; 54:2135-48. [PMID: 27280420 PMCID: PMC4963484 DOI: 10.1128/jcm.00432-16] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/20/2016] [Indexed: 01/23/2023] Open
Abstract
Sequence-based typing (SBT), analogous to multilocus sequence typing (MLST), is the current "gold standard" typing method for investigation of legionellosis outbreaks caused by Legionella pneumophila However, as common sequence types (STs) cause many infections, some investigations remain unresolved. In this study, various whole-genome sequencing (WGS)-based methods were evaluated according to published guidelines, including (i) a single nucleotide polymorphism (SNP)-based method, (ii) extended MLST using different numbers of genes, (iii) determination of gene presence or absence, and (iv) a kmer-based method. L. pneumophila serogroup 1 isolates (n = 106) from the standard "typing panel," previously used by the European Society for Clinical Microbiology Study Group on Legionella Infections (ESGLI), were tested together with another 229 isolates. Over 98% of isolates were considered typeable using the SNP- and kmer-based methods. Percentages of isolates with complete extended MLST profiles ranged from 99.1% (50 genes) to 86.8% (1,455 genes), while only 41.5% produced a full profile with the gene presence/absence scheme. Replicates demonstrated that all methods offer 100% reproducibility. Indices of discrimination range from 0.972 (ribosomal MLST) to 0.999 (SNP based), and all values were higher than that achieved with SBT (0.940). Epidemiological concordance is generally inversely related to discriminatory power. We propose that an extended MLST scheme with ∼50 genes provides optimal epidemiological concordance while substantially improving the discrimination offered by SBT and can be used as part of a hierarchical typing scheme that should maintain backwards compatibility and increase discrimination where necessary. This analysis will be useful for the ESGLI to design a scheme that has the potential to become the new gold standard typing method for L. pneumophila.
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25
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Animals in healthcare facilities: recommendations to minimize potential risks. Infect Control Hosp Epidemiol 2016; 36:495-516. [PMID: 25998315 DOI: 10.1017/ice.2015.15] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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26
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Cassier P, Bénet T, Nicolle MC, Brunet M, Buron F, Morelon E, Béraud L, Descours G, Jarraud S, Vanhems P. Community-acquired Legionnaires' disease in a renal transplant recipient with unclear incubation period: the importance of molecular typing. Transpl Infect Dis 2015; 17:756-60. [PMID: 26256573 DOI: 10.1111/tid.12432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/13/2015] [Accepted: 07/26/2015] [Indexed: 11/29/2022]
Abstract
Transplant recipients are at risk of developing Legionnaires' disease (LD) because of impaired cellular immunity. Here, we describe a renal transplant recipient who developed LD at least 10 days after hospital admission and transplantation. The hospital water network was initially suspected, but further testing determined that the probable source was the patient's domestic water supply. Our report also suggests that the patient's immunosuppressed state may have switched potential colonization to pneumonia.
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Affiliation(s)
- P Cassier
- Hospices Civils de Lyon, Unité d'Hygiène et d'Epidémiologie, Groupement Hospitalier Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Centre National de Reference des Legionelles, Centre de Biologie Est Hospices Civils de Lyon, Bron, France.,CIRI, International Center for Infectiology Research, Legionella Pathogenesis Team, Université de Lyon, Lyon, France.,Inserm, U1111, Lyon, France.,Ecole Normale Supérieure de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon 1, Lyon, France
| | - T Bénet
- Hospices Civils de Lyon, Unité d'Hygiène et d'Epidémiologie, Groupement Hospitalier Edouard Herriot, Lyon, France.,Laboratoire d'épidémiologie et de santé publique, CNRS, UMR5308, Université de Lyon 1, Lyon, France
| | - M C Nicolle
- Hospices Civils de Lyon, Unité d'Hygiène et d'Epidémiologie, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - M Brunet
- Hospices Civils de Lyon, Transplantation, Néphrologie et Immunologie Clinique, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - F Buron
- Hospices Civils de Lyon, Transplantation, Néphrologie et Immunologie Clinique, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - E Morelon
- Hospices Civils de Lyon, Transplantation, Néphrologie et Immunologie Clinique, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - L Béraud
- Hospices Civils de Lyon, Centre National de Reference des Legionelles, Centre de Biologie Est Hospices Civils de Lyon, Bron, France
| | - G Descours
- Hospices Civils de Lyon, Centre National de Reference des Legionelles, Centre de Biologie Est Hospices Civils de Lyon, Bron, France.,CIRI, International Center for Infectiology Research, Legionella Pathogenesis Team, Université de Lyon, Lyon, France.,Inserm, U1111, Lyon, France.,Ecole Normale Supérieure de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon 1, Lyon, France
| | - S Jarraud
- Hospices Civils de Lyon, Centre National de Reference des Legionelles, Centre de Biologie Est Hospices Civils de Lyon, Bron, France.,CIRI, International Center for Infectiology Research, Legionella Pathogenesis Team, Université de Lyon, Lyon, France.,Inserm, U1111, Lyon, France.,Ecole Normale Supérieure de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon 1, Lyon, France
| | - P Vanhems
- Hospices Civils de Lyon, Unité d'Hygiène et d'Epidémiologie, Groupement Hospitalier Edouard Herriot, Lyon, France.,Hospices Civils de Lyon, Centre National de Reference des Legionelles, Centre de Biologie Est Hospices Civils de Lyon, Bron, France.,CIRI, International Center for Infectiology Research, Legionella Pathogenesis Team, Université de Lyon, Lyon, France.,Inserm, U1111, Lyon, France.,Ecole Normale Supérieure de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Université de Lyon 1, Lyon, France.,Laboratoire d'épidémiologie et de santé publique, CNRS, UMR5308, Université de Lyon 1, Lyon, France
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Legionellosis in Patients With Cancer. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Farnham A, Alleyne L, Cimini D, Balter S. Legionnaires' disease incidence and risk factors, New York, New York, USA, 2002-2011. Emerg Infect Dis 2015; 20:1795-1802. [PMID: 25513657 PMCID: PMC4214295 DOI: 10.3201/eid2011.131872] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Living in low-income areas and working in certain occupations may increase risk. Incidence of Legionnaires’ disease in the United States is increasing. We reviewed case records to determine the the epidemiology of and risk factors for the 1,449 cases reported to the New York City Department of Health and Mental Hygiene, New York, New York, USA, during 2002–2011. The highest incidence (2.74 cases/100,000 population) occurred in 2009; this incidence was higher than national incidence for that year (1.15 cases/100,000 population). Overall, incidence of Legionnaires’ disease in the city of New York increased 230% from 2002 to 2009 and followed a socioeconomic gradient, with highest incidence occurring in the highest poverty areas. Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires’ disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease.
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Affiliation(s)
- Andrea Farnham
- Current affiliation: University of Zurich, Zurich, Switzerland
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van Heijnsbergen E, Schalk JAC, Euser SM, Brandsema PS, den Boer JW, de Roda Husman AM. Confirmed and Potential Sources of Legionella Reviewed. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:4797-815. [PMID: 25774976 DOI: 10.1021/acs.est.5b00142] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Legionella bacteria are ubiquitous in natural matrices and man-made systems. However, it is not always clear if these reservoirs can act as source of infection resulting in cases of Legionnaires' disease. This review provides an overview of reservoirs of Legionella reported in the literature, other than drinking water distribution systems. Levels of evidence were developed to discriminate between potential and confirmed sources of Legionella. A total of 17 systems and matrices could be classified as confirmed sources of Legionella. Many other man-made systems or natural matrices were not classified as a confirmed source, since either no patients were linked to these reservoirs or the supporting evidence was weak. However, these systems or matrices could play an important role in the transmission of infectious Legionella bacteria; they might not yet be considered in source investigations, resulting in an underestimation of their importance. To optimize source investigations it is important to have knowledge about all the (potential) sources of Legionella. Further research is needed to unravel what the contribution is of each confirmed source, and possibly also potential sources, to the LD disease burden.
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Affiliation(s)
- Eri van Heijnsbergen
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Johanna A C Schalk
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Sjoerd M Euser
- ‡Regional Public Health Laboratory Kennemerland, Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Petra S Brandsema
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Jeroen W den Boer
- ‡Regional Public Health Laboratory Kennemerland, Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Ana Maria de Roda Husman
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
- §Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
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Legionnaires’ disease in France. Med Mal Infect 2015; 45:65-71. [DOI: 10.1016/j.medmal.2015.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 12/31/2014] [Accepted: 01/29/2015] [Indexed: 11/30/2022]
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Guridi A, Diederich AK, Aguila-Arcos S, Garcia-Moreno M, Blasi R, Broszat M, Schmieder W, Clauss-Lendzian E, Sakinc-Gueler T, Andrade R, Alkorta I, Meyer C, Landau U, Grohmann E. New antimicrobial contact catalyst killing antibiotic resistant clinical and waterborne pathogens. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 50:1-11. [PMID: 25746238 DOI: 10.1016/j.msec.2015.01.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/21/2014] [Accepted: 01/24/2015] [Indexed: 12/19/2022]
Abstract
Microbial growth on medical and technical devices is a big health issue, particularly when microorganisms aggregate to form biofilms. Moreover, the occurrence of antibiotic-resistant bacteria in the clinical environment is dramatically growing, making treatment of bacterial infections very challenging. In search of an alternative, we studied a novel antimicrobial surface coating based on micro galvanic elements formed by silver and ruthenium with surface catalytic properties. The antimicrobial coating efficiently inhibited the growth of the nosocomial pathogens Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis and Enterococcus faecium as demonstrated by the growth inhibition on agar surface and in biofilms of antibiotic resistant clinical E. faecalis, E. faecium, and S. aureus isolates. It also strongly reduced the growth of Legionella in a drinking water pipeline and of Escherichia coli in urine. We postulate a mode of action of the antimicrobial material, which is independent of the release of silver ions. Thus, the novel antimicrobial coating could represent an alternative to combat microbial growth avoiding the toxic side effects of high levels of silver ions on eukaryotic cells.
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Affiliation(s)
- A Guridi
- Biophysics Unit (CSIC, UPV/EHU), Department of Biochemistry and Molecular Biology, University of the Basque Country, 48940 Leioa, Spain
| | - A-K Diederich
- University Medical Center Freiburg, Division of Infectious Diseases, Hugstetter Strasse 55, 79106 Freiburg, Germany; Biology II, Microbiology, Albert-Ludwigs-University Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany
| | - S Aguila-Arcos
- Biophysics Unit (CSIC, UPV/EHU), Department of Biochemistry and Molecular Biology, University of the Basque Country, 48940 Leioa, Spain
| | - M Garcia-Moreno
- Biophysics Unit (CSIC, UPV/EHU), Department of Biochemistry and Molecular Biology, University of the Basque Country, 48940 Leioa, Spain
| | - R Blasi
- University Medical Center Freiburg, Division of Infectious Diseases, Hugstetter Strasse 55, 79106 Freiburg, Germany; Biology II, Microbiology, Albert-Ludwigs-University Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany
| | - M Broszat
- University Medical Center Freiburg, Division of Infectious Diseases, Hugstetter Strasse 55, 79106 Freiburg, Germany; Biology II, Microbiology, Albert-Ludwigs-University Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany
| | - W Schmieder
- Biology II, Microbiology, Albert-Ludwigs-University Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany
| | - E Clauss-Lendzian
- Biology II, Microbiology, Albert-Ludwigs-University Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany
| | - T Sakinc-Gueler
- University Medical Center Freiburg, Division of Infectious Diseases, Hugstetter Strasse 55, 79106 Freiburg, Germany
| | - R Andrade
- Advanced Research Facilities (SGIker), University of the Basque Country, UPV/EHU, 48940 Leioa, Spain
| | - I Alkorta
- Biophysics Unit (CSIC, UPV/EHU), Department of Biochemistry and Molecular Biology, University of the Basque Country, 48940 Leioa, Spain
| | - C Meyer
- Largentec GmbH, Am Waldhaus 32, 14129 Berlin, Germany
| | - U Landau
- Largentec GmbH, Am Waldhaus 32, 14129 Berlin, Germany
| | - E Grohmann
- Biophysics Unit (CSIC, UPV/EHU), Department of Biochemistry and Molecular Biology, University of the Basque Country, 48940 Leioa, Spain; University Medical Center Freiburg, Division of Infectious Diseases, Hugstetter Strasse 55, 79106 Freiburg, Germany; Biology II, Microbiology, Albert-Ludwigs-University Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany.
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Marzouk M, Boukadida A, Chouchene I, Ferjani A, Hannachi N, Besbes M, Bouchoucha S, Boukadida J. Analyse des cas de légionellose grave hospitalisés dans les services de réanimation en Tunisie. ACTA ACUST UNITED AC 2015; 108:191-6. [DOI: 10.1007/s13149-014-0414-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 10/30/2014] [Indexed: 11/29/2022]
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Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K, Lortholary O, Zumla A, Abubakar I. Epidemiology and clinical management of Legionnaires' disease. THE LANCET. INFECTIOUS DISEASES 2014; 14:1011-21. [DOI: 10.1016/s1473-3099(14)70713-3] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Finch S, Gordon I. The Development of a First Course in Statistical Literacy for Undergraduates. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-1-4939-0603-1_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Burdet C, Lepeule R, Duval X, Caseris M, Rioux C, Lucet JC, Yazdanpanah Y. Quinolones versus macrolides in the treatment of legionellosis: a systematic review and meta-analysis. J Antimicrob Chemother 2014; 69:2354-60. [PMID: 24827889 DOI: 10.1093/jac/dku159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Legionellosis is a life-threatening disease. The clinical superiority of quinolones or macrolides for treating patients with legionellosis has not been established. METHODS We performed a systematic review and meta-analysis of studies reporting data that allowed the comparison of quinolones versus macrolides in the treatment of proven legionellosis published from 1 January 1985 to 31 January 2013. We collected baseline aggregate patient characteristics. Studied outcomes included mortality, clinical cure, time to apyrexia, length of hospital stay and occurrence of complications in each treatment group. Treatment effect was assessed using a Mantel-Haenszel random effects model. RESULTS Among 1005 abstracts reviewed, 12 studies were selected (n=879 patients). No randomized controlled trial was performed directly comparing quinolone and macrolide efficacy in legionellosis. Mean age was 58.3 years, 27.7% were women and Fine score was ≥ 4 in 35.8%. Among 253 patients who received quinolone monotherapy, 10 died (4.0%). Among 211 patients who received macrolide monotherapy, 23 died (10.9%). The pooled OR of death for treatment with a quinolone versus a macrolide was 0.5 (95% CI 0.2-1.3, n=8 studies, 464 patients). Length of stay was significantly shorter in the quinolone monotherapy group. The difference was 3.0 days (95% CI 0.7-5.3, P=0.001, n=3 studies, 263 patients). Neither of two tests for heterogeneity was significant (I (2)=0% for both, P=1). Other studied outcomes were not significantly different among treatment groups. CONCLUSIONS Few clinical data on legionellosis treatment are available. This first meta-analysis showed a trend toward a lower mortality rate and a significant decrease in length of hospital stay among patients receiving quinolones. These results must be confirmed by a randomized controlled trial.
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Affiliation(s)
- C Burdet
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France APHP, Bichat Hospital, Biostatistics Department, Paris, France INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France
| | - R Lepeule
- APHP, Beaujon Hospital, Internal Medicine Department, Clichy, France
| | - X Duval
- INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France INSERM CIC 1425, APHP, Bichat Hospital, Paris, France
| | - M Caseris
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France
| | - C Rioux
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France
| | - J-C Lucet
- INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France APHP, Bichat Hospital, Infection Control Unit, Paris, France
| | - Y Yazdanpanah
- APHP, Bichat Hospital, Infectious Diseases Department, Paris, France INSERM, IAME, UMR 1137 and Université Paris-Diderot, Paris, France
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Walser SM, Gerstner DG, Brenner B, Höller C, Liebl B, Herr CE. Assessing the environmental health relevance of cooling towers – A systematic review of legionellosis outbreaks. Int J Hyg Environ Health 2014; 217:145-54. [DOI: 10.1016/j.ijheh.2013.08.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/07/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
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Summer increase of Legionnaires' disease 2010 in The Netherlands associated with weather conditions and implications for source finding. Epidemiol Infect 2014; 142:2360-71. [PMID: 24576486 DOI: 10.1017/s0950268813003476] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
During August and September 2010 an unexpected high number of domestic cases of Legionnaires' disease (LD) were reported in The Netherlands. To examine this increase, patient characteristics and results of source finding and environmental sampling during the summer peak were compared to other domestic cases in 2008-2011. This analysis did not provide an explanation for the rise in cases. A similar increase in LD cases in 2006 was shown to be associated with warm and wet weather conditions, using an extended Poisson regression model with adjustment for long-term trends. This model was optimized with the new data from 2008 to 2011. The increase in 2010 was very accurately described by a model, which included temperature in the preceding 4 weeks, and precipitation in the preceding 2 weeks. These results confirm the strong association of LD incidence with weather conditions, but it remains unclear which environmental sources contributed to the 2010 summer increase.
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Mehraj V, Wiramus S, Capo C, Leone M, Mege JL, Textoris J. Early sex-specific modulation of the molecular clock in trauma. J Trauma Acute Care Surg 2014; 76:241-4. [PMID: 24368387 DOI: 10.1097/ta.0b013e3182a90014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immune system biology and most physiologic functions are tightly linked to circadian rhythms. Time of day-dependent variations in many biologic parameters also play a fundamental role in the disease process. We previously showed that the genes encoding the peripheral molecular clock were modulated in a sex-dependent manner in Q fever. METHODS Here, we examined severe trauma patients at admission to the intensive care unit. Using quantitative real-time polymerase chain reaction, the whole-blood expression of the molecular clock components ARNTL, CLOCK, and PER2 was assessed in male and female trauma patients. Healthy volunteers of both sexes were used as controls. RESULTS We observed a significant overexpression of both ARNTL and CLOCK in male trauma patients. CONCLUSION We report, for the first time, the sex-related modulation of the molecular clock genes in the blood following severe trauma. These results emphasize the role of circadian rhythms in the immune response in trauma patients. LEVEL OF EVIDENCE Epidemiologic study, level IV.
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Affiliation(s)
- Vikram Mehraj
- From the Equipe Infection (V.M., C.C., M.L., J.-L.M., J.T.), Genre et Grossesse, URMITE CNRS UMR7278, INSERM U1095, Aix- Marseille Université; Service d'anesthésie et de reanimation (S.W., M.L., J.T.), Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université; and Service d'anesthésie et de reanimation (S.W.), Réanimation du centre des brûlés inter-régional de Méditerranée, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Abstract
A community outbreak of legionellosis occurred in Barrow-in-Furness, Cumbria, during July and August 2002. A descriptive study and active case-finding were instigated and all known wet cooling systems and other potential sources were investigated. Genotypic and phenotypic analysis, and amplified fragment length polymorphism of clinical human and environmental isolates confirmed the air-conditioning unit of a council-owned arts and leisure centre to be the source of infection. Subsequent sequence-based typing confirmed this link. One hundred and seventy-nine cases, including seven deaths [case fatality rate (CFR) 3·9%] were attributed to the outbreak. Timely recognition and management of the incident very likely led to the low CFR compared to other outbreaks. The outbreak highlights the responsibility associated with managing an aerosol-producing system, with the potential to expose and infect a large proportion of the local population and the consequent legal ramifications and human cost.
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Yiallouros PK, Papadouri T, Karaoli C, Papamichael E, Zeniou M, Pieridou-Bagatzouni D, Papageorgiou GT, Pissarides N, Harrison TG, Hadjidemetriou A. First Outbreak of Nosocomial Legionella Infection in Term Neonates Caused by a Cold Mist Ultrasonic Humidifier. Clin Infect Dis 2013; 57:48-56. [DOI: 10.1093/cid/cit176] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kaku N, Sato T, Nakashima M, Nagashima S, Fukuda M, Hashiguchi K, Kaku N, Yanagihara K, Morinaga Y, Yanagihara K, Morinaga Y, Kohno S, Sakai T, Tominaga H, Wakigawa F. Detection of Legionella pneumophila serogroup 1 in blood cultures from a patient treated with tumor necrosis factor-alpha inhibitor. J Infect Chemother 2013; 19:166-70. [DOI: 10.1007/s10156-012-0459-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
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Stommel EW, Field NC, Caller TA. Aerosolization of cyanobacteria as a risk factor for amyotrophic lateral sclerosis. Med Hypotheses 2012; 80:142-5. [PMID: 23246360 DOI: 10.1016/j.mehy.2012.11.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/30/2012] [Accepted: 11/09/2012] [Indexed: 11/17/2022]
Abstract
Sporadic amyotrophic lateral sclerosis (sALS) is a fatal neurodegenerative disease with no known cause. There are many clues to suggest an environmental trigger for the disease, including reports of conjugal couples and co-localized employees that developed sALS. On the island of Guam,a very high incidence of sALS occurred among the Chamorro natives back in the 1940s and 1950s and has been linked to the neurotoxin beta-N-methylamino-L-alanine (BMAA) that is produced by cyanobacteria that live symbiotically in the roots of the cycad plant, the seeds from which were a staple of the Chamorro diet. It has been shown that BMAA was biomagnified up the food chain from the cycad seeds to the now largely extinct, indigenous flying foxes, a former delicacy of the Chamorro natives. Recent evidence suggests that long term, chronic exposure to low levels of BMAA might cause ALS in genetically predisposed individuals. Many exposure routes to BMAA have been implicated thus far, including consumption of contaminated food and exposure to water harboring cyanobacterial blooms which have the capability of producing BMAA. Aerosolization is a well documented means for bacterial or toxin exposure causing subsequent illness, as in the case of brevetoxins and pulmonary disease and Legionnaire's disease. We hypothesize that some cases of ALS may be related to chronic exposure to the aerosolization of cyanobacteria derived BMAA from cooling towers and might explain the observation of conjugal ALS couples.
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Affiliation(s)
- Elijah W Stommel
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, United States.
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Smith KF, Schmidt V, Rosen GE, Amaral-Zettler L. Microbial diversity and potential pathogens in ornamental fish aquarium water. PLoS One 2012; 7:e39971. [PMID: 22970112 PMCID: PMC3435374 DOI: 10.1371/journal.pone.0039971] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/05/2012] [Indexed: 12/12/2022] Open
Abstract
Ornamental fishes are among the most popular and fastest growing categories of pets in the United States (U.S.). The global scope and scale of the ornamental fish trade and growing popularity of pet fish in the U.S. are strong indicators of the myriad economic and social benefits the pet industry provides. Relatively little is known about the microbial communities associated with these ornamental fishes or the aquarium water in which they are transported and housed. Using conventional molecular approaches and next generation high-throughput amplicon sequencing of 16S ribosomal RNA gene hypervariable regions, we characterized the bacterial community of aquarium water containing common goldfish (Carassius auratus) and Chinese algae eaters (Gyrinocheilus aymonieri) purchased from seven pet/aquarium shops in Rhode Island and identified the presence of potential pathogens. Our survey identified a total of 30 phyla, the most common being Proteobacteria (52%), Bacteroidetes (18%) and Planctomycetes (6%), with the top four phyla representing >80% of all sequences. Sequences from our water samples were most closely related to eleven bacterial species that have the potential to cause disease in fishes, humans and other species: Coxiella burnetii, Flavobacterium columnare, Legionella birminghamensis, L. pneumophila, Vibrio cholerae, V. mimicus. V. vulnificus, Aeromonas schubertii, A. veronii, A. hydrophila and Plesiomonas shigelloides. Our results, combined with evidence from the literature, suggest aquarium tank water harboring ornamental fish are an understudied source for novel microbial communities and pathogens that pose potential risks to the pet industry, fishes in trade, humans and other species.
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Affiliation(s)
- Katherine F. Smith
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island, United States of America
| | - Victor Schmidt
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island, United States of America
- The Josephine Bay Paul Center for Comparative Molecular Biology and Evolution, Marine Biological Laboratory, Woods Hole, Massachusetts, United States of America
| | - Gail E. Rosen
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island, United States of America
- Columbia University Center for Infection and Immunity, Mailman School of Public Health, New York, New York, United States of America
| | - Linda Amaral-Zettler
- The Josephine Bay Paul Center for Comparative Molecular Biology and Evolution, Marine Biological Laboratory, Woods Hole, Massachusetts, United States of America
- Department of Geological Sciences, Brown University, Providence, Rhode Island, United States of America
- * E-mail:
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Park CG, Kim BJ, Kim HY, Yun YJ, Ko KS, Miyamoto H, Kim BJ, Kook YH. Analysis of population structure among Korean and Japanese Legionella pneumophila isolates using hsp60 sequences. Microbiol Immunol 2012; 56:572-8. [PMID: 22672106 DOI: 10.1111/j.1348-0421.2012.00474.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dorevitch S, Pratap P, Wroblewski M, Hryhorczuk DO, Li H, Liu LC, Scheff PA. Health risks of limited-contact water recreation. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:192-7. [PMID: 22030231 PMCID: PMC3279449 DOI: 10.1289/ehp.1103934] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 10/21/2011] [Indexed: 05/03/2023]
Abstract
BACKGROUND Wastewater-impacted waters that do not support swimming are often used for boating, canoeing, fishing, kayaking, and rowing. Little is known about the health risks of these limited-contact water recreation activities. OBJECTIVES We evaluated the incidence of illness, severity of illness, associations between water exposure and illness, and risk of illness attributable to limited-contact water recreation on waters dominated by wastewater effluent and on waters approved for general use recreation (such as swimming). METHODS The Chicago Health, Environmental Exposure, and Recreation Study was a prospective cohort study that evaluated five health outcomes among three groups of people: those who engaged in limited-contact water recreation on effluent-dominated waters, those who engaged in limited-contact recreation on general-use waters, and those who engaged in non-water recreation. Data analysis included survival analysis, logistic regression, and estimates of risk for counterfactual exposure scenarios using G-computation. RESULTS Telephone follow-up data were available for 11,297 participants. With non-water recreation as the reference group, we found that limited-contact water recreation was associated with the development of acute gastrointestinal illness in the first 3 days after water recreation at both effluent-dominated waters [adjusted odds ratio (AOR) 1.46; 95% confidence interval (CI): 1.08, 1.96] and general-use waters (1.50; 95% CI: 1.09, 2.07). For every 1,000 recreators, 13.7 (95% CI: 3.1, 24.9) and 15.1 (95% CI: 2.6, 25.7) cases of gastrointestinal illness were attributable to limited-contact recreation at effluent-dominated waters and general-use waters, respectively. Eye symptoms were associated with use of effluent-dominated waters only (AOR 1.50; 95% CI: 1.10, 2.06). Among water recreators, our results indicate that illness was associated with the amount of water exposure. CONCLUSIONS Limited-contact recreation, both on effluent-dominated waters and on waters designated for general use, was associated with an elevated risk of gastrointestinal illness.
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Affiliation(s)
- Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, UIC School of Public Health, 2121 W. Taylor, M/C 922, Chicago, IL 60612 USA.
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Lam MC, Ang LW, Tan AL, James L, Goh KT. Epidemiology and control of legionellosis, singapore. Emerg Infect Dis 2012; 17:1209-15. [PMID: 21762574 PMCID: PMC3381417 DOI: 10.3201/eid1707.101509] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine trends and clinical and epidemiologic features of legionellosis in Singapore, we studied cases reported during 2000–2009. During this period, 238 indigenous and 33 imported cases of legionellosis were reported. Cases were reported individually and sporadically throughout each year. Although the annual incidence of indigenous cases had decreased from 0.46 cases per 100,000 population in 2003 to 0.16 cases per 100,000 in 2009, the proportion of imported cases increased correspondingly from 6.2% during 2000–2004 to 27.3% during 2005–2009 (p<0.0005). The prevalence of Legionella bacteria in cooling towers and water fountains was stable (range 12.1%–15.3%) during 2004–August 2008.
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Ozeki Y, Yamada F, Saito A, Kishimoto T, Tanno S, Nakamura Y. Seasonal Patterns of Legionellosis in Saitama, 2005^|^ndash;2009. Jpn J Infect Dis 2012. [DOI: 10.7883/yoken.65.330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
SUMMARYThis study evaluated the spatio-temporal variation ofLegionellaspp. in New Zealand using notification and laboratory surveillance data from 1979 to 2009 and analysed the epidemiological trends. To achieve this we focused on changing incidence rates and occurrence of different species over this time. We also examined whether demographic characteristics such as ethnicity may be related to incidence. The annual incidence rate for laboratory-proven cases was 2·5/100 000 and 1·4/100 000 for notified cases. Incidence was highest in the European population and showed large geographical variations between 21 District Health Boards. An important finding of this study is that the predominantLegionellaspecies causing disease in New Zealand differs from that found in other developed countries, with about 30–50% of cases due toL. longbeachaeand a similar percentage due toL. pneumophilafor any given year. The environmental risk exposure was identified in 420 (52%) cases, of which 58% were attributed to contact with compost; travel was much less significant as a risk factor (6·5%). This suggests that legionellosis has a distinctive epidemiological pattern in New Zealand.
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Rangel KM, Delclos G, Emery R, Symanski E. Assessing maintenance of evaporative cooling systems in legionellosis outbreaks. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2011; 8:249-265. [PMID: 21416443 DOI: 10.1080/15459624.2011.565409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study was designed to conduct systematic reviews of existing evaporative cooling system maintenance guidelines and of published Legionnaires' disease outbreaks to determine what, if any, maintenance practices were in place at the time of the disease outbreaks and then to contrast the reported practices with the published guidelines for evaporative cooling systems. For the first review, similarities in the reported recommendations were assessed; in the second review, any reported information about the state of the evaporative cooling system during the outbreak investigation was summarized. The systematic reviews yielded 38 current guidelines for evaporative cooling systems and 38 published outbreak investigations. The guidelines varied regarding the recommended type and dose of biocides, frequency of general inspections and total system maintenance, the preferred disinfection and cleaning procedures when testing a system for microbiological contamination, the type and frequency of testing procedures, and interpretation of test results. Overall, the maintenance guidelines did not contain sufficiently detailed procedures to prevent the problems that were observed in the outbreak investigations. These maintenance procedures included lack or improper use of a biocide; infrequent testing for microbiological contamination; improper use or maintenance of drift eliminators; and lack of a total system cleaning within 6 months of the outbreak for cooling systems that were either under continuous use, recently started up, or frequently switched on and off. This study suggests that more specific and standardized maintenance guidelines for the control of Legionella bacteria are needed and that these guidelines must be properly implemented to help reduce further Legionnaires' disease outbreaks associated with evaporative cooling systems.
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Affiliation(s)
- Kelly M Rangel
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas 77030, USA.
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