Environmental Cultures and Hospital-Acquired Legionnaires' Disease: A 5-Year Prospective Study in 20 Hospitals in Catalonia, Spain

AbstractObjective:To determine whether environmental cultures forLegionellaincrease the index of suspicion for legionnaires' disease (LD).Design:Five-year prospective study.Setting:Twenty hospitals in Catalonia, Spain.Methods:From 1994 to 1996, the potable water systems of 20 hospitals in Catalonia were tested forLegionella, Cases of hospital-acquired LD and availability of an “in-house”Legionellatest in the previous 4 years were assessed. After the hospitals were informed of the results of their water cultures, a prospective 5-year-study was conducted focusing on the detection of new cases of nosocomial legionellosis and the availability and use of Legionella testing.Results:Before environmental cultures were started, only one hospital had conducted active surveillance of hospital-acquired pneumonia and usedLegionellatests includingLegionellaurinary antigen in all pneumonia cases. Only one other hospital had used the latter test at all. In six hospitals,Legionellatests had been completely unavailable. Cases of nosocomial LD had been diagnosed in the previous 4 years in only two hospitals. During prospective surveillance, 12 hospitals (60%) usedLegionellaurinary antigen testing in house and 11 (55%) found cases of nosocomial legionellosis, representing 64.7% (11 of 17) of those with positive water cultures. Hospitals with negative water cultures did not find nosocomial LD.Conclusions:The environmental study increased the index of suspicion for nosocomial LD. The number of cases of nosocomial LD increased significantly during the prospective follow-up period, and most hospitals began using theLegionellaurinary antigen test in their laboratories.

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A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System

Infection Control and Hospital Epidemiology ◽

10.1086/647761 ◽

1998 ◽

Vol 19 (12) ◽

pp. 905-910 ◽

Cited By ~ 20

Author(s):

Lisa A. Lepine ◽

Daniel B. Jernigan ◽

Jay C. Butler ◽

Janet M. Pruckler ◽

Robert F. Benson ◽

...

Keyword(s):

Plumbing System ◽

Urinary Antigen ◽

Urinary Antigen Testing ◽

Legionnaires Disease ◽

Antigen Testing

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Legionella pneumonia presenting with bilateral flank pain, hyponatraemia and acute renal failure

Canadian Urological Association Journal ◽

10.5489/cuaj.738 ◽

2013 ◽

Vol 5 (6) ◽

pp. 96

Author(s):

Celia Birkin ◽

Chandra Shekhar Biyani ◽

Anthony J. Browning

Keyword(s):

Gastrointestinal Symptoms ◽

Community Acquired Pneumonia ◽

Flank Pain ◽

High Fever ◽

Urinary Antigen ◽

Legionella Pneumonia ◽

Urinary Antigen Testing ◽

Legionella Species ◽

Legionnaires Disease ◽

Antigen Testing

Legionnaires’ disease (LD) is an often overlooked but a possiblecause of sporadic community acquired pneumonia. High fever,cough and gastrointestinal symptoms are non-specific symptoms.Hyponatremia is more common in LD than pneumonia linkedwith other causes. A definitive diagnosis is usually confirmed byculture, urinary antigen testing for Legionella species. Macolideor quinolone antibiotic is the treatment of choice. We describe acase of Legionella pneumonia presenting with high fever, bilateralflank pain and oliguria. It is important for clinicians to be awareof this diagnosis when managing patients with flank pain. Thecase highlights the problems in differentiating LD from renal colicand the importance of proper history, physical examination withlaboratory tests for appropriate management.

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Healthcare-associated Legionnaires’ disease: Limitations of surveillance definitions and importance of epidemiologic investigation

Journal of Infection Prevention ◽

10.1177/1757177417720999 ◽

2017 ◽

Vol 18 (6) ◽

pp. 307-310 ◽

Cited By ~ 2

Author(s):

Laila M Castellino ◽

Shantini D Gamage ◽

Patti V Hoffman ◽

Stephen M Kralovic ◽

Mark Holodniy ◽

...

Keyword(s):

Legionella Pneumophila ◽

Sequence Type ◽

Significant Morbidity ◽

Urinary Antigen ◽

Epidemiologic Investigation ◽

Urinary Antigen Testing ◽

Legionnaires Disease ◽

Healthcare Associated ◽

Antigen Testing

Healthcare-associated Legionnaires’ disease (HCA LD) causes significant morbidity and mortality, with varying guidance on prevention. We describe the evaluation of a case of possible HCA LD and note the pitfalls of relying solely on an epidemiologic definition for association of a case with a facility. Our detailed investigation led to the identification of a new Legionella pneumophila serogroup 1 sequence type, confirmed a healthcare association and helped build the framework for our ongoing preventive efforts. Our experience highlights the role of routine environmental cultures in the assessment of risk for a given facility. As clinicians increasingly rely on urinary antigen testing for the detection of L. pneumophila, our investigation emphasises the importance of clinical cultures in an epidemiologic investigation.

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A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing Evidence for Long-Term Colonization of a Hospital Plumbing System

Infection Control ◽

10.1017/s0195941700092092 ◽

1998 ◽

Vol 19 (12) ◽

pp. 905-910

Author(s):

Lisa A. Lepine ◽

Daniel B. Jernigan ◽

Jay C. Butler ◽

Janet M. Pruckler ◽

Robert F. Benson ◽

...

Keyword(s):

Plumbing System ◽

Urinary Antigen ◽

Urinary Antigen Testing ◽

Legionnaires Disease ◽

Antigen Testing

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A Recurrent Outbreak of Nosocomial Legionnaires' Disease Detected by Urinary Antigen Testing: Evidence for Long-Term Colonization of a Hospital Plumbing System

Infection Control and Hospital Epidemiology ◽

10.2307/30142015 ◽

1998 ◽

Vol 19 (12) ◽

pp. 905-910 ◽

Cited By ~ 48

Author(s):

Lisa A. Lepine ◽

Daniel B. Jernigan ◽

Jay C. Butler ◽

Janet M. Pruckler ◽

Robert F. Benson ◽

...

Keyword(s):

Plumbing System ◽

Urinary Antigen ◽

Urinary Antigen Testing ◽

Legionnaires Disease ◽

Antigen Testing

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Legionella infection in pregnancy: imitator of HELLP syndrome, presenting as acute respiratory failure and septic shock

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2019-0049 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Moti Gulersen ◽

Eran Bornstein

Keyword(s):

Septic Shock ◽

Hellp Syndrome ◽

Laboratory Evaluation ◽

Maternal Complications ◽

Elevated Liver Enzymes ◽

Low Platelet Count ◽

Urinary Antigen Testing ◽

Legionnaires Disease ◽

Antigen Testing ◽

In Pregnancy

Abstract Background Legionnaires’ disease in pregnancy may cause severe maternal complications. Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome is a disorder associated with significant maternal and fetal morbidity and mortality. Several medical conditions have been described as imitators of this syndrome, presenting with similar laboratory abnormalities. Case presentation A healthy, multiparous woman presented at 26 weeks’ gestation with fever, headache and general malaise, rapidly progressing to septic shock and respiratory collapse. Laboratory evaluation revealed similar abnormalities to those seen with HELLP syndrome. Emergent cesarean delivery was performed for worsening maternal and fetal conditions. Following delivery, infection with Legionella was diagnosed on urinary antigen testing. Supportive care was administered in the intensive care unit. Conclusion Legionnaires’ disease should be considered in gravidas presenting with rapidly deteriorating respiratory status, septic shock and laboratory abnormalities mimicking HELLP syndrome.

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Urinary antigene and PCR can both be used to detect Legionella pneumophila in children’s hospital-acquired pneumonia

European Journal of Translational Myology ◽

10.4081/ejtm.2019.8120 ◽

2019 ◽

Vol 29 (2) ◽

Author(s):

Sayed-Yousef Mojtahedi ◽

Aliakbar Rahbarimanesh ◽

Samileh Noorbakhsh ◽

Hossein Shokri ◽

Saeedreza Jamali-Moghadam-Siyahkali ◽

...

Keyword(s):

Legionella Pneumophila ◽

Pediatric Intensive Care ◽

Antigen Test ◽

Urinary Antigen ◽

Urinary Antigen Test ◽

Legionella Pneumonia ◽

Hospital Acquired Pneumonia ◽

The Difference ◽

Underlying Diseases ◽

Hospital Acquired

Legionella pneumophila is the causative agent of more than 95% cases of severe Legionella pneumonia. Nosocomial pneumonias in different hospital wards is an important medical and pharmaceutical concern. This study aimed to detect Legionella with two methods: polymerase chain reaction (PCR) and detection of urine antigenic test (UAT) in patients suffering from nosocomial pneumonia admitted to pediatric intensive care unit (PICU) of children hospitals. This study was conducted in PICU wards of Rasool Akram and Bahrami children hospitals, Tehran, Iran during 2013 - 2014. In patients diagnosed with hospital-acquired pneumonia, intratracheal secretion samples for PCR and urine sample for UAT were taken. Simultaneously, PCR and urinary antigen test were conducted using commercial kits. The results of urinary antigen test and PCR were analyzed by SPSS v.19 for statistical comparison. In this study, 96 patients aging 2.77 years on average with two age peaks of less than 1 year and 7-8 year were enrolled. More than half of the patients were under 1 year old. The most common underlying diseases were seizure, Acute Lymphoblastic Lymphoma, Down syndrome and metabolic syndromes. The positivity rate of Legionella urinary antigen test was 16.7% and positivity rate of PCR test was 19.8%. There were no significant associations between the results obtained by both assays with age, gender or underlying diseases. In conclusion, PCR is a better detection method for Legionella infection than urinary antigen test, but the difference between the two methods was not significant.

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Evaluation of pneumococcal urinary antigen testing for respiratory tract infection investigations

Médecine et Maladies Infectieuses ◽

10.1016/j.medmal.2019.06.009 ◽

2020 ◽

Vol 50 (1) ◽

pp. 57-62 ◽

Cited By ~ 1

Author(s):

F. Charton ◽

P.L. Conan ◽

H. Le Floch ◽

O. Bylicki ◽

W. Gaspard ◽

...

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Urinary Antigen ◽

Urinary Antigen Testing ◽

Antigen Testing

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Active Surveillance of Legionnaires Disease During a Prospective Observational Study of Community-and Hospital-Acquired Pneumonia

Infection Control and Hospital Epidemiology ◽

10.1086/519867 ◽

2007 ◽

Vol 28 (9) ◽

pp. 1085-1088 ◽

Cited By ~ 6

Author(s):

Erica Leoni ◽

Rossella Sacchetti ◽

Manuela Aporti ◽

Claudio Lazzari ◽

Manuela Donati ◽

...

Keyword(s):

Legionella Pneumophila ◽

Prospective Observational Study ◽

Urinary Antigen Test ◽

Serological Tests ◽

Source Of Infection ◽

Colony Forming Units ◽

Clinical Surveillance ◽

Hospital Acquired Pneumonia ◽

Legionnaires Disease ◽

Hospital Acquired

A prospective surveillance study of legionnaires disease and an environmental survey of Legionella species were performed simultaneously in a general hospital. During a period of 3 years, 705 patients with pneumonia were screened with a Legionella urinary antigen test, and pneumonia was confirmed by culture and serological tests. Twelve cases of legionnaires disease were identified, none of which were hospital acquired, despite the fact that 60% of hospital water samples were contaminated with Legionella pneumophila at a concentration of more than 103 colony-forming units/L. The probable source of infection was identified for only 2 community-acquired cases. The results show that environmental contamination alone is not able to predict the risk of legionnaires disease. If no cases are present, monitoring of hospital water systems is of little significance; clinical surveillance is much more important.

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