Community-acquired Legionnaires' Disease in Nottingham – too many cases?

The aim of this study was to compare the incidence of community-acquired Legionnaires' Disease in Nottingham with England and Wales and to explore reasons for any difference observed. Based on data from the National Surveillance Scheme for Legionnaires' Disease (1980–1999), the rate of infection in England and Wales was 1·3 per million/year compared with 6·6 per million/year in Nottingham. Domestic water samples were obtained from 41 (95%) of 43 Nottingham cases between 1997 and 2000. In 16 (39%) cases, Legionella sp. were cultured in significant quantities. Proximity to a cooling tower was examined using a 1[ratio ]4 case-controlled analysis. No significant difference in the mean distance between place of residence to the nearest cooling tower was noted (cases 2·7 km vs. controls 2·3 km; P=0·5). These data suggest that Nottingham does have a higher rate of legionella infection compared to national figures and that home water systems are a source.

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Nosocomial Legionnaires' disease in England and Wales, 1980–92

Epidemiology and Infection ◽

10.1017/s0950268800057745 ◽

1994 ◽

Vol 112 (2) ◽

pp. 329-346 ◽

Cited By ~ 47

Author(s):

C. A. Joseph ◽

J. M. Watson ◽

T. G. Harrison ◽

C. L. R. Bartlett

Keyword(s):

Prevention And Control ◽

Clinical History ◽

National Surveillance ◽

England And Wales ◽

Hospital Patients ◽

Sporadic Cases ◽

Legionnaires Disease ◽

And Control ◽

Surveillance Scheme

SUMMARYTwo hundred and eighteen nosocomial cases of Legionnaires' disease with 68 deaths were reported to the National Surveillance Scheme for Legionnaires Disease between 1980 and 1992, representing 15% of the reported infections acquired in England and Wales. Twenty–two nosocomial outbreaks accounted for 135 (62%) of these cases, the remainder occurring as single cases either in hospitals where other single cases or outbreaks had been reported in different years or as ‘sporadic’ cases in hospitals from which no other cases were reported. A clinical history prior to onset of Legionnaires' disease was available for 124 patients, 61 of whom had undergone recent transplant therapy or were immunosuppressed for other reasons.Sixty cases (27%) were diagnosed by culture of the organism and isolates from 56 patients were typed; 25 (42%) were nonL. pneumophilaserogroup 1 infections.Methods for prevention and control of nosocomial outbreaks are discussed, in particular the susceptibility to Legionnaires' disease of certain groups of hospital patients.

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Fungal biodiversity and mycotoxigenic fungi in cooling-tower water systems in Istanbul, Turkey

Journal of Water and Health ◽

10.2166/wh.2017.274 ◽

2017 ◽

Vol 15 (2) ◽

pp. 308-320 ◽

Cited By ~ 4

Author(s):

Duygu Göksay Kadaifciler ◽

Rasime Demirel

Keyword(s):

Internal Transcribed Spacer ◽

Cooling Tower ◽

Water Systems ◽

Its Sequencing ◽

Aspergillus Versicolor ◽

Opportunistic Pathogens ◽

The Public ◽

Skin Contact ◽

Mycotoxigenic Fungi ◽

The Mean

This is the first study to assess fungal diversity and mycotoxigenic fungi in open recirculating cooling-tower (CT) water systems (biofilm and water phase). The production capability of mycotoxin from fungal isolates was also examined. The mean fungal count in 21 different water and biofilm samples was determined as 234 CFU/100 mL and 4 CFU/cm2. A total of 32 species were identified by internal transcribed spacer (ITS) sequencing. The most common isolated fungi belonged to the genera Aspergillus and Penicillium, of which the most prevalent fungi were Aspergillus versicolor, Aspergillus niger, and Penicillium dipodomyicola. From 42% of the surveyed CTs, aflatoxigenic A. flavus isolates were identified. The detection of opportunistic pathogens and/or allergen species suggests that open recirculating CTs are a possible source of fungal infection for both the public and for occupational workers via the inhalation of aerosols and/or skin contact.

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An unusually long-lasting outbreak of community-acquired Legionnaires' disease, 2005–2008, Italy

Epidemiology and Infection ◽

10.1017/s0950268814003094 ◽

2014 ◽

Vol 143 (11) ◽

pp. 2416-2425 ◽

Cited By ~ 7

Author(s):

M. SCATURRO ◽

S. FONTANA ◽

S. CRIPPA ◽

M. G. CAPORALI ◽

T. SEYLER ◽

...

Keyword(s):

Wind Direction ◽

Water Samples ◽

Cooling Tower ◽

Northern Italy ◽

Clinical Samples ◽

Environmental Isolates ◽

Clinical Strains ◽

Municipal Water ◽

Water Mains ◽

Legionnaires Disease

SUMMARYAn unusually long-lasting community-acquired outbreak of Legionnaires’ disease (LD) occurred in the inhabitants of a town in northern Italy from 2005 to 2008. Overall, 43 cases were diagnosed including five deaths. Hundreds of water samples were collected forLegionellaisolation but only two clinical samples were obtained. Clinical strains were ST23 as were environmental isolates detected in mostLegionella-positive patients' homes and those from a public fountain. Although noLegionellawas found in the municipal water mains, a continuous chlorination was applied in 2008. This action resulted in a halving of cases, although incidence remained tenfold higher than the Italian average incidence until the end of 2013, when it dropped to the expected rate. Retrospective analyses of prevalent wind direction suggested that a hidden cooling tower could have been the main cause of this uncommon outbreak, highlighting the importance of implementation of cooling tower registers in supporting LD investigations.

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Evaluation of heavy metals composition of drinking water distributed to Addis Ababa City, Addis Ababa, Ethiopia.

10.21203/rs.3.rs-861073/v1 ◽

2021 ◽

Author(s):

Solomon Genet Gebre ◽

Anmut Tilahun

Keyword(s):

Heavy Metals ◽

Drinking Water ◽

Water Samples ◽

Addis Ababa ◽

Cadmium Concentration ◽

Lead Level ◽

P Value ◽

Significant Difference ◽

The Mean ◽

Admissible Limit

Abstract Background Compromised drinking water quality due to accumulation of heavy metals is becoming a serious concern for many countries, including Ethiopia. Chronic exposure to heavy metals is associated with many human diseases. This study aimed at determining the levels of heavy metals in drinking water supplied to Addis Ababa city. There has been no such study done on drinking water supplied to the city Methodology: A community based cross-sectional study design was employed from April 2018 to December 2018. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was used to measure the concentration of heavy metals in drinking water samples. Result The highest concentration of lead was recorded in water samples taken from Gefersa, Asko and Kolfie areas. Results of this study also showed that there was a statistically significant difference in the mean levels of lead in water samples taken from different treatment plants and their respective catchments (p-value < 0.01). Conclusion The mean lead level in water samples were higher than the maximum admissible limit set by the WHO in 2011. The mean level of cadmium concentration was higher than the maximum admissible limit of cadmium set by WHO in 2011 in water samples of the Gefersa surface water & catchment area. However, all values of heavy metals were lower than their respective maximum contaminant level set by USEPA in 2010.

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The Impact of Storms on Legionella pneumophila in Cooling Tower Water, Implications for Human Health

Frontiers in Microbiology ◽

10.3389/fmicb.2020.543589 ◽

2020 ◽

Vol 11 ◽

Author(s):

Robin L. Brigmon ◽

Charles E. Turick ◽

Anna S. Knox ◽

Courtney E. Burckhalter

Keyword(s):

Human Health ◽

Legionella Pneumophila ◽

Count Data ◽

Distribution Systems ◽

Cooling Tower ◽

Water Systems ◽

The Other ◽

Cooling Towers ◽

Legionnaires Disease ◽

The Impact

At the U.S. Department of Energy’s Savannah River Site (SRS) in Aiken, SC, cooling tower water is routinely monitored for Legionella pneumophila concentrations using a direct fluorescent antibody (DFA) technique. Historically, 25–30 operating SRS cooling towers have varying concentrations of Legionella in all seasons of the year, with patterns that are unpredictable. Legionellosis, or Legionnaires’ disease (LD), is a pneumonia caused by Legionella bacteria that thrive both in man-made water distribution systems and natural surface waters including lakes, streams, and wet soil. Legionnaires’ disease is typically contracted by inhaling L. pneumophila, most often in aerosolized mists that contain the bacteria. At the SRS, L. pneumophila is typically found in cooling towers ranging from non-detectable up to 108 cells/L in cooling tower water systems. Extreme weather conditions contributed to elevations in L. pneumophila to 107–108 cells/L in SRS cooling tower water systems in July–August 2017. L. pneumophila concentrations in Cooling Tower 785-A/2A located in SRS A-Area, stayed in the 108 cells/L range despite biocide addition. During this time, other SRS cooling towers did not demonstrate this L. pneumophila increase. No significant difference was observed in the mean L. pneumophila mean concentrations for the towers (p < 0.05). There was a significant variance observed in the 285-2A/A Tower L. pneumophila results (p < 0.05). Looking to see if we could find “effects” led to model development by analyzing 13 months of water chemistry and microbial data for the main factors influencing the L. pneumophila concentrations in five cooling towers for this year. It indicated chlorine and dissolved oxygen had a significant impact (p < 0.0002) on cooling tower 785A/2A. Thus, while the variation in the log count data for the A-area tower is statistically greater than that of the other four towers, the average of the log count data for the A-Area tower was in line with that of the other towers. It was also observed that the location of 785A/2A and basin resulted in more debris entering the system during storm events. Our results suggest that future analyses should evaluate the impact of environmental conditions and cooling tower design on L. pneumophila water concentrations and human health.

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Distribution of Sequence-Based Types of Legionella pneumophila Serogroup 1 Strains Isolated from Cooling Towers, Hot Springs, and Potable Water Systems in China

Applied and Environmental Microbiology ◽

10.1128/aem.03844-13 ◽

2014 ◽

Vol 80 (7) ◽

pp. 2150-2157 ◽

Cited By ~ 25

Author(s):

Tian Qin ◽

Haijian Zhou ◽

Hongyu Ren ◽

Hong Guan ◽

Machao Li ◽

...

Keyword(s):

South Korea ◽

Legionella Pneumophila ◽

Potable Water ◽

Hot Springs ◽

Cooling Tower ◽

Hot Spring ◽

Water Systems ◽

Cooling Towers ◽

Content Type ◽

Legionnaires Disease

ABSTRACTLegionella pneumophilaserogroup 1 causes Legionnaires' disease. Water systems contaminated withLegionellaare the implicated sources of Legionnaires' disease. This study analyzedL. pneumophilaserogroup 1 strains in China using sequence-based typing. Strains were isolated from cooling towers (n= 96), hot springs (n= 42), and potable water systems (n= 26). Isolates from cooling towers, hot springs, and potable water systems were divided into 25 sequence types (STs; index of discrimination [IOD], 0.711), 19 STs (IOD, 0.934), and 3 STs (IOD, 0.151), respectively. The genetic variation among the potable water isolates was lower than that among cooling tower and hot spring isolates. ST1 was the predominant type, accounting for 49.4% of analyzed strains (n= 81), followed by ST154. With the exception of two strains, all potable water isolates (92.3%) belonged to ST1. In contrast, 53.1% (51/96) and only 14.3% (6/42) of cooling tower and hot spring, respectively, isolates belonged to ST1. There were differences in the distributions of clone groups among the water sources. The comparisons amongL. pneumophilastrains isolated in China, Japan, and South Korea revealed that similar clones (ST1 complex and ST154 complex) exist in these countries. In conclusion, in China, STs had several unique allelic profiles, and ST1 was the most prevalent sequence type of environmentalL. pneumophilaserogroup 1 isolates, similar to its prevalence in Japan and South Korea.

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COMPARATIVE ASSESSMENT OF HEAVY METALS IN AJIWA AND JIBIA IRRIGATION DAMS OF KATSINA STATE, NIGERIA

FUDMA Journal of Sciences ◽

10.33003/fjs-2020-0403-385 ◽

2020 ◽

Vol 4 (3) ◽

pp. 32-35

Author(s):

Mohammed Salisu Musa ◽

M. S. Dagari ◽

A. Umar ◽

I. M. Shafiu

Keyword(s):

Heavy Metals ◽

Water Samples ◽

Atomic Emission ◽

Water Bodies ◽

P Value ◽

Plasma Atomic Emission ◽

Maximum Permissible Level ◽

Metal Contents ◽

Significant Difference ◽

The Mean

Concentrations of some heavy metals in water samples from Ajiwa and Jibia irrigation Dams of Katsina State were determined using Micro Plasma Atomic Emission Spectroscopy (MP-AES). The water samples were analyzed to determine zinc (Zn), cadmium (Cd), copper (Cu), nickel (Ni), cobalt (Co), lead (Pb), manganese (Mn) and chromium (Cr) contents. The mean concentrations (mg/L) of the heavy metals in water samples of Ajiwa and Jibia dams respectively were: zinc (1.00±0.010, 0.04±0.010); cadmium (0.03±0.010, ND); copper (0.03±0.010, ND); lead (0.01±0.001, 0.02±0.001); manganese (0.21±0.001, 0.18±0.001); and chromium (0.05±0.001, 0.05±0.001), while nickel and cobalt were not detected in both samples. The P value (0.60314) indicates that there is no significant difference in the metal contents between the water bodies. Assessment of these metals in both water samples shows that none of the metals was above maximum permissible limit. However, cadmium and chromium concentrations were found to be at the maximum permissible level allowed in irrigation water. These findings therefore indicated that, the two water bodies are suitable and safe for irrigation purposes

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Distribution of Virulence Genes and Sequence-Based Types Among Legionella pneumophila Isolated From the Water Systems of a Tertiary Care Hospital in India

Frontiers in Public Health ◽

10.3389/fpubh.2020.596463 ◽

2020 ◽

Vol 8 ◽

Author(s):

K. Sreenath ◽

Rama Chaudhry ◽

E. V. Vinayaraj ◽

A. B. Dey ◽

S. K. Kabra ◽

...

Keyword(s):

Legionella Pneumophila ◽

Water Samples ◽

Virulence Genes ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Water Systems ◽

Hospital Environment ◽

Care Hospital ◽

Environmental Isolates ◽

Legionnaires Disease

Background: Legionnaires' disease (LD) is a potentially fatal pneumonia predominantly caused by infection due to Legionella pneumophila although more than 50 other Legionella species are described. Water systems contaminated with Legionella spp. are the implicated sources of Legionnaires' disease. In this study, we aimed to assess Legionella contamination in the water sources of a tertiary care hospital and to determine the virulence properties and molecular characteristics of L. pneumophila environmental isolates.Methods: During May 2015 through August 2018, a total of 201 hospital water samples were tested for L. pneumophila by standardized culture procedures; environmental isolates were examined for the presence of two virulence genes: Legionella vir homolog (lvh) and repeats in structural toxin (rtxA) by PCR. The genotyping of isolates was performed by sequence-based typing (SBT) according to the protocol of the European Study Group for Legionella Infections (ESGLI).Results:L. pneumophila was isolated from 38/201 (18.9%) water samples; among the 46 isolates, the lvh locus was present in 45 (97.8%), the rtxA locus was found in 45 (97.8%), and both loci were found in 44 (95.7%) isolates. A total of 23 sequence types (STs) were identified among the 44 isolates (index of discrimination [IOD] of 0.929), and 11/23 (47.8%) STs were new to the ESGLI database.Conclusions: The study results showed genetic diversity in L. pneumophila isolates from the hospital environment along with a high percentage of pathogenicity loci. Besides, certain STs may have an increased ability to cause legionellosis, thus requires specific infection control and prevention strategies whenever identified.

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Vowel Recognition Threshold as a Function of Temporal Segmentations

Journal of Speech and Hearing Research ◽

10.1044/jshr.1304.715 ◽

1970 ◽

Vol 13 (4) ◽

pp. 715-724 ◽

Cited By ~ 6

Author(s):

Richard L. Powell ◽

Oscar Tosi

Keyword(s):

Normal Hearing ◽

Recognition Threshold ◽

Vowel Sound ◽

Significant Difference ◽

The Mean ◽

Vowel Recognition ◽

Temporal Segment

Vowels were segmented into 15 different temporal segments taken from the middle of the vowel and ranging from 4 to 60 msecs, then presented to 6 subjects with normal hearing. The mean temporal-segment recognition threshold of 15 msecs with a range from 9.3 msecs for the /u/ to 27.2 milliseconds for the /a/. Misidenti-fication of vowels was most often confused with the vowel sound adjacent to it on the vowel-hump diagram. There was no significant difference between the cardinal and noncardinal vowels.

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Left Ventricular Dysfunction and Blood Glycohemoglobin Levels in Young Diabetics

Nuklearmedizin ◽

10.1055/s-0038-1629573 ◽

1991 ◽

Vol 30 (05) ◽

pp. 183-188

Author(s):

A. Aydrner ◽

A. Oto ◽

E. Oram ◽

O. Gedik ◽

C. F. Bekdik ◽

...

Keyword(s):

Ejection Fraction ◽

Left Ventricular Function ◽

Ventricular Function ◽

Left Ventricular ◽

Diabetic Patients ◽

Filling Fraction ◽

Time To Peak ◽

Significant Difference ◽

The Mean ◽

Hba1c Levels

Left ventricular function including regional wall motion (RWM) was evaluated by 99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection /cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.

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