Legionellosis and legionnaires’ disease

2020 ◽  
pp. 1226-1229
Author(s):  
Diego Viasus ◽  
Jordi Carratalà

Legionellaceae are Gram-negative bacilli, of which Legionella pneumophila is the principal cause of human infections. Their natural habitats are freshwater streams, lakes, thermal springs, moist soil, and mud, but the principal source for large outbreaks of legionellosis is cooling systems used for air conditioning and other cooling equipment. Legionella spp. are principally transmitted to humans through contaminated water aerosols. Middle-aged men, smokers, regular alcohol drinkers, and those with comorbidity are most at risk. Aside from supportive care, the first-choice antibiotics are macrolides (mainly azithromycin) and/or fluoroquinolones (especially levofloxacin). Case fatality is 5–15% in previously well adults, but much higher in those who are immunocompromised or develop respiratory failure. Prognosis is improved by early administration of effective anti-legionella antibiotic therapy. Prevention is by the correct design, maintenance, and monitoring of water systems.

2018 ◽  
Vol 2018 ◽  
pp. 1-15 ◽  
Author(s):  
Clémence Loiseau ◽  
Emilie Portier ◽  
Marie-Hélène Corre ◽  
Margot Schlusselhuber ◽  
Ségolène Depayras ◽  
...  

Legionella pneumophila, the causative agent of Legionnaires’ disease, is a waterborne bacterium mainly found in man-made water systems in close association with free-living amoebae and multispecies biofilms. Pseudomonas strains, originating from various environments including freshwater systems or isolated from hospitalized patients, were tested for their antagonistic activity towards L. pneumophila. A high amount of tested strains was thus found to be active. This antibacterial activity was correlated to the presence of tensioactive agents in culture supernatants. As Pseudomonas strains were known to produce biosurfactants, these compounds were specifically extracted and purified from active strains and further characterized using reverse-phase HPLC and mass spectrometry methods. Finally, all biosurfactants tested (lipopeptides and rhamnolipids) were found active and this activity was shown to be higher towards Legionella strains compared to various other bacteria. Therefore, described biosurfactants are potent anti-Legionella agents that could be used in the water treatment industry although tests are needed to evaluate how effective they would be under field conditions.


Author(s):  
Ashley Heida ◽  
Alexis Mraz ◽  
Mark Hamilton ◽  
Mark Weir ◽  
Kerry A Hamilton

Legionella pneumophila are bacteria that when inhaled cause Legionnaires’ Disease (LD) and febrile illness Pontiac Fever. As of 2014, LD is the most frequent cause of waterborne disease outbreaks due...


2005 ◽  
Vol 71 (10) ◽  
pp. 5805-5813 ◽  
Author(s):  
Paola Borella ◽  
Maria Teresa Montagna ◽  
Serena Stampi ◽  
Giovanna Stancanelli ◽  
Vincenzo Romano-Spica ◽  
...  

ABSTRACT A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of ≥103 CFU liter−1, and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup 1 was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.


2007 ◽  
Vol 136 (6) ◽  
pp. 823-832 ◽  
Author(s):  
J. CASTILLA ◽  
A. BARRICARTE ◽  
J. ALDAZ ◽  
M. GARCÍA CENOZ ◽  
T. FERRER ◽  
...  

SUMMARYAn outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detectLegionella pneumophilaantigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed.L. pneumophilaantigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.


1982 ◽  
Vol 88 (3) ◽  
pp. 369-381 ◽  
Author(s):  
J. B. Kurtz ◽  
C. L. R. Bartlett ◽  
U. A. Newton ◽  
R. A. White ◽  
N. L. Jones

SummaryFourteen recirculating cooling water systems were surveyed during the summer, 1981, to see what factors might influence the prevalence ofLegionella pneumophila. The effect on the organism of three anti-microbials was studied, each in two systems, by intermittent treatment at two week intervals.L. pneumophilawas isolated from six of the 14 cooling systems at the beginning of the trial but by the end was present in ten. An association was found between the presence of the organism and the concentration of dissolved solids, and chlorides and the pH. There also appeared to be associations with exclusion of light and higher water temperatures.Repeated tests on eight untreated systems showed that two were consistently infected, three became and remained infected, one was infected on a single occasion and two were never infected withL. pneumophila. Treatment of a contaminated system, either with a 10 p.p.m mixture of a quaternary ammonium compound and tributyltinoxide or slow release chlorine briquettes (maximum recorded free chlorine level 1·2 p.p.m.), did not eliminated legionellae. Treatment of two infected towers with a chlorinated phenol (100 p.p.m.) eliminated legionellae for at least three days, but after 14 days the organism was again found.


2015 ◽  
Vol 20 (46) ◽  
Author(s):  
Anna Maisa ◽  
Ansgar Brockmann ◽  
Frank Renken ◽  
Christian Lück ◽  
Stefan Pleischl ◽  
...  

Between 1 August and 6 September 2013, an outbreak of Legionnaires’ disease (LD) with 159 suspected cases occurred in Warstein, North Rhine-Westphalia, Germany. The outbreak consisted of 78 laboratory-confirmed cases of LD, including one fatality, with a case fatality rate of 1%. Legionella pneumophila, serogroup 1, subtype Knoxville, sequence type 345, was identified as the epidemic strain. A case–control study was conducted to identify possible sources of infection. In univariable analysis, cases were almost five times more likely to smoke than controls (odds ratio (OR): 4.81; 95% confidence interval (CI): 2.33–9.93; p < 0.0001). Furthermore, cases were twice as likely to live within a 3 km distance from one identified infection source as controls (OR: 2.14; 95% CI: 1.09–4.20; p < 0.027). This is the largest outbreak of LD in Germany to date. Due to a series of uncommon events, this outbreak was most likely caused by multiple sources involving industrial cooling towers. Quick epidemiological assessment, source tracing and shutting down of potential sources as well as rapid laboratory testing and early treatment are necessary to reduce morbidity and mortality. Maintenance of cooling towers must be carried out according to specification to prevent similar LD outbreaks in the future.


2021 ◽  
Author(s):  
Shayna R. Deecker ◽  
Malene L. Urbanus ◽  
Beth Nicholson ◽  
Alexander W. Ensminger

ABSTRACTLegionella pneumophila is a ubiquitous freshwater pathogen and the causative agent of Legionnaires’ disease. This pathogen and its ability to cause disease is closely tied to its environmental encounters. From phagocytic protists, L. pneumophila has “learned” how to avoid predation and exploit conserved eukaryotic processes to establish an intracellular replicative niche. Legionnaires’ disease is a product of these evolutionary pressures as L. pneumophila uses the same molecular mechanisms to replicate in grazing protists and in macrophages of the human lung. L. pneumophila growth within protists also provides a refuge from desiccation, disinfection, and other remediation strategies. One outstanding question has been whether this protection extends to phages. L. pneumophila isolates are remarkably devoid of prophages and to date no Legionella phages have been identified. Nevertheless, many L. pneumophila isolates maintain active CRISPR-Cas defenses. So far, the only known target of these systems has been an episomal element that we previously named Legionella Mobile Element-1 (LME-1). In this study, we have identified over 150 CRISPR-Cas systems across 600 isolates, to establish the clearest picture yet of L. pneumophila’s adaptive defenses. By leveraging the sequence of 1,500 unique spacers, we can make two main conclusions: current data argue against CRISPR-Cas targeted integrative elements beyond LME-1 and the heretofore “missing” L. pneumophila phages are most likely lytic gokushoviruses.IMPORTANCEThe causative agent of Legionnaires’ disease, an often-fatal pneumonia, is an intracellular bacterium, Legionella pneumophila, that normally grows inside amoebae and other freshwater protists. Unfortunately for us, this has two major consequences: the bacterium can take what it has learned in amoebae and use similar strategies to grow inside our lungs; and these amoebae can protect Legionella from various forms of chemical and physical disinfection regimes. Legionella are ubiquitous in the environment and frequently found in man-made water systems. Understanding the challenges to Legionella survival before it reaches the human lung is critical to preventing disease.We have leveraged our earlier discovery that L. pneumophila CRISPR-Cas systems are active and adaptive – meaning that they respond to contemporary threats encountered in the environment. In this way, CRISPR arrays can be considered genomic diaries of past encounters, with spacer sequences used to identify elements that may impinge on the pathogen’s survival. One outstanding question in the field is whether L. pneumophila is susceptible to phage, given the presumptive protection provided by intracellular replication within its eukaryotic hosts. In this work, we use CRISPR spacer sequences to suggest that the heretofore “missing” L. pneumophila phage are most likely lytic gokushoviruses. Such information is critical to the long-term goal of developing of new strategies for preventing colonization of our water systems by Legionella and subsequent human exposure to the pathogen.


Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 417
Author(s):  
Ashraf R. Zayed ◽  
Marina Pecellin ◽  
Lina Jaber ◽  
Suha Butmeh ◽  
Shereen A. Bahader ◽  
...  

Legionella pneumophila is the causative agent of Legionnaires’ disease. Due to the hot climate and intermittent water supply, the West Bank, Palestine, can be considered a high-risk area for this often fatal atypical pneumonia. L. pneumophila occurs in biofilms of natural and man-made freshwater environments, where it infects and replicates intracellularly within protozoa. To correlate the genetic diversity of the bacteria in the environment with their virulence properties for protozoan and mammalian host cells, 60 genotyped isolates from hospital water systems in the West Bank were analyzed. The L. pneumophila isolates were previously genotyped by high resolution Multi Locus Variable Number of Tandem Repeat Analysis (MLVA-8(12)) and sorted according to their relationship in clonal complexes (VACC). Strains of relevant genotypes and VACCs were compared according to their capacity to infect Acanthamoeba castellanii and THP-1 macrophages, and to mediate pore-forming cytotoxicity in sheep red blood cells (sRBCs). Based on a previous detailed analysis of the biogeographic distribution and abundance of the MLVA-8(12)-genotypes, the focus of the study was on the most abundant L. pneumophila- genotypes Gt4(17), Gt6 (18) and Gt10(93) and the four relevant clonal complexes [VACC1, VACC2, VACC5 and VACC11]. The highly abundant genotypes Gt4(17) and Gt6(18) are affiliated with VACC1 and sequence type (ST)1 (comprising L. pneumophila str. Paris), and displayed seroroup (Sg)1. Isolates of these two genotypes exhibited significantly higher virulence potentials compared to other genotypes and clonal complexes in the West Bank. Endemic for the West Bank was the clonal complex VACC11 (affiliated with ST461) represented by three relevant genotypes that all displayed Sg6. These genotypes unique for the West Bank showed a lower infectivity and cytotoxicity compared to all other clonal complexes and their affiliated genotypes. Interestingly, the L. pneumophila serotypes ST1 and ST461 were previously identified by in situ-sequence based typing (SBT) as main causative agents of Legionnaires’ disease (LD) in the West Bank at a comparable level. Overall, this study demonstrates the site-specific regional diversity of L. pneumophila genotypes in the West Bank and suggests that a combination of MLVA, cellular infection assays and hierarchical agglomerative cluster analysis allows an improved genotype-based risk assessment.


Author(s):  
Daina Pūle ◽  
Olga Valciņa ◽  
Aivars Bērziņš ◽  
Ludmila Vīksna ◽  
Angelika Krūmiņa

Abstract Legionella pneumophila is an environmental pathogen of engineered water systems that can cause different forms of legionellosis - from mild fever to potentially lethal pneumonia. Low concentrations of legionellae in natural habitats can increase markedly in engineered hot water systems where water temperatures are below 55 °C. In the current study, we aimed to investigate the influence of sampling season, hot water temperature and sampling protocol on occurrence of L. pneumophila. A total of 120 hot water samples from 20 apartment buildings were collected in two sampling periods - winter 2014 (n = 60) and summer 2015 (n = 60). Significantly higher occurrence of L. pneumophila was observed in summer 2015. Significant differences in temperature for negative and positive samples were not observed, which can be explained by low water temperatures at the point of water consumption. Temperature above 55 °C was observed only once, for all other sampling events it ranged from 14 °C to 53 °C.


2020 ◽  
Vol 11 ◽  
Author(s):  
Robin L. Brigmon ◽  
Charles E. Turick ◽  
Anna S. Knox ◽  
Courtney E. Burckhalter

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 &lt; 0.05). There was a significant variance observed in the 285-2A/A Tower L. pneumophila results (p &lt; 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 &lt; 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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