scholarly journals Multiple Types of Legionella pneumophilaSerogroup 6 in a Hospital Heated-Water System Associated with Sporadic Infections

1999 ◽  
Vol 37 (7) ◽  
pp. 2189-2196 ◽  
Author(s):  
Paolo Visca ◽  
Paola Goldoni ◽  
P. Christian Lück ◽  
Jürgen H. Helbig ◽  
Lorena Cattani ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Water System ◽  
Hot Water ◽  
Control Measures ◽  
Hospital Environment ◽  
Modes Of Transmission ◽  
Sequence Of Events ◽  
Single Clone ◽  
Arbitrarily Primed Pcr

Five sporadic cases of nosocomial Legionnaires’ disease were documented from 1989 to 1997 in a hospital in northern Italy. Two of them, which occurred in a 75-year-old man suffering from ischemic cardiopathy and in an 8-year-old girl suffering from acute leukemia, had fatal outcomes. Legionella pneumophila serogroup 6 was isolated from both patients and from hot-water samples taken at different sites in the hospital. These facts led us to consider the possibility that a single clone of L. pneumophila serogroup 6 had persisted in the hospital environment for 8 years and had caused sporadic infections. Comparison of clinical and environmental strains by monoclonal subtyping, macrorestriction analysis (MRA), and arbitrarily primed PCR (AP-PCR) showed that the strains were clustered into three different epidemiological types, of which only two types caused infection. An excellent correspondence between the MRA and AP-PCR results was observed, with both techniques having high discriminatory powers. However, it was not possible to differentiate the isolates by means of ribotyping and analysis of rrnoperon polymorphism. Environmental strains that antigenically and chromosomally matched the infecting organism were present at the time of infection in hot-water samples taken from the ward where the patients had stayed. Interpretation of the temporal sequence of events on the basis of the typing results for clinical and environmental isolates enabled the identification of the ward where the patients became infected and the modes of transmission of Legionellainfection. The long-term persistence in the hot-water system of different clones of L. pneumophila serogroup 6 indicates that repeated heat-based control measures were ineffective in eradicating the organism.

scholarly journals Environmental Surveillance of Legionellosis within an Italian University Hospital—Results of 15 Years of Analysis

2019 ◽  
Vol 16 (7) ◽  
pp. 1103 ◽  
Author(s):  
Pasqualina Laganà ◽  
Alessio Facciolà ◽  
Roberta Palermo ◽  
Santi Delia
Keyword(s):  
Potential Risk ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Continuous Monitoring ◽  
Water System ◽  
Hot Water ◽  
University Hospital ◽  
Environmental Surveillance ◽  
Standard Procedures ◽  
Legionnaires Disease

Legionnaires’ disease is normally acquired by inhalation of legionellae from a contaminated environmental source. Water systems of large and old buildings, such as hospitals, can be contaminated with legionellae and therefore represent a potential risk for the hospital population. In this study, we demonstrated the constant presence of Legionella in water samples from the water system of a large university hospital in Messina (Sicily, Italy) consisting of 11 separate pavilions during a period of 15 years (2004–2018). In total, 1346 hot water samples were collected between January 2004 and December 2018. During this period, to recover Legionella spp. from water samples, the standard procedures reported by the 2000 Italian Guidelines were adopted; from May 2015 to 2018 Italian Guidelines revised in 2015 (ISS, 2015) were used. Most water samples (72%) were positive to L. pneumophila serogroups 2–14, whereas L. pneumophila serogroup 1 accounted for 18% and non-Legionella pneumophila spp. Accounted for 15%. Most of the positive samples were found in the buildings where the following critical wards are situated: (Intensive Care Unit) ICU, Neurosurgery, Surgeries, Pneumology, and Neonatal Intensive Unit Care. This study highlights the importance of the continuous monitoring of hospital water samples to prevent the potential risk of nosocomial legionellosis.

scholarly journals Legionella pneumophila in a hospital water system following a nosocomial outbreak: prevalence, monoclonal antibody subgrouping and effect of control measures

1987 ◽  
Vol 98 (3) ◽  
pp. 253-262 ◽  
Author(s):  
C. D. Ribeiro ◽  
S. H. Burge ◽  
S. R. Palmer ◽  
J. O'H. Tobin ◽  
I. D. Watkins
Keyword(s):  
Monoclonal Antibody ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Water System ◽  
Extended Period ◽  
Control Measures ◽  
Nosocomial Outbreak ◽  
Water Supplies ◽  
Chemical Sterilization ◽  
Legionnaires Disease

SUMMARYSwabs and water samples from a hospital water system were cultured for legionellae over an extended period. Legionella pneumophila serogroup 1, including outbreak associated strains, were isolated in small numbers from approximately 5% of these samples despite implementation of the current DHSS/Welsh Office regulations. No cases of nosocomial legionnaires' disease were proven during the study. Physical cleaning and chemical sterilization of taps, and replacement of washers with ‘approved’ brands did not eradicate the organisms. Eradication of legionellae in hospital water supplies appears to be unnecessary in preventing nosocomial legionnaires' disease provided the current DHSS/Welsh Office recommendations are implemented.

Nosocomial Outbreak of Legionnaires' Disease: Molecular Epidemiology and Disease Control Measures

1987 ◽  
Vol 8 (2) ◽  
pp. 53-58 ◽  
Author(s):  
Jeffrey M. Johnston ◽  
Robert H. Latham ◽  
Frederick A. Meier ◽  
Jon A. Green ◽  
Rebecca Boshard ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Potable Water ◽  
Cooling Tower ◽  
Water System ◽  
Hot Water ◽  
Control Measures ◽  
Laboratory Techniques ◽  
Legionnaires Disease ◽  
Water Holding ◽  
Methods Of Control

AbstractMolecular laboratory techniques were used to study the epidemiology of an outbreak of nosocomial Legionnaires' disease. All patient isolates were Legionella pneumophila serogroup 1 and showed identical plasmid profiles and reactions with serogroup-specific monoclonal antibodies. L pneumophila was also cultured from four of five cooling tower water samples; however, the isolate from only one tower was serogroup 1 of the same sub-type as patient isolates. Since the cases were temporally clustered and epidemiologically associated with exposure to cooling tower aerosols, the single cooling tower implicated by molecular analysis was the most likely source of the outbreak. Chlorination of cooling tower ponds has eradicated the epidemic strain. Since potable water also harbored the infecting organism and was the probable source for cooling tower contamination, decontamination of the hospital water system was also undertaken. Superchlorination of hot water holding tanks to 17 ppm on a weekly basis has effectively eradicated L pneumophila from the potable water system and appears to be a reasonable, simple, and relatively inexpensive alternative to previously described methods of control.

Isolation of Legionella pneumophila from the Cold Water of Hospital Ice Machines: Implications for Origin and Transmission of the Organism

1985 ◽  
Vol 6 (4) ◽  
pp. 141-146 ◽  
Author(s):  
Janet E. Stout ◽  
Victor L. Yu ◽  
Paul Muraca
Keyword(s):  
Legionella Pneumophila ◽  
Distribution System ◽  
Water Distribution ◽  
Water Distribution System ◽  
Cold Water ◽  
Water System ◽  
Primary Source ◽  
Hot Water ◽  
Hospital Environment ◽  
Water Storage Tank

AbstractAlthough the mode of transmission of L. pneumophila is as yet unclear, the hot water distribution system has been shown to be the reservoir for Legionella within the hospital environment. In this report we identify a previously unrecognized reservoir for L. pneumophila within the hospital environment, ie, the cold water dispensers of hospital ice machines. The cold water dispensers of 14 ice machines were cultured monthly over a 1-year period. Positive cultures were obtained from 8 of 14 dispensers, yielding from 1 to 300 CFU/plate. We were able to link the positivity of these cold water sites to the incoming cold water supply by recovering L. pneumophila from the cold water storage tank, which is directly supplied by the incoming municipal water line. This was accomplished by a novel enrichment experiment designed to duplicate the conditions (temperature, sediment, stagnation, and continuous seeding) of the hot water system. Our data indicate that significant contamination of cold water outlets with L. pneumophila can occur. Although no epidemiologic link to disease was made, the fact that the primary source of a patient's drinking water is from the ice machines warrants further investigation of these water sources as possible reservoirs.

scholarly journals A field study of the survival ofLegionella pneumophilain a hospital hot–water system

1990 ◽  
Vol 104 (3) ◽  
pp. 381-387 ◽  
Author(s):  
I. D. Farrell ◽  
J. E. Barker ◽  
E. P. Miles ◽  
J. G. P. Hutchison
Keyword(s):  
Water Supply ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Cold Water ◽  
Water System ◽  
Hot Water ◽  
Undetectable Level ◽  
Drain Water ◽  
Water Feed ◽  
And Control

SUMMARYThe colonization, survival and control ofLegionella pneumophilain a hospital hot–water system was examined. The organism was consistently isolated from calorifier drain–water samples at temperatures of 50°C or below, despite previous chlorination of the system. When the temperature of one of two linked calorifiers was raised to 60°C, by closing off the cold–water feed, the legionella count decreased from c. 104c.f.u./l to an undetectable level. However, 10 min after turning on the cold–water feed which produced a fall in calorifier temperature, the count in the calorifier drain water returned to its original level. Investigations revealed that the cold–water supply was continually feeding the calorifiers withL. pneumophila. Simple modifications in the design of the system were made so that the cold–water feed no longer exceeds 20°C; these measures have considerably reduced the number ofL. pneumophilareaching the calorifiers.

Effect of heat flushing on the concentrations of Legionella pneumophila and other heterotrophic microbes in hot water systems of apartment buildings

1996 ◽  
Vol 42 (8) ◽  
pp. 811-818 ◽  
Author(s):  
Outi M. Zacheus ◽  
Pertti J. Martikainen
Keyword(s):  
Water Temperature ◽  
Legionella Pneumophila ◽  
Heterotrophic Bacteria ◽  
Water System ◽  
Water Systems ◽  
Hot Water ◽  
Circulating Water ◽  
Heterotrophic Microbes ◽  
Before And After ◽  
Circulating Water System

The decontamination of Legionella pneumophila and other heterotrophic microbes by heat flushing in four legionellae-positive hot water systems was studied. Before the decontamination procedure, the concentration of legionellae varied from 3.0 × 10−3 to 3.5 × 10−5 cfu/L and the hot water temperature from 43.6 to 51.5 °C. During the contamination the temperature was raised to 60–70 °C. All taps and showers were cleaned from sediments and flushed with hot water twice a day for several minutes. The decontamination lasted for 2–4 weeks. In a few weeks the heat-flushing method reduced the concentration of legionellae below the detection limit (50 cfu/L) in the hot circulating water system just before and after the heat exchanger. The high hot water temperature also decreased the viable counts of heterotrophic bacteria, fungi, and total microbial cells determined by the epifluorescent microscopy. However, the eradication of legionellae failed in a water system where the water temperature remained below 60 °C in some parts of the system. After the decontamination, the temperature of hot water was lowered to 55 °C. Thereafter, all the studied hot water systems were recolonized by legionellae within a few months, showing that the decontamination by heat flushing was temporary. Also, the contamination of other bacteria increased in a few months to the level before decontamination.Key words: legionellae, hot water system, decontamination, water temperature, heterotrophic bacteria.

scholarly journals Effects of Disinfection on Legionella spp., Eukarya, and Biofilms in a Hot Water System

2012 ◽  
Vol 78 (19) ◽  
pp. 6850-6858 ◽  
Author(s):  
Maha Farhat ◽  
Marina Moletta-Denat ◽  
Jacques Frère ◽  
Séverine Onillon ◽  
Marie-Cécile Trouilhé ◽  
...  
Keyword(s):  
Community Structure ◽  
Heat Shock ◽  
Legionella Pneumophila ◽  
Water System ◽  
Single Strand Conformation Polymorphism ◽  
Pilot Scale ◽  
Small Subunit ◽  
Hot Water ◽  
Content Type ◽  
Chemical Treatments

ABSTRACTLegionellaspecies are frequently detected in hot water systems, attached to the surface as a biofilm. In this work, the dynamics ofLegionellaspp. and diverse bacteria and eukarya associated together in the biofilm, coming from a pilot scale 1 system simulating a real hot water system, were investigated throughout 6 months after two successive heat shock treatments followed by three successive chemical treatments. Community structure was assessed by a fingerprint technique, single-strand conformation polymorphism (SSCP). In addition, the diversity and dynamics ofLegionellaand eukarya were investigated by small-subunit (SSU) ribosomal cloning and sequencing. Our results showed that pathogenicLegionellaspecies remained after the heat shock and chemical treatments (Legionella pneumophilaandLegionella anisa, respectively). The biofilm was not removed, and the bacterial community structure was transitorily affected by the treatments. Moreover, several amoebae had been detected in the biofilm before treatments (Thecamoebaesp.,Vannellasp., andHartmanella vermiformis) and after the first heat shock treatment, but onlyH. vermiformisremained. However, another protozoan affiliated with Alveolata, which is known as a host cell forLegionella, dominated the eukaryal species after the second heat shock and chemical treatment tests. Therefore, effectiveLegionelladisinfection may be dependent on the elimination of these important microbial components. We suggest that eradicatingLegionellain hot water networks requires better study of bacterial and eukaryal species associated withLegionellain biofilms.

scholarly journals Integrated Real-Time PCR for Detection and Monitoring of Legionella pneumophila in Water Systems

2006 ◽  
Vol 73 (5) ◽  
pp. 1452-1456 ◽  
Author(s):  
Diaraf Farba Yaradou ◽  
Sylvie Hallier-Soulier ◽  
Sophie Moreau ◽  
Florence Poty ◽  
Yves Hillion ◽  
...  
Keyword(s):  
Real Time ◽  
Legionella Pneumophila ◽  
Cooling Tower ◽  
Water System ◽  
Culture Method ◽  
Hot Water ◽  
Pcr Assay ◽  
Standard Culture ◽  
Serial Samples ◽  
Over Time

ABSTRACT We evaluated a ready-to-use real-time quantitative Legionella pneumophila PCR assay system by testing 136 hot-water-system samples collected from 55 sites as well as 49 cooling tower samples collected from 20 different sites, in parallel with the standard culture method. The PCR assay was reproducible and suitable for routine quantification of L. pneumophila. An acceptable correlation between PCR and culture results was obtained for sanitary hot-water samples but not for cooling tower samples. We also monitored the same L. pneumophila-contaminated cooling tower for 13 months by analyzing 104 serial samples. The culture and PCR results were extremely variable over time, but the curves were similar. The differences between the PCR and culture results did not change over time and were not affected by regular biocide treatment. This ready-to-use PCR assay for L. pneumophila quantification could permit more timely disinfection of cooling towers.

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