scholarly journals Source attribution of community-acquired cases of Legionnaires’ disease–results from the German LeTriWa study; Berlin, 2016–2019

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241724
Author(s):  
Udo Buchholz ◽  
Heiko Juergen Jahn ◽  
Bonita Brodhun ◽  
Ann-Sophie Lehfeld ◽  
Marina M. Lewandowsky ◽  
...  
Keyword(s):  
Drinking Water ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Population Attributable Risk ◽  
Source Attribution ◽  
Positive Strain ◽  
Household Water ◽  
Sources Of Infection ◽  
Legionnaires Disease ◽  
Infectious Source

Introduction Sources of infection of most cases of community-acquired Legionnaires’ disease (CALD) are unknown. Objective Identification of sources of infection of CALD. Setting Berlin; December 2016–May 2019. Participants Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls. Main outcome measure Percentage of cases of CALD with attributed source of infection. Methods Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)). Results Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25–93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed. Conclusion Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.

scholarly journals Results of intensified source finding efforts among community-acquired cases of Legionnaires’ disease – first results of the German LeTriWa study; Berlin, 2016−2019

2020 ◽  
Author(s):  
U. Buchholz ◽  
H. J. Jahn ◽  
B. Brodhun ◽  
A-S. Lehfeld ◽  
M. Lewandowsky ◽  
...  
Keyword(s):  
Drinking Water ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
External Source ◽  
District Health ◽  
Positive Strain ◽  
Household Water ◽  
Sources Of Infection ◽  
Legionnaires Disease ◽  
Infectious Source

AbstractIntroductionSources of infection of most cases of community-acquired Legionnaires’ disease (CALD) are unknown.ObjectiveIdentification of sources of infection of CALD.SettingBerlin; December 2016–May 2019.ParticipantsAdult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.Main outcome measurePercentage of cases of CALD with identified source of infection.MethodsAnalysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and contents of standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source, residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).ResultsInclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25– 93 years), 74 (67 %) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them.Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (OR = 4.9, 95 % confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain, by cluster evidence if at least two cases were exposed to it and by analytical-comparative evidence if a case was exposed to it and the type of source was statistically significantly associated with being a case. We identified an infectious source in 53 (48 %) of 111 cases: in 16 (14 %) an external source, in 9 (8 %) a RnDW source, and in 28 (25 %) we attributed RDW. We attributed 9 cases to RnDW because cases were associated with wearing not regularly disinfected dentures (OR = 3.2, 95 % CI 1.3 to 7.8).ConclusionUsing the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.

scholarly journals Hygienic assessment of population health risk under exposure to chemicals that penetrate drinking water from household water mixers

2021 ◽  
pp. 50-57
Author(s):  
V.M. Boev ◽  
◽  
I.V. Georgi ◽  
D.A. Kryazhev ◽  
Е.A. Kryazhevа ◽  
...  
Keyword(s):  
Drinking Water ◽  
Health Risk ◽  
Health Risks ◽  
Water Samples ◽  
Human Health Risk ◽  
Hazard Index ◽  
Environmental Chemicals ◽  
Zinc Alloy ◽  
Testing Procedures ◽  
Household Water

At present a truly vital task is to evaluate possible changes in the structure and properties of drinking water occurring in the process of delivering it to end customers. Our research aim was to perform hygienic assessment of health risks caused by consumption of drinking water with changed chemical structure influenced by domestic faucets made from zinc alloys. Hygienic assessment of drinking water was performed to test its conformity with the requirements fixed in the Sanitary Rules and Standards SanPiN 1.2.3685-21 “Hygienic standards and requirements to providing safety and (or) harmlessness of environmental factors for people”. Water samples were aged in new household water mixers with their cases made from ZAM zinc alloy (a zinc alloy doped with aluminum, magnesium, and copper) at pH6 and pH9 in accordance with the State Standard GOST 34771-2021 “Sanitary-technical water mixing and distributing accessories. Testing procedures”. Health risks for children and adults and population risks were assessed for situations involving oral and cutaneous introduction according to the Guide R 2.1.10.1920-04 Human Health Risk Assessment from Environmental Chemicals. We established that water samples aged in household water mixers contained authentically elevated concentrations of metals included into ZAM alloy, namely copper, nickel, lead, and zinc, both at pH = 6 and pH = 9. We also detected enhanced organoleptic properties: color grew by 2–2.3 times and turbidity by 2.3–5 times. Carcinogenic risks caused by consuming water with changed properties turned out to be unacceptable both for children and adults. We also established that calculated hazard index for the blood system didn’t conform to hygienic requirements; calculated hazard indices for the central nervous system, liver, hormonal and reproductive systems were statistically significantly higher when people consumed drinking water with changed properties. We also calculated population carcinogenic risks for the whole population in the Russian Federation based on the maximum possible exposure to drinking water with changes in its chemical properties due to household water mixers. The total population risks amounted to approximately 131 thousand cases. Our research indicates it is necessary to develop preven-tion activities with a carefully planned monitoring system and control over quality and use of domestic faucets.

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.

scholarly journals Cooccurrence of Five Pathogenic Legionella spp. and Two Free-Living Amoebae Species in a Complete Drinking Water System and Cooling Towers

Pathogens ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1407
Author(s):  
Alshae Logan-Jackson ◽  
Joan B. Rose
Keyword(s):  
Drinking Water ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Water System ◽  
Water Supply Systems ◽  
Cooling Towers ◽  
Free Living ◽  
Reservoir Water ◽  
Drinking Water System ◽  
Legionella Species

Pathogenic Legionella species grow optimally inside free-living amoebae to concentrations that increase risks to those who are exposed. The aim of this study was to screen a complete drinking water system and cooling towers for the occurrence of Acanthamoeba spp. and Naegleria fowleri and their cooccurrence with Legionella pneumophila, Legionella anisa, Legionella micdadei, Legionella bozemanii, and Legionella longbeachae. A total of 42 large-volume water samples, including 12 from the reservoir (water source), 24 from two buildings (influents to the buildings and exposure sites (taps)), and six cooling towers were collected and analyzed using droplet digital PCR (ddPCR). N. fowleri cooccurred with L. micdadei in 76 (32/42) of the water samples. In the building water system, the concentrations of N. fowleri and L. micdadei ranged from 1.5 to 1.6 Log10 gene copies (GC)/100 mL, but the concentrations of species increased in the cooling towers. The data obtained in this study illustrate the ecology of pathogenic Legionella species in taps and cooling towers. Investigating Legionella’s ecology in drinking and industrial waters will hopefully lead to better control of these pathogenic species in drinking water supply systems and cooling towers.

scholarly journals Nontuberculous Mycobacteria, Fungi, and Opportunistic Pathogens in Unchlorinated Drinking Water in the Netherlands

2012 ◽  
Vol 79 (3) ◽  
pp. 825-834 ◽  
Author(s):  
Paul W. J. J. van der Wielen ◽  
Dick van der Kooij
Keyword(s):  
Drinking Water ◽  
Organic Carbon ◽  
The Netherlands ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Distribution System ◽  
Nontuberculous Mycobacteria ◽  
Opportunistic Pathogens ◽  
Content Type ◽  
Premise Plumbing

ABSTRACTThe multiplication of opportunistic pathogens in drinking water supplies might pose a threat to public health. In this study, distributed unchlorinated drinking water from eight treatment plants in the Netherlands was sampled and analyzed for fungi, nontuberculous mycobacteria (NTM), and several opportunistic pathogens by using selective quantitative PCR methods. Fungi and NTM were detected in all drinking water samples, whereasLegionella pneumophila,Pseudomonas aeruginosa,Stenotrophomonas maltophilia, andAspergillus fumigatuswere sporadically observed.Mycobacterium aviumcomplex andAcanthamoebaspp. were not detected. Season had no influence on the occurrence of these organisms, except for NTM andS. maltophilia, which were present in higher numbers in the summer. Opportunistic pathogens were more often observed in premise plumbing water samples than in samples from the distribution system. The lowest number of these organisms was observed in the finished water at the plant. Thus, fungi, NTM, and some of the studied opportunistic pathogens can multiply in the distribution and premise plumbing systems. Assimilable organic carbon (AOC) and/or total organic carbon (TOC) had no clear effects on fungal and NTM numbers or onP. aeruginosa- andS. maltophilia-positive samples. However,L. pneumophilawas detected more often in water with AOC concentrations above 10 μg C liter−1than in water with AOC levels below 5 μg C liter−1. Finally, samples that containedL. pneumophila,P. aeruginosa, orS. maltophiliawere more frequently positive for a second opportunistic pathogen, which shows that certain drinking water types and/or sampling locations promote the growth of multiple opportunistic pathogens.

scholarly journals Prevalence of Legionella spp. and Escherichia coli in the drinking water distribution system of Wrocław (Poland)

2020 ◽  
Vol 20 (3) ◽  
pp. 1083-1090
Author(s):  
M. Wolf-Baca ◽  
A. Siedlecka
Keyword(s):  
Escherichia Coli ◽  
Drinking Water ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Distribution System ◽  
Water Distribution ◽  
Tap Water ◽  
Potential Threat ◽  
E Coli ◽  
Drinking Water Distribution

Abstract Drinking water should be free from bacterial pathogens that threaten human health. The most recognised waterborne opportunistic pathogens, dwelling in tap water, are Legionella pneumophila and Escherichia coli. Drinking water samples were tested for the presence of Legionella spp., L. pneumophila, and E. coli in overall sample microbiomes using a quantitative real-time polymerase chain reaction (qPCR) approach. The results indicate a rather low contribution of Legionella spp. in total bacteria in the tested samples, but L. pneumophila was not detected in any sample. E. coli was detected in only one sample, but at a very low level. The qacEΔ1 gene, conferring resistance to quaternary ammonium compounds, was also not detected in any sample. The results point to generally sufficient quality of drinking water, although the presence of Legionella spp. in tap water samples suggests proliferation of these bacteria in heating units, causing a potential threat to consumer health.

scholarly journals Cluster of Legionnaires’ Disease in an Italian Prison

2019 ◽  
Vol 16 (11) ◽  
pp. 2062
Author(s):  
Teresa Fasciana ◽  
Chiara Mascarella ◽  
Salvatore Antonino Distefano ◽  
Cinzia Calà ◽  
Giuseppina Capra ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Water System ◽  
Growth Conditions ◽  
Etiologic Agent ◽  
Clinical Samples ◽  
Reference Laboratory ◽  
High Concentration ◽  
Western Sicily ◽  
Legionnaires Disease

Background: Legionella pneumophila (Lp) is the most common etiologic agent causing Legionnaires’ Disease (LD). Water systems offer the best growth conditions for Lp and support its spread by producing aerosols. From 2015 to 2017, the Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis of Palermo monitored the presence of Lp in nine prisons in Western Sicily. During this investigation, we compared Lp isolates from environmental samples in a prison located in Palermo with isolates from two prisoners in the same prison. Methods: We collected 93 water samples from nine Sicilian prisons and the bronchoalveolar lavages (BALs) of two prisoners considered cases of LD. These samples were processed following the procedures described in the Italian Guidelines for the Prevention and Control of Legionellosis of 2015. Then, genotyping was performed on 19 Lp colonies (17 from water samples and 2 from clinical samples) using the Sequence-Based Typing (SBT) method, according to European Study Group for Legionella Infections (ESGLI) protocols. Results: Lp serogroup (sg) 6 was the most prevalent serogroup isolated from the prisons analyzed (40%), followed by Lp sg 1 (16%). Most of all, in four penitentiary institutions, we detected a high concentration of Lp >104 Colony Forming Unit/Liter (CFU/L). The environmental molecular investigation found the following Sequence Types (STs) in Lp sg 6: ST 93, ST 292, ST 461, ST 728, ST 1317 and ST 1362, while most of the isolates in sg 1 belonged to ST 1. We also found a new ST that has since been assigned the number 2451 in the ESGLI-SBT database. From the several Lp sg 1 colonies isolated from the two BALs, we identified ST 2451. Conclusions: In this article, we described the results obtained from environmental and epidemiological investigations of Lp isolated from prisons in Western Sicily. Furthermore, we reported the first cluster of Legionnaires’ in an Italian prison and the molecular typing of Lp sg 1 from one prison’s water system and two BALs, identified the source of the contamination, and discovered a new ST.

scholarly journals A community-acquired Legionnaires’ disease outbreak caused by Legionella pneumophila serogroup 2: an uncommon event, Italy, August to October 2018

2021 ◽  
Vol 26 (25) ◽  
Author(s):  
Maria Scaturro ◽  
Maria Cristina Rota ◽  
Maria Grazia Caporali ◽  
Antonietta Girolamo ◽  
Michele Magoni ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Environmental Water ◽  
Urinary Antigen Test ◽  
Respiratory Sample ◽  
Environmental Investigation ◽  
Three Samples ◽  
Legionnaires Disease ◽  
Private Homes ◽  
Nested Sequence

In September 2018 in Brescia province, northern Italy, an outbreak of Legionnaires' disease (LD) caused by Legionella pneumophila serogroup 2 (Lp2) occurred. The 33 cases (two fatal) resided in seven municipalities along the Chiese river. All cases were negative by urinary antigen test (UAT) and most were diagnosed by real-time PCR and serology. In only three cases, respiratory sample cultures were positive, and Lp2 was identified and typed as sequence type (ST)1455. In another three cases, nested sequence-based typing was directly applied to respiratory samples, which provided allelic profiles highly similar to ST1455. An environmental investigation was undertaken immediately and water samples were collected from private homes, municipal water systems, cooling towers and the river. Overall, 533 environmental water samples were analysed and 34 were positive for Lp. Of these, only three samples, all collected from the Chiese river, were Lp2 ST1455. If and how the river water could have been aerosolised causing the LD cases remains unexplained. This outbreak, the first to our knowledge caused by Lp2, highlights the limits of UAT for LD diagnosis, underlining the importance of adopting multiple tests to ensure that serogroups other than serogroup 1, as well as other Legionella species, are identified.

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