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.

scholarly journals Developing a Methodology for Testing and Preliminary Determination of the Presence of Legionella Spp. and Legionella Pneumophila in Environmental Water Samples by Immunomagnetic Separation Combined with Flow Cytometry

2019 ◽  
Vol 68 (3) ◽  
pp. 71-92
Author(s):  
Zbigniew Dąbrowiecki ◽  
Małgorzata Dąbrowiecka ◽  
Romuald Olszański ◽  
Piotr Siermontowski
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Classical Method ◽  
Environmental Water ◽  
Immunomagnetic Separation ◽  
Supply System ◽  
Necessary Condition ◽  
Source Of Infection ◽  
Legionnaires Disease

Abstract In the event of an epidemic of Legionnaires’ disease, prompt and unambiguous identification of the source of infection and immediate undertaking of repair actions is a necessary condition to limit and minimise the effects of the developing epidemic. In the classical method for determining the level of Legionella bacteria in water samples, the effectiveness of the reparative action (increase of the water temperature in the water supply system to 600C, additional chlorination) can only be confirmed after 14 days!!! Only by using the IMMS&FCM method can Legionella’s determination time be reduced to 2-4 hours, which is the most important factor in limiting the development of an epidemic.

scholarly journals A cluster of Legionnaires' disease in Belgium linked to a cooling tower, August–September 2016: practical approach and challenges

2019 ◽  
Vol 147 ◽  
Author(s):  
N. Hammami ◽  
V. Laisnez ◽  
I. Wybo ◽  
D. Uvijn ◽  
C. Broucke ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Cooling Tower ◽  
Geographical Information ◽  
Cluster Management ◽  
Respiratory Sample ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Legionnaires Disease ◽  
Environmental Sample Analysis

Abstract A cluster of Legionnaires' disease (LD) with 10 confirmed, three probable and four possible cases occurred in August and September 2016 in Dendermonde, Belgium. The incidence in the district was 7 cases/100 000 population, exceeding the maximum annual incidence in the previous 5 years of 1.5/100 000. Epidemiological, environmental and geographical investigations identified a cooling tower (CT) as the most likely source. The case risk around the tower decreased with increasing distance and was highest within 5 km. Legionella pneumophila serogroup 1, ST48, was identified in a human respiratory sample but could not be matched with the environmental results. Public health authorities imposed measures to control the contamination of the CT and organised follow-up sampling. We identified obstacles encountered during the cluster investigation and formulated recommendations for improved LD cluster management, including faster coordination of teams through the outbreak control team, improved communication about clinical and environmental sample analysis, more detailed documentation of potential exposures obtained through the case questionnaire and earlier use of a geographical information tool to compare potential sources and for hypothesis generation.

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

2007 ◽  
Vol 28 (9) ◽  
pp. 1085-1088 ◽  
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.

scholarly journals Legionnaires’ disease cluster linked to a metal product aqueous pre-treatment process, Staffordshire, England, May 2008

2009 ◽  
Vol 14 (40) ◽  
Author(s):  
N Coetzee ◽  
W K Liu ◽  
N Astbury ◽  
P Williams ◽  
S Robinson ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Treatment Process ◽  
Medical Practitioners ◽  
Disease Cluster ◽  
Environmental Investigation ◽  
Worker Absenteeism ◽  
Community Exposure ◽  
Legionnaires Disease ◽  
Pre Treatment ◽  
Biocide Treatment

In May 2008, a report of two workers from the same construction equipment manufacturing plant who were admitted to hospital with Legionnaires’ disease confirmed by urine antigen prompted an outbreak investigation. Both cases were middle aged men, smokers, and with no travel, leisure or other common community exposure to Legionella sources. There were no wet cooling towers at the plant or in the surrounding area. No increase in respiratory disease or worker absenteeism occurred at the plant during the preceding month. Wider case ascertainment including alerts to hospitals and medical practitioners yielded no further cases. The environmental investigation (and sampling of water systems for Legionella) identified a Legionella pneumophila serogroup1 (Mab 2b) count of >3.0x104cfu/l in water samples from an aqueous metal pre-treatment tunnel, which generates profuse water aerosol. Drainage, cleaning and biocide treatment using thiazalone eliminated Legionella from the system.

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 Unusual clinical picture in an overweight patient with Legionella pneumophila: A case report

2017 ◽  
Vol 4 (3) ◽  
pp. 31
Author(s):  
Leonidas Grigorakos ◽  
Daria Lazarescu ◽  
Anthi Georgiadou ◽  
Maria Bikou ◽  
Magda Gkouni ◽  
...  
Keyword(s):  
Case Report ◽  
Legionella Pneumophila ◽  
Clinical Picture ◽  
Clinical Condition ◽  
Antigen Test ◽  
Overweight Patient ◽  
Urinary Antigen ◽  
Urinary Antigen Test ◽  
Legionnaires Disease ◽  
Continue Therapy

This case report describes a case of a patient with Legionnaires’ disease (LD) manifested three days upon his return from a medical conference, which took place in a hotel close to the seaside. Our patient presented to the hospital febrile, weak, confused and with mild difficulty in breathing. After being subjected to several tests, he was diagnosed with LD. Even though his initial urinary antigen test (UAT) was negative, subsequent immunofluorescent assays (IFA) were positive for Legionella pneumophila (LP). The patient was immediately initiated specific antibiotics therapy and supportive measures. After 11 days he was released from the hospital with considerable melioration of his clinical condition and with specific instructions to continue therapy at home.

scholarly journals Clusters of Healthcare-Associated Legionnaires’ Disease in Two Hospitals of Central Greece

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Maria A. Kyritsi ◽  
Varvara A. Mouchtouri ◽  
Anna Katsiafliaka ◽  
Foteini Kolokythopoulou ◽  
Elias Plakokefalos ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Environmental Samples ◽  
Distribution Systems ◽  
Water Distribution ◽  
Control Measures ◽  
Aerosol Therapy ◽  
Environmental Investigation ◽  
Source Of Infection ◽  
Legionnaires Disease ◽  
Healthcare Associated

Healthcare-associated Legionnaires’ disease often leads to fatal respiratory tract infection among hospitalized patients. In this report, three cases of Legionnaires’ disease among patients in two different hospitals (Hospital A and Hospital B) were investigated. After conducting an epidemiologic and environmental investigation, the water distribution systems (WDSs) were identified as the possible source of infection, as Legionella pneumophila serogroup 1 (Lp1) was isolated from both clinical and environmental samples. Patients received aerosol therapy with nebulizers during their hospitalization. Based on the results of the investigation, the hospitals’ infection control committees reviewed their policies for Legionnaires’ disease prevention and implemented control measures focusing on using sterile fluids for aerosol treatments.

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 Total and Viable Legionella pneumophila Cells in Hot and Natural Waters as Measured by Immunofluorescence-Based Assays and Solid-Phase Cytometry

2011 ◽  
Vol 77 (17) ◽  
pp. 6225-6232 ◽  
Author(s):  
N. Parthuisot ◽  
M. Binet ◽  
A. Touron-Bodilis ◽  
C. Pougnard ◽  
P. Lebaron ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Natural Waters ◽  
Solid Phase ◽  
Environmental Water ◽  
Thermal Spring ◽  
Hot Water ◽  
Content Type ◽  
Thermal Spring Water ◽  
Plate Counts

ABSTRACTA new method was developed for the rapid and sensitive detection of viableLegionella pneumophila. The method combines specific immunofluorescence (IF) staining using monoclonal antibodies with a bacterial viability marker (ChemChrome V6 cellular esterase activity marker) by means of solid-phase cytometry (SPC). IF methods were applied to the detection and enumeration of both the total and viableL. pneumophilacells in water samples. The sensitivity of the IF methods coupled to SPC was 34 cells liter−1, and the reproducibility was good, with the coefficient of variation generally falling below 30%. IF methods were applied to the enumeration of total and viableL. pneumophilacells in 46 domestic hot water samples as well as in cooling tower water and natural water samples, such as thermal spring water and freshwater samples. Comparison with standard plate counts showed that (i) the total direct counts were always higher than the plate counts and (ii) the viable counts were higher than or close to the plate counts. With domestic hot waters, when the IF assay was combined with the viability test, SPC detected up to 3.4 × 103viable but nonculturableL. pneumophilacells per liter. These direct IF methods could be a powerful tool for high-frequency monitoring of domestic hot waters or for investigating the occurrence of viableL. pneumophilain both man-made water systems and environmental water samples.

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