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 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 Lessons From an Outbreak of Legionnaires’ Disease on a Hematology-Oncology Unit

2016 ◽  
Vol 38 (3) ◽  
pp. 306-313 ◽  
Author(s):  
Louise K. Francois Watkins ◽  
Karrie-Ann E. Toews ◽  
Aaron M. Harris ◽  
Sherri Davidson ◽  
Stephanie Ayers-Millsap ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Potable Water ◽  
Single Case ◽  
Healthcare Providers ◽  
Water System ◽  
Positive Sequence ◽  
Environmental Isolates ◽  
Legionnaires Disease ◽  
Oncology Unit ◽  
Healthcare Associated

OBJECTIVESTo define the scope of an outbreak of Legionnaires’ disease (LD), to identify the source, and to stop transmission.DESIGN AND SETTINGEpidemiologic investigation of an LD outbreak among patients and a visitor exposed to a newly constructed hematology-oncology unit.METHODSAn LD case was defined as radiographically confirmed pneumonia in a person with positive urinary antigen testing and/or respiratory culture forLegionellaand exposure to the hematology-oncology unit after February 20, 2014. Cases were classified as definitely or probably healthcare-associated based on whether they were exposed to the unit for all or part of the incubation period (2–10 days). We conducted an environmental assessment and collected water samples for culture. Clinical and environmental isolates were compared by monoclonal antibody (MAb) and sequence-based typing.RESULTSOver a 12-week period, 10 cases were identified, including 6 definite and 4 probable cases. Environmental sampling revealedLegionella pneumophilaserogroup 1 (Lp1) in the potable water at 9 of 10 unit sites (90%), including all patient rooms tested. The 3 clinical isolates were identical to environmental isolates from the unit (MAb2-positive, sequence type ST36). No cases occurred with exposure after the implementation of water restrictions followed by point-of-use filters.CONCLUSIONSContamination of the unit’s potable water system with Lp1 strain ST36 was the likely source of this outbreak. Healthcare providers should routinely test patients who develop pneumonia at least 2 days after hospital admission for LD. A single case of LD that is definitely healthcare associated should prompt a full investigation.Infect Control Hosp Epidemiol2017;38:306–313

scholarly journals Flagellum of Legionella pneumophilaPositively Affects the Early Phase of Infection of Eukaryotic Host Cells

2001 ◽  
Vol 69 (4) ◽  
pp. 2116-2122 ◽  
Author(s):  
Claudia Dietrich ◽  
Klaus Heuner ◽  
Bettina C. Brand ◽  
Jörg Hacker ◽  
Michael Steinert
Keyword(s):  
Electron Microscopy ◽  
Legionella Pneumophila ◽  
Kanamycin Resistance ◽  
Etiologic Agent ◽  
Polyclonal Antiserum ◽  
Host Cells ◽  
Kanamycin Resistance Cassette ◽  
Legionnaires Disease ◽  
Invasion Capacity

ABSTRACT Legionella pneumophila, the etiologic agent of Legionnaires' disease, contains a single, monopolar flagellum which is composed of one major subunit, the FlaA protein. To evaluate the role of the flagellum in the pathogenesis and ecology ofLegionella, the flaA gene of L. pneumophila Corby was mutagenized by introduction of a kanamycin resistance cassette. Immunoblots with antiflagellin-specific polyclonal antiserum, electron microscopy, and motility assays confirmed that the specific flagellar mutant L. pneumophila Corby KH3 was nonflagellated. The redelivery of the intact flaA gene into the chromosome (L. pneumophila Corby CD10) completely restored flagellation and motility. Coculture studies showed that the invasion efficiency of the flaA mutant was moderately reduced in amoebae and severely reduced in HL-60 cells. In contrast, adhesion and the intracellular rate of replication remained unaffected. Taking these results together, we have demonstrated that the flagellum of L. pneumophila positively affects the establishment of infection by facilitating the encounter of the host cell as well as by enhancing the invasion capacity.

scholarly journals Development of a DNA Microarray Method for Detection and Identification of All 15 Distinct O-Antigen Forms of Legionella pneumophila

2013 ◽  
Vol 79 (21) ◽  
pp. 6647-6654 ◽  
Author(s):  
Boyang Cao ◽  
Fangfang Yao ◽  
Xiangqian Liu ◽  
Lu Feng ◽  
Lei Wang
Keyword(s):  
Dna Microarray ◽  
Legionella Pneumophila ◽  
Detection Sensitivity ◽  
Immunological Methods ◽  
Clinical Samples ◽  
Content Type ◽  
O Antigen ◽  
Detection And Identification ◽  
Legionnaires Disease ◽  
Reference Strains

ABSTRACTLegionellais ubiquitous in many environments. At least 50 species and 70 serogroups of the Gram-negative bacterium have been identified. Of the 50 species, 20 are pathogenic, andLegionella pneumophilais responsible for the great majority (approximately 90%) of the Legionnaires' disease cases that occur. Furthermore, of the 15L. pneumophilaserogroups identified, O1 alone causes more than 84% of the Legionnaires' disease cases that occur worldwide. Rapid and reliable assays for the detection and identification ofL. pneumophilain water, environmental, and clinical samples are in great demand.L. pneumophilabacteria are traditionally identified by their O antigens by immunological methods. We have recently developed an O serogroup-specific DNA microarray for the detection of all 15 distinct O-antigen forms ofL. pneumophila, including serogroups O1 to O15. A total of 35 strains were used to verify the specificity of the microarray, including 15L. pneumophilaO-antigen standard reference strains and sevenL. pneumophilaclinical isolates as target strains, seven reference strains of other non-pneumophila Legionellaspecies as closely related strains, and six non-Legionellabacterial species as nonrelated strains. The detection sensitivity was 1 ng of genomic DNA or 0.4 CFU/ml in water samples with filter enrichment and plate culturing. This study demonstrated that the microarray allows specific, sensitive, and reproducible detection ofL. pneumophilaserogroups. To the best of our knowledge, this is the first report of a microarray serotyping method for all 15 distinct O-antigen forms ofL. pneumophila.

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 Lab Diagnosis of Legionnaires’ Disease

JMS SKIMS ◽  
2014 ◽  
Vol 17 (2) ◽  
pp. 50-54
Author(s):  
Nayeem U-Din Wani ◽  
Aamir Ali
Keyword(s):  
Legionella Pneumophila ◽  
Water System ◽  
Laboratory Diagnosis ◽  
Significant Rise ◽  
Control Measures ◽  
Causative Organism ◽  
Common Source ◽  
Contaminated Water ◽  
Atypical Pneumonia ◽  
Legionnaires Disease

Legionnaires’ disease is a multi-system disease which causes atypical pneumonia due to Legionella bacteria, most commonly of the species Legionella pneumophila. About one out of every 10 people who get sick from Legionnaires’ disease will die. Most common source of infection-contaminated water supply through inhalation of contaminated water droplets (aerosols). A laboratory diagnosis of Legionnaires’ disease can be made using a variety of laboratory tests including: culture/isolation of the causative organism, antigen detection in urine, a significant rise in antibody titres or PCR methods. Determination of the monoclonal subtype and molecular sequence typing can support linking between strains from the sampled environment and from patients. The control measures available to reduce the amount of Legionella in a water system include structural adaptations to the water system, temperature control, disinfection using chemicals or other oxidizing materials, and use of biocides or installation of filters. JMS 2014;17(2):50-54

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 Reduction of Legionella spp. in Water and in Soil by a Citrus Plant Extract Vapor

2014 ◽  
Vol 80 (19) ◽  
pp. 6031-6036 ◽  
Author(s):  
Katie Laird ◽  
Elena Kurzbach ◽  
Jodie Score ◽  
Jyoti Tejpal ◽  
George Chi Tangyie ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water System ◽  
Severe Form ◽  
Gas Chromatography Mass Spectrometry ◽  
Free Living ◽  
Content Type ◽  
Soil Systems ◽  
Viable Cells ◽  
Legionnaires Disease ◽  
Soil And Water

ABSTRACTLegionnaires' disease is a severe form of pneumonia caused byLegionellaspp., organisms often isolated from environmental sources, including soil and water.Legionellaspp. are capable of replicating intracellularly within free-living protozoa, and once this has occurred,Legionellais particularly resistant to disinfectants. Citrus essential oil (EO) vapors are effective antimicrobials against a range of microorganisms, with reductions of 5 log cells ml−1on a variety of surfaces. The aim of this investigation was to assess the efficacy of a citrus EO vapor againstLegionellaspp. in water and in soil systems. Reductions of viable cells ofLegionella pneumophila,Legionella longbeachae,Legionella bozemanii, and an intra-amoebal culture ofLegionella pneumophila(water system only) were assessed in soil and in water after exposure to a citrus EO vapor at concentrations ranging from 3.75 mg/liter air to 15g/liter air. Antimicrobial efficacy via different delivery systems (passive and active sintering of the vapor) was determined in water, and gas chromatography-mass spectrometry (GC-MS) analysis of the antimicrobial components (linalool, citral, and β-pinene) was conducted. There was up to a 5-log cells ml−1reduction inLegionellaspp. in soil after exposure to the citrus EO vapors (15 mg/liter air). The most susceptible strain in water wasL. pneumophila, with a 4-log cells ml−1reduction after 24 h via sintering (15 g/liter air). Sintering the vapor through water increased the presence of the antimicrobial components, with a 61% increase of linalool. Therefore, the appropriate method of delivery of an antimicrobial citrus EO vapor may go some way in controllingLegionellaspp. from environmental sources.

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