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1.
Epidemiol Infect ; 147: e326, 2019 12 20.
Artículo en Inglés | MEDLINE | ID: mdl-31858932

RESUMEN

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.


Asunto(s)
Brotes de Enfermedades , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Microbiología del Agua , Adulto , Anciano , Bélgica/epidemiología , Femenino , Humanos , Incidencia , Enfermedad de los Legionarios/microbiología , Enfermedad de los Legionarios/prevención & control , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
2.
Przegl Epidemiol ; 73(2): 151-155, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31385671

RESUMEN

OBJECTIVE: The aim of this study is to assess the epidemiological situation of legionellosis in Poland in 2017 in comparison with previous years. MATERIAL AND METHODS: The analysis is based on national surveillance data published in the annual bulletin: "Infectious diseases and poisonings in Poland in 2017" and bulletins from previous years along with data from legionellosis case reports collected and sent to the Department of Epidemiology of Infectious Diseases and Surveillance NIPH ­ NIH by Sanitary and Epidemiological Stations. RESULTS: In Poland, both cases of Legionnaires' disease (an acute form of infection with pneumonia) and Pontiac fever (a mild, influenza-like form of infection) are routinely reported to the surveillance system. In 2017, a total of 39 cases of legionellosis were registered, including 38 cases of Legionnaires' disease and 1 case of Pontiac fever; the annual incidence rate 0.102 (per 100,000 population) has increased by almost 50 percent since previous year (0.070) and is almost three times higher than the median incidence (0.036) for 2011-2015. The infections were reported in fourteen voivodeships; only one voivodeship (Swietokrzyskie) did not register any case in last years. The incidence in men (0.129 per 100,000) was higher compared to women (0.076); the highest incidence (0.323) was noted in men aged 50-59. All reported cases were sporadic and were hospitalised. The Sanitary Inspection reported nine fatal cases ­ 6 women and 3 men. Thirty three cases were autochthonous including four cases linked with contaminated water systems in health-care settings. Six cases were associated with travels abroad (to Egypt, Albania, Italy and Crete). SUMMARY AND CONCLUSIONS: Although in recent years number of reported cases continues to rise, the incidence of legionellosis in Poland remains one of the lowest in the entire EU. Also draws attention variation of incidence between provinces and a high mortality among reported cases. Our data suggest significant under-diagnosis of legionellosis. A priority remains to improve early diagnosis of Legionnaires' disease in health care settings.


Asunto(s)
Legionelosis/epidemiología , Sistema de Registros , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Enfermedad de los Legionarios/epidemiología , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Adulto Joven
3.
Artículo en Inglés | MEDLINE | ID: mdl-31212678

RESUMEN

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.


Asunto(s)
Legionella pneumophila/patogenicidad , Prisiones/estadística & datos numéricos , Microbiología del Agua/normas , Análisis por Conglomerados , Monitoreo del Ambiente , Humanos , Italia/epidemiología , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Prevalencia
4.
Emerg Infect Dis ; 25(6): 1218-1219, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31107214

RESUMEN

We report national surveillance of Legionnaires' disease in China. Urine samples from 11 (3.85%) of 286 patients with severe pneumonia of unknown cause were positive for the Legionella pneumophila serogroup 1 antigen. We isolated Legionella strains from 7 patients. Improved diagnostic testing is needed for this underestimated disease in China.


Asunto(s)
Legionella pneumophila , Enfermedad de los Legionarios/epidemiología , Enfermedad de los Legionarios/microbiología , Adulto , Anciano , Antígenos Bacterianos/inmunología , China/epidemiología , Femenino , Humanos , Legionella pneumophila/clasificación , Legionella pneumophila/efectos de los fármacos , Legionella pneumophila/genética , Legionella pneumophila/inmunología , Enfermedad de los Legionarios/diagnóstico , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Tipificación Molecular , Vigilancia en Salud Pública , Serogrupo , Adulto Joven
5.
PLoS One ; 14(5): e0217632, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31145765

RESUMEN

Detection of clusters of Legionnaires' disease, a leading waterborne cause of pneumonia, is challenging. Clusters vary in size and scope, are associated with a diverse range of aerosol-producing devices, including exposures such as whirlpool spas and hotel water systems typically associated with travel, and can occur without an easily identified exposure source. Recently, jurisdictions have begun to use SaTScan spatio-temporal analysis software prospectively as part of routine cluster surveillance. We used data collected by the Active Bacterial Core surveillance platform to assess the ability of SaTScan to detect Legionnaires' disease clusters. We found that SaTScan analysis using traditional surveillance data and geocoded residential addresses was unable to detect many common Legionnaires' disease cluster types, such as those associated with travel or a prolonged time between cases. Additionally, signals from an analysis designed to simulate a real-time search for clusters did not align with clusters identified by traditional surveillance methods or a retrospective SaTScan analysis. A geospatial analysis platform better tailored to the unique characteristics of Legionnaires' disease epidemiology would improve cluster detection and decrease time to public health action.


Asunto(s)
Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Neumonía/enzimología , Vigilancia de la Población , Análisis por Conglomerados , Brotes de Enfermedades , Humanos , Legionella pneumophila/patogenicidad , Enfermedad de los Legionarios/microbiología , Neumonía/microbiología , Neumonía/prevención & control , Estudios Prospectivos , Estudios Retrospectivos , Programas Informáticos , Microbiología del Agua
6.
Artículo en Inglés | MEDLINE | ID: mdl-30925660

RESUMEN

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.


Asunto(s)
Monitoreo del Ambiente/métodos , Hospitales Universitarios/organización & administración , Legionella/aislamiento & purificación , Microbiología del Agua/normas , Abastecimiento de Agua/normas , Infección Hospitalaria/prevención & control , Humanos , Italia/epidemiología , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología
7.
Cien Saude Colet ; 24(3): 793-804, 2019 Mar.
Artículo en Español | MEDLINE | ID: mdl-30892501

RESUMEN

The scope of this paper is to review the available scientific literature about the effects on health of occupational exposure to Legionella spp. A systematic review of the scientific literature retrieved from the MEDLINE (via PubMed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library, LILCAS and SCOPUS databases through February 2015 was conducted. The key words used were ««Legionnaires' Disease¼ «Legionellosis¼ «Occupational Exposure¼ «Occupational Diseases¼. Two hundred and twenty-two references were retrieved of which, after applying inclusion/exclusion criteria, 13 complete articles were selected. Of these, 9 describe pneumonia, 4 list Pontiac Fever, 1 reveals legionellosis and 3 result in death. The main causative agent of disease in workers exposed was Legionella pneumophila serogroup 1. Legionella spp infection is closely related to professions where there is nebulization with water, mainly among workers subjected to long exposure or even re-exposure. Outbreaks occurs seasonally, especially in the hottest months.


Asunto(s)
Legionelosis/epidemiología , Enfermedades Profesionales/epidemiología , Exposición Profesional/efectos adversos , Adulto , Brotes de Enfermedades/estadística & datos numéricos , Humanos , Legionella/aislamiento & purificación , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Enfermedades Profesionales/microbiología , Microbiología del Agua
8.
mSphere ; 4(1)2019 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-30814318

RESUMEN

Between 2000 and 2017, a total of 236 Legionella species isolates from Arizona were submitted to the CDC for reference testing. Most of these isolates were recovered from bronchoalveolar lavage specimens. Although the incidence of legionellosis in Arizona is less than the overall U.S. incidence, Arizona submits the largest number of isolates to the CDC for testing compared to those from other states. In addition to a higher proportion of culture confirmation of legionellosis cases in Arizona than in other states, all Legionella pneumophila isolates are forwarded to the CDC for confirmatory testing. Compared to that from other states, a higher proportion of isolates from Arizona were identified as belonging to L. pneumophila serogroups 6 (28.2%) and 8 (8.9%). Genome sequencing was conducted on 113 L. pneumophila clinical isolates not known to be associated with outbreaks in order to understand the genomic diversity of strains causing legionellosis in Arizona. Whole-genome multilocus sequence typing (wgMLST) revealed 17 clusters of isolates sharing at least 99% identical allele content. Only two of these clusters contained isolates from more than one individual with exposure at the same facility. Additionally, wgMLST analysis revealed a group of 31 isolates predominantly belonging to serogroup 6 and containing isolates from three separate clusters. Single nucleotide polymorphism (SNP) and pangenome analysis were used to further resolve genome sequences belonging to a subset of isolates. This study demonstrates that culture of clinical specimens for Legionella spp. reveals a highly diverse population of strains causing legionellosis in Arizona which could be underappreciated using other diagnostic approaches.IMPORTANCE Culture of clinical specimens from patients with Legionnaires' disease is rarely performed, restricting our understanding of the diversity and ecology of Legionella Culture of Legionella from patient specimens in Arizona revealed a greater proportion of non-serogroup 1 Legionella pneumophila isolates than in other U.S. isolates examined. Disease caused by such isolates may go undetected using other diagnostic methods. Moreover, genome sequence analysis revealed that these isolates were genetically diverse, and understanding these populations may help in future environmental source attribution studies.


Asunto(s)
Variación Genética , Genoma Bacteriano , Legionella pneumophila/clasificación , Enfermedad de los Legionarios/microbiología , Arizona/epidemiología , Técnicas de Tipificación Bacteriana , Genotipo , Humanos , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Tipificación de Secuencias Multilocus , Serogrupo , Estados Unidos , Secuenciación Completa del Genoma
9.
Microb Pathog ; 129: 93-98, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30738817

RESUMEN

BACKGROUND: Legionella pneumophila is the main cause for community-acquired pneumonia especially in hospital environments. In this systematic review and meta-analysis, we evaluated the prevalence of L. pneumophila in clinical samples obtained from Iranian patients. METHODS: The studies reporting L. pneumophila prevalence in Iranian clinical samples that were published between January 2000 and July 2016 were recruited. Comprehensive Meta-Analysis Software (version 3.3.070) was used for quantitative data analysis. Because of high heterogeneity between the studies according to the Cochrane Q and I2 statistics, a random-effects model was used for meta-analysis. RESULTS: Sixteen studies encompassing 1956 subjects were included in the meta-analysis. The overall prevalence of L. pneumophila was 9.6% in clinical samples obtained from the Iranian patients. The age spectrum ranged from 6 months to 80 years old. Dyspnea and cough comprised the most common clinical manifestations. In the subgroup analysis, the prevalence of L. pneumophila was higher in studies with sample size ≤100 (12.9%) in comparison with studies with sample size >100 (8.4%). In addition, the prevalence of L. pneumophila was higher in the years 2009-2016 (9.2%) compared with 2000-2008 (0.7%). CONCLUSION: L. pneumophila is a major cause of community- and hospital-acquired pneumonia. It is of pivotal importance to implement sensitive and reliable molecular and culture-based techniques to detect and control this infection in healthcare environments.


Asunto(s)
Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infección Hospitalaria/epidemiología , Femenino , Humanos , Lactante , Irán/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
10.
Disaster Med Public Health Prep ; 13(2): 372-374, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-29716666

RESUMEN

Geographic information systems (GIS) have emerged in the past few decades as a technology capable of assisting in the control of infectious disease outbreaks. A Legionnaires' disease cluster investigation in May 2016 in Sydney, New South Wales (NSW), Australia, demonstrated the importance of using GIS to identify at-risk water sources in real-time for field investigation to help control any immediate environmental health risk, as well as the need for more staff trained in the use of this technology. Sydney Local Health District Public Health Unit (PHU) subsequently ran an exercise (based on this investigation) with 11 staff members from 4 PHUs across Sydney to further test staff capability to use GIS across NSW. At least 80% of exercise participants reported that the scenario progression was realistic, assigned tasks were clear, and sufficient data were provided to complete tasks. The exercise highlighted the multitude of geocoding applications and need for inter-operability of systems, as well as the need for trained staff with specific expertise in spatial analysis to help assist in outbreak control activity across NSW. Evaluation data demonstrated the need for a common GIS, regular education and training, and guidelines to support the collaborative use of GIS for infectious disease epidemiology in NSW. (Disaster Med Public Health Preparedness. 2019;13:372-374).


Asunto(s)
Sistemas de Información Geográfica/instrumentación , Enfermedad de los Legionarios/diagnóstico , Brotes de Enfermedades/prevención & control , Brotes de Enfermedades/estadística & datos numéricos , Sistemas de Información Geográfica/tendencias , Humanos , Control de Infecciones/métodos , Enfermedad de los Legionarios/epidemiología , Nueva Gales del Sur/epidemiología , Salud Pública/instrumentación , Salud Pública/métodos , Salud Pública/tendencias
11.
J Microbiol Immunol Infect ; 52(3): 465-470, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28964650

RESUMEN

BACKGROUND/PURPOSE: Legionella pneumophila had been recognized as an important pathogen for community-acquired pneumonia. We aimed to investigate clinical features and outcomes of patients with Legionnaires' disease at a tertiary medical center in northern Taiwan. METHODS: From June 2012 to February 2017, a retrospective review of adult community-acquired. Legionnaires' disease at a medical center was conducted. All Legionella infections were confirmed by positive urinary Legionella antigen assay, sera indirect immunofluorescence assay, or sputum culture for Legionella. Literature review of Legionnaires' disease from Medline and PubMED websites was performed. RESULTS: A total of 32 cases of Legionnaires' disease were identified. Their mean age was 64.3 years, with male predominance (27 cases, 84.3%). The underlying diseases were varied and most were attributed to chronic disorders, such as diabetes mellitus (31%) and cigarette smoking (40.6%). The most common symptoms were cough (68%) and fever (59.3%). More than half of patients (18, 56.2%) with Legionnaires' disease could initially present with extrapulmonary manifestations. Sixteen (50%) patients had delay in initiation of appropriate antibiotic therapy. Patients without adequately initiation of appropriate antibiotic therapy had higher proportion (11 of 16, 68.7%) of intensive care unit admission than patients with adequate initiation (5 of 16, 31.2%). Our results inferred that a delay in treatment might result in worsening of disease severity and the need for more intensive management. Overall mortality rate was 21.8%. Development of vasopressor requirement is an independent risk factor associated with mortality. CONCLUSION: Legionnaires' disease in Taiwan frequently present with extrapulmonary manifestations. Patients with hemodynamic instability that need vasopressor therapy associated with mortality.


Asunto(s)
Infecciones Comunitarias Adquiridas/epidemiología , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/tratamiento farmacológico , Enfermedad de los Legionarios/microbiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología , Centros de Atención Terciaria , Tiempo de Tratamiento
12.
BMC Infect Dis ; 18(1): 696, 2018 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-30587144

RESUMEN

BACKGROUND: An explosive outbreak of Legionnaires' disease (LD) was identified on 11 December 2015 in Manzanares, Ciudad Real, Spain, and was declared closed by 03 February 2016. The number of declared cases was 593 with 277 confirmed cases so that it can be considered as one of the outbreaks with highest attack rate. This rate could be attributed to the ageing of the population, among others, in addition to various risk factors and habits, and the meteorological conditions (thermal inversion) maintained in this municipality at the time. The Public Health Services succeeded in breaking the bacterial transmission. Several facilities were early identified by microbiological analysis, including a cooling tower and a decorative fountain, as possible infectious sources. Rapid analytical techniques for rapid Legionella detection and the shutdown and preventative closure of positive installations have been considered key elements in the control of this outbreak. RESULTS: Rapid microbiological analysis helped to the early identification of potential risk sources in a Legionnaires´ disease outbreak, reducing decision-making processes according to the actual needs of the intervention in public health and shortening the exposure of the population. CONCLUSIONS: Protocolized and immediate intervention in an outbreak is a crucial issue to reduce their effects on public health. For this, identification and control of the suspicious sources able to disseminate the bacteria and cause the illness is required. Rapid analytical techniques like immunomagnetic separation (IMS) method based on the whole bacterial cell detection are shown as excellent tools to investigate all the potential sources of risk.


Asunto(s)
Técnicas Biosensibles/métodos , Brotes de Enfermedades , Reservorios de Enfermedades/microbiología , Monitoreo del Ambiente/métodos , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Anciano , Reservorios de Enfermedades/estadística & datos numéricos , Diagnóstico Precoz , Ambiente , Microbiología Ambiental , Humanos , Inmunoensayo/métodos , Legionella pneumophila/inmunología , Enfermedad de los Legionarios/microbiología , Salud Pública/métodos , Factores de Riesgo , España/epidemiología , Microbiología del Agua
13.
Swiss Med Wkly ; 148: w14687, 2018 11 19.
Artículo en Inglés | MEDLINE | ID: mdl-30552854

RESUMEN

PURPOSE: Eight confirmed cases of Legionnaires’ disease were identified at the Geneva University Hospitals between 28 July 2017 and 02 August 2017, leading to a detailed outbreak investigation. METHODS: Legionnaires’ disease cases were defined according to Swiss and European (ELDSNet) consensus guidelines. An outbreak investigation task force was put in place. Patients were interviewed, when feasible, with a standard questionnaire. A Legionella pneumophila urinary antigen test was performed in all cases. Lower respiratory tract (LRT) specimens were collected for culture, polymerase chain-reaction (PCR) assay, monoclonal antibody subtyping and sequenced-based typing (SBT). Multiple environmental samples were collected. Case geographical mapping was performed and local meteorological data were obtained. RESULTS: Thirty-four confirmed cases of Legionnaires’ disease were identified between 20 June 2017 and 16 September 2017, including 28 patients living in the Canton of Geneva and 6 cases in neighbouring cantons and France. The case fatality rate was 8.8%. The urinary antigen test was positive in 32/34 (94.1%) cases. Among the 17/34 (50%) cases with available LRT specimens, 8 (47.1%) were culture/PCR positive, 5 (29.4%) were PCR positive only, and 4 (23.5%) were culture/PCR negative. Monoclonal antibody subtyping and SBT on 12 samples allowed subtype identification of 8 samples, with a predominance of L. pneumophila serogroup-1 subtype-France/Allentown ST23 among clinical isolates. A specific city area was identified as a possible outbreak epicentre in 25/34 (73.5%) cases, although molecular analysis of clinical and environmental specimens revealed heterogeneous subtypes of L. pneumophila. CONCLUSIONS: In this largest documented outbreak of Legionnaires’ disease in Switzerland, we report prompt outbreak identification, leading to timely initiation of a detailed, well-orchestrated clinical and epidemiological investigation.


Asunto(s)
Brotes de Enfermedades , Legionella pneumophila/genética , Enfermedad de los Legionarios/epidemiología , Femenino , Genotipo , Humanos , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/genética , Enfermedad de los Legionarios/orina , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Vigilancia de la Población , Suiza/epidemiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-30513698

RESUMEN

This study aimed to assess the colonization of hotel water systems in central Greece and Corfu by Legionella, and to investigate the association between physicochemical parameters and Legionella colonization. Standardized hygiene inspection was conducted in 51 hotels, and 556 water samples were analyzed for Legionella spp. Free chlorine concentration, pH, hardness, conductivity, and trace metals were defined in cold water samples. The results of inspections and chemical analyses were associated with the microbiological results using univariate and logistic regression analysis. According to the score of the checklist used for the inspections, 17.6% of the hotels were classified as satisfactory, 15.7% as adequate, and 66.7% as unsatisfactory. Moreover, 74.5% of the hotels were colonized by Legionella spp. and 31.4% required remedial measures according to the European guidelines. Legionella spp. were isolated in 28% of the samples. Unsatisfactory results of inspections were associated with Legionella presence (relative risk (RR) = 7.67, p-value = 0.043). In hot-water systems, <50 °C temperatures increased the risk of Legionella colonization (RR = 5.36, p-value < 0.001). In cold-water systems, free chlorine concentration <0.375 mg/L (odds ratio (OR) = 9.76, p-value = 0.001), pH ≥ 7.45 (OR = 4.05, p-value = 0.007), and hardness ≥321 mgCaCO3/L (OR = 5.63, p-value = 0.003) increased the risk, whereas copper pipes demonstrated a protective role (OR = 0.29, p-value = 0.0024). The majority of the hotels inspected were colonized with Legionella. Supplementary monitoring of the risk factors that were identified should be considered.


Asunto(s)
Legionella/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Instalaciones Públicas , Abastecimiento de Agua/normas , Recuento de Colonia Microbiana , Brotes de Enfermedades , Grecia , Humanos , Enfermedad de los Legionarios/microbiología , Enfermedad de los Legionarios/prevención & control , Instalaciones Públicas/normas , Factores de Riesgo , Temperatura , Microbiología del Agua
15.
Indian J Med Microbiol ; 36(3): 324-333, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30429383

RESUMEN

Legionella pneumophila was first recognised as a fatal cause of pneumonia more than four decades ago, during the 1976-American Legion convention in Philadelphia, USA. Legionella spp. continue to cause disease outbreaks of public health significance, and at present, Legionnaires' disease (LD) has emerged as an important cause of community and hospital-acquired pneumonia. Parallel to this, the understanding of LD has also increased exponentially. However, the disease is likely to be underreported in many countries because of the dearth of common definitions, diagnostic tests and active surveillance systems. In this review, we outline the basic concepts of Legionella including clinical presentations, epidemiology, laboratory diagnosis and the status of LD in India. This article also summarises the progress of research related to Legionella in this country, identifying the research gaps and discussing priorities to explore this unexplored pathogen in India.


Asunto(s)
Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Investigación Biomédica/tendencias , Técnicas de Laboratorio Clínico/métodos , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/patología , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/patología , Humanos , India/epidemiología , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/patología
16.
J Natl Black Nurses Assoc ; 29(1): 44-50, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30282132

RESUMEN

The water crisis in Flint, Michigan raised national awareness about lead- tainted drinking water, particularly its harm to children and pregnant and lactating women. However, according to recent findings, there may be another by-product of this man-made crisis. Failure to use anticorrosive material in the water, a practice mandated by the 1978 Clean Water Act, is being linked to an outbreak of Legionnaires' disease, an illness detrimental primarily to adults over 65 years of age. While Legionnaires' disease is relatively rare, it is also likely to remain undiagnosed. Clinicians, therefore, are urged to consider this diagnosis in adults with pneumonia that does not respond to typical antibiotic treatment, and in newborns with respiratory distress along with other non-typical symptoms as well as those who have had water births or who were exposed to ultrasonic, cool-mist humidification.


Asunto(s)
Brotes de Enfermedades , Enfermedad de los Legionarios/epidemiología , Diagnóstico Diferencial , Humanos , Enfermedad de los Legionarios/diagnóstico , Michigan/epidemiología , Abastecimiento de Agua/legislación & jurisprudencia , Abastecimiento de Agua/normas
17.
PLoS One ; 13(10): e0206110, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30335848

RESUMEN

Legionella spp. are the cause of a severe bacterial pneumonia known as Legionnaires' disease (LD). In some cases, current genetic subtyping methods cannot resolve LD outbreaks caused by common, potentially endemic L. pneumophila (Lp) sequence types (ST), which complicates laboratory investigations and environmental source attribution. In the United States (US), ST1 is the most prevalent clinical and environmental Lp sequence type. In order to characterize the ST1 population, we sequenced 289 outbreak and non-outbreak associated clinical and environmental ST1 and ST1-variant Lp strains from the US and, together with international isolate sequences, explored their genetic and geographic diversity. The ST1 population was highly conserved at the nucleotide level; 98% of core nucleotide positions were invariant and environmental isolates unassociated with human disease (n = 99) contained ~65% more nucleotide diversity compared to clinical-sporadic (n = 139) or outbreak-associated (n = 28) ST1 subgroups. The accessory pangenome of environmental isolates was also ~30-60% larger than other subgroups and was enriched for transposition and conjugative transfer-associated elements. Up to ~10% of US ST1 genetic variation could be explained by geographic origin, but considerable genetic conservation existed among strains isolated from geographically distant states and from different decades. These findings provide new insight into the ST1 population structure and establish a foundation for interpreting genetic relationships among ST1 strains; these data may also inform future analyses for improved outbreak investigations.


Asunto(s)
Brotes de Enfermedades , Legionella pneumophila/genética , Enfermedad de los Legionarios/microbiología , Tipificación Molecular/métodos , Secuencia de Bases , Secuencia Conservada , Heterogeneidad Genética , Genotipo , Humanos , Enfermedad de los Legionarios/epidemiología , Filogenia
18.
Med. clín (Ed. impr.) ; 151(7): 265-269, oct. 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-173946

RESUMEN

Objetivo: La mayoría de los datos de la neumonía por Legionella en nuestro país proceden del área mediterránea, y apenas existen estudios en la zona del Noroeste. Con este trabajo se pretende conocer la situación de la infección en nuestro medio. Método: Estudio retrospectivo de todos los pacientes con antigenuria positiva para Legionella en el Hospital Universitario Lucus Augusti de Lugo desde 2001, año en que se introdujo la antigenuria como prueba diagnóstica en nuestro centro, hasta 2015. Se analizaron datos epidemiológicos, factores de riesgo, hallazgos clínicos, radiológicos, analíticos y evolutivos. Resultados: Se registraron 136 pacientes. Si comparamos los primeros 5años del estudio con los 5últimos, la incidencia aumentó de 10,9 a 64,5 casos/1.000.000, el número de peticiones de antigenuria se incrementó 3,4 veces, y con respecto a otras neumonías, Legionella pasó del 0,9 al 15% de ellas. La edad media fue de 64,1años, y el 84,6% fueron varones. El 74,3% tenían comorbilidades. Los varones fueron significativamente más jóvenes (62,7±16,6 vs 71,9±17,3) y consumían más alcohol (26,1% vs 0%) y tabaco (67,8% vs 14,3%). El 88,9% se diagnosticaron dentro de las primeras 72h y la mayoría recibió levofloxacino (95,6%). El 85% necesitaron ingreso hospitalario, el 11,7% en UCI y el 4,4% fallecieron. Conclusiones: Coincidiendo con la introducción de la antigenuria, se observa un aumento de incidencia de neumonía por Legionella en nuestra área sanitaria, con tasas en los últimos años que se sitúan entre las más altas de nuestro país. A pesar de tener pacientes con elevada edad media y un alto porcentaje de comorbilidades, la mortalidad fue reducida


Objective: Most of the data on Legionella pneumonia in our country come from the Mediterranean area, and there are few studies from the Northwest area. This study tries to assess the situation of this infection in this area. Method: Retrospective study of all patients with positive Legionella antigenuria treated at the University Hospital Lucus Augusti in Lugo (Spain) from 2001, the year in which this test was introduced in our centre, until 2015. We analysed epidemiological data, risk factors, clinical, radiological and biochemical findings, and clinical outcome. Results: The sampled included 136 patients. When comparing the first five years of the study with the last five, the incidence increased from 10.9 to 64.5 cases/1,000,000; the number of antigenuria requests increased 3.4 times, and compared to other pneumonia aetiologies Legionella increased from 0.9% to 15%. The mean age was 64.1years and 84.6% were males; 74.3% had comorbidities. Males were significantly younger (62.7±16.6 vs 71.9±17.3) and consumed more alcohol (26.1% vs 0%) and tobacco (67.8% vs 14.3%). Diagnosis was established within the first 72hours in 88.9% of cases and most received levofloxacin (95.6%). Hospitalisation was needed in 85% of cases, 11.7% in ICU and 4.4% died. Conclusions: After the introduction of antigenuria there was an increase in the incidence of Legionella pneumonia recorded in our health area. Its rate in recent years has been one of the highest in our country. Despite the fact that the patients had advanced age and comorbidities, mortality was low


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad de los Legionarios/epidemiología , Legionella pneumophila/patogenicidad , Antígenos/orina , Enfermedad de los Legionarios/diagnóstico por imagen , Enfermedad de los Legionarios/diagnóstico , Factores de Riesgo , Estudios Retrospectivos , Antígenos/sangre , Infecciones Comunitarias Adquiridas , Enfermedad de los Legionarios/tratamiento farmacológico
19.
Emerg Infect Dis ; 24(10): 1914-1918, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30226165

RESUMEN

A biologic wastewater treatment plant was identified as a common source for 2 consecutive Legionnaires' disease clusters in the Netherlands in 2016 and 2017. Sequence typing and transmission modeling indicated direct and long-distance transmission of Legionella, indicating this source type should also be investigated in sporadic Legionnaires' disease cases.


Asunto(s)
Enfermedad de los Legionarios/epidemiología , Administración de Residuos , Aguas Residuales/microbiología , Microbiología del Agua , Anciano , Anciano de 80 o más Años , Comorbilidad , Brotes de Enfermedades , Femenino , Geografía Médica , Hospitalización , Humanos , Enfermedad de los Legionarios/transmisión , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Vigilancia en Salud Pública , Estaciones del Año
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