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1.
MMWR Morb Mortal Wkly Rep ; 69(8): 207-211, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32106217

RESUMO

In January 2018, the Wisconsin Department of Health Services, Division of Public Health (DPH), received a report of a culture-confirmed case of Legionnaires' disease. The patient, who was immunocompromised, had died at a local hospital 10 days after being admitted. DPH and an infection preventionist from the hospital investigated to determine the source of the infection and prevent additional cases. Because the case was suspected to be nosocomial, health care facility water samples were tested for Legionella. When these samples were negative, water sources in the patient's home were tested. These tested positive for Legionella pneumophila, and the bacteria remained after an attempt to remediate. The patient and home isolates were identified as L. pneumophila serogroup 3, sequence type 93, by whole-genome multilocus sequence typing. A second resident of the home did not become ill. This case highlights the potential for immunocompromised persons and others at risk for Legionnaires' disease to be exposed to Legionella through home water systems containing the bacteria and demonstrates the difficulty of home remediation. This case also illustrates the role of lower respiratory tract specimens in the identification of less common Legionella infections (e.g., L. pneumophila serogroup 3) and confirmation of the infection source.


Assuntos
Exposição Ambiental/efeitos adversos , Habitação , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Idoso , Evolução Fatal , Humanos , Legionella pneumophila/classificação , Sorotipagem , Wisconsin
2.
Artigo em Inglês | MEDLINE | ID: mdl-31947755

RESUMO

Legionnaires' disease (LD) is a severe pneumonia with a mortality rate of about 10%. The illness remains largely underdiagnosed with outbreaks occurring with alarming incidence. In this study, we assessed the frequency of Legionnaires' disease among pneumonia cases treated at a large community hospital over a summer season. We invited all admitted patients diagnosed with pneumonia, able to provide a urine sample for an antigen test, presenting from May to October 2018, to enroll in our study; 35 patients were tested for the presence of Legionella. Out of 33 patients tested, 9 (28%) were positive for Legionella. Three sets of the 9 Legionella cases exhibited spatiotemporal clustering indicative of LD outbreaks. Only one of the 9 Legionella UAT-positive patients presented a sporadic case of LD. The number of pneumonia cases in our community confirmed to be LD was strikingly high (28%), compared to other survey studies that report between 3.7% and 14%. These results are consistent with previous knowledge that LD is underdiagnosed and support that routine testing should be considered for all possible LD cases, particularly in the summer months. Such testing is likely to prevent further cases of community acquired LD.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Doença dos Legionários/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia
3.
Lett Appl Microbiol ; 70(4): 232-240, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31904109

RESUMO

Unregulated private wells are understudied potential sources of community-acquired Legionnaires' disease. Here we conducted a comprehensive survey of 44 homes supplied by private wells in Wake County, North Carolina, quantifying Legionella spp. DNA, Legionella pneumophila DNA, and total bacterial 16S rRNA genes via real-time polymerase chain reaction in hot and cold drinking water samples, along with culturable L. pneumophila via IDEXX Legiolert in cold drinking water samples. Legionella spp. DNA, L. pneumophila DNA and culturable L. pneumophila were detected in 100, 65·5 and 15·9% of the 44 homes, respectively, and culturable levels were comparable to some municipal surveys applying the same methods. Total coliforms and Escherichia coli were monitored as representative faecal indicators and were found in 20·4 and 0·0% of homes. Within certain sample types, Legionella spp. and L. pneumophila gene copy numbers were positively associated with total bacteria (i.e. total 16S rRNA genes) and water softener use, but were not associated with faecal indicator bacteria, inorganic water parameters or other well characteristics. These findings confirm that occurrence of Legionella and L. pneumophila is highly variable in private wells. SIGNIFICANCE AND IMPACT OF THE STUDY: Legionella is the leading identified cause of waterborne disease outbreaks associated with US municipal water systems. While Legionella is known to occur naturally in groundwater, prior efforts to characterize its occurrence in unregulated private wells are limited to sampling at the wellhead and not in the home plumbing where Legionella can thrive. This work documents much higher levels of Legionella in home plumbing versus water directly from private wells and examines factors associated with higher Legionella occurrence.


Assuntos
Água Potável/microbiologia , Legionella pneumophila/isolamento & purificação , DNA Bacteriano/genética , Humanos , Legionella pneumophila/classificação , Legionella pneumophila/genética , Doença dos Legionários/microbiologia , North Carolina , RNA Ribossômico 16S/genética , Engenharia Sanitária , Microbiologia da Água , Abastecimento de Água
4.
Int J Infect Dis ; 91: 174-176, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31707135

RESUMO

Three cases of pneumonia caused by Legionella pneumophila serogroup 1 (Lp1) in immunosuppressed patients with repeated hospitalization were suspected as a healthcare-associated cluster. The environmental investigation did not reveal the presence of legionellae in the hospital patient rooms. Water samples collected from the homes of two patients were also negative for Legionella spp. In the absence of environmental strains potentially involved in the infections, we proceeded to genotype environmental Lp1 strains isolated in the hospital during routine water sampling during the decade 2009-2019 and recovered after long-term storage at -20°C. These 'historical' strains exhibited a high grade of similarity and stability over time, regardless of the disinfection systems. The different molecular profiles shown among the clinical and environmental strains excluded a nosocomial outbreak. The study suggests that the application of molecular typing may be a useful tool to discriminate hospital vs community-acquired cases, mostly for severely immunosuppressed patients in whom the symptomatology could be insidious and the incubation period could be prolonged. Moreover, the genotyping allowed us to exclude any link between the cases.


Assuntos
Técnicas de Genotipagem , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/microbiologia , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/microbiologia , Surtos de Doenças , Feminino , Humanos , Imunossupressão , Legionella pneumophila/classificação , Legionella pneumophila/genética , Doença dos Legionários/epidemiologia , Doença dos Legionários/terapia , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Sorogrupo
5.
Epidemiol Infect ; 147: e326, 2019 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-31858932

RESUMO

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.


Assuntos
Surtos de Doenças , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/epidemiologia , Microbiologia da Água , Adulto , Idoso , Bélgica/epidemiologia , Feminino , Humanos , Incidência , Doença dos Legionários/microbiologia , Doença dos Legionários/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Biocontrol Sci ; 24(4): 213-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31875613

RESUMO

We analyzed the contamination of environmental water samples with Legionella spp. using a conventional culture method, real-time quantitative PCR (qPCR), and real-time qPCR combined with an amoebic co-culture method. Samples (n = 110) were collected from 19 cooling towers, 31 amenity water facilities, and 60 river water sources of tap water in Japan. Legionella was detected in only three samples (3/110, 2.7%) using the culture method. The rate of Legionella detection using amoebic co-culture followed by qPCR was 74.5%, while that using qPCR without amoebic co-culture was 75.5%. A higher than 10-fold bacterial count was observed in 19 samples (19/110, 17.3%) using real-time qPCR subsequent to amoebic co-culture, compared with identical samples analyzed without co-culture. Of these 19 samples, 13 were identified as Legionella spp., including L. pneumophila and L. anisa, and the non-culturable species were identified as L. lytica and L. rowbothamii. This study showed that the detection of Legionella spp., even in those samples where they were not detected by the culture method, was possible using real-time qPCR and an amoebic co-culture method. In addition, this analytical test combination is a useful tool to detect viable and virulent Legionella spp..


Assuntos
Legionella/isolamento & purificação , Microbiologia da Água , Amoeba , Técnicas de Cocultura/métodos , Humanos , Japão , Legionella/classificação , Legionella/genética , Legionella pneumophila/genética , Legionella pneumophila/isolamento & purificação , Filogenia , Reação em Cadeia da Polimerase em Tempo Real , Rios/microbiologia , Especificidade da Espécie , Abastecimento de Água
7.
PLoS One ; 14(11): e0224144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31765384

RESUMO

Legionnaires' disease, a form of pneumonia which can be fatal, is transmitted via the inhalation of water droplets containing Legionella bacteria. These droplets can be dispersed in the atmosphere several kilometers from their source. The most common such sources are contaminated water within cooling towers and other air-conditioning systems but other sources such as ornamental fountains and spa pools have also caused outbreaks of the disease in the past. There is an obvious need to locate and eliminate any such sources as quickly as possible. Here a maximum likelihood model estimating the source of an outbreak from case location data has been developed and implemented. Unlike previous models, the average dose exposure sub-model is formulated using a atmospheric dispersion model. How the uncertainty in inferred parameters can be estimated is discussed. The model is applied to the 2012 Edinburgh Legionnaires' disease outbreak.


Assuntos
Ar Condicionado/efeitos adversos , Microbiologia do Ar , Surtos de Doenças/prevenção & controle , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/prevenção & controle , Ar Condicionado/instrumentação , Atmosfera/análise , Simulação por Computador , Humanos , Legionella pneumophila/patogenicidade , Doença dos Legionários/microbiologia , Doença dos Legionários/transmissão , Funções Verossimilhança , Reino Unido/epidemiologia
8.
Emerg Infect Dis ; 25(11): 2013-2020, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31625848

RESUMO

During the water crisis in Flint, Michigan, USA (2014-2015), 2 outbreaks of Legionnaires' disease occurred in Genesee County, Michigan. We compared whole-genome sequences of 10 clinical Legionella pneumophila isolates submitted to a laboratory in Genesee County during the second outbreak with 103 water isolates collected the following year. We documented a genetically diverse range of L. pneumophila strains across clinical and water isolates. Isolates belonging to 1 clade (3 clinical isolates, 3 water isolates from a Flint hospital, 1 water isolate from a Flint residence, and the reference Paris strain) had a high degree of similarity (2-1,062 single-nucleotide polymorphisms), all L. pneumophila sequence type 1, serogroup 1. Serogroup 6 isolates belonging to sequence type 2518 were widespread in Flint hospital water samples but bore no resemblance to available clinical isolates. L. pneumophila strains in Flint tap water after the outbreaks were diverse and similar to some disease-causing strains.


Assuntos
Água Potável/microbiologia , Genoma Bacteriano , Legionella pneumophila/genética , Doença dos Legionários/epidemiologia , Doença dos Legionários/microbiologia , Microbiologia da Água , Sequenciamento Completo do Genoma , Humanos , Legionella pneumophila/classificação , Legionella pneumophila/isolamento & purificação , Michigan/epidemiologia , Filogenia , Polimorfismo de Nucleotídeo Único
9.
Emerg Infect Dis ; 25(11): 2104-2107, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31625866

RESUMO

Legionellosis was diagnosed in an immunocompromised 3-year-old girl in Canada. We traced the source of the bacterium through co-culture with an ameba collected from a hot tub in her home. We identified Legionella pneumophila serogroup 6, sequence type 185, and used whole-genome sequencing to confirm the environmental and clinical isolates were of common origin.


Assuntos
Amoeba/microbiologia , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/epidemiologia , Doença dos Legionários/microbiologia , Canadá/epidemiologia , Técnicas de Cocultura , Surtos de Doenças , Genoma Bacteriano , Humanos , Legionella pneumophila/classificação , Legionella pneumophila/genética , Filogenia , Vigilância em Saúde Pública , Sequenciamento Completo do Genoma
10.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 37(8): 514-520, oct. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-189378

RESUMO

PURPOSE: To perform epidemiological surveillance of Legionella pneumophila in recreational swimming pools in the city of Valladolid (Spain), an area with a continental climate and low incidence of legionella-associated infections. Additionally, wild-type minimum inhibitory concentration (MIC) distributions for eight antibiotics commonly used for the treatment of legionellosis were calculated from the isolates obtained. METHODS: Twelve recreational pools were enrolled between June 2003 and December 2016 and 7221 water samples were taken from three different points of the water network (tank, tap and shower). Legionella culture was performed according to ISO 11731 and 11731-2 standards. MICs of antibiotics were obtained by a gradient test. RESULTS: 1.44% of the water samples were positive for L. pneumophila. 60 strains (57.69%) were isolated from showers, 26 (25.00%) from tanks and 18 (17.31%) from taps. L. pneumophila counts were < 100 CFU/L in 75 samples (72.12%), 100-1000 CFU/L in 17 (16.35%) and > 1000 CFU/L in 12 (11.54%). The MIC90 values obtained were for Rifampicin 0.125 mg/L; Trimethoprim-Sulfamethoxazole 0.25mg/L; Azithromycin and Levofloxacin 0.5 mg/L; Clarithromycin and Ciprofloxacin 1.0mg/L; Doxycycline and Tigecycline 4.0 mg/L. CONCLUSIONS: The use of showers in recreational pools can become a potential pathway for exposure to L. pneumophila, even in cold climates. The wild-type MIC distributions presented in this article may be useful for a better detection of antibiotic resistance and can contribute to improvements in the choice of the antibiotic treatment of legionellosis


PROPÓSITO: Realizar la vigilancia epidemiológica de Legionella pneumophila en piscinas recreacionales de Valladolid (España), un área con clima continental y baja incidencia de legionelosis. La distribución de las CMIs de ocho antibióticos usados en la legionelosis fue calculada a partir de los aislados obtenidos. MÉTODOS: Se incluyeron doce piscinas recreacionales entre junio 2003-diciembre 2016. 7.221 muestras de agua fueron tomadas en tres puntos de la red (vaso, grifo y ducha). El cultivo de legionela se realizó acorde a las normas ISO 11731 y 11731-2. Las CMIs de los antibióticos se obtuvieron mediante un método en gradiente. RESULTADOS: 1,44% de las muestras proporcionaron crecimiento de L. pneumophila. 60 cepas (57,69%) se aislaron en duchas, 26 (25,00%) en vasos y 18 (17,31%) en grifos. Los recuentos de L. pneumophila fueron < 100 UFC/L en 75 muestras (72,12%), 100-1.000 UFC/L en 17 (16,35%) y > 1.000 UFC/L en 12 (11,54%). Las CMI90 obtenidas fueron para rifampicina 0,125 mg/L; trimetoprim-sulfametoxazol 0,25 mg/L; azitromicina y levofloxacino 0,5 mg/L; clarithromicina y ciprofloxacino 1,0 mg/L; doxiciclina y tigeciclina 4, 0mg/L. CONCLUSIONES: El uso de las duchas en piscinas recreacionales puede convertirse en una vía potencial para la exposición a L. pneumophila, incluso en climas fríos. Las CMIs presentadas en este artículo son útiles para la detección de la resistencia a antibióticos y pueden mejorar la elección del tratamiento antibiótico de la legionelosis


Assuntos
Humanos , Monitoramento Epidemiológico , Doença dos Legionários/epidemiologia , Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana/métodos , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/microbiologia , Espanha/epidemiologia , Resistência Microbiana a Medicamentos , Legionella pneumophila/efeitos dos fármacos
12.
Biomed Environ Sci ; 32(7): 520-530, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31331436

RESUMO

OBJECTIVE: To investigate the molecular characteristics and intracellular growth ability of Legionella pneumophila (L. pneumophila) strains from 1989 to 2016 in Sichuan Province, China. METHODS: Seventy-nine isolates of L. pneumophila were collected from environmental and clinical sources, including cooling towers, hot springs, bath water, fountains, and patients, and identified with 16S rRNA gene analysis and serum agglutination assay. The isolates were then typed by Sequence-Based Typing (SBT), and Genotyping of forty-two LP1 strains were analyzed by means of multiple-locus VNTR analysis with 8 loci (MLVA-8). All strains were further analyzed for two virulence genes: Legionella vir homologue (lvh) and repeats in structural toxin (rtxA). The intracellular growth ability of 33 selected isolates was determined by examining their interaction with J774 cells. RESULTS: All isolates were identified to L. pneumophila including 11 serogroups, among which the main serogroup were LP1, accounting for 54.43%. Thirty-three different sequence types (STs) from five main clonal groups and five singletons were identified, along with 8 different MLVA patterns. Both the lvh and rtxA loci were found in all 79 strains. Thirty isolates showed high intracellular growth ability in J774 cells. CONCLUSION: L. pneumophila is a potential threat to public health, and effective control and prevention strategies are urgently needed.


Assuntos
Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Legionella pneumophila/genética , RNA Ribossômico 16S/genética , China , Técnicas de Genotipagem , Humanos , Legionella pneumophila/crescimento & desenvolvimento , Legionella pneumophila/isolamento & purificação , Microbiologia da Água
13.
PLoS One ; 14(7): e0218687, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31287819

RESUMO

Legionella spp. are considered an important cause of potentially preventable morbidity and mortality, making environmental surveillance a crucial component of risk assessment plans. In this work, 20,319 water samples were collected in 3,983 environmental surveys during a 16-year period by ARPA, the Regional Agency for Environmental Protection, Friuli Venezia Giulia, and the results were studied to better understand the diffusion mechanisms of Legionella. The data showed a strong seasonal signal, a prevalence of L. pneumophila serogroup 2-15 in most environments (63% of positive samples), a prevalence of L. pneumophila serogroup 1 in swimming pool-associated environments (82% of positive samples), a persistent presence of Legionella in hospitals and a recurrent presence of Legionella in other facilities such as hotels, possibly years after interventions, highlighting the difficulty of eradicating the bacteria. Retrospective spatio-temporal analyses on geocoded historical data were carried out with SaTScan using an ordinal model with risk as a covariate to identify potential clusters with an excess of cases in the higher-risk categories. Although no outbreaks occurred during the period of study, such analyses identified spatially restricted zones with unusual contamination, which sometimes were also areas in which several surveys triggered by notifications of clinical cases were performed. Simulations of periodic prospective analyses permitted the assessment of the efficacy of the method in early detection of such clusters. The proposed method may be a useful tool in environmental surveillance, prevention and control of Legionella.


Assuntos
Monitoramento Ambiental , Legionella pneumophila/isolamento & purificação , Legionelose/epidemiologia , Microbiologia da Água , Conservação dos Recursos Naturais , Humanos , Itália , Legionella pneumophila/patogenicidade , Legionelose/microbiologia , Medição de Risco , Análise Espaço-Temporal , Piscinas , Abastecimento de Água
14.
PLoS One ; 14(6): e0218941, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31246988

RESUMO

Legionella pneumophila are environmental bacteria found ubiquitously in both natural and man-made water reservoirs, sometimes as constituents of biofilm communities, but mostly intracellularly within protozoal hosts. In the event that Legionella become aerosolized in water droplets and inhaled by humans, they can cause a potentially fatal form of pneumonia called Legionnaires' disease. Strains of L. pneumophila have highly plastic genomes that harbor numerous inter- and intra-genomic elements, enhancing their ability to live under diverse environmental conditions. One such mobile genomic element, p45 carries ~45 kbp of genes, including the Lvh (Legionella Vir homolog) type IVa secretion system. This element was evaluated for its contribution to L. pneumophila environmental resilience and virulence-related characteristics by comparing clinically isolated strain Philadelphia-1 that carries p45, Lp01 that lacks p45, and Lp01 with p45 reintroduced, Lp01+p45. We found that the p45 element impacts host cell entry and resistance to sodium, both virulence-related characteristics in Legionella species.


Assuntos
Elementos de DNA Transponíveis/genética , Legionella pneumophila/patogenicidade , Doença dos Legionários/microbiologia , Sódio/metabolismo , Animais , Proteínas de Bactérias/genética , Biofilmes , Linhagem Celular , DNA Bacteriano/genética , Humanos , Legionella pneumophila/genética , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/metabolismo , Camundongos , Virulência
15.
Intern Med ; 58(19): 2831-2834, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243196

RESUMO

We herein report the case of a 62-year-old man diagnosed with Legionella pneumonia while engaged in recovery work in a flooded area after the Heavy Rain Event of July 2018 in Japan. The patient was intubated and maintained on mechanical ventilation and continuous hemodiafiltration. He was also administered antimicrobial therapy with ciprofloxacin and azithromycin. After 53 days in the hospital, he was discharged. It is important to recognize the risk of Legionella infection and to take measures to prevent it during recovery work that involves exposure to water and soil after a flood disaster.


Assuntos
Antibacterianos/uso terapêutico , Hemodiafiltração/métodos , Doença dos Legionários/etiologia , Desastres Naturais , Chuva , Respiração Artificial/métodos , Humanos , Japão , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Doença dos Legionários/terapia , Masculino , Pessoa de Meia-Idade
16.
Future Microbiol ; 14: 661-669, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148475

RESUMO

Aim: Data are limited regarding the antibiotic susceptibility of Legionella pneumophila in India. The aim of this study was to determine the drug susceptibility of environmental L. pneumophila isolates in India for antibiotics commonly used in clinical practice for Legionnaires' disease treatment. Materials & methods: The activities of seven antibiotics against 46 environmental isolates of L. pneumophila were evaluated by using E-test on buffered charcoal yeast extract-α agar. Results: Among the L. pneumophila isolates tested, no tendency toward drug resistance was observed. Rifampicin was the most potent drug followed by levofloxacin, while doxycycline and tetracycline were found to be the less active agents. Conclusion: Susceptibility testing of Legionella environmental isolates could be beneficial to notify resistance to antibiotics in the environment before it becomes evident in clinical strains.


Assuntos
Antibacterianos/farmacologia , Microbiologia Ambiental , Legionella pneumophila/efeitos dos fármacos , Legionella pneumophila/isolamento & purificação , Farmacorresistência Bacteriana , Monitoramento Ambiental , Fluoroquinolonas/farmacologia , Humanos , Índia , Legionella/efeitos dos fármacos , Legionella/isolamento & purificação , Doença dos Legionários/microbiologia , Levofloxacino/farmacologia , Macrolídeos/farmacologia , Testes de Sensibilidade Microbiana , Rifampina/farmacologia , Centros de Atenção Terciária , Tetraciclina/farmacologia , Água , Microbiologia da Água
17.
Artigo em Inglês | MEDLINE | ID: mdl-31212678

RESUMO

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.


Assuntos
Legionella pneumophila/patogenicidade , Prisões/estatística & dados numéricos , Microbiologia da Água/normas , Análise por Conglomerados , Monitoramento Ambiental , Humanos , Itália/epidemiologia , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/epidemiologia , Prevalência
18.
BMJ Case Rep ; 12(6)2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31227570

RESUMO

Legionnaires' disease is a recognised but rare cause of rhabdomyolysis. It can be further complicated with renal impairment. In this case report, we describe a previously healthy, semiactive 50-year-old man who within days was reduced to having periods of dyspnea after minutes of walking in addition to near fatal acute renal failure. He was found to have the rare triad of Legionella pneumonia, renal failure and rhabdomyolysis, which is associated with high morbidity and mortality. He was treated according to guidelines with azithromycin monotherapy and aggressive fluid hydration. 20 days after admission, the patient was walking independently and discharged home.


Assuntos
Doença dos Legionários/complicações , Pneumonia/complicações , Rabdomiólise/etiologia , Lesão Renal Aguda/etiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Diagnóstico Diferencial , Humanos , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/microbiologia , Rabdomiólise/microbiologia , Rabdomiólise/patologia , Resultado do Tratamento
19.
Eur J Clin Microbiol Infect Dis ; 38(7): 1377-1382, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119574

RESUMO

The objective of this study was to identify potential false-positive urine Legionella pneumophila (Legionella) enzyme immunoassay test results. A total of 107 consecutive patients with positive EIA tests were retrospectively analyzed over a 34-month period. Concurrent blood, urine, and sputum cultures, as well as chest radiographic findings, were reviewed in these patients. Twenty patients (19%) had no radiographic evidence of pulmonary disease despite a positive EIA test. In those 20 patients, 14 also had growth of non-Legionella bacteria. Of patients with an infiltrate or opacity on chest imaging, only 27 had Legionella sputum cultures obtained, with Legionella culture growth occurring in 7 (26%). Nine other patients had negative Legionella sputum cultures but the growth of another pathogenic organism in blood, sputum, and/or urine cultures. Pseudomonas aeruginosa was the most common organism isolated, found in 20% of patients in the entire cohort. Twenty-five patients (23%) were characterized as having probable false-positive Legionella urinary antigen EIA testing, and an additional 17 patients (16%) were characterized as having possible false-positive Legionella EIA tests. Our findings suggest that urine Legionella EIA tests may lead to a substantial number of cases being misdiagnosed as Legionaries' disease in patients with non-Legionella bacterial colonization or infection.


Assuntos
Antígenos de Bactérias/urina , Técnicas Imunoenzimáticas , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Doença dos Legionários/urina , Urinálise , Antígenos de Bactérias/imunologia , Bactérias/isolamento & purificação , Erros de Diagnóstico , Reações Falso-Positivas , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Escarro/microbiologia , Tórax/diagnóstico por imagem , Tórax/microbiologia
20.
Int J Hyg Environ Health ; 222(4): 678-686, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31036480

RESUMO

Prolific growth of pathogenic Legionella pneumophila within engineered water systems and premise plumbing, and human exposure to aerosols containing this bacterium results in the leading health burden of any water-related pathogen in developed regions. Ecologically, free-living amoebae (FLA) are an important group of the microbial community that influence biofilm bacterial diversity in the piped-water environment. Using fluorescent microscopy, we studied in-situ the colonization of L. pneumophila in the presence of two water-related FLA species, Willaertia magna and Acanthamoeba polyphaga in drinking water biofilms. During water flow as well as after periods of long-stagnation, the attachment and colonization of L. pneumophila to predeveloped water-biofilm was limited. Furthermore, W. magna and A. polyphaga showed no immediate interactions with L. pneumophila when introduced to the same natural biofilm environment. A. polyphaga encysted within 5-7 d after introduction to the tap-water biofilms and mostly persisted in cysts till the end of the study period (850 d). W. magna trophozoites, however, exhibited a time delay in feeding on Legionella and were observed with internalized L. pneumophila cells after 3 weeks from their introduction to the end of the study period and supported putative (yet limited) intracellular growth. The culturable L.pneumophila in the bulk water was reduced by 2-log over 2 years at room temperature but increased (without a change in mip gene copies by qPCR) when the temperature was elevated to 40 °C within the same closed-loop tap-water system without the addition of nutrients or fresh water. The overall results suggest that L. pneumophila maintains an ecological balance with FLA within the biofilm environment, and higher temperature improve the viability of L. pneumophila cells, and intracellular growth of Legionella is possibly cell-concentration dependent. Observing the preferential feeding behavior, we hypothesize that an initial increase of FLA numbers through feeding on a range of other available bacteria could lead to an enrichment of L. pneumophila, and later force predation of Legionella by the amoeba trophozoites results in rapid intracellular replication, leading to problematic concentration of L. pneumophila in water. In order to find sustainable control options for legionellae and various other saprozoic, amoeba-resisting bacterial pathogens, this work emphasizes the need for better understanding of the FLA feeding behavior and the range of ecological interactions impacting microbial population dynamics within engineered water systems.


Assuntos
Amoeba/isolamento & purificação , Água Potável/microbiologia , Legionella pneumophila/isolamento & purificação , Amoeba/fisiologia , Biofilmes , Legionella pneumophila/fisiologia , Temperatura , Microbiologia da Água
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