Environmental sources of community-acquired legionnaires’ disease: A review

Orkis, Lauren; Harrison, Lee H.; Mertz, Kristen J.; Brooks, Maria M.; Bibby, Kyle; Stout, Janet E.

doi:10.1016/j.ijheh.2018.04.013

Cited by 52 publications

(45 citation statements)

References 53 publications

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“…Legionella grows in free-living amoebas, replicates between 25 °C and 45 °C ( Garrity et al, 2005 ), but can survive at temperatures ranging from 5.7 °C to 63 °C, especially if the water is stagnant ( Fliermans, 1996 ) with an optimal growth temperature of 35 ± 2 °C ( Katz and Hammel, 1987 ).These bacteria can cause a serious form of pneumonia, known as Legionnaires' disease, or a flu-like illness, the Pontiac fever, which is normally acquired by inhaling aerosols produced by sources of contaminated water ( De Giglio et al, 2019 ; Montagna et al, 2018 ; Napoli et al, 2010 ; Orkis et al, 2018 ). In Italy, 2964 cases of legionellosis were reported in 2018 (incidence rate = 48.9 cases per 1 million inhabitants), 3.4% of which was of nosocomial origin ( ISS, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic

Giglio

Diella

Lopuzzo

et al. 2020

Environmental Research

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The COVID-19 pandemic started in China in early December 2019, and quickly spread around the world. The epidemic gradually started in Italy at the end of February 2020, and by May 31, 2020, 232,664 cases and 33,340 deaths were confirmed. As a result of this pandemic, the Italian Ministerial Decree issued on March 11, 2020, enforced lockdown; therefore, many social, recreational, and cultural centers remained closed for months. In Apulia (southern Italy), all non-urgent hospital activities were suspended, and some wards were closed, with a consequent reduction in the use of the water network and the formation of stagnant water. This situation could enhance the risk of exposure of people to waterborne diseases, including legionellosis. The purpose of this study was to monitor the microbiological quality of the water network (coliforms, E. coli , Enterococci, P. aeruginosa, and Legionella ) in three wards (A, B and C) of a large COVID-19 regional hospital, closed for three months due to the COVID-19 emergency. Our study revealed that all three wards' water network showed higher contamination by Legionella pneumophila sg 1 and sg 6 at T1 (after lockdown) compared to the period before the lockdown (T0). In particular, ward A at T1 showed a median value = 5600 CFU/L (range 0–91,000 CFU/L) vs T0, median value = 75 CFU/L (range 0–5000 CFU/L) ( p-value = 0.014); ward B at T1 showed a median value = 200 CFU/L (range 0–4200 CFU/L) vs T0, median value = 0 CFU/L (range 0–300 CFU/L) ( p-value = 0.016) and ward C at T1 showed a median value = 175 CFU/L (range 0–22,000 CFU/L) vs T0, median value = 0 CFU/L (range 0–340 CFU/L) ( p-value < 0.001). In addition, a statistically significant difference was detected in ward B between the number of positive water samples at T0 vs T1 for L. pneumophila sg 1 and sg 6 (24% vs 80% p-value < 0.001) and for coliforms (0% vs 64% p-value < 0.001). Moreover, a median value of coliform load resulted 3 CFU/100 ml (range 0–14 CFU/100 ml) at T1, showing a statistically significant increase versus T0 (0 CFU/100 ml) ( p-value < 0.001). Our results highlight the need to implement a water safety plan that includes staff training and a more rigorous environmental microbiological surveillance in all hospitals before occupying a closed ward for a longer than one week, according to national and international guidelines.

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Section: Introductionmentioning

confidence: 99%

Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic

Giglio

Diella

Lopuzzo

et al. 2020

Environmental Research

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“…However, just under half of the known species cause illness and, in several countries such as New Zealand, soil-born L. longbeachae is the primary cause of LD [1]. Infection is acquired through inhalation of contaminated aerosols produced by various man-made water systems, such as showers, spa pools, fountains and cooling towers of air conditioning systems [3]. When Legionella colonizes the water systems, it often finds favorable conditions for growth, such as temperatures between 25 • C and 45 • C or the presence of biofilm, reaching high concentrations and becoming a serious risk for human health.…”

Section: Introductionmentioning

confidence: 99%

Performance of Legiolert Test vs. ISO 11731 to Confirm Legionella pneumophila Contamination in Potable Water Samples

et al. 2020

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Detection and enumeration of Legionella in water samples is of great importance for risk assessment analysis. The plate culture method is the gold standard, but has received several well-known criticisms, which have induced researchers to develop alternative methods. The purpose of this study was to compare Legionella counts obtained by the analysis of potable water samples through the plate culture method and through the IDEXX liquid culture Legiolert method. Legionella plate culture, according to ISO 11731:1998, was performed using 1 L of water. Legiolert was performed using both the 10 mL and 100 mL Legiolert protocols. Overall, 123 potable water samples were analyzed. Thirty-seven (30%) of them, positive for L. pneumophila, serogroups 1 or 2–14 by plate culture, were used for comparison with the Legiolert results. The Legiolert 10 mL test detected 34 positive samples (27.6%) and the Legiolert 100 mL test detected 37 positive samples, 27.6% and 30% respectively, out of the total samples analyzed. No significant difference was found between either the Legiolert 10 mL and Legiolert 100 mL vs. the plate culture (p = 0.9 and p = 0.3, respectively) or between the Legiolert 10 mL and Legiolert 100 mL tests (p = 0.83). This study confirms the reliability of the IDEXX Legiolert test for Legionella pneumophila detection and enumeration, as already shown in similar studies. Like the plate culture method, the Legiolert assay is also suitable for obtaining isolates for typing purposes, relevant for epidemiological investigations.

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“…It is true that we were not able to find the source of infection of the Legionella pneumonia case described in our study, but we know that for Legionella sporadic or isolated cases the finding of the origin of the causative pathogen is rarely pursued [2].…”

Section: To the Editormentioning

confidence: 78%

Authors’ response: importance of a careful investigation to avoid attributing Legionnaires’ disease cases to an incorrect source of infection

et al. 2020

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Environmental sources of community-acquired legionnaires’ disease: A review

Cited by 52 publications

References 53 publications

Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic

Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic

Performance of Legiolert Test vs. ISO 11731 to Confirm Legionella pneumophila Contamination in Potable Water Samples

Authors’ response: importance of a careful investigation to avoid attributing Legionnaires’ disease cases to an incorrect source of infection

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