First Outbreak of Nosocomial Legionella Infection in Term Neonates Caused by a Cold Mist Ultrasonic Humidifier

Yiallouros, Panayiotis K.; Papadouri, Thalia; Karaoli, Christina; Papamichael, Elena; Zeniou, Maria; Pieridou-Bagatzouni, Despo; Papageorgiou, Georgios T.; Pissarides, Nicolas; Harrison, Timothy G.; Hadjidemetriou, Andreas

doi:10.1093/cid/cit176

Cited by 53 publications

(37 citation statements)

References 25 publications

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“…Most LD risk factors were originally compiled during outbreak investigations, and ongoing research is needed to fully document, refine, and continually update this description. For example, a wide spectrum of clinical features was recently reported for full-term infants exposed to Legionella-containing aerosols from a cold-mist humidifier (559). Surveillance has also demonstrated sustained, high levels of travel-associated LD cases, which creates challenges for health care systems in all countries and states, regardless of the regional LD prevalence (15,202,210).…”

Section: Education Awareness and Reportingmentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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SUMMARY Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

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Section: Education Awareness and Reportingmentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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“…Nosocomial Legionnaires' disease outbreaks can be either intermittent or continue for years [5]. Important aerosol sources for hospital-acquired legionellosis include WDS outlets (eg, showers, taps, and cooling towers), therapeutic devices (eg, humidifiers and nebulizer masks) [6,7], and decorative features such as fountains in common reception areas [8]. While early reports indicate that hospitals at risk of outbreaks have greater than 30% of their potable water outlets culture positive for LPSG1 [5], recent data demonstrate that much lower proportions of culture-positive outlets should also be considered problematic [9].…”

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confidence: 99%

Hospital-wide Eradication of a NosocomialLegionella pneumophilaSerogroup 1 Outbreak

et al. 2015

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Background. Two proven nosocomial cases of Legionella pneumonia occurred at the Wesley Hospital (Brisbane, Australia) in May 2013. To trace the epidemiology of these cases, whole genome sequence analysis was performed on Legionella pneumophila isolates from the infected patients, prospective isolates collected from the hospital water distribution system (WDS), and retrospective patient isolates available from the Wesley Hospital and other local hospitals.Methods. Legionella pneumophila serogroup 1 isolates were cultured from patient sputum (n = 3), endobronchial washings (n = 3), pleural fluid (n = 1), and the Wesley Hospital WDS (n = 39). Whole genome sequencing and de novo assembly allowed comparison with the L. pneumophila Paris reference strain to infer phylogenetic and epidemiological relationships. Rapid disinfection of the hospital WDS with a chlorinated, alkaline detergent and subsequent superchlorination followed by maintenance of residual free chlorine, combined with removal of redundant plumbing, was instituted.Results. The 2011 and 2013 L. pneumophila patient isolates were serogroup 1 and closely related to all 2013 hospital water isolates based on single nucleotide polymorphisms and mobile genetic element profiles, suggesting a single L. pneumophila population as the source of nosocomial infection. The L. pneumophila population has evolved to comprise 3 clonal variants, each associated with different parts of the hospital WDS.Conclusions. This study provides an exemplar for the use of clinical and genomic epidemiological methods together with a program of rapid, effective remedial biofilm, plumbing and water treatment to characterize and eliminate a L. pneumophila population responsible for nosocomial infections.

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“…Cases have been reported sporadically, with up to 13 cases cited in a 2010 review 2 and as a part of a nosocomial outbreak in which nine neonates in a newborn unit were infected. 3 Reports have documented legionellosis following water births.…”

Section: Discussionmentioning

confidence: 99%

“…8 Disease is often multilobar and may become cavitary, as in our patient. [2][3][4] Progression to respiratory failure is common (67% among six outbreak cases with abnormal chest imaging 3 ) and infants may end up requiring high-frequency oscillatory ventilation, inhaled nitric oxide or even extracorporeal life support. 1 Endotoxemia may result in septic shock, coagulopathy and multiorgan failure.…”

Section: Discussionmentioning

confidence: 99%

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Legionellosis following water birth in a hot tub in a Canadian neonate

Barton

McKelvie

Campigotto

et al. 2017

CMAJ

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First Outbreak of Nosocomial Legionella Infection in Term Neonates Caused by a Cold Mist Ultrasonic Humidifier

Abstract: Use of humidifiers in nursery units must be avoided as the risk of disseminating Legionella in neonates is very high. In neonates legionellosis should be suspected when signs of infection first appear and take an unusual course, even when no pulmonary infiltrates appear.

Cited by 53 publications

References 25 publications

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Hospital-wide Eradication of a NosocomialLegionella pneumophilaSerogroup 1 Outbreak

Legionellosis following water birth in a hot tub in a Canadian neonate

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