Water-Related Nosocomial Pneumonia Caused by Legionella pneumophila Serogroups 1 and 10

Meenhorst, Pieter L.; Reingold, Arthur; Groothuis, D.G.; Gorman, George W.; Wilkinson, Hazel W.; McKinney, Roger M.; Feeley, James C.; Brenner, Don J.; Furth, R. van

doi:10.1093/infdis/152.2.356

Cited by 94 publications

(42 citation statements)

References 25 publications

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“…Our findings indicate that the hospital water has to be considered the source of nosocomial legionella infections. This is consistent with those of other studies (Meenhorst et al 1985;Neill et al 1985). There is no evidence that other potential sources were implicated.…”

Section: Discussionsupporting

confidence: 94%

“…A number of techniques, e.g. plasmid analysis, subtyping with monoclonal antibodies (MAB), have been used to prove the identity of corresponding clinical and environmental legionella 648 B. RUF AND OTHERS isolates, and thus to localize the likely source of infection (Edelstein et al 1986b;Meenhorst et al 1985;Neil et al 1985). In the Rudolf Virchow University Hospital (UKRV) legionellae were also found to be a cause of nosocomial pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Nosocomial legionella pneumonia: demonstration of potable water as the source of infection

et al. 1988

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, 35 cases of sporadic nosocomial legionella pneumonia, all caused by Legionella pneumophila, were diagnosed in a university hospital. L. pneumophila serogroup (SG) 1 was cultured from 12 of the 35 cases and compared to corresponding L. pneumophila SG 1 isolates from water outlets in the patients' immediate environment by subtyping with monoclonal antibodies. The corresponding environmental isolates were identical to 9 out of 12 (75 %) of those from the cases. However, even in the remaining three cases identical subtypes were found distributed throughout the hospital water supply. From the hospital water supply four different subtypes of L. pneumophila SG 1 were isolated, three of which were implicated in legionella pneumonia. Of 453 water samples taken during the study 298 (65 8 %) were positive for legionellae. Species of Legionella other than L. pneumophila have not been isolated. This may explain the exclusiveness of L. pneumophila as the legionella pneumonia-causing agent. Our results suggest that the water supply system was the source of infection.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Nosocomial legionella pneumonia: demonstration of potable water as the source of infection

et al. 1988

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“…These samples correspond to cold domestic waters or well deep waters known to be free of Legionella. Eight samples analyzed in singular (samples 1,3,10,11,19,36,37) or in duplicates (sample 23) were positive by the IDS method but negative in culture, whereas the opposite was never found. It is interesting that the sampling temperature of these water samples (excepting samples 1 and 37) exceeded 45°C.…”

Section: Resultsmentioning

confidence: 95%

“…appear to represent a health risk to humans when a threshold value estimated at 10 4 to 10 5 CFU liter Ϫ1 is reached. Epidemiological data show that outbreaks of legionellosis occur at these concentrations (37,44), and corrective actions such as chlorination must be taken promptly in the case of contaminations. Besides a monitoring of water quality, the IDS method described in this study also allows the evaluation of the efficiency of the disinfection measures as suggested by the chlorination results.…”

Section: Discussionmentioning

confidence: 99%

Rapid Method for Enumeration of Viable Legionella pneumophila and Other Legionella spp. in Water

Delgado‐Viscogliosi

Simonart

Parent

et al. 2005

Appl Environ Microbiol

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A sensitive and specific method has been developed to enumerate viable L. pneumophila and other Legionella spp. in water by epifluorescence microscopy in a short period of time (a few hours). This method allows the quantification of L. pneumophila or other Legionella spp. as well as the discrimination between viable and nonviable Legionella. It simultaneously combines the specific detection of Legionella cells using antibodies and a bacterial viability marker (ChemChrome V6), the enumeration being achieved by epifluorescence microscopy. The performance of this immunological double-staining (IDS) method was investigated in 38 natural filterable water samples from different aquatic sources, and the viable Legionella counts were compared with those obtained by the standard culture method. The recovery rate of the IDS method is similar to, or higher than, that of the conventional culture method. Under our experimental conditions, the limit of detection of the IDS method was <176 Legionella cells per liter. The examination of several samples in duplicates for the presence of L. pneumophila and other Legionella spp. indicated that the IDS method exhibits an excellent intralaboratory reproducibility, better than that of the standard culture method. This immunological approach allows rapid measurements in emergency situations, such as monitoring the efficacy of disinfection shock treatments. Although its field of application is as yet limited to filterable waters, the double-staining method may be an interesting alternative (not equivalent) to the conventional standard culture methods for enumerating viable Legionella when rapid detection is required.

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“…Regrowth is limited by a far-reaching removal of growth-promoting compounds from the water to achieve biological stability (57). A number of reports showed that L. pneumophila multiplying in hot-water systems in buildings originated from the water supply (27,27,37). The aim of our study was to elucidate the role of drinking water in the distribution of Legionella.…”

mentioning

confidence: 97%

Occurrence and Genetic Diversity of Uncultured Legionella spp. in Drinking Water Treated at Temperatures below 15°C

Wullings

Kooij

2006

Appl Environ Microbiol

102

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Representatives of the genus Legionella were detected by use of a real-time PCR method in all water samples collected directly after treatment from 16 surface water (SW) supplies prior to postdisinfection and from 81 groundwater (GW) supplies. Legionella concentrations ranged from 1.1 ؋ 10 3 to 7.8 ؋ 10 5 cells liter ؊1 and were significantly higher in SW treated with multiple barriers at 4°C than in GW treated at 9 to 12°C with aeration and filtration but without chemical disinfection. No Legionellae (<50 CFU liter ؊1 ) were detected in treated water by the culture method. Legionella was also observed in untreated SW and in untreated aerobic and anaerobic GW. Filtration processes in SW and GW treatment had little effect or increased the Legionella concentration, but ozonation in SW treatment caused about 1-log-unit reduction. A phylogenetic analysis of 16S rRNA gene sequences of 202 clones, obtained from a selection of samples, showed a high similarity (>91%) with Legionella sequences in the GenBank database. A total of 40 (33%) of the 16S rRNA gene sequences obtained from treated water were identified as described Legionella species and types, including L. bozemanii, L. worsleiensis, Legionella-like amoebal pathogen types, L. quateirensis, L. waltersii, and L. pneumophila. 16S rRNA gene sequences with a similarity of below 97% from described species were positioned all over the phylogenetic tree of Legionella. Hence, a large diversity of yet-uncultured Legionellae are common members of the microbial communities in SW and GW treated at water temperatures of below 15°C.

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Water-Related Nosocomial Pneumonia Caused by Legionella pneumophila Serogroups 1 and 10

Cited by 94 publications

References 25 publications

Nosocomial legionella pneumonia: demonstration of potable water as the source of infection

Nosocomial legionella pneumonia: demonstration of potable water as the source of infection

Rapid Method for Enumeration of Viable Legionella pneumophila and Other Legionella spp. in Water

Occurrence and Genetic Diversity of Uncultured Legionella spp. in Drinking Water Treated at Temperatures below 15°C

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