Legionella
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- Chapter [57] http://www.w3.org/1999/02/22-rdf-syntax-ns#type http://pub2web.metastore.ingenta.com/ns/Chapter
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- Publication Date : January 2013
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Treatment of Legionnaires’ Disease
- Authors: Jorge Roig, Jordi Rello
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Source: Legionella , pp 8-14
Publication Date :
January 2006
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Abstract:
Legionnaires’ disease (LD) treatment recommendations are supported by data obtained from in vitro and cellular studies, experimental studies with animal models, and observational studies, some of which come from prospective clinical studies of community-acquired pneumonia (CAP). There is some controversy about the use of new fluoroquinolones versus macrolides as the treatment of choice for LD. The least inflammation is found in the animal model with azithromycin, while the most is observed with erythromycin, with the quinolones being intermediate. Extrapulmonary manifestations of legionellosis, which are rare but sometimes observed in the immunocompromized host, may indicate significant therapeutic connotations. Mixed infections in legionellosis should be kept in mind concerning the inmunocompromized population since there are many reports of death when clinicians fail to identify and treat the dual component of infection. Some international guidelines recommend combined therapy for severe episodes but no consistent evidence supports this suggestion. For most patients monotherapy with a macrolide or a selected fluoroquinolone usually leads to a more cost-effective outcome. Possible toxicities of adding more than one antibiotic may be a concern, particularly in the intensive care unit setting. In vitro and in vivo evidence shows a highest potency of rifampin against Legionella, although the theoretical possibility of rapid induction of rifampin-resistant strains when it is administered alone precludes its use as sole therapy. The only variable that remained statistically significant on multivariate logistic regression analysis was the APACHE score (OR 1.86) at intensive care unit admission.
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Nosocomial Legionella Infection in the County of Copenhagen, 2000–2004
- Authors: Jette M. Bangsborg, Jens Otto Jarløv, Søren A. Uldum
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Source: Legionella , pp 33-36
Publication Date :
January 2006
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In Denmark (5,400,000 inhabitants), Legionella infection is a notifiable disease. Two departments at Statens Serum Institut (SSI) in Copenhagen are involved in collecting data about these cases, since (i) notifications based on clinical and local laboratory data are sent to the Department of Epidemiology; (ii) all cultured Legionella patient isolates are referred to the Department of Bacteriology, Mycology, and Parasitology (ABMP) from local departments of clinical microbiology for confirmatory identification and serotyping; and (iii) water samples from environmental investigations are sent to AMBP for culture and DNA typing. Every local clinical microbiology department in Denmark has its own infectious disease control unit, which is responsible for the surveillance and investigation of nosocomial infections. The diagnosis of Legionella infection was made by the detection of Legionella species in respiratory specimens by PCR, a positive urinary antigen test, or a significant rise in antibody titre. Diagnostic results and clinical data, including onset of disease and location of the patients, were retrieved from the laboratory information system at DCM Herlev. During the period of 2000 to 2004, several efforts were made to combat nosocomial Legionella infection, such as increasing the hot water temperature and replacing hot water tanks with heat exchangers.
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Legionella Detection from Water Samples by Real-Time PCR
- Authors: Laura Franzin, Daniela Cabodi, Nicoletta Bonfrate
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Source: Legionella , pp 446-448
Publication Date :
January 2006
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This chapter deals about the direct detection of Legionella from hospital water samples by commercial real-time (RT)-PCR system, that offers rapid results and reduced risk of cross-contamination. The preliminary results of 61 water samples from 6 hospitals and 15 water samples from air conditioning systems are presented and compared with those of the isolation method. Water samples were concentrated by filtration through cellulose acetate membrane filter and resuspended in 10 ml of the same water. The principle steps were cell lysis with proteinase K, purification on spin column and elution. Culture was positive in 28 (45.9%) hospital water samples, and the strains were identified as Legionella pneumophila serogroup 1, 3, 6, and 2-14 and Legionella spp. The results of qualitative RT-PCR were as follows: Legionella spp. was positive (detection limit: 133 GU/liter) in 60 (98.4%) samples and L. pneumophila was positive in 44 (72.1%). The results of culture and qualitative analysis for L. pneumophila by RT-PCR are shown. All hospitals examined showed some positive samples for culture and PCR, except for one that was culture negative and PCR positive. All water samples from air conditioning systems were culture negative, but RT-PCR was positive in 15 water samples for Legionella spp. and in 2 for L. pneumophila. In conclusion, Legionella detection by RT-PCR from environmental methods seems to be promising. However, at the moment, correlation between the method-result interpretations and public health significance need further evaluations.
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Evaluation of the Dynal Biotech Legionella Immunomagnetic Separation Method versus Conventional Culture for the Isolation of Legionella pneumophila Serogroup 1 from Water Samples
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Source: Legionella , pp 449-452
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January 2006
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Abstract:
Environmental monitoring of water systems for Legionella is performed for routine microbiological surveillance and outbreak investigations. The recovery of Legionella from water samples using conventional culture on selective media can be improved by sample concentration and/or sample decontamination techniques, but there is a reduction in recovery associated with these processes. A new immunoseparation method has been developed to improve the recovery of Legionella by concentrating and selectively separating Legionella spp. directly from water samples using immunomagnetic separation (IMS). Immunomagnetic separation has been used successfully for detection of other pathogens including Salmonella spp. The authors conducted the study in two phases and evaluated the IMS process alone and in combination with concentration and/or acid pretreatment in detecting Legionella spp. and Legionella pneumophila serogroup 1 (sg 1). The IMS procedure was performed using the BeadRetriever apparatus (Dynal Biotech Ltd., Preston, United Kingdom) for automated IMS using Dynabeads anti-Legionella (Dynal Biotech Ltd.). With the 11 known potable water samples, there was concordance (100% sensitivity) of culture results between the two methods, regardless of concentration or pretreatment of samples. The unconcentrated, untreated samples showed the greatest agreement in CFU/ml. Compared to conventional culture for L. pneumophila sg 1 only, the IMS method demonstrated a specificity of 98.5% (65 were negative and 2 were false-positive).
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A Novel and Rapid Legionella Detection System for Water Analysis
- Authors: Steven Giglio, Paul T. Monis, Christopher P. Saint
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Source: Legionella , pp 453-455
Publication Date :
January 2006
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The usefulness of sampling waters for the detection of Legionella remains a point of discussion among researchers and industry for a variety of reasons. This chapter describes a novel detection system utilizing two liquid media (medium 1 and medium 2, formulations are currently under provisional patent applications) and real-time PCR that is capable of detecting viable Legionella in a variety of waters within 2 to 3 days. Over 30 strains of Legionella have been tested by this method, and the real-time PCR detection system has been validated by authors' laboratory. Real-time PCR utilizing Legionella 16S rRNA primers was performed on a Corbett Rotor-Gene 3000 utilizing SYTO9 as a DNA intercalating dye for PCR. The GMS method was challenged with 82 field samples (cooling tower, evaporative tower, and potable waters) and run in parallel to AS/NZS 3896:1998. Comparison of methods using field samples showed that the GMS method is 100% specific (no false positives) and 92% sensitive, with a single discrepant sample. The GMS method described is rapid, simple, cost-effective, less laborious than conventional culture, and easy to implement in any modern day microbiology laboratory.
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Field Evaluation of the Binax Equate Test Kit for Enumeration of Legionella pneumophila Serogroup 1 in Cooling Water Samples
- Authors: Anita Benovic, Richard Bentham
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Source: Legionella , pp 460-462
Publication Date :
January 2006
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This chapter investigates on the efficacy of detection of Legionella pneumophila serogroup 1 (sg 1) in cooling waters using the Binax Equate Legionella water test. The test kit offers a rapid detection method (45 min) for L. pneumophila sg 1 in environmental water samples. A high proportion of Binax positive results were also between 1.0 and 1.9 OD450. Legionella species were cultured from 22% (n = 31) of all cooling water samples. Presumptive Pseudomonas spp. were isolated from 42.9% of all cooling water samples. Two samples grew to confluence, indicating very high concentrations of Pseudomonas spp. in those samples. Presumptive P. fluorescens was isolated from 21.9% of all cooling water samples. The post-treatment results for the heat-treated sample showed that the average absorbance decreased following the treatment. A large number of false-positive Binax results were recorded whether or not Legionella spp. were cultured from the sample. Alternatively, the test also recognized heat-killed cells and false-positive results may have been due to the presence of dead L. pneumophila in the cooling systems. The results suggest that this system lacks the required specificity for routine use in cooling towers or other water systems. It seems likely that the test method would produce false-positive results in systems where disinfection was applied. False-positive results from cooling tower samples in this study may have been due to the presence of killed L. pneumophila sg 1. The results point to the necessity of indication of viability in future environmental tests for Legionella.
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Method Development for Legionella Detection in Metalworking Fluids
- Authors: Katalin Rossmoore, Leonard Rossmoore, Christine Cuthbert
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Source: Legionella , pp 463-464
Publication Date :
January 2006
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Metalworking fluids (MWFs) are highly susceptible to microbiological contamination from the environment due to high water content, available nutrients, and optimum growth temperature for most environmental microorganisms. Outbreaks of Pontiac fever and Legionnaires' disease were associated with MWFs at two unrelated automotive facilities. Legionella feeleii and L. pneumophila serogroup 1 (sg 1) were identified as the probable causative organisms. The objective of this chapter was to develop a selective and sensitive culture method for detection of Legionella in MWFs in order to prevent and control possible occupational health-related problems. Recovery efficiency was evaluated by spiking MWF field samples, highly contaminated (107 to 108/ml) with nonlegionella organisms with high levels (106 to 107/ml) of L. pneumophila sg 1 and L. feeleii. Several sample treatment conditions to reduce the interference of the high background population, including acidification, heat treatment, and use of antibiotics in the recovery medium, were evaluated.
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Risk Assessment for Legionella in Building Water Systems: Managing the Myths
- Author: Richard Bentham
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Source: Legionella , pp 465-468
Publication Date :
January 2006
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This chapter relates to the microbial ecology of building water systems, aspects of Legionella virulence and dose response, and the notion of generic risk factors. Total heterotrophic plate count (TPC) evaluations can be a rapid and reliable means to augment Legionella culture for risk management in spa pools. Legionella virulence is extremely variable within and between species and serogroups. Cooling tower-associated outbreaks of disease are almost exclusively associated with Legionella pneumophila, and for the most part with L. pneumophila serogroup 1. It has been suggested that Legionella concentrations in water relate to risk, as they can be used as predictors of dose. Action directives based on the colony-forming units have been promoted as reliable risk management tools. The currently available evidence base demonstrates that health risk is variable between water systems. Factors such as total microbial load, Legionella species, disease transmission, and population exposure change dramatically with the nature of the disseminating system. Although there are common ecological determinants of Legionella growth and infection, the risks cannot rationally be generically applied. Available reports strongly suggest that good design, knowledge, and maintenance of water systems in the built environment are the most critical factors in preventing disease. An accurate and cost-effective risk assessment can only be made by considering these factors and the exposed demography.
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Controlling Legionella in Hospital Water Systems: Facts versus Folklore
- Author: Janet E. Stout
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Source: Legionella , pp 469-472
Publication Date :
January 2006
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Acute-care and long term-care facilities continue to experience cases of hospital-acquired Legionnaires’ disease. One of the major unresolved issues is whether the recommendations found in the guidelines will, if followed, result in the control and prevention of hospital-acquired Legionnaires’ disease. An evidence-based approach has been suggested as a way to resolve many of these issues. If applied to a guideline, the criteria should be that (i) the recommendations should be prospectively validated under controlled studies using a step-wise approach, (ii) the evaluation should be a prolonged observational period (>1 year) to evaluate the efficacy of the recommendations, and (iii) the recommended approach/actions should achieve the expected result-prevention of the disease through environmental control. Legionnaires’ disease is an environmentally acquired illness. One recommendation often found in guidance documents is “remove showerheads and aerators monthly for cleaning with chlorine bleach’’. The role of environmental monitoring in Legionella prevention has been a source of debate for many years. A number of disinfection methods have been used for control of Legionella in hospital water systems. These include thermal eradication (heat and flush), hyperchlorination, copper-silver ionization, point-of-use filters, and chlorine dioxide. Each of these methods has completed some of the evaluation criteria. All four steps of the evaluation criteria have been fulfilled for copper-silver ionization. The path to effective control of hospital acquired Legionnaires’ disease must be evidence based. Patients and healthcare facilities suffer when unconfirmed and untested recommendations become part of prevention guidelines.
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Review of Nosocomial Legionella Outbreaks
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Source: Legionella , pp 483-485
Publication Date :
January 2006
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This chapter reviews the evidence of different disinfection methods to stop outbreaks of Legionnaires’ diseases (LD). Articles describing original outbreaks of Legionella were selected for the review. Full reports of potentially relevant publications were obtained and checked for eligibility. Decisions on which trials to include were based on full text articles. The following parameters were extracted: country, year of publication, year of outbreak, duration of outbreak, source of outbreak, facility and department, number of patients involved, number of health care workers involved, mortality, disinfection methods, and success of methods. Legionella outbreaks have a significant impact on patient morbidity and mortality in hospitals. In 68% of outbreaks, the source was the hospital water system or showers. In these cases, disinfection methods focusing on the water system should be chosen. The success of these disinfection methods depends on the status of the water system and the disinfection method used. This implies that technical measurements are very important factors for termination of outbreaks, despite other effective disinfection methods such as chlorination (70.6%) and elevating temperature once per month (71.4%). The safest interventions are sterile water for patient care or point-of-use filters. Interestingly, the number of published outbreaks has decreased since the 1980s, whereas the literature about Legionella did not. Whether or not this is due to better plumbing design of hospital water systems and more successful disinfection methods remains to be proven.
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Risk of Legionella in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes
- Authors: Vladimir Drasar, Radomir Polcar, Paul Christian Lück
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Source: Legionella , pp 489-492
Publication Date :
January 2006
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This chapter investigates the overall Legionella colonization of thermal water and cold and hot water of particular hotels, including the detailed identification and typing of species and serogroups. The aim was also to evaluate the risk of particular hydrotherapy procedures, to identify the source of the Philadelphia strain in the spa complex, and to propose corrective actions to minimize the risk of future Legionella infections. Permanent chlorine dioxide disinfection was recommended for the hot water systems of the two hotels. A dilemma caused by the legislation has arisen as to how to treat the thermal water and its distribution system. Oxidizing biocides and ionizers are not permitted by law. Regular thermal disinfection is recommended, but its application is often unfeasible for the rapid settling of mineral deposits and scale, which usually clog pipes and valves. The bath equipment (mostly very sophisticated) contained many different kinds of tubing and hoses and air and water jets that were almost all colonized with biofilms harboring Legionella. Thermal and hot water distribution systems and hydrotherapy procedures present the sources, while aerosol inhalation and drinking water appear to be the transmission.
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Biological Treatment of Industrial Wastewater: a Possible Source of Legionella Infection
- Authors: Görel Allestam, Birgitta de Jong, Jonas Långmark
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Source: Legionella , pp 493-496
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January 2006
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This chapter summarizes the results of an extensive study of biological treatment plants (BTPs) from 43 paper mills in Sweden. During September and October 2005, each paper mill with a BTP was sampled systematically. High concentrations of Legionella, up to 109 CFU /liter, were found in investigated treatment plants. In total, 66% of all investigated paper mills were positive for Legionella. The biomass that undergoes sedimentation in secondary ponds is reinoculated into the system by return-loops to stimulate the growth of the microflora. The remaining biomass is dewatered and used as an energy source at the mill and for soil-making outside the plant. As much as 30 tons of biosludge is produced daily and is often mixed with fibrous waste. Conditions for legionella growth in these systems are almost optimal with a temperature of approximately 37°C, available nutrients and iron sources, and massive aeration. In an investigation the authors found that the cooling towers seem to have little impact on the introduction of legionella downstream into BTPs. Other international studies of biological treatment of sewage have detected legionella with PCR but not by culture. A local risk assessment should be done together with the public health authorities to identify risks for spreading legionella by aerosols and to minimize the spread of disease. Maintenance of cooling towers including regular cleaning is also recommended.
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Six-Month Experience of Silver-Hydrogen Peroxide Treatment for Legionella Control in Two Nursing Home Water Systems
- Authors: M. L. Ricci, I. Dell’Eva, M. Scaturro, P. Baruchelli, G. De Ponte, M. Losardo, M. Ottaviani, F. Guizzardi
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Source: Legionella , pp 505-508
Publication Date :
January 2006
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Different methods have been applied to control Legionella in water systems such as copper-silver ionization, chlorine dioxide, thermal treatments, hyperchlorination, UV radiation. In this chapter, authors evaluated the efficacy of a continuous system based on a silver-hydrogen peroxide mixture in two nursing home water systems. Recent studies showed a decline of Legionnaire's disease (LD) in health care facility-acquired cases where environmental monitoring of the water system and installation of a disinfection method were performed. Therefore, when the plumbing system is heavily contaminated by Legionella, it is important to apply control measures to reduce Legionella colonization and infection risk. Studies on the efficacy of the silver-hydrogen peroxide disinfection system are currently lacking, and to our knowledge, the present study is the first reported for Legionella control in hot water systems. In vitro studies demonstrated that hydrogen peroxide is a weak disinfectant in the absence of a catalyst. The combined action of hydrogen peroxide with silver as the catalyst characterize the disinfection power of the mixture used in this study. Results of this study, although preliminary, show that such disinfection systems can effectively control Legionella water system colonization even if some increase of Legionella levels at distal sites is observed.
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Legionella Population Control in Cooling Water Systems
- Authors: Michèle Merchat, Taher Mamodaly, Gilles Chaperon
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Source: Legionella , pp 519-521
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January 2006
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The use of a specific chemical product to minimize the population density of bacteria is the required and usual approach to prevent cooling towers from becoming amplifiers of Legionella. Sampling the cooling water to control bacterial populations is the most common way to evaluate the water treatment program’s efficiency. This chapter compares Legionella population counts obtained from different trials on the system to determine the most representative sampling point of the cooling water. Then the authors checked the results obtained after 3, 5, and 10 days of incubation in order to test the relevancy of the results. Experiments were performed on Climespace cooling tower plants in Paris, France. On site, the basin towers were connected. The results obtained from the different points showed that the tower basin provides irregular Legionella concentrations. The results obtained from the air flush-out sample show scattered distribution. To date, the use of other techniques which make it possible to evaluate all the Legionella (like the technique by PCR) could lead to an abusive use of the chemical treatments generating a significant risk to the environment.
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Control of Legionella Proliferation Risk in Cooling Water Systems
- Authors: Michèle Merchat, Anabel Deumier
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Source: Legionella , pp 522-525
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January 2006
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Legionnaires’ disease is a potentially fatal form of pneumonia caused by the bacterium Legionella. Legionella control in cooling water systems depends on many parameters (conception, hydraulic management, maintenance) favorable to biological deposits. Any variation in the parameters measured (microbiological, physicochemical and environmental parameters) made it possible to identify and destroy Legionella growth sources. The cooling tower system is an ecosystem in which Legionella is always present and can proliferate any time of year. The percentage of samples in which Legionella is detected increased after April. A meticulous analysis of the risks made it possible to identify and manage all the factors of risk of proliferation of Legionella. The Legionella risk management cannot be carried out without taking account of the protozoa which are resistant to biocides. To fight continuously against the formation of biofilm seems to be the method most adapted to fight effectively against the proliferation of Legionella and limit the use of biocides.
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Control of Legionella in Large Buildings through Community-Wide Introduction of Monochloramine
- Authors: Matthew R. Moore, Brendan Flannery, Lisa B. Gelling, Michael Conroy, Duc Vugia, James Salerno, June Weintraub, Valerie Stevens, S. Fields Barry, Richard Besser
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Source: Legionella , pp 526-528
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January 2006
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Monochloramine can be more effective than chlorine at reducing Legionella colonization of potable water systems in large buildings, which are key sources of community-and hospital-acquired Legionnaire's disease. Because monochloramine use is associated with lower concentrations of trihalomethanes, many utilities are converting their residual disinfectant from chlorine to monochloramine. In this chapter, the author observed that monochloramine conversion was associated with decreased Legionella colonization of buildings served by the municipal water system. To determine whether this decreased risk was sustainable over a longer period of time and at a larger number of distal sites, a larger colonization survey was performed in San Francisco before and after conversion to monochloramine. Legionella were isolated from water samples and biofilm swabs, speciated, and serogrouped using standard methods. In the chlorine phase, 29% (45 of 157) of samples collected from water heaters yielded Legionella; fewer than 1% (1 of 159) of water heaters sampled during the monochloramine phase were positive (P<0.001). After controlling for water heater temperature, building height, and disruptions in service, monochloramine use was associated with a 96% reduction in the prevalence of water heater colonization (P<0.001).
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Specific Detection of Legionella in Samples from Patients with Community-Acquired Pneumonia by PCR and a Colorimetric Detection System (Reverse Dot Blot)
- Authors: Jörn Kircher, Kirchhoff Alexander, Arndt Rolfs
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Source: Legionella , pp 51-52
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January 2006
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Despite extensive efforts, the etiology of about 40 to 60% of community-acquired pneumonia remains unclear; a number of these cases are attributed to Legionella. The incidence in this group may be as high as 38%. Cultivation is still supposed to be the gold standard, but there is doubt about the sensitivity in clinical practice. Researchers established a new method for the detection of Legionella by using PCR to amplify genomic ribosomal DNA and a reverse dot blot for the detection of L. pneumophila and non-pneumophila species. The authors used a multiplex-PCR and the coamplification of human DNA (pyruvate dehydrogenase gene) as an internal control to avoid false-positive results. To avoid false-positive results, incubation with uracil-N-glycosylase was used, and for avoidance of false-negative results the coamplification of the pyruvate dehydrogenase gene was used, creating an amplificate of 185 bp in length in each PCR. The authors used the established method to investigate clinical specimens of 93 patients taken out of a prospective randomized study about the epidemiology of community-acquired pneumonia in Berlin, Germany, from 1991 to 1992. They were able to demonstrate the ability to detect Legionella using PCR in conjunction with reverse dot blotting. This method allows the enhanced detection of non-pneumophila species in addition to established methods. Interpretation of the results for the incidence of non-pneumophila infections remains controversial because of a lack of facts about pathogenity of this group and comparable results in other studies.
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Duopath Legionella: a New Immunochromatographic Test for Simultaneous Identification of Legionella pneumophila and Legionella Species
- Authors: Jürgen H. Helbig, Paul Christian Lück, Britta Kunz, Andreas Bubert
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Source: Legionella , pp 73-75
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January 2006
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Several molecular biological methods are increasingly being used for the identification of legionellae in man-made aquatic environments. Currently, the genus Legionella is known to include 51 species. Some of the species have been isolated only from environmental sources up to now, but it is generally accepted that all species may cause pneumonia, especially in immunocompromised persons. These huge numbers of Legionella spp. represent a very wide serological heterogeneity that can lead to unsatisfying sensitivity and specificity of serological identification tools. The specificity of Duopath Legionella was calculated by testing 50 bacterial strains isolated from water samples and grown on GVPC agar plates. The latex agglutination assay Legionella spp. recognizes seven of the most frequent Legionella non-pneumophila species causing Legionnaires’ disease but not the wide range of legionellae found in water systems, which are also suspected to be pneumonia pathogens. In many countries, water or environmental samples have to be analyzed for the presence of Legionella spp. instead of only Legionella pneumophila. Here, Duopath Legionella revealed a significant advantage over the latex assay and makes the phenotypic diagnostic gap significantly smaller. Therefore, Duopath Legionella can be considered a user-friendly, simple and reliable test for the simultaneous identification of L. pneumophila and non-pneumophila.
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Antigenic Diversity of a 19-Kilodalton Peptidoglycan-Associated Lipoprotein among Legionella Species Determined by Reactivity Patterns to Monoclonal Antibodies
- Authors: Jin-Hee Moon, Jin-Ah Yang, Hee-Sun Sim, Dae Won Park, Jang Wook Sohn, Hae Kyung Lee, Mi Yeon Park, Min Ja Kim
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Source: Legionella , pp 76-78
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January 2006
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Legionella is an important cause of both community-acquired and nosocomial pneumonias. In this chapter, the authors produced 17 monoclonal antibodies (mAbs) against the recombinant PAL (rPAL) cloned from Legionella pneumophila serogroup (sg) 1 and investigated antigenic diversity of the peptidoglycan-associated lipoprotein (PAL) proteins from soluble fractions of 16 Legionella species including 22 serogroups by mAb reactivity patterns in ELISA. Soluble antigens from Legionella strains (L. pneumophila sg 1, 3, 4, 5, and 6; L. annisa; L. dumoffii; L. gormanii; L. jordanis; L. micdadei; L. oakridgensis; L. sainthelensi; L. bozemanii sg 1 and 2; L. longbeachae sg 1 and 2; L. Hackeliae sg 1) were prepared by the method of Berdal et al. The authors concluded that antigenic diversity of a Legionella species–common PAL protein is present among Legionella species and that developing diagnostic agents using a Legionella antigen, even if it is conserved, might be better for separately detecting L. pneumophila species and non-pneumophila Legionella species.