Community Outbreak of Legionnaires' Disease: An Investigation Confirming the Potential for Cooling Towers to Transmit Legionella Species

Keller, David W.; Hajjeh, Rana; DeMaria, Alfred; Fields, Barry S.; Pruckler, Janet M.; Klein, Catherine; Benson, Robert S.; Kludt, Pat E.; Lett, Susan M.; Mermel, Leonard A.; Giorgio, Christina; Breiman, Robert F.

doi:10.1093/clinids/22.2.257

Cited by 69 publications

(39 citation statements)

References 24 publications

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“…Second, the application domain of the IDS method is limited as yet to filterable water. Cooling tower water, frequently cited as a source of infection in outbreaks of Legionnaires' disease (1,15,27,57), cannot be easily analyzed by the IDS procedure due to interferences. The presence of particulate material that accumulates during the concentration procedure interferes with microscopic analysis.…”

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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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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“…Legionellosis was first identified in 1976 (13), and outbreaks of legionellosis occurred prior to 2001 (18,27,33). CDC is currently conducting a review of legionellosis outbreaks that occurred prior to 2001 and plans to add these outbreaks to WBDOSS to provide a more complete representation of the role of Legionella in waterborne outbreaks.…”

Section: Legionella and The Changing Illness Profile Of Drinking Watementioning

confidence: 99%

Causes of Outbreaks Associated with Drinking Water in the United States from 1971 to 2006

et al. 2010

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SUMMARY Since 1971, the CDC, EPA, and Council of State and Territorial Epidemiologists (CSTE) have maintained the collaborative national Waterborne Disease and Outbreak Surveillance System (WBDOSS) to document waterborne disease outbreaks (WBDOs) reported by local, state, and territorial health departments. WBDOs were recently reclassified to better characterize water system deficiencies and risk factors; data were analyzed for trends in outbreak occurrence, etiologies, and deficiencies during 1971 to 2006. A total of 833 WBDOs, 577,991 cases of illness, and 106 deaths were reported during 1971 to 2006. Trends of public health significance include (i) a decrease in the number of reported outbreaks over time and in the annual proportion of outbreaks reported in public water systems, (ii) an increase in the annual proportion of outbreaks reported in individual water systems and in the proportion of outbreaks associated with premise plumbing deficiencies in public water systems, (iii) no change in the annual proportion of outbreaks associated with distribution system deficiencies or the use of untreated and improperly treated groundwater in public water systems, and (iv) the increasing importance of Legionella since its inclusion in WBDOSS in 2001. Data from WBDOSS have helped inform public health and regulatory responses. Additional resources for waterborne disease surveillance and outbreak detection are essential to improve our ability to monitor, detect, and prevent waterborne disease in the United States.

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“…L. pneumophila is a Gram-negative bacterium that is ubiquitous in natural environments. In addition, it has been found in anthropogenic environments, such as cooling towers, baths, showers, and decorative fountains (2)(3)(4)(5). Legionellosis may be acquired through inhalation of aerosolized water contaminated with Legionella species (6).…”

mentioning

confidence: 99%

Close Genetic Relationship between Legionella pneumophila Serogroup 1 Isolates from Sputum Specimens and Puddles on Roads, as Determined by Sequence-Based Typing

Kanatani

Isobe

Kimata

et al. 2013

Appl Environ Microbiol

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bWe investigated the prevalence of Legionella species isolated from puddles on asphalt roads. In addition, we carried out sequence-based typing (SBT) analysis on the genetic relationship between L. pneumophila serogroup 1 (SG 1) isolates from puddles and from stock strains previously obtained from sputum specimens and public baths. Sixty-nine water samples were collected from puddles on roads at 6 fixed locations. Legionella species were detected in 33 samples (47.8%) regardless of season. Among the 325 isolates from puddles, strains of L. pneumophila SG 1, a major causative agent of Legionnaires' disease, were the most frequently isolated (n ‫؍‬ 62, 19.1%). Sixty-two isolates of L. pneumophila SG 1 from puddles were classified into 36 sequence types (STs) by SBT. ST120 and ST48 were identified as major STs. Environmental ST120 strains from puddles were found for the first time in this study. Among the 14 STs of the clinical isolates (n ‫؍‬ 19), 4 STs (n ‫؍‬ 6, 31.6%), including ST120, were also detected in isolates from puddles on roads, and the sources of infection in these cases remained unclear. The lag-1 gene, a tentative marker for clinical isolates, was prevalent in puddle isolates (61.3%). Our findings suggest that puddles on asphalt roads serve as potential reservoirs for L. pneumophila in the environment.

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Community Outbreak of Legionnaires' Disease: An Investigation Confirming the Potential for Cooling Towers to Transmit Legionella Species

Cited by 69 publications

References 24 publications

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

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

Causes of Outbreaks Associated with Drinking Water in the United States from 1971 to 2006

Close Genetic Relationship between Legionella pneumophila Serogroup 1 Isolates from Sputum Specimens and Puddles on Roads, as Determined by Sequence-Based Typing

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