<i>Legionella pneumophila</i> Serogroup 1 in the Water Facilities of a Tertiary Healthcare Center, India

Chaudhry, Rama; Sreenath, K R; Valavane, Arvind; Vinayaraj, E V; Sagar, Tanu

doi:10.3201/eid2311.171071

Cited by 13 publications

(13 citation statements)

References 8 publications

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“…37 In previous studies, we reported Legionella colonization in the hospital water supply. 31,32 The results of our environmental study increased the index of suspicion for nosocomial LD among clinicians and recommended Legionella diagnostic testing for suspected cases of nosocomial pneumonia. According to the CDC, Legionella testing in patients at risk for LD with nosocomial pneumonia should always be pursued; however, environmental cultures should be reserved for clearly documented cases of HALD.…”

Section: Study Populationmentioning

confidence: 86%

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Legionella pneumophila in Patients with Pneumonia at a Referral Hospital, New Delhi, India, 2015–2020

Sreenath

Dey

Kabra

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Legionnaires' disease (LD) is an established cause of pneumonia, and the disease remains largely underdiagnosed. Even though LD has been reported from many parts of the world, only sporadic cases have been reported in India. During February 2015-January 2020, we enrolled 597 patients with radiographically confirmed pneumonia and tested respiratory secretions for Legionella spp. by using real-time PCR, and culture. A commercial urinary antigen test (UAT) was also used to detect the Legionella pneumophila (Lp) serogroup 1 antigen in urine. An LD case was defined as a patient with pneumonia and positive results for Legionella spp. infections determined by real-time PCR (from any respiratory specimen) or culture or UAT. Demographic data, risk factors, clinical, radiological, and outcome data of Lppositive and Lp-negative patients were compared using logistic regression. Over the study period, 14 (2.3%) patients were positive for Legionella spp. infections by real-time PCR and UAT; eight (57%) were admitted to the intensive care unit, and four (28.6%) in-hospital deaths occurred. Bivariate analysis showed that renal disease, neurological conditions, confusion, leukocytosis, and requirement of oxygen support were more common in the Lp-positive group than in the Lpnegative group. However, multivariate analysis failed to confirm most of these differences; renal disease was the only independent variable remaining significant. All test methods have intrinsic limitations in identifying Legionella; therefore, more than one testing method should be used. Application of molecular assays including real-time PCR has great value because of its high sensitivity, specificity, and rapid diagnostic potency. Increased awareness and improved diagnostic testing could facilitate early detection of cases, pathogen-directed therapy, and improved outcomes for patients.

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Section: Study Populationmentioning

confidence: 86%

“…However, in environmental surveys, non-Lp1 serogroups were also recovered from hospital water samples. 31,32 Continuous clinical surveillance is required to identify the significance of these serotypes in LD patients.…”

Section: Study Populationmentioning

confidence: 99%

Legionella pneumophila in Patients with Pneumonia at a Referral Hospital, New Delhi, India, 2015–2020

Sreenath

Dey

Kabra

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…12 In India, L. pneumophila was found in 6.66 to 15.2% of distal outlet waters in patient care areas in tertiary hospitals. 13 14 Outbreaks of the LD are more common in late summer and early autumn because of stagnation of water which provides an ideal ground for bacterial growth. 15…”

Section: Reservoirsmentioning

confidence: 99%

Advances in Environmental Detection and Clinical Diagnostic Tests for Legionella Species

Vittal

Raj

Kumar

et al. 2021

Journal of Health and Allied Sciences NU

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Legionella is a fastidious organism that is difficult to culture in the lab but is widely distributed in environmental, domestic, and hospital settings. The clinical manifestations due to Legionella infections range from mild fever to fatal pneumonia and multiorgan pathologies. Legionella outbreaks though prevalent globally are not reported in developing countries due to difficulties in isolating this organism and the lack of simple diagnostic protocols. Here, we review the literature from across countries to present various methods used to detect Legionella from environmental and clinical samples. We compare the sensitivity and the specificity of the conventional culture-based assays with the recent methods and discuss approaches to develop better detection and diagnostic tests. With better cost-effective detection techniques and regular monitoring of the susceptible sites, which may harbor Legionella colonies, most of the Legionella infections can be prevented. As a result, considerable burden, caused by Legionella infections, on the healthcare system, in especially economically weaker countries, can be mitigated.

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“…Legionella isolation and identification from water samples was done following the guidelines issued by the US Centers for Disease Control and Prevention (19). The detailed methodology regarding L. pneumophila environmental surveillance has been published elsewhere (20,21).…”

Section: Environmental Surveillancementioning

confidence: 99%

Distribution of Virulence Genes and Sequence-Based Types Among Legionella pneumophila Isolated From the Water Systems of a Tertiary Care Hospital in India

Sreenath

Chaudhry

Vinayaraj

et al. 2020

Front. Public Health

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Background: Legionnaires' disease (LD) is a potentially fatal pneumonia predominantly caused by infection due to Legionella pneumophila although more than 50 other Legionella species are described. Water systems contaminated with Legionella spp. are the implicated sources of Legionnaires' disease. In this study, we aimed to assess Legionella contamination in the water sources of a tertiary care hospital and to determine the virulence properties and molecular characteristics of L. pneumophila environmental isolates.Methods: During May 2015 through August 2018, a total of 201 hospital water samples were tested for L. pneumophila by standardized culture procedures; environmental isolates were examined for the presence of two virulence genes: Legionella vir homolog (lvh) and repeats in structural toxin (rtxA) by PCR. The genotyping of isolates was performed by sequence-based typing (SBT) according to the protocol of the European Study Group for Legionella Infections (ESGLI).Results:L. pneumophila was isolated from 38/201 (18.9%) water samples; among the 46 isolates, the lvh locus was present in 45 (97.8%), the rtxA locus was found in 45 (97.8%), and both loci were found in 44 (95.7%) isolates. A total of 23 sequence types (STs) were identified among the 44 isolates (index of discrimination [IOD] of 0.929), and 11/23 (47.8%) STs were new to the ESGLI database.Conclusions: The study results showed genetic diversity in L. pneumophila isolates from the hospital environment along with a high percentage of pathogenicity loci. Besides, certain STs may have an increased ability to cause legionellosis, thus requires specific infection control and prevention strategies whenever identified.

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Legionella pneumophila Serogroup 1 in the Water Facilities of a Tertiary Healthcare Center, India

Cited by 13 publications

References 8 publications

Legionella pneumophila in Patients with Pneumonia at a Referral Hospital, New Delhi, India, 2015–2020

Legionella pneumophila in Patients with Pneumonia at a Referral Hospital, New Delhi, India, 2015–2020

Advances in Environmental Detection and Clinical Diagnostic Tests for Legionella Species

Distribution of Virulence Genes and Sequence-Based Types Among Legionella pneumophila Isolated From the Water Systems of a Tertiary Care Hospital in India

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