<i>Notes from the Field:</i> Two Cases of Legionnaires’ Disease in Newborns After Water Births — Arizona, 2016

Granseth, Geoffrey; Bhattarai, Rachana; Sylvester, Tammy; Prasai, Siru; Livar, Eugene

doi:10.15585/mmwr.mm6622a4

Cited by 9 publications

(10 citation statements)

References 3 publications

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“…Non-Lp1 strains have been detected in Arizona previously, including an outbreak involving an Lp6 strain in the potable water system of a hospital (9), a pseudo-outbreak associated with patients undergoing bronchoscopy where an Lp8 strain contaminated syringes during a bronchoscopy procedure that used ice made with the facility’s potable water (10), and more recently, both Lp1 and Lp6 were associated with legionellosis in neonates delivered in water births in tubs filled with tap water at private residences (11).…”

Section: Discussionmentioning

confidence: 99%

Culture of Clinical Specimens Reveals Extensive Diversity of Legionella pneumophila Strains in Arizona

Raphael

Huynh

Brown

et al. 2019

mSphere

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Between 2000 and 2017, a total of 236 Legionella species isolates from Arizona were submitted to the CDC for reference testing. Most of these isolates were recovered from bronchoalveolar lavage specimens. Although the incidence of legionellosis in Arizona is less than the overall U.S. incidence, Arizona submits the largest number of isolates to the CDC for testing compared to those from other states. In addition to a higher proportion of culture confirmation of legionellosis cases in Arizona than in other states, all Legionellapneumophila isolates are forwarded to the CDC for confirmatory testing. Compared to that from other states, a higher proportion of isolates from Arizona were identified as belonging to L. pneumophila serogroups 6 (28.2%) and 8 (8.9%). Genome sequencing was conducted on 113 L. pneumophila clinical isolates not known to be associated with outbreaks in order to understand the genomic diversity of strains causing legionellosis in Arizona. Whole-genome multilocus sequence typing (wgMLST) revealed 17 clusters of isolates sharing at least 99% identical allele content. Only two of these clusters contained isolates from more than one individual with exposure at the same facility. Additionally, wgMLST analysis revealed a group of 31 isolates predominantly belonging to serogroup 6 and containing isolates from three separate clusters. Single nucleotide polymorphism (SNP) and pangenome analysis were used to further resolve genome sequences belonging to a subset of isolates. This study demonstrates that culture of clinical specimens for Legionella spp. reveals a highly diverse population of strains causing legionellosis in Arizona which could be underappreciated using other diagnostic approaches. IMPORTANCE Culture of clinical specimens from patients with Legionnaires’ disease is rarely performed, restricting our understanding of the diversity and ecology of Legionella. Culture of Legionella from patient specimens in Arizona revealed a greater proportion of non-serogroup 1 Legionellapneumophila isolates than in other U.S. isolates examined. Disease caused by such isolates may go undetected using other diagnostic methods. Moreover, genome sequence analysis revealed that these isolates were genetically diverse, and understanding these populations may help in future environmental source attribution studies.

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Section: Discussionmentioning

confidence: 99%

Culture of Clinical Specimens Reveals Extensive Diversity of Legionella pneumophila Strains in Arizona

Raphael

Huynh

Brown

et al. 2019

mSphere

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“…It has also been documented in the exposure of babies during water births [7], while human-to-human transmission is exceptional [8]. Smokers, heavy drinkers, elderly adults and people with weakened immune systems, with chronic metabolic or lung diseases are particularly susceptible to the infection.…”

Section: Introductionmentioning

confidence: 99%

Preventing Healthcare-Associated Legionellosis: Results after 3 Years of Continuous Disinfection of Hot Water with Monochloramine and an Effective Water Safety Plan

Coniglio

Ferrante

Yassin

2018

IJERPH

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The purpose of this study is to report the experience of the implementation and application of a 3-year Water Safety Plan (WSP) together with the secondary disinfection of water by monochloramine to control and prevent healthcare-associated legionellosis in an Italian hospital strongly colonized by Legionella. Risk assessment was carried out by the WSP team. The main critical control points focused on in developing the WSP for the control of Legionella was the water distribution system. A sampling plan for the detection of Legionella was implemented. A widespread contamination of the hot water distribution system by L. pneumophila sg5 was found. Results after 3 years of the continuous disinfection of hot water with monochloramine indicate the eradication of Legionella. The implementation and application of a WSP in a hospital, together with the disinfection of the water distribution system with monochloramine, can be effective in controlling the growth of Legionella and in preventing nosocomial legionellosis.

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“…Both were infected with Legionella pneumophila , serogroup 1, and serogroup 6, respectively. The first one also had a congenital heart disease [28]. There was a Legionella pneumophila serotype 1 and aspergillus infection in a child almost 2 years old with T-lymphoblastic leukemia who was probably exposed to apparatus discharging water after showering [29].…”

Section: Discussionmentioning

confidence: 99%

A Proactive Environmental Approach for Preventing Legionellosis in Infants: Water Sampling and Antibiotic Resistance Monitoring, a 3-Years Survey Program

et al. 2019

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A proactive environmental monitoring program was conducted to determine the risk and prevent nosocomial waterborne infections of Legionella spp. in infants. Sink taps in a neonatal intensive care unit (NICU) and two obstetric clinics were monitored for Legionella spp. A total of 59 water samples were collected during a 3-year period and 20 of them were found colonized with Legionella pneumophila. Standard culture, molecular, and latex agglutination methods were used for the detection and identification of Legionella bacteria. Hospital personnel also proceeded with remedial actions (hyperchlorination and thermal shock treatment) in the event of colonization. The minimal inhibitory concentration (MIC) values of erythromycin, ciprofloxacin was determined for Legionella isolates using the e-test method. Our data indicate that the majority of neonatal sink-taps were colonized at least once during the study with Legionella spp. Among 20 isolates, 5 were considered as low-level resistant, 3 in erythromycin and 2 in ciprofloxacin, while no resistant strains were detected. Environmental surveillance in neonatal and obstetric units is suggested to prevent waterborne infections, and thus to reduce the risk of neonatal nosocomial infections.

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Notes from the Field: Two Cases of Legionnaires’ Disease in Newborns After Water Births — Arizona, 2016

Cited by 9 publications

References 3 publications

Culture of Clinical Specimens Reveals Extensive Diversity of Legionella pneumophila Strains in Arizona

Culture of Clinical Specimens Reveals Extensive Diversity of Legionella pneumophila Strains in Arizona

Preventing Healthcare-Associated Legionellosis: Results after 3 Years of Continuous Disinfection of Hot Water with Monochloramine and an Effective Water Safety Plan

A Proactive Environmental Approach for Preventing Legionellosis in Infants: Water Sampling and Antibiotic Resistance Monitoring, a 3-Years Survey Program

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