Legionellosis and Recent Advances in Technologies for Legionella Control in Premise Plumbing Systems: A Review

Carlson, Kelsie M.; Boczek, Laura A.; Chae, So-Ryong; Ryu, Hodon

doi:10.3390/w12030676

Cited by 25 publications

(24 citation statements)

References 100 publications

(208 reference statements)

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“…As such, several works have investigated the effect of different control measures (conventional and new) on Legionella prevalence in real-field systems. Conventional approaches include disinfectant dose, temperature control, or water flushing [85]. Under this topic, most of the published studies are focused on hot water networks, probably because there is only a restricted number of control measures available, and these should fulfill the requirements of drinking water regulations (which limit, for example, the type of biocides to use), as well as comply with safety measures for users (e.g., avoid scalding).…”

Section: Microbial Control Strategiesmentioning

confidence: 99%

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

2021

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Legionella is responsible for the life-threatening pneumonia commonly known as Legionnaires’ disease or legionellosis. Legionellosis is known to be preventable if proper measures are put into practice. Despite the efforts to improve preventive approaches, Legionella control remains one of the most challenging issues in the water treatment industry. Legionellosis incidence is on the rise and is expected to keep increasing as global challenges become a reality. This puts great emphasis on prevention, which must be grounded in strengthened Legionella management practices. Herein, an overview of field-based studies (the system as a test rig) is provided to unravel the common roots of research and the main contributions to Legionella’s understanding. The perpetuation of a water-focused monitoring approach and the importance of protozoa and biofilms will then be discussed as bottom-line questions for reliable Legionella real-field surveillance. Finally, an integrated monitoring model is proposed to study and control Legionella in water systems by combining discrete and continuous information about water and biofilm. Although the successful implementation of such a model requires a broader discussion across the scientific community and practitioners, this might be a starting point to build more consistent Legionella management strategies that can effectively mitigate legionellosis risks by reinforcing a pro-active Legionella prevention philosophy.

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Section: Microbial Control Strategiesmentioning

confidence: 99%

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

2021

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“…However, all cases, clusters, or outbreaks are linked to artificial freshwater environments, which represent a main reservoir of Legionella and a significant health risk from an epidemiological point of view since the main vehicle of microorganism diffusion and exposure to humans is the aerosol produced by some devices, such as condensers, showers, faucets, humidifiers, whirlpool baths, and medication nebulizer devices (Hines et al, 2014;Mercante and Winchell, 2015;Carlson et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of MALDI–TOF Mass Spectrometry in Diagnostic and Environmental Surveillance of Legionella Species: A Comparison With Culture and Mip-Gene Sequencing Technique

et al. 2020

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Legionella spp. are widespread bacteria in aquatic environments with a growing impact on human health. Between the 61 species, Legionella pneumophila is the most prevalent in human diseases; on the contrary, Legionella non-pneumophila species are less detected in clinical diagnosis or during environmental surveillance due to their slow growth in culture and the absence of specific and rapid diagnostic/analytical tools. Reliable and rapid isolate identification is essential to estimate the source of infection, to undertake containment measures, and to determine clinical treatment. Matrix-assisted laser desorption ionization–time-of-flight mass spectrometry (MALDI–TOF MS), since its introduction into the routine diagnostics of laboratories, represents a widely accepted method for the identification of different bacteria species, described in a few studies on the Legionella clinical and environmental surveillance. The focus of this study was the improvement of MALDI–TOF MS on Legionella non-pneumophila species collected during Legionella nosocomial and community surveillance. Comparative analysis with cultural and mip-gene sequencing results was performed. Moreover, a phylogenetic analysis was carried out to estimate the correlations amongst isolates. MALDI–TOF MS achieved correct species-level identification for 45.0% of the isolates belonging to the Legionella anisa, Legionella rubrilucens, Legionella feeleii, and Legionella jordanis species, displaying a high concordance with the mip-gene sequencing results. In contrast, less reliable identification was found for the remaining 55.0% of the isolates, corresponding to the samples belonging to species not yet included in the database. The phylogenetic analysis showed relevant differences inside the species, regruped in three main clades; among the Legionella anisa clade, a subclade with a divergence of 3.3% from the main clade was observed. Moreover, one isolate, identified as Legionella quinlivanii, displayed a divergence of 3.8% from the corresponding reference strain. However, these findings require supplementary investigation. The results encourage the implementation of MALDI–TOF MS in routine diagnostics and environmental Legionella surveillance, as it displays a reliable and faster identification at the species level, as well as the potential to identify species that are not yet included in the database. Moreover, phylogenetic analysis is a relevant approach to correlate the isolates and to track their spread, especially in unconventional reservoirs, where Legionella prevention is still underestimated.

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“…Many hot water system configurations require large tank sizes in open-loop systems that provide increased system volumes and water ages. Water-efficient fixtures also significantly reduce flow and therefore demand [15]. For example, an inefficient showerhead can use between 15 and 25 L of water per minute, while an efficient showerhead can use between 6 and 8 L of water per minute.…”

Section: Leadership In Energy and Environmentalmentioning

confidence: 99%

“…In general, superheat-and-flush should only be implemented as a component for the short-term management of premise plumbing pathogens, since it can cause infrastructure damage, does not prevent re-seeding, and can exacerbate other water quality issue including tastes and odours. For example, several studies have observed recolonisation by Legionella within weeks to months after treatment [15,43,151]. Temmerman et al [152] also demonstrated the ability of Legionella pneumophila to rapidly proliferate after temperatures were lowered and suggested this was a microbial response to nutrients released by newly killed biofilm.…”

Section: Temperature Controlmentioning

confidence: 99%

“…Review papers published on the topic to date provide useful accounts of occurrence [9][10][11], monitoring [12], individual factors [13], guidelines [14], and different methods of control [9,[15][16][17][18][19] of opportunistic premise plumbing pathogens. The current review paper fills a gap in that it provides an up-to-date and systematic comprehensive review of causes, factors, and control measures of opportunistic premise plumbing pathogens in general and Legionella in particular.…”

Section: Introductionmentioning

confidence: 99%

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Causes, Factors, and Control Measures of Opportunistic Premise Plumbing Pathogens—A Critical Review

Leslie

Hinds²,

Hai

2021

Applied Sciences

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This review critically analyses the chemical and physical parameters that influence the occurrence of opportunistic pathogens in the drinking water distribution system, specifically in premise plumbing. A comprehensive literature review reveals significant impacts of water age, disinfectant residual (type and concentration), temperature, pH, and pipe materials. Evidence suggests that there is substantial interplay between these parameters; however, the dynamics of such relationships is yet to be elucidated. There is a correlation between premise plumbing system characteristics, including those featuring water and energy conservation measures, and increased water quality issues and public health concerns. Other interconnected issues exacerbated by high water age, such as disinfectant decay and reduced corrosion control efficiency, deserve closer attention. Some common features and trends in the occurrence of opportunistic pathogens have been identified through a thorough analysis of the available literature. It is proposed that the efforts to reduce or eliminate their incidence might best focus on these common features.

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Legionellosis and Recent Advances in Technologies for Legionella Control in Premise Plumbing Systems: A Review

Cited by 25 publications

References 100 publications

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

Evaluation of MALDI–TOF Mass Spectrometry in Diagnostic and Environmental Surveillance of Legionella Species: A Comparison With Culture and Mip-Gene Sequencing Technique

Causes, Factors, and Control Measures of Opportunistic Premise Plumbing Pathogens—A Critical Review

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