Legionnaires' Disease and Associated Comorbid Conditions as Causes of Death in the U.S., 2000–2010

Wickramasekaran, Ranjana N.; Sorvillo, Frank; Kuo, Tony

doi:10.1177/003335491513000309

Cited by 13 publications

(12 citation statements)

References 28 publications

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“…Although it is normally controlled by the innate immune response, L . pneumophila has the potential to cause a severe pneumonia known as Legionnaires' disease with mortality rates of up to 30% if early bacterial replication is not controlled [ 4 – 6 ]. Infection occurs through inhalation of L .…”

Section: Introductionmentioning

confidence: 99%

Neutrophil and Alveolar Macrophage-Mediated Innate Immune Control of Legionella pneumophila Lung Infection via TNF and ROS

2016

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Legionella pneumophila is a facultative intracellular bacterium that lives in aquatic environments where it parasitizes amoeba. However, upon inhalation of contaminated aerosols it can infect and replicate in human alveolar macrophages, which can result in Legionnaires’ disease, a severe form of pneumonia. Upon experimental airway infection of mice, L. pneumophila is rapidly controlled by innate immune mechanisms. Here we identified, on a cell-type specific level, the key innate effector functions responsible for rapid control of infection. In addition to the well-characterized NLRC4-NAIP5 flagellin recognition pathway, tumor necrosis factor (TNF) and reactive oxygen species (ROS) are also essential for effective innate immune control of L. pneumophila. While ROS are essential for the bactericidal activity of neutrophils, alveolar macrophages (AM) rely on neutrophil and monocyte-derived TNF signaling via TNFR1 to restrict bacterial replication. This TNF-mediated antibacterial mechanism depends on the acidification of lysosomes and their fusion with L. pneumophila containing vacuoles (LCVs), as well as caspases with a minor contribution from cysteine-type cathepsins or calpains, and is independent of NLRC4, caspase-1, caspase-11 and NOX2. This study highlights the differential utilization of innate effector pathways to curtail intracellular bacterial replication in specific host cells upon L. pneumophila airway infection.

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Section: Introductionmentioning

confidence: 99%

Neutrophil and Alveolar Macrophage-Mediated Innate Immune Control of Legionella pneumophila Lung Infection via TNF and ROS

2016

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“…Most reported cases are community acquired, but at least 7% are healthcare associated 3 ; mortality in healthcare-associated LD is higher than in community-acquired cases and ranges from 13% to 46% 4 6 Patients with immune compromise are at increased risk of developing LD if exposed to Legionella 7 and may experience increased severity and fatal outcomes, 8 , 9 making prompt detection of outbreaks in healthcare facilities particularly important.…”

mentioning

confidence: 99%

Lessons From an Outbreak of Legionnaires’ Disease on a Hematology-Oncology Unit

Watkins

Toews

Harris

et al. 2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVESTo define the scope of an outbreak of Legionnaires’ disease (LD), to identify the source, and to stop transmission.DESIGN AND SETTINGEpidemiologic investigation of an LD outbreak among patients and a visitor exposed to a newly constructed hematology-oncology unit.METHODSAn LD case was defined as radiographically confirmed pneumonia in a person with positive urinary antigen testing and/or respiratory culture for Legionella and exposure to the hematology-oncology unit after February 20, 2014. Cases were classified as definitely or probably healthcare-associated based on whether they were exposed to the unit for all or part of the incubation period (2–10 days). We conducted an environmental assessment and collected water samples for culture. Clinical and environmental isolates were compared by monoclonal antibody (MAb) and sequence-based typing.RESULTSOver a 12-week period, 10 cases were identified, including 6 definite and 4 probable cases. Environmental sampling revealed Legionella pneumophila serogroup 1 (Lp1) in the potable water at 9 of 10 unit sites (90%), including all patient rooms tested. The 3 clinical isolates were identical to environmental isolates from the unit (MAb2-positive, sequence type ST36). No cases occurred with exposure after the implementation of water restrictions followed by point-of-use filters.CONCLUSIONSContamination of the unit’s potable water system with Lp1 strain ST36 was the likely source of this outbreak. Healthcare providers should routinely test patients who develop pneumonia at least 2 days after hospital admission for LD. A single case of LD that is definitely healthcare associated should prompt a full investigation.

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“…According to recent cohort studies, several risk factors correlate with Legionella infection, most notably, male gender and older age starting at 50 years onward [ 9 ]. Individuals with noncommunicable diseases such as diabetes, heart disease, kidney failure, and cancer are also at higher risk [ 10 ]. Immunosuppression treatment of a solid organ transplant weakens host immunity and increases the risk of acquiring L. pneumophila [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Management of Legionella Disease in Immunocompromised Patients

Kao¹,

Myer²,

Wickrama³

et al. 2021

Cureus

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Legionella pneumonia is a gram-negative bacterial infection commonly associated with aerosol transmission from contaminated water sources. Impaired immunity leads to delayed clearance of infection and further predisposes individuals with Legionella pneumonia at risk of developing complications. We present a case report on a renal transplant patient with comorbid cardiac and renal dysfunction who developed community-acquired Legionella pneumonia. The case emphasizes the importance of adopting a multidisciplinary approach when managing Legionella infection in patients with multiple comorbidities and immunosuppressive states.

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Legionnaires' Disease and Associated Comorbid Conditions as Causes of Death in the U.S., 2000–2010

Abstract: Comorbid conditions that could lead to an immunocompromised state were associated with fatal LD on U.S. death certificates. Characterization of LD mortality burden and related comorbidities has practice implications for clinical medicine and public health surveillance.

Cited by 13 publications

References 28 publications

Neutrophil and Alveolar Macrophage-Mediated Innate Immune Control of Legionella pneumophila Lung Infection via TNF and ROS

Neutrophil and Alveolar Macrophage-Mediated Innate Immune Control of Legionella pneumophila Lung Infection via TNF and ROS

Lessons From an Outbreak of Legionnaires’ Disease on a Hematology-Oncology Unit

Multidisciplinary Management of Legionella Disease in Immunocompromised Patients

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