Restaurant outbreak of Legionnaires' disease associated with a decorative fountain: an environmental and case-control study

O’Loughlin, Rosalyn; Kightlinger, Lon; Werpy, Matthew C; Brown, Ellen; Stevens, Valerie A.; Hepper, Clark; Keane, Tim; Benson, Robert F.; Fields, Barry S.; Moore, Matthew R.

doi:10.1186/1471-2334-7-93

Cited by 55 publications

(53 citation statements)

References 27 publications

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“…1), such as fountains (84,85,(172)(173)(174)(175)(176), building water systems (75,79,(177)(178)(179)(180)(181)(182)(183)(184), cooling towers (185)(186)(187)(188)(189)(190)(191)(192)(193), and whirlpool spas (194)(195)(196)(197)(198), among others. U.S. surveillance data from 2001 to 2010 have consistently included Legionella as one of the leading causes of drinking waterassociated outbreaks, accounting for 58% of cases in 2010 (199).…”

Section: Epidemiology and Diseasementioning

confidence: 99%

“…An extensive collection of case studies and research articles dating back Ͼ30 years demonstrates the adaptability and potential of legionellae to colonize man-made aquatic environments ( Fig. 1), from the initial point of water treatment (69)(70)(71)(72)(73) to private homes (74)(75)(76)(77)(78), hospitals (79)(80)(81)(82)(83), restaurants (84,85), bath houses (86)(87)(88)(89), hotels (90)(91)(92), and, eventually, wastewater facilities (93,94). These studies underscore the resiliency and persistence of legionellae.…”

Section: Physiology and Ecologymentioning

confidence: 99%

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Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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SUMMARY Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

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Section: Epidemiology and Diseasementioning

confidence: 99%

Section: Physiology and Ecologymentioning

confidence: 99%

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

2015

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“…These alleles were derived from sputum samples that could not be cultured satisfactorily, and their sequences were not found in the EWGLI database, to which they are being submitted. According to the EWGLI scheme, the most common sequence type (6,10,15,13,9,14) was found in 17 patients related to the main outbreak that occurred in Alcoi in 1999 and 2000 (6). The isolates from only six patients from this epidemiologically related group did not show the same profile but did show a very closely related one.…”

Section: Resultsmentioning

confidence: 99%

“…In the study of most legionellosis outbreaks, the number of clinical samples included in the molecular characterization of strains is very low due to the low efficiency of retrieval of Legionella isolates. As an example, O'Loughin et al (15) analyzed isolates from only 4 of the 18 patients included in an outbreak because they were the only patients from whom they were able to get Legionella isolates.…”

Section: Discussionmentioning

confidence: 99%

Direct Sequencing of Legionella pneumophila from Respiratory Samples for Sequence-Based Typing Analysis

Coscollá

Gónzález-Candelas

2009

J Clin Microbiol

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We have developed a procedure to test the efficiency and reliability of sequencing of Legionella pneumophila genes directly from respiratory samples and have compared the results with those derived from cultured isolates. We tried to obtain the nucleotide sequences of six protein-coding loci included in the sequence-based typing scheme for Legionella pneumophila and three intergenic regions from 132 samples corresponding to 106 patients positive for urine antigen. A seminested PCR approach was used to amplify and sequence these nine loci directly from respiratory samples. Nucleotide sequences were directly obtained for 23 Legionella isolates and also for 66 respiratory secretions from a total of 69 patients. The efficiency of sequencing from respiratory secretions was higher than that of sequencing after the isolation of the Legionella isolates. Moreover, the perfect match between the sequences obtained by both approaches when respiratory samples and cultured isolates from the same patient were available corroborates the suitability of the direct sequencing approach for the identification of Legionella species and molecular epidemiology studies with Legionella species.

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“…Legionella can occasionally produce serious infections among humans, including Legionnaires' disease, a respiratory illness associated with inhalation of aerosols [33] generated by man-made water systems [34][35][36]. Legionella are a food source for protozoa, which abundantly graze on biofilm bacteria [37].…”

Section: Legionellaementioning

confidence: 99%

Amoeba-Related Health Risk in Drinking Water Systems: Could Monitoring of Amoebae Be a Complementary Approach to Current Quality Control Strategies?

Codony¹,

Pérez

Adrados

et al. 2011

Future Microbiol.

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Culture-based methods for fecal indicator microorganisms are the standard protocol to assess potential health risk from drinking water systems. However, these traditional fecal indicators are inappropriate surrogates for disinfection-resistant fecal pathogens and the indigenous pathogens that grow in drinking water systems. There is now a range of molecular-based methods, such as quantitative PCR, which allow detection of a variety of pathogens and alternative indicators. Hence, in addition to targeting total Escherichia coli (i.e., dead and alive) for the detection of fecal pollution, various amoebae may be suitable to indicate the potential presence of pathogenic amoeba-resisting microorganisms, such as Legionellae. Therefore, monitoring amoeba levels by quantitative PCR could be a useful tool for directly and indirectly evaluating health risk and could also be a complementary approach to current microbial quality control strategies for drinking water systems.

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Restaurant outbreak of Legionnaires' disease associated with a decorative fountain: an environmental and case-control study

Abstract: Background: From June to November 2005, 18 cases of community-acquired Legionnaires' disease (LD) were reported in Rapid City South Dakota. We conducted epidemiologic and environmental investigations to identify the source of the outbreak.

Cited by 55 publications

References 27 publications

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

Direct Sequencing of Legionella pneumophila from Respiratory Samples for Sequence-Based Typing Analysis

Amoeba-Related Health Risk in Drinking Water Systems: Could Monitoring of Amoebae Be a Complementary Approach to Current Quality Control Strategies?

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