Rolling epidemic of Legionnaires’ disease outbreaks in small geographic areas

MacIntyre, C. Raina; Dyda, Amalie; Bui, Chau Minh; Chughtai, Abrar Ahmad

doi:10.1038/s41426-018-0051-z

Cited by 12 publications

(20 citation statements)

References 19 publications

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“…Although there are limited data available, the incidence reported is around 10-15 cases detected per million population. From them, 75-80% are >50 years and 60-70% are male with underlying chronic diseases [15].…”

Section: Epidemiologymentioning

confidence: 99%

A Clinical Overview of Hospital-Acquired Legionella Pneumonia: Prevention Is the Key?

Mendez¹,

Rueda²,

García³

et al. 2020

Hospital Acquired Infection and Legionnaires' Disease

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Legionella pneumophila is a Gram-negative bacteria that cause communityacquired pneumonia in very common circumstances. Although it is rare to develop hospital-acquired pneumonia due to Legionella pneumophila, there are cases where the infection appears during its presence in the hospital environment or because of the existence of Legionella outbreaks. It is important to mention that the colonization of this organism is mostly found in some hospital water supplies. The prevention of the spreading of this nosocomial pathogen is crucial for the hospital setting by identification of the bacteria. Using surveillance and control of infection, as well as maintaining beneficial isolation of those patients with the disease, could prevent the dissemination of this rare infection among hospitalized patients that are highly vulnerable. The treatment should be effective and according to the standard of care guidelines. The initiation of empiric antibiotic therapy is critical once the pathogen is suspected to be the etiology of pneumonia.

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Section: Epidemiologymentioning

confidence: 99%

A Clinical Overview of Hospital-Acquired Legionella Pneumonia: Prevention Is the Key?

Mendez¹,

Rueda²,

García³

et al. 2020

Hospital Acquired Infection and Legionnaires' Disease

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“…The 2015 Legionnaires' disease outbreak in Bronx County, NY was considered to be a group of three distinct outbreaks in space and time, attributed to different sources, termed a rolling epidemic [23]. The source for the largest portion of the epidemic, the South Bronx outbreak, was officially identified as a hotel cooling tower.…”

Section: Outbreak Sourcementioning

confidence: 99%

“…The source for the largest portion of the epidemic, the South Bronx outbreak, was officially identified as a hotel cooling tower. This was unusual, because in the US, cooling tower sources accounted for only 7% of all outbreaks from 2000-2012, while in NYC, 16% of outbreaks were related to cooling towers from 2003 to 2012 [23,40,41].…”

Section: Outbreak Sourcementioning

confidence: 99%

“…Legionnaires' disease is considered an atypical pneumonia because, historically, the organism itself In July, 2015, the second largest outbreak of Legionnaires' disease in United States history would begin in the southern part of Bronx County, New York. By the time this rolling epidemic was complete in September, 2015, it would extend to the eastern part of the borough and total 155 cases with 17 deaths [23]. The largest portion of cases was seen at Lincoln Medical and Mental Health Center (LMMHC) with 48 patients treated.…”

Section: Introductionmentioning

confidence: 99%

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A Review of the Public Health and Municipal Hospital Response to the Bronx County, New York Legionnaires' Disease Outbreak

Skelly¹,

Mohammad²,

Jaime³

et al. 2020

J Infect Dis Epidemiol

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Background: The second largest outbreak of Legionnaires' disease in United States history began in July, 2015 in Bronx County, NY. It was initially described as a single outbreak affecting 138 patients with 16 deaths. Subsequently, additional cases were noted in the same area and time period, officially attributed to different exposures, making the final total 155 patients and 17 deaths before ending in September, 2015. The largest portion of cases was seen at Lincoln Medical and Mental Health Center with 48 patients treated. Methods: We reviewed the hospital and public health timeline regarding the official response to the outbreak and performed performed a study of all patients who presented to Lincoln Medical and Mental Health Center from July 8 to August 03, 2015 with laboratory confirmed Legionella infection. The overall mortality was evaluated as well as risk factors for disease and clinical presentation. Results: The standard use of Legionella urine antigen testing for community acquired pneumonia allowed for early identification of the outbreak prior to public health notification. The type of public health service investigations varied by location due to non-uniform application of Centers for Disease Control guidelines. Of the 48 patients with laboratory confirmed disease, median age was 55 years. Patients presented most commonly with tachycardia (88%), fever (79%), and cough (79%). The most common clinical findings were hyponatremia (52%), rhabdomyolysis (42%) and respiratory failure (31%). Antibiotic therapy was initiated within 6 hours for 31 of 48 (65%) patients. Two patients (4%) died during this outbreak. Conclusions: Divergence from Centers for Disease Control guidelines may have limited the investigators' abilities to more accurately determine the sources for the outbreak and may have prevented this from being seen as one rolling epidemic instead of three separate events. Standard use of Legionella urine antigen testing in community acquired pneumonia by Lincoln Medical and Mental Health Center allowed for identification of the outbreak prior to the public health authorities and neighboring hospitals. Rapid diagnosis and prompt treatment led to an overall mortality of 4%.

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“…Outbreaks of LD consistently occur globally and have increased in recent years. The average incidence rate is about 10-15 cases per million people 6 . According to the Centre for Disease Control, incidences of legionellosis have increased by four and a half times between 2000 and 2016 7 .…”

Section: Introductionmentioning

confidence: 99%

Identification of two aptamers binding toLegionella pneumophilawith high affinity and specificity

Saad

Chinerman

Tabrizian

et al. 2019

Preprint

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19Legionella pneumophila (Lp) is a water borne bacterium causing Legionnaires' Disease (LD) in 20 humans. Rapid detection of Lp in water system is essential to reduce the risk of LD outbreaks. 21 The methods currently available require expert skills and are time intensive, thus delaying 22 intervention. In situ detection of Lp by biosensor would allow rapid implementation of control 23 strategies. To this end, a biorecognition element is required. Aptamers are considered promising 24 biorecognition molecules for biosensing. Aptamers are short oligonucleotide sequence folding 25 into a specific structure and are able to bind to specific molecules. Currently no aptamer and thus 26 no aptamer-based technology exists for the detection of Lp. In this study, Systemic Evolution of 27 Ligands through EXponential enrichment (SELEX) was used to identify aptamers binding 28 specifically to Lp. Ten rounds of positive selection and two rounds of counter-selection against 29 two Pseudomonas species were performed. Two aptamers binding strongly to Lp were identified 30 with KD of 116 and 135 nM. Binding specificity of these two aptamers to Lp was confirmed by 31 flow cytometry and fluorescence microscopy. Therefore, these two aptamers are promising 32 biorecognition molecules for the detection of Lp in water systems. 33 34 Key words: Legionella pneumophila, aptamers, SELEX, flow cytometry, fluorescence 35 microscopy, Pseudomonas 36 37 38 Legionella pneumophila (Lp) is a pathogenic Gram-negative bacterium responsible for two types 39 of respiratory diseases, namely the severe pneumonia Legionnaires' Disease (LD) and the milder 40 flu-like Pontiac fever 1 . Lp occurs in both natural and engineered water systems and is one of the 41 most prevalent pathogens in man-made, engineered water systems 2 . Infections occur when the 42 bacteria are aerosolized, and the contaminated aerosols are inhaled; Lp can then infect and replicate 43 inside alveolar macrophages 3 . Modern water systems provide optimal transmission conditions for 44 Lp by generating aerosols 4 . Leading sources of infection are cooling towers, hot water distribution 45 systems, humidifiers, misters, showers, fountains, spa pools and evaporative condensers 5 . 46 47 Outbreaks of LD consistently occur globally and have increased in recent years. The average 48 incidence rate is about 10-15 cases per million people 6 . According to the Centre for Disease 49 Control, incidences of legionellosis have increased by four and a half times between 2000 and 50 2016 7 . The rise in LD outbreaks can be attributed to several factors such as aging infrastructures 51and an aging population who is more vulnerable to such infections, as well as increases in diagnosis 52 and reporting 8,9 . Nevertheless, most LD outbreaks are the consequences of management failure of 53 man-made water systems 10 . Examples of these failures for water distribution systems include 54 keeping the temperature of hot water distribution system below 50°C and allowing water to 55 stagnate 10 . For coolin...

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Rolling epidemic of Legionnaires’ disease outbreaks in small geographic areas

Cited by 12 publications

References 19 publications

A Clinical Overview of Hospital-Acquired Legionella Pneumonia: Prevention Is the Key?

A Clinical Overview of Hospital-Acquired Legionella Pneumonia: Prevention Is the Key?

A Review of the Public Health and Municipal Hospital Response to the Bronx County, New York Legionnaires' Disease Outbreak

Identification of two aptamers binding toLegionella pneumophilawith high affinity and specificity

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