The role of arbitrarily primed PCR in identifying the source of an outbreak of Legionnaires' disease

Whitney, Cynthia G.; Hofmann, Jo; Pruckler, Janet M.; Benson, Robert F.; Fields, Barry S.; Bandyopadhyay, Utpala; Donnally, Edward F.; Giorgio-Almonte, C; Mermel, Leonard A.; Boland, Sara; Mátyás, Béla T.; Breiman, Robert F.

doi:10.1128/jcm.35.7.1800-1804.1997

Cited by 15 publications

(6 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5). The PFGE profile was similar to a published profile from isolates of an outbreak that had occurred in Providence, Rhode Island, in 1993 [5,9]. Subsequent re-testing by one laboratory of all isolates confirmed that strains isolated from the Rhode Island outbreak were indeed indistinguishable, by each subtyping method, from the strain that caused this outbreak (Fig.…”

Section: Environmental Investigationsupporting

confidence: 69%

“…Molecular subtyping was useful in our outbreak investigation because it distinguished clinical outbreak isolates from clinical isolates of patients in other areas of the County. However, multiple DNA fingerprinting techniques could not distinguish isolates of two cooling towers from each other, from the outbreak strain, and even from an unrelated Legionnaires' disease outbreak that occurred in 1993 in Rhode Island [5,9]. This implies that this subtype may be common in the United States or that the subtyping techniques were insufficiently discriminating for this strain.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Strengths and limitations of molecular subtyping in a community outbreak of Legionnaires' disease

et al. 2000

View full text Add to dashboard Cite

An epidemiological and microbiological investigation of a cluster of eight cases of Legionnaires' disease in Los Angeles County in November 1997 yielded conflicting results. The epidemiological part of the investigation implicated one of several mobile cooling towers used by a film studio in the centre of the outbreak area. However, water sampled from these cooling towers contained L. pneumophila serogroup 1 of another subtype than the strain that was recovered from case-patients in the outbreak. Samples from two cooling towers located downwind from all of the case-patients contained a Legionella strain that was indistinguishable from the outbreak strain by four subtyping techniques (AP-PCR, PFGE, MAb, and MLEE). It is unlikely that these cooling towers were the source of infection for all the case-patients, and they were not associated with risk of disease in the case-control study. The outbreak strain also was not distinguishable, by three subtyping techniques (AP-PCR, PFGE, and MAb), from a L. pneumophila strain that had caused an outbreak in Providence, RI, in 1993. Laboratory cross-contamination was unlikely because the initial subtyping was done in different laboratories. In this investigation, microbiology was helpful for distinguishing the outbreak cluster from unrelated cases of Legionnaires' disease occurring elsewhere. However, multiple subtyping techniques failed to distinguish environmental sources that were probably not associated with the outbreak. Persons investigating Legionnaires' disease outbreaks should be aware that microbiological subtyping does not always identify a source with absolute certainty.

show abstract

Section: Environmental Investigationsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 95%

Strengths and limitations of molecular subtyping in a community outbreak of Legionnaires' disease

et al. 2000

View full text Add to dashboard Cite

show abstract

“…Various molecular methods based on genomic DNA polymorphisms of L. pneumophila serogroup 1 can be used to discriminate between epidemic and nonepidemic isolates (9,10,13,14,16,18,21,22,(25)(26)(27). The finding that 25 sporadic clinical L. pneumophila isolates from the Paris area had identical AP-PCR patterns led us to suspect that the method lacked discriminatory power.…”

Section: Discussionmentioning

confidence: 99%

Single Clonal Origin of a High Proportion of Legionella pneumophila Serogroup 1 Isolates from Patients and the Environment in the Area of Paris, France, over a 10-Year Period

et al. 1999

View full text Add to dashboard Cite

Arbitrarily primed PCR with three primers and pulsed-field gel electrophoresis were used to characterize a set of 75 clinicalLegionella pneumophila serogroup 1 isolates, with no apparent epidemiological link, obtained from 24 hospitals in Paris, France, from 1987 to 1997. Unexpectedly, 25 clinical isolates from 15 hospitals had an identical profile (termed type A) by both methods. The same profile was subsequently found in 16 of 64 randomly selected environmental L. pneumophila serogroup 1 isolates from 15 different sites in the Paris area. There was no evidence of geographic clustering or a peak incidence of type A isolation. Type A has not been found in France outside the Paris area, suggesting that a particular type of L. pneumophila serogroup 1 is specifically present in the Paris water distribution network.

show abstract

“…The respective advantages and limits of the different epidemiologic markers used in this investigation have been discussed in detail elsewhere [14]. Overall, AP‐PCR—which was found to be rapid, easy to perform, cost‐effective and discriminative—appears to be the method of choice for analyzing strains of Legionella involved in nosocomial infections [14,16].…”

Section: Discussionmentioning

confidence: 99%

“…A number of typing methods have already been proposed for comparing strains of Legionella. They include monoclonal antibody (MAb) typing [9,11,12], plasmid profiles [4], DNA restriction patterns [3,9], ribotyping [12,13], pulsed‐field gel electrophoresis [10,13], and various PCR fingerprinting methods [12,14–16].…”

Section: Introductionmentioning

confidence: 99%

Nosocomial legionellosis outbreak over a three-year period: investigation and control

Berthelot

Grattard

Ros

et al. 1998

Clinical Microbiology and Infection

View full text Add to dashboard Cite

OBJECTIVE: To investigate the epidemiologic relatedness of nosocomial infections due to Legionella pneumophila serogroup 1 diagnosed between 1992 and 1994 in six immunocompromised patients of the same hospital and to describe the measures which were developed to control the outbreak. METHODS: Legionella strains isolated from patients and from potable hot water were compared using three typing methods: monoclonal antibody analysis, arbitrarily primed PCR and ribotyping. RESULTS: Environmental investigations revealed the presence of high levels of L. pneumophila serogroup 1 in hot water. The typing methods gave concordant results for demonstrating (1) the persistence of an epidemic strain of L. pneumophila serogroup 1 in the major water distribution circuit of the hospital over a 3-year period, and (2) the identity between patients' and environmental strains. Five of the six patients were probably infected via aerosols of hot tap water following inappropriate therapeutic procedures. Repetitive heat flushings associated with regular bacteriologic surveillance allowed correct disinfection of the water distribution systems. Specific recommendations concerning aerosol delivery and oxygen therapy were implemented in order to prevent further nosocomial legionellosis. CONCLUSIONS: The same strain of L. pneumophila had been able to colonize the main water circuit of the hospital for at least 3 years; the relatedness between clinical and environmental strains was easily confirmed by the use of molecular markers.

show abstract

The role of arbitrarily primed PCR in identifying the source of an outbreak of Legionnaires' disease

Cited by 15 publications

References 37 publications

Strengths and limitations of molecular subtyping in a community outbreak of Legionnaires' disease

Strengths and limitations of molecular subtyping in a community outbreak of Legionnaires' disease

Single Clonal Origin of a High Proportion of Legionella pneumophila Serogroup 1 Isolates from Patients and the Environment in the Area of Paris, France, over a 10-Year Period

Nosocomial legionellosis outbreak over a three-year period: investigation and control

Contact Info

Product

Resources

About