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Cureus Jul 2023This case report aims to highlight a rare and severe presentation of Legionnaires' disease complicated by thrombotic thrombocytopenic purpura (TPP). The patient, a...
This case report aims to highlight a rare and severe presentation of Legionnaires' disease complicated by thrombotic thrombocytopenic purpura (TPP). The patient, a 75-year-old male with a history of COVID-19 infection, presented with bilateral pneumonia positive for . He developed signs of TTP, cerebral hemorrhage, and renal failure. Despite treatment, the patient's condition deteriorated, leading to flaccid paralysis, absent reflexes, and multiple brain hemorrhages. This case suggests a potential autoimmune mechanism for the neurological symptoms seen in this combination of Legionnaires' disease and TTP. Thus, it would be worthwhile to further investigate and understand the relationship between these two conditions. Further research into underlying mechanisms will contribute to improving therapeutic approaches for this rare presentation. Additionally, the patient's previous COVID-19 infection could have contributed to thrombotic complications due to its association with respiratory infections, warranting further investigation.
PubMed: 37605684
DOI: 10.7759/cureus.42277 -
International Immunopharmacology Jun 2024Patients with diabetes are particularly susceptible to Legionella pneumophila (LP) infection, but the exact pathogenesis of LP infection in diabetic patients is still...
BACKGROUND
Patients with diabetes are particularly susceptible to Legionella pneumophila (LP) infection, but the exact pathogenesis of LP infection in diabetic patients is still not fully understood. Herein, we investigated the effect of diabetes on immune function during LP infection in vitro and in vivo.
METHODS
The time course of LP infection in macrophages under normal and high-glucose (HG) conditions was examined in vitro. Western blot was used to determine nucleotide-binding oligomerization domain 1 (NOD1), kinase 1/2 (ERK1/2), mitogen-activated protein kinase p38 (MAPK p38), and c-Jun N-terminal kinases (JNK). Enzyme-linked immunosorbent assay (ELISA) was used to assess the secretion of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Cell Counting Kit-8 (CCK8) assay assessed U937 cell viability after treating cells with different concentrations of high sugar medium and ML130 (NOD1 inhibitor). For the in vivo study, normal and streptozocin-induced diabetic guinea pigs were infected with LP for 6, 24, and 72 h, after which NOD1, MAPK-related signals, TNF-α, and IL-6 expression in lung tissues were assessed using immunohistochemistry, western blot, and RT-PCR.
RESULTS
HG attenuated the upregulation of NOD1 expression and reduced TNF-α and IL-6 secretion caused by LP compared with LP-infected cells exposed to normal glucose levels (all p < 0.05). In diabetic guinea pigs, HG inhibited the upregulation of NOD1 expression in lung tissues and the activation of p38, ERK1/2, and cJNK caused by LP infection compared to control pigs (all p < 0.05).
CONCLUSION
HG attenuates the response of macrophages to LP infection by inhibiting NOD1 upregulation and the activation of MAPK signaling.
Topics: Nod1 Signaling Adaptor Protein; Animals; Humans; Macrophages; Legionella pneumophila; Glucose; Guinea Pigs; Male; Interleukin-6; Legionnaires' Disease; Diabetes Mellitus, Experimental; MAP Kinase Signaling System; U937 Cells; Tumor Necrosis Factor-alpha; Mice
PubMed: 38749333
DOI: 10.1016/j.intimp.2024.112254 -
Case Reports in Nephrology 2023Legionnaires' disease is a severe pneumonia caused by that results in laboratory abnormalities including hyponatremia and elevated liver enzymes. Rarely skeletal muscle...
Legionnaires' disease is a severe pneumonia caused by that results in laboratory abnormalities including hyponatremia and elevated liver enzymes. Rarely skeletal muscle and renal abnormalities occur. This case report describes a case of pneumonia complicated by rhabdomyolysis and acute renal failure in a patient with the human immunodeficiency virus.
PubMed: 38162958
DOI: 10.1155/2023/8772577 -
MMWR. Morbidity and Mortality Weekly... Sep 2023In July 2022, the Pennsylvania Department of Health received two reports of laboratory-confirmed Legionnaires disease in patients who had recently received lung...
In July 2022, the Pennsylvania Department of Health received two reports of laboratory-confirmed Legionnaires disease in patients who had recently received lung transplants from the same donor at a single Pennsylvania hospital. The donor's cause of death was freshwater drowning in a river, raising suspicion of potential donor-derived transmission, because Legionella bacteria naturally live in fresh water. Further investigation of patients receiving other organs from the same donor did not identify additional legionellosis cases. Health care-associated infection caused by water exposure at the hospital was also evaluated as a potential source of infection and was found to be unlikely. Hospital water quality parameter measurements collected during May-June 2022 were within expected ranges and no water disruptions were noted, although no testing for Legionella was performed during this period. Notifiable disease data did not identify any other Legionnaires disease cases with exposure to this hospital within the 6 months before or after the two cases. Although laboratory testing did not confirm the source of recipient infections, available data suggest that the most likely source was the donor lungs. This cluster highlights the need for increased clinical awareness of possible infection with Legionella in recipients of lungs from donors who drowned in fresh water before organ recovery.
Topics: Humans; Legionella; Legionnaires' Disease; Pennsylvania; Transplant Recipients; Drowning; Lung
PubMed: 37708069
DOI: 10.15585/mmwr.mm7237a1 -
Heliyon Jun 2024is the causative agent of Legionnaires' disease, and its prevalence in potable water is a significant public health issue. Water stagnation within buildings increases...
Increased flushing frequency of a model plumbing system initially promoted the formation of viable but non culturable cells but ultimately reduced the concentration of culturable and total DNA.
is the causative agent of Legionnaires' disease, and its prevalence in potable water is a significant public health issue. Water stagnation within buildings increases the risk of However, there are limited studies investigating how stagnation arising through intermittent usage affects proliferation and the studies that are available do not consider viable but non culturable (VBNC) . This study used a model plumbing system to examine how intermittent water stagnation affects both VBNC and culturable . The model plumbing system contained a water tank supplying two biofilm reactors. The model was initially left stagnant for ≈5 months (147 days), after which one reactor was flushed daily, and the other weekly. Biofilm coupons, and water samples were collected for analysis at days 0, 14 and 28. These samples were analysed for culturable and VBNC , free-living amoebae, and heterotrophic bacteria. After 28 days, once-a-day flushing significantly ( < 0.001) reduced the amount of biofilm-associated culturable (1.5 log reduction) compared with weekly flushing. However, higher counts of biofilm-associated VBNC (1 log higher) were recovered from the reactor with once-a-day flushing compared with weekly flushing. Likewise, once-a-day flushing increased the population of biofilm-associated (approximately 3 log higher) compared with weekly flushing, which indicated a positive relationship between VBNC and . This is the first study to investigate the influence of stagnation on VBNC under environmental conditions. Overall, this study showed that a reduction in water stagnation decreased culturable but not VBNC .
PubMed: 38933949
DOI: 10.1016/j.heliyon.2024.e32334 -
Polish Archives of Internal Medicine Oct 2023
Topics: Humans; Legionnaires' Disease; Legionella; Poland
PubMed: 37818628
DOI: 10.20452/pamw.16584 -
European Journal of Clinical... Jun 2024In case of pneumonia, some biological findings are suggestive for Legionnaire's disease (LD) including C-reactive protein (CRP). A low level of CRP is predictive for... (Observational Study)
Observational Study
INTRODUCTION
In case of pneumonia, some biological findings are suggestive for Legionnaire's disease (LD) including C-reactive protein (CRP). A low level of CRP is predictive for negative Legionella Urinary-Antigen-Test (L-UAT).
METHOD
Observational retrospective study in Nord-Franche-Comté Hospital with external validation in Besançon University Hospital, France which included all adults with L-UAT performed during January 2018 to December 2022. The objective was to determine CRP optimal threshold to predict a L-UAT negative result.
RESULTS
URINELLA included 5051 patients (83 with positive L-UAT). CRP optimal threshold was 131.9 mg/L, with a negative predictive value (NPV) at 100%, sensitivity at 100% and specificity at 58.0%. The AUC of the ROC-Curve was at 88.7% (95% CI, 86.3-91.1). External validation in Besançon Hospital patients showed an AUC at 89.8% (95% CI, 85.5-94.1) and NPV, sensitivity and specificity was respectively 99.9%, 97.6% and 59.1% for a CRP threshold at 131.9 mg/L; after exclusion of immunosuppressed patients, index sensitivity and NPV reached also 100%.
CONCLUSION
In case of pneumonia suspicion with a CRP level under 130 mg/L (independently of the severity) L-UAT is useless in immunocompetent patients with a NPV at 100%. We must remain cautious in patients with symptoms onset less than 48 h before CRP dosage.
Topics: Humans; Legionnaires' Disease; Legionella pneumophila; C-Reactive Protein; Retrospective Studies; Male; Female; Middle Aged; Aged; Sensitivity and Specificity; Serogroup; Adult; France; ROC Curve; Predictive Value of Tests
PubMed: 38530466
DOI: 10.1007/s10096-024-04814-x -
Case Reports in Pulmonology 2024Legionella bozemanii pneumonia is a rare form of Legionnaires' disease caused by the bacterium Legionella bozemanii. It is well known to cause pneumonia in...
Legionella bozemanii pneumonia is a rare form of Legionnaires' disease caused by the bacterium Legionella bozemanii. It is well known to cause pneumonia in immunocompromised patients and has rarely been reported in immunocompetent hosts. We describe a case of a 59-year-old immunocompetent female presented with pneumonia, acute respiratory failure, acute respiratory distress, and septic shock, who was treated with azithromycin, goal-directed resuscitation, and extracorporeal membrane oxygenation (ECMO) but did not survive. Clinicians should have high suspicion of rare legionella pathogens as causative agents for pneumonia.
PubMed: 38596699
DOI: 10.1155/2024/7571380 -
Microbiology Resource Announcements Jun 2024Legionnaires' disease is a severe form of pneumonia caused by spp. bacteria. According to the European Centre for Disease Prevention and Control, problems related to...
Legionnaires' disease is a severe form of pneumonia caused by spp. bacteria. According to the European Centre for Disease Prevention and Control, problems related to this pathogen showed a significant surge in recent years, making its monitoring critical.
PubMed: 38690889
DOI: 10.1128/mra.01154-23 -
Euro Surveillance : Bulletin Europeen... May 2024Wastewater treatment plants (WWTPs) are increasingly identified as Legionnaires' disease (LD) sources. An outbreak investigation was initiated following five LD cases...
Wastewater treatment plants (WWTPs) are increasingly identified as Legionnaires' disease (LD) sources. An outbreak investigation was initiated following five LD cases reported in September 2022 in Houten, the Netherlands. Case identification was based on the European LD case definition, with symptom onset from 1 September 2022, residence in or within 5 km of Houten, or visit to Houten within the incubation period, without other likely sources. We sampled potential sources and genotyped environmental and clinical isolates. We identified 15 LD cases with onset between 13 September and 23 October 2022. A spatial source identification and wind direction model suggested an industrial (iWWTP) and a municipal WWTP (mWWTP) as potential sources, with the first discharging water into the latter. Both tested positive for serogroups 1 and 6 with multiple sequence types (ST). We detected sg1 ST42 in the mWWTP, matching with one of three available clinical isolates. Following control measures at the WWTPs, no further cases were observed. This outbreak underlines that municipal and industrial WWTPs can play an important role in community LD cases and outbreaks, especially those with favourable conditions for growth and dissemination, or even non-favourable conditions for growth but with the influx of contaminated water.
Topics: Legionnaires' Disease; Humans; Disease Outbreaks; Netherlands; Wastewater; Legionella pneumophila; Male; Middle Aged; Aged; Female; Water Microbiology; Water Purification; Adult; Genotype
PubMed: 38757288
DOI: 10.2807/1560-7917.ES.2024.29.20.2300506