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PloS One 2020The performances of the ImmuView Streptococcus pneumoniae (Sp) and Legionella pneumophila (Lp) urinary antigen test were compared to that of the BinaxNOW Sp and Lp...
Performance of the ImmuView and BinaxNOW assays for the detection of urine and cerebrospinal fluid Streptococcus pneumoniae and Legionella pneumophila serogroup 1 antigen in patients with Legionnaires' disease or pneumococcal pneumonia and meningitis.
The performances of the ImmuView Streptococcus pneumoniae (Sp) and Legionella pneumophila (Lp) urinary antigen test were compared to that of the BinaxNOW Sp and Lp assays, using frozen urine from 166 patients with Legionnaires' disease (LD) and 59 patients with pneumococcal pneumonia. Thirty Sp-positive or contrived cerebrospinal fluids (CSF) were also tested. Test specimens were collected and tested at different sites, with each site testing unique specimens by technologists blinded to expected results. No significant differences in test concordances were detected for the ImmuView and BinaxNOW assays for the Sp or Lp targets for urine from patients with pneumococcal pneumonia or LD when performance from both sites were combined. At one of two test sites the ImmuView Lp assay was more sensitive than the BinaxNOW assay, with no correlation between test performance and Lp serogroup 1 monoclonal type. Urines from six of seven patients with LD caused by Legionella spp. bacteria other than Lp serogroup 1 were negative in both assays. Both tests had equivalent performance for Sp-positive CSF. The clinical sensitivities for pneumococcal pneumonia were 88.1 and 94.4% for the ImmuView and Binax assays, and 87.6 and 84.2% for the Lp assays, respectively. Test specificities for pneumococcal pneumonia were 96.2 and 97.0% for the ImmuView and Binax assays, and 99.6 and 99.1% for the Lp assays. Both assays were highly specific for Sp in pediatric urines from children with nasopharyngeal colonization by the bacterium. ImmuView and BinaxNOW assay performance was equivalent in these studies.
Topics: Adolescent; Adult; Antigens, Bacterial; Biological Assay; Cerebrospinal Fluid; Child; Child, Preschool; Female; Humans; Immunologic Tests; Infant; Legionella pneumophila; Legionnaires' Disease; Male; Meningitis; Pneumonia, Pneumococcal; Sensitivity and Specificity; Serogroup; Streptococcus pneumoniae; Urine; Young Adult
PubMed: 32866217
DOI: 10.1371/journal.pone.0238479 -
European Journal of Case Reports in... 2023Legionnaire's disease can cause rare and severe complications such as rhabdomyolysis and acute kidney injury. This case report details a 45-year-old male patient who...
UNLABELLED
Legionnaire's disease can cause rare and severe complications such as rhabdomyolysis and acute kidney injury. This case report details a 45-year-old male patient who presented with features of Legionnaire's disease. Laboratory results showed a significantly elevated serum creatinine kinase level and an increased creatinine level. Imaging showed right lower lobe consolidation, and a positive urine antigen test confirmed Legionnaire's disease. The patient was administered azithromycin and underwent fluid repletion to manage the rhabdomyolysis and acute kidney injury, resulting in improved creatinine kinase levels and kidney function. He was discharged and continued on azithromycin for 10 days. His outpatient follow-up showed that creatinine kinase levels had further decreased. This case report emphasises the importance of early recognition and management of Legionnaire's disease and its rare but severe complications.
LEARNING POINTS
Legionnaire's disease is a severe form of pneumonia caused by Legionella bacteria that can lead to rare complications such as rhabdomyolysis and acute kidney injury, which have high morbidity and mortality rates.The treatment for Legionnaire's disease complicated with rhabdomyolysis and acute kidney injury involves early fluid repletion, antibiotics and close monitoring of creatinine kinase levels, electrolytes and kidney function.For patients with creatinine kinase levels over 5000 U/l without hypocalcaemia or alkalaemia, urinary alkalinisation with bicarbonate therapy may be considered as a treatment option.
PubMed: 37554481
DOI: 10.12890/2023_003940 -
The American Journal of Case Reports Dec 2019BACKGROUND Legionella pneumonia can be an aggressive form of pneumonia. However, it is rare in pregnant women, particularly in the peripartum period. To the best of our...
BACKGROUND Legionella pneumonia can be an aggressive form of pneumonia. However, it is rare in pregnant women, particularly in the peripartum period. To the best of our knowledge this is the only case of Legionella pneumonia with endometrial sepsis. We are reporting a patient with this rare condition. CASE REPORT The patient was an 18-year-old female, pregnant with her first baby, who developed symptoms of the common cold near term. The patient was seen at another major facility initially and was discharged home with a diagnosis of "cold". She was still uncomfortable and came to our facility Aront Ogden Medical Center Elmira, NY, USA, where she had rupture of membranes and underwent C-section. She was suspected clinically of having pneumonia. Initial chest x-ray was negative, but computed tomography (CT)-scan did show bilateral pneumonia. Further workup confirmed the diagnosis of Legionella pneumonia and was treated for that as well as for endometritis. She did require Intensive Care Unit (ICU) care during her hospital stay. The patient was seen and evaluated by multiple subspecialties, including Critical Care, Infectious Disease, and Gastroenterology subspecialties. The patient improved steadily, and was later discharged home in the care of her family with a healthy baby and was advised to follow up with her Primary Medical Provider as outpatient. CONCLUSIONS Legionella pneumonia in pregnancy may be more common than we think, and could be easily overlooked in that patient population, have to be in the back mind of medical provider. Overlooking diagnosis could lead to serious adverse consequences for these patients.
Topics: Adolescent; Common Cold; Diagnostic Errors; Female; Humans; Legionnaires' Disease; Pneumonia, Bacterial; Pregnancy; Pregnancy Complications, Infectious; Tomography, X-Ray Computed
PubMed: 31882569
DOI: 10.12659/AJCR.916071 -
ELife Dec 2023Identifying virulence-critical genes from pathogens is often limited by functional redundancy. To rapidly interrogate the contributions of combinations of genes to a...
Identifying virulence-critical genes from pathogens is often limited by functional redundancy. To rapidly interrogate the contributions of combinations of genes to a biological outcome, we have developed a ltiplex, andomized RISPR nterference equencing (MuRCiS) approach. At its center is a new method for the randomized self-assembly of CRISPR arrays from synthetic oligonucleotide pairs. When paired with PacBio long-read sequencing, MuRCiS allowed for near-comprehensive interrogation of all pairwise combinations of a group of 44 virulence genes encoding highly conserved transmembrane proteins for their role in pathogenesis. Both amoeba and human macrophages were challenged with bearing the pooled CRISPR array libraries, leading to the identification of several new virulence-critical combinations of genes. and were particularly fascinating for their apparent redundant functions during human macrophage infection, while alone was essential for virulence in the amoeban host . Thus, MuRCiS provides a method for rapid genetic examination of even large groups of redundant genes, setting the stage for application of this technology to a variety of biological contexts and organisms.
Topics: Humans; Macrophages; Legionella pneumophila; Acanthamoeba castellanii; Virulence; Legionnaires' Disease; Bacterial Proteins
PubMed: 38095310
DOI: 10.7554/eLife.86903 -
Polski Merkuriusz Lekarski : Organ... Feb 2022Coronavirus disease-2019 (COVID-19) and legionnaires disease (LD) caused by Gram-negative water-born bacteria Legionella pneumophila show certain similarities, including...
UNLABELLED
Coronavirus disease-2019 (COVID-19) and legionnaires disease (LD) caused by Gram-negative water-born bacteria Legionella pneumophila show certain similarities, including a predisposition to pulmonary involvement and extrapulmonary manifestations in some of the patients infected. One disease can mimic the other, both can rarely coexist.
CASE SERIES REPORT
The authors describe 7 such cases (5 females), aged 51-90 years (mean 69.7 years) detected while screening 133 subjects with moderate to severe pneumonia and confirmed COVID- 19, which constituted 5.3% of the patients in whom urinary antigen test (UAT) for L. pneumophila was performed. The patients had multiple concomitant disorders: hypertension (6), heart failure (4), diabetes (4), obesity (4), coronary heart disease (3), chronic kidney disease (3), chronic obstructive pulmonary disease (3), anemia (3). Positive UAT was obtained at admission in 4 patients, and on 3rd, 11th and 14th days of hospitalization in the remaining 3 patients. One patient also had positive UAT for Streptococcus pneumoniae. We analyzed: radiological imaging, laboratory data (CRP, interleukin-6, procalcitonin, troponin I, BNP), ECG, echocardiography, treatment and outcome. Three patients required a modification of initial antibiotic therapy, two developed Clostridioides difficile infection. The duration of hospitalization ranged from 13 to 59 days (mean 24.3 days); two patients died.
CONCLUSIONS
The authors suggest that the coexistence of COVID- 19 and LD may result in prolonged hospitalization, in increased mortality risk and in subsequent cardiovascular complications, including takotsubo syndrome (TTS) which was found in 2 cases, both presented as focal TTS (fTTS).
Topics: Aged; Aged, 80 and over; COVID-19; Female; Humans; Legionella pneumophila; Legionnaires' Disease; Middle Aged; Pneumonia; SARS-CoV-2
PubMed: 35278295
DOI: No ID Found -
Journal of Medical Virology Jan 2022Emerging evidence shows co-infection with atypical bacteria in coronavirus disease 2019 (COVID-19) patients. Respiratory illness caused by atypical bacteria such as...
Emerging evidence shows co-infection with atypical bacteria in coronavirus disease 2019 (COVID-19) patients. Respiratory illness caused by atypical bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila may show overlapping manifestations and imaging features with COVID-19 causing clinical and laboratory diagnostic issues. We conducted a prospective study to identify co-infections with SARS-CoV-2 and atypical bacteria in an Indian tertiary hospital. From June 2020 to January 2021, a total of 194 patients with laboratory-confirmed COVID-19 were also tested for atypical bacterial pathogens. For diagnosing M. pneumoniae, a real-time polymerase chain reaction (PCR) assay and serology (IgM ELISA) were performed. C. pneumoniae diagnosis was made based on IgM serology. L. pneumophila diagnosis was based on PCR or urinary antigen testing. Clinical and epidemiological features of SARS-CoV-2 and atypical bacteria-positive and -negative patient groups were compared. Of the 194 patients admitted with COVID-19, 17 (8.8%) were also diagnosed with M. pneumoniae (n = 10) or C. pneumoniae infection (n = 7). Confusion, headache, and bilateral infiltrate were found more frequently in the SARS CoV-2 and atypical bacteria co-infection group. Patients in the M. pneumoniae or C. pneumoniae co-infection group were more likely to develop ARDS, required ventilatory support, had a longer hospital length of stay, and higher fatality rate compared to patients with only SARS-CoV-2. Our report highlights co-infection with bacteria causing atypical pneumonia should be considered in patients with SARS-CoV-2 depending on the clinical context. Timely identification of co-existing pathogens can provide pathogen-targeted treatment and prevent fatal outcomes of patients infected with SARS-CoV-2 during the current pandemic.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atypical Bacterial Forms; COVID-19; Chlamydophila Infections; Chlamydophila pneumoniae; Coinfection; Female; Humans; India; Legionella pneumophila; Legionnaires' Disease; Length of Stay; Male; Middle Aged; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Prospective Studies; SARS-CoV-2; Severity of Illness Index; Young Adult
PubMed: 34491594
DOI: 10.1002/jmv.27324 -
Environmental Research Nov 2022A number of studies suggest that meteorological conditions are related to the risk of Legionnaires' disease (LD) but the findings are not consistent. A systematic review...
A number of studies suggest that meteorological conditions are related to the risk of Legionnaires' disease (LD) but the findings are not consistent. A systematic review was conducted to investigate the association of weather with sporadic LD and highlight the key meteorological conditions related to this outcome. PubMed, EMBASE, The Cochrane Library and OpenGrey were searched on 26-27 March 2020 without date, language or location restrictions. Key words included "legionellosis", "legionnaires' disease", combined with "meteorological conditions", "weather", "temperature", "humidity", "rain", "ultraviolet rays", "wind speed", etc. Studies were excluded if they did not examine the exposure of interest, the outcome of interest and their association or if they only reported LD outbreak cases. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and it was registered in PROSPERO (#CRD42020168869). There were 811 articles, of which 17 were included in the review. The studies investigated different meteorological variables and most of them examined the combined effect of several variables. The most commonly examined factors were precipitation and temperature, followed by relative humidity. The studies suggested that increased precipitation, temperature and relative humidity were positively associated with the incidence of LD. There was limited evidence that higher wind speed, pressure, visibility, UV radiation and longer sunshine duration were inversely linked with the occurrence of LD. A period of increased but not very high temperatures, followed by a period of increased precipitation, favour the occurrence of LD. Increased awareness of the association of temperature and precipitation and LD occurrence among clinicians and public health professionals can improve differential diagnosis for cases of sporadic community-acquired pneumonia and at the same time contribute to improving LD surveillance.
Topics: Humans; Humidity; Legionnaires' Disease; Meteorology; Temperature; Weather
PubMed: 35964674
DOI: 10.1016/j.envres.2022.114080 -
The Lancet. Microbe Nov 2022Legionella pneumophila is the main cause of a severe pneumonic illness known as Legionnaires' disease and is a global public health threat. Whole-genome sequencing (WGS)...
BACKGROUND
Legionella pneumophila is the main cause of a severe pneumonic illness known as Legionnaires' disease and is a global public health threat. Whole-genome sequencing (WGS) can be applied to trace environmental origins of L pneumophila infections, providing information to guide appropriate interventions. We aim to explore the evolutionary and epidemiological relationships in a 36-year Scottish L pneumophila reference isolate collection.
METHODS
We investigated the genomic epidemiology of Legionnaires' disease over 36 years in Scotland, comparing genome sequences for all clinical L pneumophila isolates (1984-2020) with a sequence dataset of 3211 local and globally representative isolates. We used a stratified clustering approach to capture epidemiological relationships by core genome Multi-locus Sequence Typing, followed by high-resolution phylogenetic analysis of clusters to measure diversity and evolutionary relatedness in context with epidemiological metadata.
FINDINGS
Clustering analysis showed that 111 (57·5 %) of 193 of L pneumophila infections in Scotland were caused by ten endemic lineages with a wide temporal and geographical distribution. Phylogenetic analysis of L pneumophila identified hospital-associated sublineages that had been detected in the hospital environment up to 19 years. Furthermore, 12 (30·0%) of 40 community-associated infections (excluding a single, large outbreak) that occurred over a 13 year period (from 2000 to 2013) were caused by a single widely distributed endemic clone (ST37), consistent with enhanced human pathogenicity. Finally, our analysis revealed clusters linked by national or international travel to distinct geographical regions, indicating several previously unrecognised travel links between closely related isolates (fewer than five single nucleotide polymorphisms) connected by geography.
INTERPRETATION
Our analysis reveals the existence of previously undetected endemic clones of L pneumophila that existed for many years in hospital, community, and travel-associated environments. In light of these findings, we propose that cluster and outbreak definitions should be reconsidered, and propose WGS-based surveillance as a critical public health tool for real-time identification and mitigation of clinically important endemic clones.
FUNDING
Chief Scientist Office, Biotechnology and Biological Sciences Research Council (UK), Medical Research Council Precision Medicine Doctoral Training Programme, Wellcome Trust, and Medical Research Council (UK).
Topics: Humans; Legionnaires' Disease; Multilocus Sequence Typing; Phylogeny; Travel; Genomics
PubMed: 36240833
DOI: 10.1016/S2666-5247(22)00231-2 -
Microorganisms Mar 2023Free-living nematodes harbor and disseminate various soil-borne bacterial pathogens. Whether they function as vectors or environmental reservoirs for the aquatic , the...
Free-living nematodes harbor and disseminate various soil-borne bacterial pathogens. Whether they function as vectors or environmental reservoirs for the aquatic , the causative agent of Legionnaires' disease, is unknown. A survey screening of biofilms of natural (swimming lakes) and technical (cooling towers) water habitats in Germany revealed that nematodes can act as potential reservoirs, vectors or grazers of in cooling towers. Consequently, the nematode species and were isolated from the same cooling tower biofilm and taken into a monoxenic culture. Using pharyngeal pumping assays, potential feeding relationships between and different strains and mutants were examined and compared with sp., a species isolated from a -positive thermal source biofilm. The assays showed that bacterial suspensions and supernatants of the cooling tower isolate KV02 decreased pumping rate and feeding activity in nematodes. However, assays investigating the hypothesized negative impact of 's major secretory protein ProA on pumping rate revealed opposite effects on nematodes, which points to a species-specific response to ProA. To extend the food chain by a further trophic level, infected with KV02 were offered to nematodes. The pumping rates of increased when fed with -infected , while sp. pumping rates were similar when fed either infected or non-infected This study revealed that cooling towers are the main water bodies where and free-living nematodes coexist and is the first step in elucidating the trophic links between coexisting taxa from that habitat. Investigating the -nematode-amoebae interactions underlined the importance of amoebae as reservoirs and transmission vehicles of the pathogen for nematode predators.
PubMed: 36985310
DOI: 10.3390/microorganisms11030738 -
International Journal of Hygiene and... Mar 2022Legionella is an opportunistic premise plumbing pathogen and causative agent of a severe pneumonia called Legionnaires' Disease (LD). Cases of LD have been on the rise... (Review)
Review
Legionella is an opportunistic premise plumbing pathogen and causative agent of a severe pneumonia called Legionnaires' Disease (LD). Cases of LD have been on the rise in the U.S. and globally. Although Legionella was first identified 45 years ago, it remains an 'emerging pathogen." Legionella is part of the normal ecology of a public water system and is frequently detected in regulatory-compliant drinking water. Drinking water utilities, regulators and public health alike are increasingly required to have a productive understanding of the evolving issues and complex discussions of the contribution of the public water utility to Legionella exposure and LD risk. This review provides a brief overview of scientific considerations important for understanding this complex topic, a review of findings from investigations of public water and LD, including data gaps, and recommendations for professionals interested in investigating public water utilities. Although the current literature is inconclusive in identifying a public water utility as a sole source of an LD outbreak, the evidence is clear that minimizing growth of Legionella in public water utilities through proper maintenance and sustained disinfectant residuals, throughout all sections of the water utility, will lead to a less conducive environment for growth of the bacteria in the system and the buildings they serve.
Topics: Disease Outbreaks; Drinking Water; Humans; Legionella; Legionella pneumophila; Legionnaires' Disease; Sanitary Engineering; Water Microbiology
PubMed: 34923288
DOI: 10.1016/j.ijheh.2021.113906