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International Journal of Infectious... May 2024The effectiveness of monotherapy and combination therapy with quinolones and macrolides for treating Legionnaires' disease remains uncertain; this study aimed to assess...
OBJECTIVES
The effectiveness of monotherapy and combination therapy with quinolones and macrolides for treating Legionnaires' disease remains uncertain; this study aimed to assess the comparative effectiveness of three treatment approaches.
METHODS
Using a nationwide inpatient database, we analyzed 3560 eligible patients hospitalized for Legionnaires' disease between April 1, 2014, and March 31, 2021; patients were divided into combination therapy, quinolone monotherapy, and macrolide monotherapy groups according to the antibiotics administered within 2 days of admission. We compared in-hospital mortality, total hospitalization costs, and length of stay across these groups using multiple propensity score analysis with inverse probability of treatment weighting.
RESULTS
Of the 3560 patients, there were 564 (15.8%), 2221 (62.4%), and 775 (21.8%) patients in the combination therapy, quinolone monotherapy, and macrolide monotherapy groups, respectively. No significant differences were observed in in-hospital mortality between combination therapy and quinolone monotherapy groups, and between combination therapy and macrolide monotherapy groups. There were no significant differences in total hospitalization costs or length of stay among the three groups.
CONCLUSION
The study suggests that there may not be a significant advantage in using a combination of quinolones and macrolides over monotherapy for the treatment of Legionnaires' disease. Given the potential for increased side effects, careful consideration is advised when choosing this combination therapy.
Topics: Humans; Legionnaires' Disease; Inpatients; Anti-Bacterial Agents; Anti-Infective Agents; Macrolides; Quinolones
PubMed: 38367954
DOI: 10.1016/j.ijid.2024.02.008 -
Occupational and Environmental Medicine Mar 2024Certain workers are at increased risk for acquiring Legionnaires' disease compared with other workers. This study aims to identify occupations at increased risk for...
BACKGROUND
Certain workers are at increased risk for acquiring Legionnaires' disease compared with other workers. This study aims to identify occupations at increased risk for acquiring Legionnaires' disease.
METHODS
Using data from the US Centers for Disease Control and Prevention's Supplemental Legionnaires' Disease Surveillance System, this study identified Legionnaires' disease confirmed patients ≥16 years of age in 39 states with reported symptom onset during 2014-2016. Age-adjusted and sex-adjusted incidence rate ratios (IRR) stratified by occupation group were calculated by comparing Legionnaires' disease patients in an occupation group (eg, transportation) to those in all other occupation groups (eg, non-transportation).
RESULTS
A total of 2553 patients had a known occupation group. The two occupations with the highest burden were transportation (N=287; IRR=2.11) and construction (N=269; IRR=1.82). Truck drivers comprised the majority (69.7%) of the transportation occupation group and construction labourers comprised almost half (49%) of the construction occupation group. The healthcare support occupation had the highest IRR (N=75; IRR=2.16).
CONCLUSION
Transportation and construction workers, who are generally not covered by guidance related to building water systems, have increased risk of Legionnaires' disease compared with other workers. One hypothesised risk factor for truck drivers is the use of non-genuine windshield cleaner in their vehicles. A simple intervention is to use genuine windshield cleaner with bactericidal properties (ie, includes isopropanol/methanol) which can reduce the risk of growth and transmission. To improve surveillance of Legionnaires' disease and identification of similar exposures, the authors encourage the collection of occupation and industry information for all patients with Legionnaires' disease.
Topics: Humans; Legionnaires' Disease; Occupations; Risk Factors; Transportation; Industry; Disease Outbreaks
PubMed: 38360725
DOI: 10.1136/oemed-2023-109108 -
European Journal of Case Reports in... 2024Cytomegalovirus (CMV) infection is often asymptomatic. However, in certain individuals, it can cause non-specific signs and symptoms that maybe hard to recognise. The...
UNLABELLED
Cytomegalovirus (CMV) infection is often asymptomatic. However, in certain individuals, it can cause non-specific signs and symptoms that maybe hard to recognise. The condition may therefore be overlooked or misdiagnosed, leading to prolonged illness and serious sequelae. In this case report, we present a rare instance of CMV infection in an HIV-negative patient who had a remote history of splenectomy and was experiencing prolonged fever and markedly elevated white blood cell (WBC) count.
LEARNING POINTS
The clinical presentation of CMV infection in a post-splenectomy patient can be intricate and deceptive, involving non-specific symptoms such as prolonged fever and a markedly elevated WBC count.The decision on treatment among individuals without apparent risk factors (such as AIDS, transplant, or cancers) led to in-depth deliberations and discussion.Post-splenectomy patients with CMV infection may exhibit prolonged illness, potentially leading to severe consequences if left untreated.
PubMed: 38352817
DOI: 10.12890/2024_004263 -
MBio Mar 2024The survival of spp. as intracellular pathogens relies on the combined action of protein effectors delivered inside their eukaryotic hosts by the Dot/Icm (efective in...
The survival of spp. as intracellular pathogens relies on the combined action of protein effectors delivered inside their eukaryotic hosts by the Dot/Icm (efective in rganelle rafficking/ntraellular ultiplication) type IVb secretion system. The specific repertoire of effector arsenals varies dramatically across over 60 known species of this genera with responsible for most cases of Legionnaires' disease in humans encoding over 360 Dot/Icm effectors. However, a small subset of "core" effectors appears to be conserved across all species raising an intriguing question of their role in these bacteria's pathogenic strategy, which for most of these effectors remains unknown. Lpg0103 effector, also known as VipF, represents one of the core effector families that features a tandem of Gcn5-related N-acetyltransferase (GNAT) domains. Here, we present the crystal structure of the Lha0223, the VipF representative from in complex with acetyl-coenzyme A determined to 1.75 Å resolution. Our structural analysis suggested that this effector family shares a common fold with the two GNAT domains forming a deep groove occupied by residues conserved across VipF homologs. Further analysis suggested that only the C-terminal GNAT domain of VipF effectors retains the active site composition compatible with catalysis, whereas the N-terminal GNAT domain binds the ligand in a non-catalytical mode. We confirmed this by enzymatic assays which revealed VipF activity not only against generic small molecule substrates, such as chloramphenicol, but also against poly-L-lysine and histone-derived peptides. We identified the human eukaryotic translation initiation factor 3 (eIF3) complex co-precipitating with Lpg0103 and demonstrated the direct interaction between the several representatives of the VipF family, including Lpg0103 and Lha0223 with the K subunit of eIF3. According to our data, these interactions involve primarily the C-terminal tail of eIF3-K containing two lysine residues that are acetylated by VipF. VipF catalytic activity results in the suppression of eukaryotic protein translation , revealing the potential function of VipF "core" effectors in 's pathogenic strategy.IMPORTANCEBy translocating effectors inside the eukaryotic host cell, bacteria can modulate host cellular processes in their favor. species, which includes the pneumonia-causing encode a widely diverse set of effectors with only a small subset that is conserved across this genus. Here, we demonstrate that one of these conserved effector families, represented by VipF (Lpg0103), is a tandem Gcn5-related N-acetyltransferase interacting with the K subunit of human eukaryotic initiation factor 3 complex. VipF catalyzes the acetylation of lysine residues on the C-terminal tail of the K subunit, resulting in the suppression of eukaryotic translation initiation factor 3-mediated protein translation . These new data provide the first insight into the molecular function of this pathogenic factor family common across .
Topics: Humans; Acetyltransferases; Eukaryotic Initiation Factor-3; Lysine; Prokaryotic Initiation Factor-3; Legionella; Legionella pneumophila; Legionnaires' Disease; Protein Biosynthesis; Bacterial Proteins
PubMed: 38335095
DOI: 10.1128/mbio.03221-23 -
Respirology Case Reports Feb 2024is the most common cause of Legionnaires' disease in Australasia. species are considered a rare cause of pleural infection, and empyema and lung abscess due to has...
is the most common cause of Legionnaires' disease in Australasia. species are considered a rare cause of pleural infection, and empyema and lung abscess due to has not previously been reported. Our patient presented with a 2-3 week history of breathlessness, lethargy, dry cough and headaches. Initial chest radiograph showed extensive left sided consolidation with an associated pleural effusion. An area of necrotising pneumonia evident on computed tomography scan evolved into a multiloculated intrapulmonary abscess. Sputum culture isolated which prompted culture of pleural fluid on buffered charcoal yeast extract agar and isolation of the organism. This case provides evidence that can cause both empyema and lung abscess, and in areas where it is prevalent, increased use of specific agar for pleural fluid culture should be considered.
PubMed: 38314099
DOI: 10.1002/rcr2.1281 -
Applied and Environmental Microbiology Mar 2024Fundamental to effective Legionnaires' disease outbreak control is the ability to rapidly identify the environmental source(s) of the causative agent, . Genomics has...
Fundamental to effective Legionnaires' disease outbreak control is the ability to rapidly identify the environmental source(s) of the causative agent, . Genomics has revolutionized pathogen surveillance, but has a complex ecology and population structure that can limit source inference based on standard core genome phylogenetics. Here, we present a powerful machine learning approach that assigns the geographical source of Legionnaires' disease outbreaks more accurately than current core genome comparisons. Models were developed upon 534 . genome sequences, including 149 genomes linked to 20 previously reported Legionnaires' disease outbreaks through detailed case investigations. Our classification models were developed in a cross-validation framework using only environmental genomes. Assignments of clinical isolate geographic origins demonstrated high predictive sensitivity and specificity of the models, with no false positives or false negatives for 13 out of 20 outbreak groups, despite the presence of within-outbreak polyclonal population structure. Analysis of the same 534-genome panel with a conventional phylogenomic tree and a core genome multi-locus sequence type allelic distance-based classification approach revealed that our machine learning method had the highest overall classification performance-agreement with epidemiological information. Our multivariate statistical learning approach maximizes the use of genomic variation data and is thus well-suited for supporting Legionnaires' disease outbreak investigations.IMPORTANCEIdentifying the sources of Legionnaires' disease outbreaks is crucial for effective control. Current genomic methods, while useful, often fall short due to the complex ecology and population structure of , the causative agent. Our study introduces a high-performing machine learning approach for more accurate geographical source attribution of Legionnaires' disease outbreaks. Developed using cross-validation on environmental genomes, our models demonstrate excellent predictive sensitivity and specificity. Importantly, this new approach outperforms traditional methods like phylogenomic trees and core genome multi-locus sequence typing, proving more efficient at leveraging genomic variation data to infer outbreak sources. Our machine learning algorithms, harnessing both core and accessory genomic variation, offer significant promise in public health settings. By enabling rapid and precise source identification in Legionnaires' disease outbreaks, such approaches have the potential to expedite intervention efforts and curtail disease transmission.
Topics: Humans; Legionella pneumophila; Legionnaires' Disease; Multilocus Sequence Typing; Genomics; Molecular Epidemiology; Disease Outbreaks
PubMed: 38289130
DOI: 10.1128/aem.01292-23 -
Cureus Dec 2023Legionnaires' disease (LD), caused by the bacterium, primarily manifests as pneumonia and could result in a spectrum of clinical severity. As treatment necessitates the...
Legionnaires' disease (LD), caused by the bacterium, primarily manifests as pneumonia and could result in a spectrum of clinical severity. As treatment necessitates the use of antibiotics, levofloxacin, a fluoroquinolone, is a commonly preferred option due to its broad-spectrum activity. However, the potential side effects of levofloxacin, including rare instances of hepatotoxicity, introduce a therapeutic challenge. This case report explores the association between levofloxacin and hepatotoxicity and its implications for treating LD.
PubMed: 38283526
DOI: 10.7759/cureus.51248 -
Epidemiology and Infection Jan 2024Legionellosis is a disease caused by the bacterium that most commonly presents as Legionnaires' disease (LD), a severe form of pneumonia. From 2015 to 2019, an average...
Legionellosis is a disease caused by the bacterium that most commonly presents as Legionnaires' disease (LD), a severe form of pneumonia. From 2015 to 2019, an average of 438 LD cases per year were reported in Canada. However, it is believed that the actual number of cases is much higher, since LD may be underdiagnosed and underreported. The purpose of this study was to develop an estimate of the true incidence of illnesses, hospitalizations, and deaths associated with LD in Canada. Values were derived using a stochastic model, based on Canadian surveillance data from 2015 to 2019, which were scaled up to account for underdiagnosis and underreporting. Overall, there were an estimated 1,113 (90% CrI: 737-1,730) illnesses, 1,008 (90% CrI: 271-2,244) hospitalizations, and 34 (90% CrI: 4-86) deaths due to domestically acquired waterborne LD annually in Canada from 2015 to 2019. It was further estimated that only 36% of illnesses and 39% of hospitalizations and deaths were captured in surveillance, and that 22% of illnesses were caused by serogroups and species other than serogroup 1 (non-Lp1). This study highlights the true burden and areas for improvement in Canada's surveillance and detection of LD.
Topics: Humans; Legionnaires' Disease; Canada; Legionella pneumophila; Legionellosis; Legionella; Cost of Illness
PubMed: 38204334
DOI: 10.1017/S0950268824000013 -
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 -
Annals of Agricultural and... Dec 2023The occurrence of bacteria of the genus Legionella sp. in hot water supply systems in buildings is a real threat to human health, especially for patients in hospitals...
INTRODUCTION AND OBJECTIVE
The occurrence of bacteria of the genus Legionella sp. in hot water supply systems in buildings is a real threat to human health, especially for patients in hospitals and residents of nursing homes. The aim of the study was determination of the degree of colonization of hot water systems in hospitals and nursing homes in the Świętokrzyskie Province in south-east Poland.
MATERIAL AND METHODS
Between 2014 - 2018, samples were collected from hot water systems in 30 hospitals and 32 nursing homes in order to determine the degree of contamination. 631 samples collected of the bacteria Legionella sp were analyzed.
RESULTS
Excessive contamination (≥ 100CFU/100 ml) with the bacteria Legionella sp. was detected in 12.12% (n=71) of samples. Contamination was significantly more frequently detected in samples from hot water systems in nursing homes, compared to hospitals (16.48% vs. 10.37%). Above-standard contamination of hot water systems with Legionella sp. bacteria occurred in 34.43% of the facilities, and was more frequent in hospitals (41.38%) than in the nursing homes (28.13%). In 21.3% of the facilities, contamination was detected many times during the study period.
CONCLUSIONS
Excessive contamination of hot water systems with Legionella sp. bacteria in the examined facilities was a common phenomenon. The presence of the pathogen in the installations of these facilities may constitute a considerable health hazard for patients and residents.
Topics: Humans; Legionella; Poland; Hot Temperature; Water Supply; Hospitals; Nursing Homes; Water; Water Microbiology; Legionella pneumophila
PubMed: 38153068
DOI: 10.26444/aaem/176501