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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. [ABSTRACT FROM AUTHOR]

This case report aims to provide up-to-date information about the conditions requiring hospitalization in primary health-care services in cases of Legionella pneumonia. This case was a 66-year-old woman with a history of smoking who admitted to the emergency department with increasing dyspnea and fatigue. On physical examination, he appeared dyspneic and tachypneic, and on auscultation, inspiratory rales and bilateral widespread expiratory rhonchi were detected. C-reactive protein was 324.3 mg/L, leukocytosis was 10980 10³ /mm³, and neutrophil-dominated (90.2%). There was a respiratory failure according to the arterial blood gas analysis (PO2: 57.3 mmHg, HCO3: 25.7 mEq/L, PCO2: 33.6 mmHg, SO²: 91.3%). Moxifloxacin (400 mg 1×1) and oseltamivir (75 mg 2×1) peroral empirically were initiated because of pneumonia, and additionally inhaler steroid and bronchodilator treatments (Salmeterol+flutikazon 50/500 mcg twice daily) for bronchitis. However, on the third day of follow-up, 40 mg methylprednisolone parenterally was added to the treatment because of bronchospasm and dyspnea continued despite bronchodilator therapy, and additionally parenteral ampicillin-sulbactam (4x1 gr.) was started to expand the spectrum of Gram-positive bacteria. Legionella was detected as the causative pathogen by viral and bacterial sampling of the airways with PCR. Low awareness about the disease may cause serious mortality and morbidity in patients presenting with a vague clinical picture in the early stages. [ABSTRACT FROM AUTHOR]

Abstract Background Infections have been recognized as an uncommon cause of rhabdomyolysis, with evidence indicating a worse prognosis when compared to rhabdomyolysis caused by other etiologies. Diseases caused by Legionella pneumophila can present variably, ranging from mild to severe illness, as is sometimes the case with pneumonia. In particular, the triad of Legionnaire’s disease, rhabdomyolysis, and acute kidney injury is associated with a significant increase in the morbidity and mortality, with most patients requiring initiation of renal replacement therapy such as hemodialysis. While the exact mechanism of both the muscle and kidney injury in this setting remains unknown, several hypotheses exist, with some research suggesting multiple yet distinct processes occurring in both target organs. Case presentation In this case report, we describe a 53-year-old African American man who presented with Legionella pneumophila pneumonia complicated by rhabdomyolysis and acute kidney injury. He was treated with aggressive fluid resuscitation and a 2-week course of azithromycin. His clinical status improved without necessitating renal replacement therapy or mechanical ventilation. We postulate that early recognition and treatment were key to his recovery. He was discharged 10 days later without recurrence of rhabdomyolysis at the time of this report. Conclusion While there are several well-established and more common causes of rhabdomyolysis, clinicians should recognize Legionella sp. as an etiology, given its association with significant morbidity and mortality.

Background: Infections have been recognized as an uncommon cause of rhabdomyolysis, with evidence indicating a worse prognosis when compared to rhabdomyolysis caused by other etiologies. Diseases caused by Legionella pneumophila can present variably, ranging from mild to severe illness, as is sometimes the case with pneumonia. In particular, the triad of Legionnaire's disease, rhabdomyolysis, and acute kidney injury is associated with a significant increase in the morbidity and mortality, with most patients requiring initiation of renal replacement therapy such as hemodialysis. While the exact mechanism of both the muscle and kidney injury in this setting remains unknown, several hypotheses exist, with some research suggesting multiple yet distinct processes occurring in both target organs. Case presentation: In this case report, we describe a 53-year-old African American man who presented with Legionella pneumophila pneumonia complicated by rhabdomyolysis and acute kidney injury. He was treated with aggressive fluid resuscitation and a 2-week course of azithromycin. His clinical status improved without necessitating renal replacement therapy or mechanical ventilation. We postulate that early recognition and treatment were key to his recovery. He was discharged 10 days later without recurrence of rhabdomyolysis at the time of this report. Conclusion: While there are several well-established and more common causes of rhabdomyolysis, clinicians should recognize Legionella sp. as an etiology, given its association with significant morbidity and mortality. [ABSTRACT FROM AUTHOR]

Preliminary research has suggested possible associations between natural waterways and Legionella infection, and we previously explored these associations in eastern Wisconsin using positive L. pneumophila serogroup 1 urine antigen tests (LUAT) as diagnostic. This case-control study was a secondary analysis of home address data from patients who underwent LUAT at a single eastern Wisconsin health system from 2013 to 2017. Only zip codes within the health system’s catchment area that registered ≥ 3 positive cases and ≥ 50 completed tests, as well as geographically adjacent zip codes with ≥ 2 positive cases and ≥ 50 tests, were included. A 1:3 ratio of cases to randomly selected controls was used. Home addresses were geocoded and mapped using ArcGIS software (Esri); nearest waterway and distance to home was identified. Distance to nearest waterway according to ArcGIS was verified/corrected using Google Maps incognito. Distances were analyzed using chi-squared and 2-sample t-tests. Overall, mean distance to nearest waterway did not differ between cases (2958 ± 2049 ft) and controls (2856 ± 2018 ft; P = 0.701). However, in a subset of nonurban zip codes, cases were closer to nearest waterway than controls (1165 ± 905 ft vs 2113 ± 1710 ft; P = 0.019). No association was found between cases and type of waterway. Further research is needed to investigate associations and differences between natural and built environmental water sources in relation to legionellosis.

Abstract Background Legionnaire’s disease is one of the major causes of community-acquired pneumonia and is occasionally complicated by neurological symptoms. However, reports of ocular lesions due to Legionnaire’s disease are limited. Case presentation We report the case of a patient with Legionnaire’s disease presenting as bilateral central scotomata due to retinal lesions. The patient consulted due to fever and bilateral central scotomata, as well as other extrapulmonary symptoms. Optical coherence tomography (OCT) showed bilateral accumulations of fluid under the retina, and the patient was diagnosed with bilateral exudative retinal detachment. Later, Legionnaire’s disease was confirmed by pulmonary infiltrates on chest imaging and positive urinary antigen for Legionella pneumophila. After administration of antibiotics, the bilateral central scotomata and bilateral subretinal fluid accumulations completely resolved, as did the other extrapulmonary symptoms and the pulmonary infiltrates. Thus, the bilateral central scotomata due to exudative retinal detachment were thought to be caused by Legionnaire’s disease. Conclusions This case demonstrates that Legionnaire’s disease can present as bilateral central scotomata. We may consider the possibility of extrapulmonary involvement complicating Legionnaire’s disease when we encounter bilateral ocular lesions in patients with fever and pneumonia.

Atypical pneumonia has evolved in recent decades to signify lower respiratory tract diseases caused by certain respiratory pathogens. These pathogens are distinguished clinically and radiologically from typical bacterial community-acquired pneumonia (CAP). The spectrum of such infections includes zoonotic and non-zoonotic transmissions, with the latter being more common. The tendency of extrapulmonary involvement, which is true for each kind of atypical CAP, distinguishes clinically from classical CAP. Therefore, clinical syndromic diagnosis is important for raising the index of suspicion and commencing appropriate empirical antibiotic therapy and prompting further diagnostic testing. We aimed to review the literature to enhance the understanding and awareness of atypical pneumonia. We reviewed the literature for atypical pneumonia; clinical manifestations, approach to diagnosis, and management. Articles were chosen from the PubMed database, and selected studies were subjected to a thorough review. Atypical organisms that cause pneumonia are more likely to cause systemic disorders with a wide range of extrapulmonary symptoms. On the other hand, some of them are difficult to culture and dangerous to isolate. As a result, clinical syndromic diagnosis is crucial for raising the index of suspicion, commencing appropriate empirical antibiotic therapy, and promoting specific diagnostic tests. [ABSTRACT FROM AUTHOR]

Infection with Legionella spp. (legionellosis) causes two distinct clinical presentations: Legionnaires’ Disease and Pontiac Fever. Legionnaire’s Disease primarily involves the lungs, often with accompanying gastrointestinal symptoms, and can also affect the liver, central nervous system, and kidneys, and cause metabolic derangements. Manifestations in the integumentary system are rare; to date, there have been eleven cases reported in the literature of Legionellosis with associated rash, with varied presentation. The relationship between Legionella pneumophila and the skin has not yet been clearly defined; immunological and/or toxic pathogenesis are possible. We report a case of Legionnaires’ Disease in a young immunocompromised man with a largely benign clinical course consisting of predominantly gastrointestinal symptoms and an extensive maculopapular rash. Chest radiography showed lobar infiltrate in the absence of clinical symptoms of pneumonia. The importance of this case is for clinicians to maintain high clinical suspicion for Legionella when extra-pulmonary symptoms predominate, specifically in immunocompromised hosts who may have atypical presentations and have higher mortality rates when treatment is delayed.

Legionnaires' disease is a severe form of pneumonia caused by Legionella 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., Competing Interests: The authors declare no conflict of interest.

This report describes a combined immunofluorescence and fluorescence viability stain applied as one staining solution for rapid detection of live Legionella pneumophila in mixed bacterial populations. Instead of sequential viability staining with the Invitrogen BacLight LIVE/DEAD staining kit followed by antibody-Alexa Fluor (AF) 647 conjugate staining to identify live L. pneumophila, a combined single cocktail solution staining protocol was developed to simplify and accelerate the time to detection of viable L. pneumophila serogroup-1 (SG-1) in mixed species populations on a filter membrane. The stain cocktail will aid in accelerating fluorescence microscopic analysis of cooling tower, air conditioner and water fountain or other liquid samples for the presence of L. pneumophila and its viability status. Visibly red stained cells were identified as dead non-L. pneumophila SG-1 cells, while green fluorescing cells represented viable non-L. pneumophila SG-1 cells. Due to also staining red with antibody-AF 647, L. pneumophila SG-1 cells were pseudocolorized as blue to distinguish them from other dead cells. Fluorescence color emission mixing from the viability dyes (SYTO 9 and propidium iodide) with antibody-AF 647 stained L. pneumophila led to other fluorescent colors. For example, green plus pseudocolorized blue AF 647-antibody- labeled cells were identified as live cyan-colored L. pneumophila SG-1 cells. Magenta-colored cells resulted from dead L. pneumophila cells that combined red propidium iodide with blue pseudocolorized AF 647-antibody emissions. Analysis of measured RGB (red, green, blue) color values in microscopic images of mixed bacterial populations suggests the possibility of facile automated discrimination of subpopulations of live and dead L. pneumophila and non-L. pneumophila species by computers in 3-dimensional RGB color space after staining in the combined cocktail which will save time for more rapid microscopic detection of potential sources of Legionnaire's disease. [ABSTRACT FROM AUTHOR]

Background The Infectious Diseases Society of America recommends either a fluoroquinolone or a macrolide as a first-line antibiotic treatment for Legionella pneumonia, but it is unclear which antibiotic leads to optimal clinical outcomes. We compared the effectiveness of fluoroquinolone versus macrolide monotherapy in Legionella pneumonia using a systematic review and meta-analysis. Methods We conducted a systematic search of literature in PubMed, Cochrane, Scopus, and Web of Science from inception to 1 June 2019. Randomized controlled trials and observational studies comparing macrolide with fluoroquinolone monotherapy using clinical outcomes in patients with Legionella pneumonia were included. Twenty-one publications out of an initial 2073 unique records met the selection criteria. Following PRISMA guidelines, 2 reviewers participated in data extraction. The primary outcome was mortality. Secondary outcomes included clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. The review and meta-analysis was registered with PROSPERO (CRD42019132901). Results Twenty-one publications with 3525 patients met inclusion criteria. The mean age of the population was 60.9 years and 67.2% were men. The mortality rate for patients treated with fluoroquinolones was 6.9% (104/1512) compared with 7.4% (133/1790) among those treated with macrolides. The pooled odds ratio assessing risk of mortality for patients treated with fluoroquinolones versus macrolides was 0.94 (95% confidence interval,.71–1.25, I 2 = 0%, P  = .661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones versus macrolides. Conclusions We found no difference in the effectiveness of fluoroquinolones versus macrolides in reducing mortality among patients with Legionella pneumonia. [ABSTRACT FROM AUTHOR]

Jea H Yu,1 Jaycob Avaylon,1 Hyein Kil,1 Jisoo K Kim,1 Ron P Gallemore1,21Department of Clinical Research, Retina Macula Institute, Torrance, CA, USA; 2Department of Ophthalmology, University of California, Los Angeles, CA, USAPurpose: To report a case of endophthalmitis associated with Legionella Pneumophila.Case Report: A 46-year-old, highly myopic male with a complex history of recurrent retinal detachments, macular hole, cataract surgery and an infected scleral buckle in the left eye, presented with pain, redness, hypopyon and vision loss in the left eye, 14 days following blunt head trauma. Empirical treatment for endophthalmitis with intravitreal injections of Vancomycin and Ceftazidime afforded minimal improvement. He developed recurrent hypopyon and underwent vitrectomy surgery with intravitreal antibiotic injections at the time of surgery and had improvement. Intraoperative culture was positive for Legionella Pneumophila. He had continued episodes of recurrent inflammation which were quelled by intravitreal moxifloxacin injections performed every 3–10 days. He developed a recurrent RD with proliferative vitreoretinopathy (PVR) and underwent vitrectomy with silicone oil. The retina was reattached but had no light perception vision in the affected eye.Conclusion: When endophthalmitis is contracted in a work-place setting, a culture for L. pneumophila should be considered. A combination of intravitreal moxifloxacin and oral azithromycin may be effective.Keywords: endophthalmitis, Legionella Pneumophila, Legionnaire’s disease

Legionella longbeachae pneumonia is much less common than Legionella pneumophila pneumonia in most of the world and may evade timely diagnosis in settings that rely primarily on urine antigen testing, which detects Legionella pnuemophila serogroup 1 only. It is, however, widely recognized in Australia and New Zealand, where it is endemic and associated with exposure to compost and potting soils, rather than contaminated water systems as seen with L. pneumophila. L. longbeachae can cause a similar spectrum and severity of illness as L. pneumophila. Here we present a case of a 47-year-old man with L. longbeacheae necrotizing pneumonia following exposure to possibly contaminated soil from a wastewater treatment facility. Initial presentation included cough, chest pain, and dyspnea, and progressed to hypoxic respiratory failure, tension pneumothorax, and cardiac arrest. L. pneumophila urine antigen was negative, but bronchioalveolar lavage samples grew L. longbeachae on buffered charcoal yeast extract agar. A review of cases reported in the literature in non-endemic regions over a 20-year period identified 38 cases in Europe, 33 in Asia, and 8 in North America. Average age was 65, 65 % were male, and 35 % had potentially relevant environmental exposures. L. longbeachae should be considered in cases of severe community acquired pneumonia, particularly following a consistent environmental exposure or if initial testing for other pathogens is unrevealing. A thorough exposure history including questions about contact with potting soil or compost, and utilization of specialized agar for culture can both be key in identifying this pathogen.

Background: Legionnaire's disease is one of the major causes of community-acquired pneumonia and is occasionally complicated by neurological symptoms. However, reports of ocular lesions due to Legionnaire's disease are limited.Case Presentation: We report the case of a patient with Legionnaire's disease presenting as bilateral central scotomata due to retinal lesions. The patient consulted due to fever and bilateral central scotomata, as well as other extrapulmonary symptoms. Optical coherence tomography (OCT) showed bilateral accumulations of fluid under the retina, and the patient was diagnosed with bilateral exudative retinal detachment. Later, Legionnaire's disease was confirmed by pulmonary infiltrates on chest imaging and positive urinary antigen for Legionella pneumophila. After administration of antibiotics, the bilateral central scotomata and bilateral subretinal fluid accumulations completely resolved, as did the other extrapulmonary symptoms and the pulmonary infiltrates. Thus, the bilateral central scotomata due to exudative retinal detachment were thought to be caused by Legionnaire's disease.Conclusions: This case demonstrates that Legionnaire's disease can present as bilateral central scotomata. We may consider the possibility of extrapulmonary involvement complicating Legionnaire's disease when we encounter bilateral ocular lesions in patients with fever and pneumonia. [ABSTRACT FROM AUTHOR]

From 2011 through 2018, there was a notable increase in sporadic Legionnaires’ disease in the state of Minnesota. Sporadic cases are those not associated with a documented outbreak. Outbreak-related cases are typically associated with a common identified contaminated water system; sporadic cases typically do not have a common source that has been identified. Because of this, it is hypothesised that weather and environmental factors can be used as pre dictors of sporadic Legionnaires’ disease. An ecological design was used with case report surveillance data from the state of Minnesota during 2011 through 2018. Over this 8-year period, there were 374 confirmed Legionnaires’ disease cases included in the analysis. Precipitation, temperature and relative humidity (RH) data were collected from weather stations across the state. A Poisson regression analysis examined the risk of Legionnaires’ disease associated with precipitation, temperature, RH, land-use and age. A lagged average 14-day precipitation had the strongest association with Legionnaires’ disease (RR 2.5, CI 2.1–2.9), when accounting for temperature, RH, land-use and age. Temperature, RH and land-use also had statistically significant associations to Legionnaires’ disease, but with smaller risk ratios. This study adds to the body of evidence that weather and environmental factors play an important role in the risk of sporadic Legionnaires’ disease. This is an area that can be used to target additional research and prevention strategies. [ABSTRACT FROM AUTHOR]

Les infections à Legionella sont causées par une bactérie intracellulaire habitant principalement les environnements aquatiques. La contamination se fait par inhalation d'aérosols. Les facteurs de risques principaux sont le tabac, l'immunodépression et l'âge avancé. Les signes extra-respiratoires sont peu spécifiques. L'argument clinique le plus solide en faveur d'une légionellose est la résistance aux béta lactamines en cas de pneumopathie. Le diagnostic repose avant tout sur l'antigénurie en cas d'infection à Legionella pneumophila de type 1. L'antigénurie est prise en défaut chez les patients infectés à Legionella non pneumophilia comme les patients immunodéprimés. La culture et la PCR sont alors indispensables au diagnostic. La maladie des légionnaires, forme pulmonaire de l'infection à Legionella , est grave, en particulier chez les sujets âgés et/ou les patients immunodéprimés. Le taux de mortalité varie de 10 % dans la population générale, à 50 % en cas d'hospitalisation en réanimation. Le traitement repose sur les macrolides ou les fluoroquinolones. La résistance aux antibiotiques est exceptionnelle. Legionella- related disease is caused by an intracellular bacteria mainly living in water. Contamination results from inhalation of Legionella sp containing aerosolized water. Main risk factors are tobacco, immunodeficiency, and advanced age. Antigenuria is the cornerstone of the diagnosis. Immunocompromised patients, more commonly infected with non pneumophila Legionella , present negative antigenuria, and culture and PCR are essential for the diagnosis. Legionnaires' disease may be severe, especially in elderly and/or immunocompromised patients. Mortality rate varies from 10 % in the general population to 50 % in intensive care. Treatment is based on macrolides or fluoroquinolones. Antibiotic resistance is very rare. [ABSTRACT FROM AUTHOR]

This case report details the clinical picture of a renal transplant recipient infected with community acquired Legionella pneumonia. While it is more commonly associated as a nosocomial infection due to pathogenic organisms in a hospital's water supply, this case serves as a reminder to consider the patient's impaired cellular immune function when trying to diagnose community acquired pneumonia. [ABSTRACT FROM AUTHOR]

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According to the Centers for Disease Control and Prevention (CDC), from 2000 to 2014, reported cases of legionellosis per 100 000 population increased by 300% in the USA, although reports on disease seasonality are inconsistent. Using two national databases, we assessed seasonal patterns of legionellosis in the USA. We created a monthly time series from 1993 to 2015 of reported cases of legionellosis from the CDC, and from 1997 to 2006 of medical claims of legionellosis-related hospitalisation in older adults from the Centers for Medicaid and Medicare Services (CMS). We split the study time interval into two segments (before and after 2003), and applied a Poisson harmonic regression model to each dataset and each segment. The time series of monthly counts exhibited a significant shift of seasonal peaks from mid-September (9.676 ± 0.164 months) before 2003 to mid-August (8.452 ± 0.042 months) after 2003, along with an alarming increase in the amplitude of seasonal peaks in both CDC and CMS data. The lowest monthly reported cases of legionellosis in 2015 (281) exceed the maximum value reported before 2003 (206). We also observed a discrepancy between CDC and CMS data, suggesting that not all cases of legionellosis diagnosed by hospital-based laboratories were reported to the CDC. Improved reporting of legionellosis is required to better inform the public and organise disease prevention. [ABSTRACT FROM AUTHOR]

Background: The purpose of the Collaborative on Fatigue Following Infection (COFFI) is for investigators of post-infection fatigue (PIF) and other syndromes to collaborate on these enigmatic and poorly understood conditions by studying relatively homogeneous populations with known infectious triggers. Utilising COFFI, pooled data and stored biosamples will support both epidemiological and laboratory research to better understand the etiology and risk factors for development and progression of PIF. Methods: COFFI consists of prospective cohorts from the UK, Netherlands, Norway, USA, New Zealand and Australia, with some cohorts closed and some open to recruitment. The 9 cohorts closed to recruitment total over 3000 participants, including nearly 1000 with infectious mononucleosis (IM), > 500 with Q fever, > 800 with giardiasis, > 600 with campylobacter gastroenteritis (CG), 190 with Legionnaires disease and 60 with Ross River virus. Follow-ups have been at least 6 months and up to 10 years. All studies use the Fukuda criteria for defining chronic fatigue syndrome (CFS). Results: Preliminary analyses indicated that risk factors for non-recovery from PIF included lower physical fitness, female gender, severity of the acute sickness response, and autonomic dysfunction. Conclusions: COFFI (https://internationalcoffi.wordpress.com/) is an international collaboration which should be able to answer questions based on pooled data that are not answerable in the individual cohorts. Possible questions may include the following: Do different infections trigger different PIF syndromes (e.g. CFS vs. irritable bowel syndrome)?; What are longitudinal predictors of PIF and its severity? [ABSTRACT FROM AUTHOR]

Background: Although the incidence of legionellosis throughout North America and Europe continues to increase, public health investigations have not been able to identify a common exposure in most cases. Over 80% of cases are sporadic with no known source. To better understand the role of the macro-environment in legionellosis risk, a retrospective ecological study assessed associations between population-level measures of demographic, socioeconomic, and environmental factors and high-risk areas. Methods: Geographic variability and clustering of legionellosis was explored in our study setting using the following methods: unadjusted and standardized incidence rate and SaTScan™ cluster detection methods using default scanning window of 1 and 50% as well as a reliability score methodology. Methods for classification of "high-risk" census tracts (areas roughly equivalent to a neighborhood with average population of 4000) for each of the spatial methods are presented. Univariate and multivariate logistic regression analyses were used to estimate associations with sociodemographic factors: population ⩾ 65 years of age, non-white race, Hispanic ethnicity, poverty, less than or some high school education; housing factors: housing vacant, renter-occupied and built pre-1950 and pre-1970; and whether drinking water is groundwater or surface water source. Results: Census tracts with high percentages of poverty, Hispanic population and non-white population were more likely to be classified as high-risk for legionellosis versus a low-risk census tract. Vacant housing, renter-occupied housing, and homes built pre-1970 were also important positively associated risk factors. Drinking water source was not found to be associated with legionellosis incidence. Discussion: Census tract level demographic, socioeconomic and environmental characteristics are important risk factors of legionellosis and add to our understanding of the macro-environment for legionellosis occurrence. Our findings can be used by public health professionals to target disease prevention communication to vulnerable populations. Future studies are needed to explore the exact mechanisms by which these risk factors may influence legionellosis clustering. [ABSTRACT FROM AUTHOR]

Objective: B. contaminans was cultured from respiratory secretions and liquid docusate (Colace) in a Neurosurgical Intensive Care Unit (NICU) patient with community-acquired Legionnaire's disease but not from another bottle given to the patient. Unexpectedly, C. pelliculosa was cultured from two bottles, but not the B. contaminans bottle or respiratory secretions. Methods: B. cepacia, later identified as B. contaminans, was cultured from a bottle of liquid docusate (Colace) dispensed to a non-cystic fibrosis patient. His respiratory secretions were colonized with B. contaminans. Results: Eradication of B. contaminans colonization in the patient's respiratory secretions was attempted. With levofloxacin, B. contaminans developed multidrug resistance (MDR). Subsequent TMP-SMX therapy did not result in further MDR. Nine other ICU patients were given docusate from the same lot, but there were no other B. contaminans isolates. Conclusion: B. contaminans colonization of respiratory secretion may be difficult to eliminate. The significance of C. pelliculosa cultured from liquid docusate (Colace) remains to be elucidated. In this case, it appeared that B. contaminans may have inhibited the growth of C. pelliculosa in the same bottle. Others should be alerted to the possibility that C. pelliculosa may be present in B. contaminans-contaminated lots of liquid docusate (Colace). [ABSTRACT FROM AUTHOR]

Background and Purpose: Collaboration between the physical therapist and prosthetist is essential for patients with any type of amputation. This case report describes a patient with multiple limb amputations due to medical complications resulting from community acquired Legionnaires' disease (LD). The physical therapy evaluation, examination, diagnosis, interventions, and outcomes along with collaboration with the prosthetist are discussed. Case Description: A 55-year-old previously healthy male contracted LD and subsequently developed multiple medical complications in acute care. This resulted in left transradial and bilateral transtibial amputations due to hypotension-induced ischemia from sepsis. A 2-month course of inpatient rehabilitation is described, including changes in functional status and progression to safe discharge home. Outcomes: Physical therapy interventions resulted in an improvement from total assist for all functional mobility to ambulating at a standby assist level with bilateral lower limb and left upper limb prosthesis. He improved his 10-m walk test score from 0.07 to 0.60 m/s, 6-minute walk test to 133 m, and timed up and go test to 47 seconds. Discussion: A comprehensive list of physical therapy interventions needs to be included for successful rehabilitation of a medically complex patient with multiple limb amputations. Collaboration with the prosthetist is inherent and critical. Future research may include a series of case reports or a study using practice-based evidence. This would allow for more associations to be made regarding interventions for patients with multiple limb amputations. [ABSTRACT FROM AUTHOR]

An explosive outbreak of Legionnaires’ disease with 64 reported cases occurred in Ulm/Neu-Ulm in the South of Germany in December 2009/January 2010 caused by Legionella ( L. ) pneumophila serogroup 1, monoclonal (mAb) subtype Knoxville, sequence type (ST) 62. Here we present the clinical microbiological results from 51 patients who were diagnosed at the University hospital of Ulm, the results of the environmental investigations and of molecular typing of patients and environmental strains. All 50 patients from whom urine specimens were available were positive for L. pneumophila antigen when an enzyme-linked immunosorbent assay (EIA) was used following concentration of those urine samples that tested initially negative. The sensitivity of the BinaxNow rapid immunographic assay (ICA), after 15 min reading and after 60 min reading were 70% and 84%, respectively. Direct typing confirmed the monoclonal subtype Knoxville in 5 out of 8 concentrated urine samples. Real time PCR testing of respiratory tract specimens for L. pneumophila was positive in 15 out of 25 (60%) patients. Direct nested sequence based typing (nSBT) in some of these samples allowed partial confirmation of ST62. L. pneumophila serogroup 1, monoclonal subtype Knoxville ST62, defined as the epidemic strain was isolated from 8 out of 31 outbreak patients (26%) and from one cooling tower confirming it as the most likely source of the outbreak. While rapid detection of Legionella antigenuria was crucial for the recognition and management of the outbreak, culture and molecular typing of the strains from patients and environmental specimens was the clue for the rapid identification of the source of infection. [ABSTRACT FROM AUTHOR]

El objetivo de este artículo es hacer una aproximación desde el punto de vista geográfico, tomando la comunidad autónoma como unidad de análisis, de 3 elementos de salud ambiental como representantes más actuales: legionelosis, seguridad química y seguridad alimentaria. La legionelosis es una patología con un perfil epidemiológico concreto: hombres mayores y con hábitos y enfermedades crónicas previas. La respuesta normativa ante los brotes y el incremento de la incidencia de legionelosis ha sido variable entre las comunidades autónomas (CCAA) debido a peculiaridades y a culturas organizativas distintas. Tanto el hundimiento del buque Prestige como el accidente de la planta de Puertollano (Ciudad Real) han aumentado la inquietud de la población sobre las sustancias químicas, tan familiares en nuestro entorno. No sólo los grandes accidentes son relevantes; sorprende conocer que la gran mayoría de las intoxicaciones registradas se deben a productos de limpieza de uso en el hogar. El reto pendiente desde el punto de vista de la salud pública es elaborar el Informe sobre la Exposición Humana a Agentes Químicos Ambientales, lo que sin duda contribuirá a establecer diferencias por clase y género. Por último, el número de brotes de enfermedades trasmitidas por alimentos se ha mantenido con el paso de los años; esto debería conducir a reflexionar sobre la efectividad de los programas de seguridad alimentaria y a incidir en el medio familiar, por ser el lugar donde se producen la mayoría de los brotes. El Registro General Sanitario de Alimentos puede ser una buena herramienta para mejorar la seguridad alimentaria.The objective of this article is to investigate three representative elements of environmental health from a geographical perspective taking the Autonomous Community as the unit of analysis: legionnaire's disease, chemical safety and food safety. Legionnaire's disease is a pathology with a specific epidemiological profile; males, adults, and with previous chronic pathologies and habits. The official response, with regard to recent outbreaks and the increase in the incidence of legionnaire's disease, has differed between autonomous communities due to peculiarities and different organizational cultures. Both the sinking of the ship Prestige and the accident at the oil refinery at Puertollano (Ciudad Real) have increased concern in the population about chemical substances, so familiar in our environment. However it is not only the big accidents which are relevant: it is surprising to learn that most of the registered poisonings are due to domestic cleaning goods. The pending challenge from the Public Health point of view is to elaborate the Report on Human Exposure to Environmental Chemical Agents which, undoubtedly, will help to establish differences between type and class. Finally, the number of outbreaks of food poisoning continues to be of concern; this should lead us to think about the effectiveness of food safety programmes and to focus on the home, being place where most of the outbreaks occur. The General Sanitary Inspection of Food ought to be a good tool to help improve food safety.

To evaluate the role of amoeba-associated bacteria as agents of ventilator-associated pneumonia (VAP), we tested the water from an intensive care unit (ICU) every week for 6 months for such bacteria isolates; serum samples and bronchoalveolar lavage samples (BAL) were also obtained from 30 ICU patients. BAL samples were examined for amoeba-associated bacteria DNA by suicide-polymerase chain reaction, and serum samples were tested against ICU amoeba-associated bacteria. A total of 310 amoeba-associated bacteria from10 species were isolated. Twelve of 30 serum samples seroconverted to one amoeba-associated bacterium isolated in the ICU, mainly Legionella anisa and Bosea massiliensis, the most common isolates from water (p=0.021). Amoeba-associated bacteria DNA was detected in BAL samples from two patients whose samples later seroconverted. Seroconversion was significantly associated with VAP and systemic inflammatory response syndrome, especially in patients for whom no etiologic agent was found by usual microbiologic investigations. Amoeba-associated bacteria might be a cause of VAP in ICUs, especially when microbiologic investigations are negative.

Legionella pneumophila is the main pathogen responsible for outbreaks of Legionnaires' disease, which can be related to contaminated water supplies such as cooling towers or water pipes. We combined conventional molecular methods and whole genome sequence (WGS) analysis to investigate an outbreak of L. pneumophila in a large Australian hospital. Typing of these isolates using sequence-based typing and virulence gene profiling, was unable to discriminate between outbreak and non-outbreak isolates. WGS analysis was performed on isolates during the outbreak, as well as on unlinked isolates from the Public Health Microbiology reference collection. The more powerful resolution provided by analysis of whole genome sequences allowed outbreak isolates to be distinguished from isolates that were temporally and spatially unassociated with the outbreak, demonstrating that this technology can be used in real-time to investigate L. pneumophila outbreaks. [ABSTRACT FROM PUBLISHER]

We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2–22·0] and 5·5 (95% CI 2·1–14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control. [ABSTRACT FROM PUBLISHER]

Legionella pneumophila is an opportunistic pathogen that replicates within alveolar macrophages resulting in the onset of severe atypical pneumonia. Previously we have identified Lpg1905, a eukaryotic-type ecto-NTPDase (nucleoside triphosphate diphosphohydrolase) from L. pneumophila that was required for optimal intracellular replication and virulence in a mouse lung infection model. In the present study, we characterized the activity of a second eukaryotic-type NTPDase, Lpg0971, from L. pneumophila. We observed that recombinant Lpg0971 hydrolysed only ATP and exhibited divalent cation preference for manganese (II) ions. Similar to lpg1905, an lpg0971 mutant carrying the plasmid pMIP was attenuated in a mouse lung infection model and impaired for replication in human macrophages and amoebae. Increased trafficking of the LCV (Legionella-containing vacuole) to a LAMP-1 (lysosome-associated membrane protein-1)-positive compartment was observed for both the lpg1905 and lpg0971 mutants carrying pMIP. Complementation with either lpg1905 or lpg0971 restored intracellular replication, suggesting that a minimum level of ATPase activity was required for this function. A double lpg1905/0971 mutant was not more impaired for intracellular replication than the single mutants and complementation of the double mutant with lpg0971, but not lpg1905, restored intracellular replication. This suggested that although the NTPDases have overlapping activities they have distinct functions. Unlike many eukaryotic-type proteins from L. pneumophila, neither Lpg1905 nor Lpg0971 were translocated into the host cell by the Dot/Icm (defective in organelle trafficking/intracellular multiplication) type IV secretion system. Overall our data suggest that the ability of L. pneumophila to replicate in eukaryotic cells relies in part on the ability of the pathogen to hydrolyse ATP within an intracellular compartment. [ABSTRACT FROM AUTHOR]

Sapronotic disease agents have evolutionary and epidemiological properties unlike other infectious organisms. Their essential saprophagic existence prevents coevolution, and no host-parasite virulence trade-off can evolve. However, the host may evolve defenses. Models of pathogens show that sapronoses, lacking a threshold of transmission, cannot regulate host populations, although they can reduce host abundance and even extirpate their hosts. Immunocompromised hosts are relatively susceptible to sapronoses. Some particularly important sapronoses, such as cholera and anthrax, can sustain an epidemic in a host population. However, these microbes ultimately persist as saprophages. One-third of human infectious disease agents are sapronotic, including nearly all fungal diseases. Recognition that an infectious disease is sapronotic illuminates a need for effective environmental control strategies. [ABSTRACT FROM AUTHOR]

Legionella pneumophila is an intracellular pathogen that replicates within alveolar macrophages. Through its ability to activate multiple host innate immune components, L. pneumophila has emerged as a useful tool to dissect inflammatory signalling pathways in macrophages. However the resolution of L. pneumophila infection requires multiple cell types and abundant cross talk between immune cells. Few studies have examined the coordination of events that lead to effective immune control of the pathogen. Here we discuss what is known about L. pneumophila interactions with macrophages and dendritic cell subsets and highlight the paucity of knowledge around how these interactions recruit and activate other immune effector cells in the lung.