1887

Abstract

is the leading cause of Legionnaires’ disease, a severe pneumonia that can occur as sporadic cases or point-source outbreaks affecting multiple patients. The infection is acquired by inhalation of aerosols from contaminated water systems. In order to identify the probable source and prevent further cases, clinical and environmental isolates are compared using phenotypic and genotypic methods. Typically up to 10 days are required to isolate prior to the application of standard typing protocols. A rapid protocol using a real-time PCR specific for and serogroup 1, combined with nested direct molecular typing, was adopted by Public Health England in 2012 to reduce reporting time for preliminary typing results. This rapid protocol was first used to investigate an outbreak that occurred in July/August 2012 and due to the positive feedback from that investigation, it was subsequently applied to other incidents in England and Wales where faster typing results would have aided incident investigation. We present here results from seven incidents that occurred between July 2012 and June 2015 where the use of this rapid approach provided preliminary characterization of the infecting strain in an average 1.58 days ( 1.01) after sample receipt in contrast to 9.53 days ( 3.73) when standard protocols were applied.

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2016-06-01
2019-12-11
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References

  1. Anonymous 1998; Water quality - detection and enumeration of Legionella. ISO 11731:1998. Geneva: International Organisation for Standardization.
  2. Bennett E., Ashton M., Calvert N., Chaloner J., Cheesbrough J., Egan J., Farrell I., Hall I., Harrison T. G., other authors. 2014; Barrow-in-furness: a large community legionellosis outbreak in the UK. Epidemiol Infect142:1763–1777 [CrossRef][PubMed]
    [Google Scholar]
  3. Coetzee N., Duggal H., Hawker J., Ibbotson S., Harrison T. G., Phin N., Laza-Stanca V., Johnston R., Iqbal Z., other authors. 2012; An outbreak of Legionnaires' disease associated with a display spa pool in retail premises, Stoke-on-Trent, United Kingdom, July 2012. Euro Surveill17:20271[PubMed]
    [Google Scholar]
  4. Collins S., Jorgensen F., Willis C., Walker J.. 2015; Real-time PCR to supplement gold-standard culture-based detection of Legionella in environmental samples. J Appl Microbiol119:1158–1169 [CrossRef][PubMed]
    [Google Scholar]
  5. Collins S. L., Afshar B., Walker J. T., Aird H., Naik F., Parry-Ford F., Phin N., Harrison T. G., Chalker V. J., Sorrell S., other authors. 2016; Heated birthing pools as a source of Legionnaires' disease. Epidemiol Infect144:796–802 [CrossRef][PubMed]
    [Google Scholar]
  6. Den Boer J. W., Yzerman E. P., Schellekens J., Lettinga K. D., Boshuizen H. C., Van Steenbergen J. E., Bosman A., Van den Hof S., Van Vliet H. A., other authors. 2002; A large outbreak of Legionnaires’ disease at a flower show, The Netherlands. 1999. Emerg Infect Dis2002:37–43[CrossRef]
    [Google Scholar]
  7. ECDC 2015; European Centre for Disease Prevention and Control 2013. Legionnaires’ Disease in Europe Stockholm: 2015. Available online at: :http://ecdc.europa.eu/en/publications/Publications/legionnaires-disease-2015.pdf
    [Google Scholar]
  8. Fraser D. W., Tsai T. R., Orenstein W., Parkin W. E., Beecham H. J., Sharrar R. G., Harris J., Mallison G. F., Martin S. M., other authors. 1977; Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med297:1189–1197 [CrossRef][PubMed]
    [Google Scholar]
  9. Gaia V., Fry N. K., Afshar B., Lück P. C., Meugnier H., Etienne J., Peduzzi R., Harrison T. G.. 2005; Consensus sequence-based scheme for epidemiological typing of clinical and environmental isolates of Legionella pneumophila . J Clin Microbiol43:2047–2052 [CrossRef][PubMed]
    [Google Scholar]
  10. Ginevra C., Lopez M., Forey F., Reyrolle M., Meugnier H., Vandenesch F., Etienne J., Jarraud S., Molmeret M.. 2009; Evaluation of a nested-PCR-derived sequence-based typing method applied directly to respiratory samples from patients with Legionnaires' disease. J Clin Microbiol47:981–987 [CrossRef][PubMed]
    [Google Scholar]
  11. Harrison T. G.. 2005; Legionella. In Topley & Wilson's Microbiology and Microbial Infections1761–1785 Edited by Borriello S. P., Murrray P. R., Funke G.. London: Hodder Arnold;
    [Google Scholar]
  12. Helbig J. H., Bernander S., Castellani Pastoris M., Etienne J., Gaia V., Lauwers S., Lindsay D., Lück P. C., Marques T., other authors. 2002; Pan-European study on culture-proven Legionnaires' disease: distribution of Legionella pneumophila serogroups and monoclonal subgroups. Eur J Clin Microbiol Infect Dis21:710–716 [CrossRef][PubMed]
    [Google Scholar]
  13. Lévesque S., Plante P. L., Mendis N., Cantin P., Marchand G., Charest H., Raymond F., Huot C., Goupil-Sormany I., other authors. 2014; Genomic characterization of a large outbreak of Legionella pneumophila serogroup 1 strains in Quebec City, 2012. PLoS One9:e103852 [CrossRef][PubMed]
    [Google Scholar]
  14. Lück C., Brzuszkiewicz E., Rydzewski K., Koshkolda T., Sarnow K., Essig A., Heuner K.. 2015; Subtyping of the Legionella pneumophila "Ulm" outbreak strain using the CRISPR-Cas system. Int J Med Microbiol305:828–837 [CrossRef][PubMed]
    [Google Scholar]
  15. Mentasti M., Fry N. K., Afshar B., Palepou-Foxley C., Naik F. C., Harrison T. G.. 2012; Application of Legionella pneumophila-specific quantitative real-time PCR combined with direct amplification and sequence-based typing in the diagnosis and epidemiological investigation of Legionnaires' disease. Eur J Clin Microbiol Infect Dis31:2017–2028 [CrossRef][PubMed]
    [Google Scholar]
  16. Mentasti M., Underwood A., Lück C., Kozak-Muiznieks N. A., Harrison T. G., Fry N. K.. 2014; Extension of the L egionella pneumophila sequence-based typing scheme to include strains carrying a variant of the N-acylneuraminate cytidylyltransferase gene. Clin Microbiol Infect20:435–441 [CrossRef][PubMed]
    [Google Scholar]
  17. Mentasti M., Kese D., Echahidi F., Uldum S. A., Afshar B., David S., Mrazek J., De Mendonça R., Harrison T. G., Chalker V. J.. 2015; Design and validation of a qPCR assay for accurate detection and initial serogrouping of Legionella pneumophila in clinical specimens by the ESCMID study group for Legionella infections (ESGLI). Eur J Clin Microbiol Infect Dis34:1387–1393 [CrossRef][PubMed]
    [Google Scholar]
  18. Moran-Gilad J., Lazarovitch T., Mentasti M., Harrison T., Weinberger M., Mordish Y., Mor Z., Stocki T., Anis E. et al. 2012; Humidifier-associated paediatric Legionnaires' disease, Israel, February 2012. Euro Surveill17:20293[PubMed]
    [Google Scholar]
  19. Mérault N., Rusniok C., Jarraud S., Gomez-Valero L., Cazalet C., Marin M., Brachet E., Aegerter P., Gaillard J. L., other authors. 2011; Specific real-time PCR for simultaneous detection and identification of L egionella pneumophila serogroup 1 in water and clinical samples. Appl Environ Microbiol77:1708–1717 [CrossRef][PubMed]
    [Google Scholar]
  20. Phin N., Parry-Ford F., Harrison T., Stagg H. R., Zhang N., Kumar K., Lortholary O., Zumla A., Abubakar I.. 2014; Epidemiology and clinical management of Legionnaires' disease. Lancet Infect Dis14:1011–1021 [CrossRef][PubMed]
    [Google Scholar]
  21. Ratzow S., Gaia V., Helbig J. H., Fry N. K., Lück P. C.. 2007; Addition of neuA, the gene encoding N-acylneuraminate cytidylyl transferase, increases the discriminatory ability of the consensus sequence-based scheme for typing Legionella pneumophila serogroup 1 strains. J Clin Microbiol45:1965–1968 [CrossRef][PubMed]
    [Google Scholar]
  22. Sedgwick J., Joseph C., Chandrakumar M., Harrison T., Lee J., de Jong B.. 2007; Outbreak of respiratory infection on a cruise ship. Euro Surveill12:E070809.1[PubMed]
    [Google Scholar]
  23. Shivaji T., Sousa Pinto C., San-Bento A., Oliveira Serra L. A., Valente J., Machado J., Marques T., Carvalho L., Nogueira P. J., other authors. 2014; A large community outbreak of Legionnaires’ disease in Vila Fanca de Xira, Portugal, October to November 2014. Euro Surveill19:20991 [CrossRef][PubMed]
    [Google Scholar]
  24. von Baum H., Ewig S., Marre R., Suttorp N., Gonschior S., Welte T., Lück C.. Competence Network for Community Acquired Pneumonia Study Group 2008; Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia. Clin Infect Dis46:1356–1364 [CrossRef][PubMed]
    [Google Scholar]
  25. von Baum H., Härter G., Essig A., Lück C., Gonser T., Embacher A., Brockmann S.. 2010; Preliminary report: outbreak of Legionnaires disease in the cities of Ulm and Neu-Ulm in Germany, December 2009 - January 2010. Euro Surveill15:19472[PubMed]
    [Google Scholar]
  26. Wewalka G., Schmid D., Harrison T. G., Uldum S. A., Lück C.. European Society of Clinical Microbiology Infectious Diseases Study Group for Legionella Infections (ESGLI) 2014; Dual infections with different Legionella strains. Clin Microbiol Infect20:O13–19 [CrossRef][PubMed]
    [Google Scholar]
  27. Yu V. L., Plouffe J. F., Pastoris M. C., Stout J. E., Schousboe M., Widmer A., Summersgill J., File T., Heath C. M., other authors. 2002; Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis186:127–128 [CrossRef][PubMed]
    [Google Scholar]
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