1/45. Multiple types of legionella pneumophila serogroup 6 in a hospital heated-water system associated with sporadic infections.Five sporadic cases of nosocomial legionnaires' disease were documented from 1989 to 1997 in a hospital in northern italy. Two of them, which occurred in a 75-year-old man suffering from ischemic cardiopathy and in an 8-year-old girl suffering from acute leukemia, had fatal outcomes. legionella pneumophila serogroup 6 was isolated from both patients and from hot-water samples taken at different sites in the hospital. These facts led us to consider the possibility that a single clone of L. pneumophila serogroup 6 had persisted in the hospital environment for 8 years and had caused sporadic infections. Comparison of clinical and environmental strains by monoclonal subtyping, macrorestriction analysis (MRA), and arbitrarily primed PCR (AP-PCR) showed that the strains were clustered into three different epidemiological types, of which only two types caused infection. An excellent correspondence between the MRA and AP-PCR results was observed, with both techniques having high discriminatory powers. However, it was not possible to differentiate the isolates by means of ribotyping and analysis of rrn operon polymorphism. Environmental strains that antigenically and chromosomally matched the infecting organism were present at the time of infection in hot-water samples taken from the ward where the patients had stayed. Interpretation of the temporal sequence of events on the basis of the typing results for clinical and environmental isolates enabled the identification of the ward where the patients became infected and the modes of transmission of Legionella infection. The long-term persistence in the hot-water system of different clones of L. pneumophila serogroup 6 indicates that repeated heat-based control measures were ineffective in eradicating the organism.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/45. Legionella pneumonia from a novel industrial aerosol.After a worker from a plastics factory was diagnosed with legionella pneumonia it was learnt that a retired employee at the factory had been in hospital with a serious chest infection six months before and legionella pneumonia was diagnosed in retrospect from stored serum. The likeliest common source was a machine cooling system that took water from an uncovered water tank outdoors (from which legionella pneumophila was isolated) and which generated an aerosol through a crack in the flow meter sight glass.- - - - - - - - - - ranking = 0.28571428571429keywords = water (Clic here for more details about this article) |
3/45. legionella pneumophila pneumonia in a newborn after water birth: a new mode of transmission.We report a case of legionella pneumophila pneumonia in a 7-day old neonate. Because the hospital water, and particularly the pool water for water birthing, was contaminated by L. pneumophila serogroup 1, the newborn was infected following prolonged delivery in contaminated water, perhaps by aspiration. This is the first case of nosocomial Legionella pneumonia in neonate after water birth.- - - - - - - - - - ranking = 1.2857142857143keywords = water (Clic here for more details about this article) |
4/45. legionnaires' disease associated with habitual drinking of hot spring water.A 57-year-old man presented with pneumonia, respiratory distress, and myelodysplastic syndrome. A diagnosis of legionnaires' disease due to Legionella pneumophila (L. pneumophila) was established. The patient had long been drinking tap water via a conduit from a hot spring resource, from which L. pneumophila was also isolated. Both the patient's strain and the water strain of L. pneumophila were identified as serogroup 1, and the genetic relatedness between the two strains as seen by pulsed-field gel electrophoresis was 87%. The patient was successfully treated with erythromycin, fluoroquinolone, and rifampicin. This case raises an important issue on public health represented by legionellosis in japan.- - - - - - - - - - ranking = 0.85714285714286keywords = water (Clic here for more details about this article) |
5/45. legionnaires' disease in a renal transplant recipient: nosocomial or home-grown?legionnaires' disease is a community-acquired or hospital-acquired pneumonia, and the immunocompromised patient is at particular risk. We report a case of serogroup 1 pneumonia in a renal transplant patient shortly after grafting. No source of infection was identified in the hospital unit, but an extended investigation located patient exposure to a shower during a weekend home stay. Sampling at the hospital, in the patient's flat, other flats, and the laundry of the same building returned only one positive result from the patient's showerhead. Strain identity was confirmed by pulsed-field electrophoresis and amplified fragment length polymorphism. Guidelines recommend -free water for transplant units, but further epidemiologic evidence is required before extending this preventive approach to the patient's home.- - - - - - - - - - ranking = 0.14285714285714keywords = water (Clic here for more details about this article) |
6/45. Hot spring bath and Legionella pneumonia: an association confirmed by genomic identification.A 59-year-old man developed pneumonia 9 days after bathing in a hot spring spa. Bilateral shadows on his chest radiograph rapidly progressed after admission. He was successfully treated with erythromycin and rifampicin. legionella pneumophila serogroup 6 was recovered from an intratrachial specimen and a significant elevation was observed in a paired indirect fluorescent antibody to Legionella. Persistent slight fever and chest rentogenographic shadows resolved after administering low-dose prednisolone to treat organizing pneumonia shown by transbronchial lung biopsy. The same serotype of Legionella was recovered from the water of the hot spring spa where the man had bathed. When the extracted dna of these two strains showed identical restriction fragments by pulsed-field gel electrophoresis, we had direct evidence that hot spring spas can be a source of Legionella pneumonia.- - - - - - - - - - ranking = 0.14285714285714keywords = water (Clic here for more details about this article) |
7/45. Residential water supply as a likely cause of community-acquired legionnaires' disease in an immunocompromised host.A 69-year-old man with Sweet's syndrome and myelodysplastic syndrome presented with pneumonia and respiratory distress. He had been taking corticosteroids and methotrexate. The diagnosis of legionnaires' disease was established by the isolation of legionella pneumophila serogroup 6 from sputum and a fourfold seroconversion of Legionella antibodies to 1:512. legionella pneumophila serogroup 6 was isolated from faucets in two homes owned by the patient. Strains of legionella pneumophila serogroup 6 isolated from the patient's sputum and from one home were demonstrated to be genetically identical by pulsed-field gel electrophoresis but different from strains found in the other home and in a hospital outpatient clinic that he visited. This case illustrates an emerging public health issue concerning acquisition of community-acquired legionnaires' disease from the homes of immunocompromised hosts. This is the first such case reported in asia.- - - - - - - - - - ranking = 0.57142857142857keywords = water (Clic here for more details about this article) |
8/45. Neonatal sudden death due to Legionella pneumonia associated with water birth in a domestic spa bath.We report the first case of neonatal legionnaires' disease associated with water birth in a spa bath at home. legionella pneumophila serogroup 6 was detected from postmortem lung tissue.- - - - - - - - - - ranking = 0.71428571428571keywords = water (Clic here for more details about this article) |
9/45. Outbreak of legionnaires' disease on a cruise ship: lessons for international surveillance and control.A sporadic case of legionnaires' disease was linked to travel on a cruise ship. Investigation identified two further cases of legionnaires' disease and one case of non-pneumonic Legionella infection. An Incident Team confirmed the source to be the ship's water system and control measures were instituted that included pasteurisation, super chlorination and chlorine dioxide dosing. The public health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC), through the European Surveillance Scheme for travel Associated legionnaires' disease, identified three previous cases associated with the same ship's water system including one fatality. Lessons for the international surveillance and control of legionnaires' disease on cruise ships are discussed.- - - - - - - - - - ranking = 0.28571428571429keywords = water (Clic here for more details about this article) |
10/45. Clinical and epidemiologic investigation of two Legionella-Rickettsia co-infections.BACKGROUND: We treated two patients diagnosed with legionellosis and simultaneous rickettsia conorii co-infection. OBJECTIVES: To report the clinical and laboratory characteristics of this unusual combination, and to describe the execution and results of our environmental and epidemiologic investigations. methods: Serial serologic testing was conducted 1, 4 and 7 weeks after initial presentation. Water samples from the patients' residence were cultured for Legionella. Follow-up cultures were taken from identical points at 2 weeks and at 3 months after the initial survey. RESULTS: Both patients initially expressed a non-specific rise in anti-Legionella immunoglobulin m titers to multiple serotypes. By week 4 a definite pattern of specifically elevated IgG titers became apparent, with patient 1 demonstrating a rise in specific anti-L. pneumophila 12 IgG titer and patient 2 an identical response to L. jordanis. At 4 weeks both patients were positive for both IgM and IgG anti-R. conorii antibodies at a titer > or = 1:100. Heavy growth of Legionella was found in water sampled from the shower heads in the rooms of both patients. Indirect immunofluorescence of water cultures was positive for L. pneumophila 12 and for L. jordanis. CONCLUSIONS: Although most cases of community-acquired Legionella pneumonia in our region appear simultaneously with at least one other causative agent, co-infection with R. conorii is unusual and has not been reported to date. This report illustrates the importance of cooperation between clinicians and public health practitioners.- - - - - - - - - - ranking = 0.28571428571429keywords = water (Clic here for more details about this article) |
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