scholarly journals When Legionnaires’ Disease Isn’t: Case Presentation and Implications of the Council of State and Territorial Epidemiologists (CSTE) Changes to Case Definitions

2020 ◽  
Vol 41 (S1) ◽  
pp. s512-s513
Author(s):  
Janet E. Stout ◽  
Anurag Malani
Keyword(s):  
Health Department ◽  
Health Departments ◽  
Urinary Antigen ◽  
Case Definitions ◽  
Case Presentation ◽  
New Information ◽  
Legionnaires Disease ◽  
Antigen Tests ◽  
Council Of State ◽  
Outbreak Case

Background: Most cases of Legionnaires’ disease are diagnosed by the urinary antigen test (UAT). Single cases of suspected healthcare-acquired Legionnaires’ disease are often investigated by local and state health departments. Such investigations can result in disruptive and expensive interventions. We report a case of a urine-antigen–positive patient whose clinical presentation was inconsistent with Legionnaires’ disease. Within the same year, an employee at this hospital was diagnosed with presumed community-acquired Legionnaires’ disease; however, the case was considered by the health department to be healthcare acquired. The occurrence of 2 cases, as determined by the health department, fulfilled the definition for an outbreak investigation and triggered water restrictions and extensive testing of the environment and patients for Legionella. The cases and the implications of these actions are reviewed in the context of new information about false-positive urinary-antigen tests and changes to the outbreak case definitions for Legionnaires’ disease by the Council of State and Territorial Epidemiologists (CTSE). This includes “probable” cases that have no positive diagnostic tests.Funding: NoneDisclosures: Janet E. Stout reports salary from the Special Pathogens Laboratory and is an owner.

Hospital Characteristics Associated With Colonization of Water Systems byLegionellaand Risk of Nosocomial Legionnaires' Disease: A Cohort Study of 15 Hospitals

1999 ◽  
Vol 20 (12) ◽  
pp. 798-805 ◽  
Author(s):  
Jacob L. Kool ◽  
David Bergmire-Sweat ◽  
Jay C. Butler ◽  
Ellen W. Brown ◽  
Deborah J. Peabody ◽  
...  
Keyword(s):  
Drinking Water ◽  
San Antonio ◽  
Water System ◽  
Water Systems ◽  
Hot Water ◽  
Control Measures ◽  
Chlorine Concentration ◽  
Urinary Antigen ◽  
Legionnaires Disease ◽  
Antigen Tests

AbstractObjective:To investigate an increase in reports of legionnaires' disease by multiple hospitals in San Antonio, Texas, and to study risk factors for nosocomial transmission of legionnaires' disease and determinants forLegionellacolonization of hospital hot-water systems.Setting:The 16 largest hospitals in the cities of San Antonio, Temple, and Austin, Texas.Design:Review of laboratory databases to identify patients with legionnaires' disease in the 3 years prior to the investigation and to determine the number of diagnostic tests forLegionellaperformed; measurement of hot-water temperature and chlorine concentration and culture of potable water forLegionella. Exact univariate calculations, Poisson regression, and linear regression were used to determine factors associated with water-system colonization and transmission ofLegionella.Results:Twelve cases of nosocomial legionnaires' disease were identified; eight of these occurred in 1996. The rise in cases occurred shortly after physicians started requestingLegionellaurinary antigen tests. Hospitals that frequently usedLegionellaurinary antigen tests tended to detect more cases of legionnaires' disease.Legionellawas isolated from the water systems of 11 of 12 hospitals in San Antonio; the 12th had just experienced an outbreak of legionnaires' disease and had implemented control measures. Nosocomial legionellosis cases probably occurred in 5 hospitals. The number of nosocomial legionnaires' disease cases in each hospital correlated better with the proportion of water-system sites that tested positive forLegionella (P=.07) than with the concentration ofLegionellabacteria in water samples (P=.23). Hospitals in municipalities where the water treatment plant used monochloramine as a residual disinfectant (n=4) and the hospital that had implemented control measures wereLegionella-free. The hot-water systems of all other hospitals (n=11) were colonized withLegionella. These were all supplied with municipal drinking water that contained free chlorine as a residual disinfectant. In these contaminated hospitals, the proportion of sites testing positive was inversely correlated with free residual chlorine concentration (P=.01). In all hospitals, hot-water temperatures were too low to inhibitLegionellagrowth.Conclusions:The increase in reporting of nosocomial legionnaires' disease was attributable to increased use of urinary antigen tests; prior cases may have gone unrecognized. Risk of legionnaires' disease in hospital patients was better predicted by the proportion of water-system sites testing positive forLegionellathan by the measured concentration ofLegionellabacteria. Use of monochloramine by municipalities for residual drinking water disinfection may help prevent legionnaires' disease.

scholarly journals Severe bilateral pleuropneumonia caused by Legionella sainthelensi: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Laure Kamus ◽  
Bénédicte Roquebert ◽  
Jérôme Allyn ◽  
Nicolas Allou ◽  
Dorothée Valance ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Bronchopleural Fistula ◽  
University Hospital ◽  
Diagnostic Tools ◽  
Urinary Antigen ◽  
Case Presentation ◽  
Freshwater Bacteria ◽  
Legionnaires Disease ◽  
Infectious Illness

Abstract Background Legionella spp. are ubiquitous freshwater bacteria responsible for rare but potentially severe cases of Legionnaires’ disease (LD). Legionella sainthelensi is a non-pneumophila Legionella species that was first isolated in 1980 from water near Mt. St-Helens (USA). Although rare cases of LD caused by L. sainthelensi have been reported, very little data is available on this pathogen. Case presentation We describe the first documented case of severe bilateral pleuropneumonia caused by L. sainthelensi. The patient was a 35-year-old woman with Sharp’s syndrome treated with long-term hydroxychloroquine and corticosteroids who was hospitalized for an infectious illness in a university hospital in Reunion Island (France). The patient’s clinical presentation was complicated at first (bilateral pneumonia, multiloculated pleural effusion, then bronchopleural fistula) but her clinical condition eventually improved with the reintroduction of macrolides (spiramycin) in intensive care unit. Etiological diagnosis was confirmed by PCR syndromic assay and culture on bronchoalveolar lavage. Conclusions To date, only 14 documented cases of L. sainthelensi infection have been described worldwide. This pathogen is difficult to identify because it is not or poorly detected by urinary antigen and molecular methods (like PCR syndromic assays that primarily target L. pneumophila and that have only recently been deployed in microbiology laboratories). Pneumonia caused by L. sainthelensi is likely underdiagnosed as a result. Clinicians should consider the possibility of non-pneumophila Legionella infection in patients with a compatible clinical presentation when microbiological diagnostic tools targeted L. pneumophila tested negative.

scholarly journals Evaluation of Four Lateral Flow Assays for the Detection of Legionella Urinary Antigen

2021 ◽  
Vol 9 (3) ◽  
pp. 493
Author(s):  
Alicia Y. W. Wong ◽  
Alexander T. A. Johnsson ◽  
Aina Iversen ◽  
Simon Athlin ◽  
Volkan Özenci
Keyword(s):  
Sensitivity And Specificity ◽  
Lateral Flow ◽  
Urine Samples ◽  
Visual Interpretation ◽  
Urinary Antigen ◽  
Lateral Flow Assays ◽  
Legionnaires Disease ◽  
Antigen Tests ◽  
Weak Result ◽  
Visual Results

Urinary antigen tests (UATs) are often used to diagnose Legionnaires’ disease as they are rapid and easy to perform on readily obtainable urine samples without the need for specialized skills compared to conventional methods. Recently developed automated readers for UATs may provide objective results interpretation, especially in cases of weak result bands. Using 53 defined patient urine samples, we evaluated the performance of the BinaxNOW Legionella Antigen Card (Abbott), ImmuView S. pneumoniae and Legionella (SSI Diagnostica), STANDARD F Legionella Ag FIA (SD Biosensor), and Sofia Legionella FIA (Quidel) simultaneously with their respective automated readers. Automatic and visual interpretation of result bands were also compared for the immunochromatography-based BinaxNOW and ImmuView UATs. Overall sensitivity and specificity of Legionella UATs were 53.9–61.5% and 90.0–94.9%, respectively. All four UATs successfully detected all samples from L. pneumophila serogroup 1-positive patients, but most failed to detect samples for Legionella spp., or other serogroups. Automatic results interpretation of results was found to be mostly concordant with visual results reading. In conclusion, the performance of the four UATs were similar to each other in the detection of Legionella urinary antigen with no major difference between automated or visual results reading.

scholarly journals Applied Epidemiology Workforce Growth and Capacity Challenges: The Council of State and Territorial Epidemiologists 2017 Epidemiology Capacity Assessment

2019 ◽  
Vol 134 (4) ◽  
pp. 379-385 ◽  
Author(s):  
Jessica Arrazola ◽  
Mia N. Israel ◽  
Nancy Binkin
Keyword(s):  
Public Health ◽  
Health Department ◽  
The United States ◽  
Current Status ◽  
Public Health Department ◽  
Health Departments ◽  
State Health ◽  
Public Health Services ◽  
Full Capacity ◽  
Council Of State

Objectives: To better understand the current status and challenges of the state public health department workforce, the Council of State and Territorial Epidemiologists (CSTE) assessed the number and functions of applied public health epidemiologists at state health departments in the United States. Methods: In 2017, CSTE emailed unique online assessment links to state epidemiologists in the 50 states and the District of Columbia (N = 51). The response rate was 100%. CSTE analyzed quantitative data (27 questions) on funding, the number of current and needed epidemiologists, recruitment, retention, perceived capacity, and training. CSTE coded qualitative data in response to an open-ended question that asked about the most important problems state epidemiologists face. Results: Most funding for epidemiologic activities came from the federal government (mean, 77%). State epidemiologists reported needing 1199 additional epidemiologists to achieve ideal capacity but noted challenges in recruiting qualified staff members. Respondents cited opportunities for promotion (n = 45, 88%), salary (n = 41, 80%), restrictions on merit raises (n = 36, 70%), and losses to the private or government sector (n = 33, 65%) as problems for retention. Of 4 Essential Public Health Services measured, most state epidemiologists reported substantial-to-full capacity to monitor health status (n = 43, 84%) and diagnose and investigate community health problems (n = 47, 92%); fewer respondents reported substantial-to-full capacity to conduct evaluations (n = 20, 39%) and research (n = 11, 22%). Conclusions: Reliance on federal funding negatively affects employee retention, core capacity, and readiness at state health departments. Creative solutions for providing stable funding, developing greater flexibility to respond to emerging threats, and enhancing capacity in evaluation and applied research are needed.

scholarly journals Sensitivity of Three Urinary Antigen Tests Associated with Clinical Severity in a Large Outbreak of Legionnaires' Disease in The Netherlands

2002 ◽  
Vol 40 (9) ◽  
pp. 3232-3236 ◽  
Author(s):  
E. P. F. Yzerman ◽  
J. W. d. Boer ◽  
K. D. Lettinga ◽  
J. Schellekens ◽  
J. Dankert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Clinical Severity ◽  
Urinary Antigen ◽  
Large Outbreak ◽  
Legionnaires Disease ◽  
Antigen Tests

scholarly journals Shifting Landscape of Healthcare-Associated Infection and Antimicrobial Resistant Infection Reporting Policy, 2005–2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s389-s389
Author(s):  
Jeremy Goodman ◽  
Samuel Clasp ◽  
Arjun Srinivasan ◽  
Elizabeth Mothershed ◽  
Seth Kroop ◽  
...  
Keyword(s):  
Health Department ◽  
Adverse Outcomes ◽  
Health Departments ◽  
Healthcare Associated Infection ◽  
Candida Auris ◽  
Quality Reporting ◽  
Notifiable Diseases ◽  
Reporting Requirements ◽  
Resistant Infection ◽  
Healthcare Associated

Background: Healthcare-associated infections (HAIs) are a serious threat to patient safety; they account for substantial morbidity, mortality, and healthcare costs. Healthcare practices, such as inappropriate use of antimicrobials, can also amplify the problem of antimicrobial resistance. Data collected to target HAI prevention and antimicrobial stewardship efforts and measure progress are an important resource for assuring transparency and accountability in healthcare, tracking adverse outcomes, investigating healthcare practices that may spread or protect against disease, detecting and responding to the spread of resistant pathogens, preventing infections, and saving lives. Methods: We discuss 3 healthcare-associated infection and antimicrobial Resistant infection (HAI-AR) reporting types: NHSN HAI-AR reporting, reportable diseases, and nationally notifiable diseases. HAI-AR reporting requirements outline facilities and data to report to NHSN and the health department to comply with state laws. Reportable diseases are those that facilities, providers, and laboratories are required to report to the health department. Nationally notifiable diseases are those reported by health departments to the CDC for nationwide surveillance and analysis as determined by Council of State and Territorial Epidemiologists (CSTE) and the CDC. Data presented are based on state and federal policy; NHSN data are based on CDC reporting statistics. Results: Since the 2005 launch of the CDC NHSN and publication of federal advisory committee HAI reporting guidance, most states have established policies stipulating healthcare facilities in their jurisdiction report HAIs and resistant infections to the NHSN to gain access to those data, increasing from 2 states in 2005, to 18 in 2010, and to 36 states, Washington, DC, and Philadelphia in 2019. Reporting policies and NHSN participation expanded greatly following the 2011 inception of CMS HAI quality reporting requirements, with several states aligning state requirements with CMS reporting. States listing carbapenem-resistant Enterobacteriaceae (CRE) as a reportable disease increased from 7 in 2013 to 41 states and the District of Columbia in 2019. Vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus (VISA/VRSA) was added as a nationally notifiable disease in 2004, carbapenemase-producing CRE (CP-CRE) was added in 2018, and Candida auris clinical infections were added in 2019. The CDC and most jurisdictions with HAI reporting mandates issue public reports based on aggregate state data and/or facility-level data. States may also alert healthcare providers and health departments of emerging threats and to assist in notifying patients of potential exposure. Conclusions: Through efforts by health departments, facilities, patient advocates, partners, the CDC, and other federal agencies, HAI-AR reporting has steadily increased. Although reporting laws and data uses vary between jurisdictions, data provided serves as valuable tools to inform prevention.Funding: NoneDisclosures: None

scholarly journals Legionnaires' Disease Outbreak at a Resort in Cozumel, Mexico

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Lee M. Hampton ◽  
Laurel Garrison ◽  
Jessica Kattan ◽  
Ellen Brown ◽  
Natalia A. Kozak-Muiznieks ◽  
...  
Keyword(s):  
United States ◽  
Potable Water ◽  
Water System ◽  
Disease Outbreak ◽  
Community Acquired Pneumonia ◽  
Health Departments ◽  
Medical Providers ◽  
Cozumel Island ◽  
European Working ◽  
Legionnaires Disease

Abstract Background.  A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease. Methods.  Reports of LD among travelers were solicited from US health departments and the European Working Group for Legionella Infections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possible Legionella exposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested for Legionella. Results.  Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers. Legionellae were found to have extensively colonized the resort's potable water system. Legionellae matching a case isolate were found in the resort's potable water system. Conclusions.  Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so.

scholarly journals Complete Genome Sequences of the HistoricalLegionella pneumophilaStrains OLDA and Pontiac

2016 ◽  
Vol 4 (4) ◽  
Author(s):  
Jeffrey W. Mercante ◽  
Shatavia S. Morrison ◽  
Brian H. Raphael ◽  
Jonas M. Winchell
Keyword(s):  
Legionella Pneumophila ◽  
Complete Genome ◽  
Health Department ◽  
Sporadic Case ◽  
Disease Outbreak ◽  
Genome Sequences ◽  
Outbreak Strain ◽  
Legionnaires Disease

Here, we report the complete genome sequences ofLegionella pneumophilaserogroup 1 strains OLDA and Pontiac, which predate the 1976 Philadelphia Legionnaires’ disease outbreak. Strain OLDA was isolated in 1947 from an apparent sporadic case, and strain Pontiac caused an explosive outbreak at a Michigan health department in 1968.

scholarly journals Secondary transmissions during the outbreak of Shiga toxin-producing Escherichia coli O104 in Hesse, Germany, 2011

2011 ◽  
Vol 16 (31) ◽  
Author(s):  
A M Hauri ◽  
U Götsch ◽  
I Strotmann ◽  
J Krahn ◽  
G Bettge-Weller ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Case Definition ◽  
Case Definitions ◽  
Secondary Transmission ◽  
E Coli ◽  
Outbreak Area ◽  
The Family ◽  
Satellite Clusters ◽  
Outbreak Case

During the recent outbreak of Shiga toxin-producing Escherichia coli (STEC) O104:H4 in Germany most cases notified in the State of Hesse (6 million inhabitants) were linked to satellite clusters or had travelled to the outbreak area in northern Germany. Intensified surveillance was introduced to rapidly identify cases not linked to known clusters or cases and thus to obtain timely information on possible further contaminated vehicles distributed in Hesse, as well to describe the risk of secondary transmission among known cases. As of 2 August 2011*, 56 cases of haemolytic uraemic syndrome (HUS) including two fatal cases, and 124 cases of STEC gastroenteritis meeting the national case definitions have been reported in Hesse. Among the 55 HUS and 81 STEC gastroenteritis cases that met the outbreak case definition, one HUS case and eight STEC gastroenteritis cases may have acquired their infection through secondary transmission. They include six possible transmissions within the family, two possible nosocomial and one possible laboratory transmission. Our results do not suggest an increased transmissibility of the outbreak strain compared to what is already known about E. coli O157 and other STEC serotypes.

Health Codes for Newborn Care

PEDIATRICS ◽  
1987 ◽  
Vol 80 (1) ◽  
pp. 1-5
Author(s):  
Salvatore J. Caravella ◽  
David A. Clark ◽  
Harry S. Dweck
Keyword(s):  
New York ◽  
Umbilical Cord ◽  
Vitamin K ◽  
New York State ◽  
Newborn Care ◽  
Health Department ◽  
Birth Certificates ◽  
Health Departments ◽  
Umbilical Cord Care ◽  
Metabolic Screening

A survey was conducted of the health departments in each of the 50 states, Washington, DC, and the Commonwealth of Puerto Rico to determine the present legal mandates for newborn care. Each of the 52 health departments were queried regarding birth certificates, identification procedures, prophylactic eye care, umbilical cord care, use of vitamin K, Apgar scoring, and metabolic screening. In each category, the departments were asked whether the procedures were mandatory or optional. Birth certificates are uniformly required within the health codes of all states. Although in-hospital identification of newborns is required in most states, four states specifically require arm banding, and only New York State requires footprinting. Eye prophylaxis with silver nitrate is required in 49 states, with erythromycin or tetracycline allowed as topical alternatives in 42 states. Clamping of the umbilical cord is addressed by eight states. Parenteral vitamin K administration is mandated by only five states. Apgar scoring is addressed by 25 states. Newborn metabolic screening is available in every health department, although significant variations exist in the tests available.

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