An Outbreak of Legionnaires Disease Associated with a Decorative Water Wall Fountain in a Hospital

Thomas E. Haupt; Richard T. Heffernan; James J. Kazmierczak; Henry Nehls-Lowe; Bruce Rheineck; Christine Powell; Kathryn K. Leonhardt; Amit S. Chitnis; Jeffrey P. Davis

doi:10.1086/663711

An Outbreak of Legionnaires Disease Associated with a Decorative Water Wall Fountain in a Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/663711 ◽

2012 ◽

Vol 33 (2) ◽

pp. 185-191 ◽

Cited By ~ 48

Author(s):

Thomas E. Haupt ◽

Richard T. Heffernan ◽

James J. Kazmierczak ◽

Henry Nehls-Lowe ◽

Bruce Rheineck ◽

...

Keyword(s):

Legionella Pneumophila ◽

Site Investigation ◽

Healthcare Facility ◽

Water Wall ◽

Need To Evaluate ◽

Legionnaires Disease ◽

Public Area ◽

Testing Case ◽

Routine Cleaning ◽

Wisconsin Hospital

Objective.To detect an outbreak-related source of Legionella, control the outbreak, and prevent additional Legionella infections from occurring.Design and Setting.Epidemiologic investigation of an acute outbreak of hospital-associated Legionnaires disease among outpatients and visitors to a Wisconsin hospital.Patients.Patients with laboratory-confirmed Legionnaires disease who resided in southeastern Wisconsin and had illness onsets during February and March 2010.Methods.Patients with Legionnaires disease were interviewed using a hypothesis-generating questionnaire. On-site investigation included sampling of water and other potential environmental sources for Legionella testing. Case-finding measures included extensive notification of individuals potentially exposed at the hospital and alerts to area healthcare and laboratory personnel.Results.Laboratory-confirmed Legionnaires disease was diagnosed in 8 patients, all of whom were present at the same hospital during the 10 days prior to their illness onsets. Six patients had known exposure to a water wall-type decorative fountain near the main hospital entrance. Although the decorative fountain underwent routine cleaning and maintenance, high counts of Legionella pneumophila serogroup 1 were isolated from cultures of a foam material found above the fountain trough.Conclusion.This outbreak of Legionnaires disease was associated with exposure to a decorative fountain located in a hospital public area. Routine cleaning and maintenance of fountains does not eliminate the risk of bacterial contamination. Our findings highlight the need to evaluate the safety of water fountains installed in any area of a healthcare facility.Infect Control Hosp Epidemiol 2012;33(2):185-191

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Efficacy of SCH27899 in an Animal Model of Legionnaires' Disease Using Immunocompromised A/J Mice

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.44.5.1333-1336.2000 ◽

2000 ◽

Vol 44 (5) ◽

pp. 1333-1336 ◽

Cited By ~ 7

Author(s):

Joan K. Brieland ◽

David Loebenberg ◽

Fred Menzel ◽

Roberta S. Hare

Keyword(s):

Animal Model ◽

Murine Model ◽

Legionella Pneumophila ◽

Immunocompromised Host ◽

Lung Infection ◽

Cortisone Acetate ◽

Contrast Administration ◽

Once Daily ◽

Legionnaires Disease ◽

Lung Infections

ABSTRACT The efficacy of SCH27899, a new everninomicin antibiotic, against replicative Legionella pneumophila lung infections in an immunocompromised host was evaluated using a murine model of Legionnaires' disease. A/J mice were immunocompromised with cortisone acetate and inoculated intratracheally with L. pneumophilaserogroup 1 (105 CFU per mouse). At 24 h postinoculation, mice were administered either SCH27899 (6 to 60 mg/kg [MPK] intravenously) or a placebo once daily for 5 days, and mortality and intrapulmonary growth of L. pneumophila were assessed. In the absence of SCH27899, there was 100% mortality inL. pneumophila-infected mice, with exponential intrapulmonary growth of the bacteria. In contrast, administration of SCH27899 at a dose of ≥30 MPK resulted in ≥90% survival of infected mice, which was associated with inhibition of intrapulmonary growth ofL. pneumophila. In subsequent studies, the efficacy of SCH27899 was compared to ofloxacin (OFX) and azithromycin (AZI). Administration of SCH27899, OFX, or AZI at a dose of ≥30 MPK once daily for 5 days resulted in ≥85% survival of infected mice and inhibition of intrapulmonary growth of the bacteria. However, L. pneumophila CFU were recovered in lung homogenates following cessation of therapy with all three antibiotics. These studies demonstrate that SCH27899 effectively prevents fatal replicativeL. pneumophila lung infection in immunocompromised A/J mice by inhibition of intrapulmonary growth of the bacteria. However, in this murine model of pulmonary legionellosis, SCH27899, like OFX and AZI, was bacteriostatic.

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Subtyping ofLegionella pneumophilaisolates by arbitrarily primed polymerase chain reaction

Canadian Journal of Microbiology ◽

10.1139/m95-116 ◽

1995 ◽

Vol 41 (9) ◽

pp. 846-848 ◽

Cited By ~ 5

Author(s):

E. Ledesma ◽

J. Llorca ◽

M. A. Dasí ◽

M. L. Camaró ◽

E. Carbonell ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Legionella Pneumophila ◽

Water Sources ◽

Chain Reaction ◽

Single Room ◽

Legionnaires Disease ◽

Polymerase Chain ◽

Resort Hotel ◽

Different Water Sources

Arbitrarily primed polymerase chain reaction (AP-PCR) was used to differentiate strains of Legionella pneumophila isolated from different water sources in a resort hotel in Benidorm, Alicante, Spain, where an outbreak of Legionnaires' disease occurred among a group of tourists between 65 and 80 years of age. All isolates were L. pneumophila serogroup 1, subtype Pontiac (Knoxville 1). Five different patterns (P1 to P5) were obtained by AP-PCR. The number of bands per pattern varied between 4 and 11. Patterns P1 and P2 represented 60 and 20% of L. pneumophila isolates, respectively. Since different subpopulations of L. pneumophila coexisted (up to three different AP-PCR patterns were identified in a single room), it was not possible to link an individual L. pneumophila strain to the occurrence of this outbreak.Key words: Legionella pneumophila, AP-PCR, subtyping, outbreak.

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Human Lung Tissue Explants Reveal Novel Interactions during Legionella pneumophila Infections

Infection and Immunity ◽

10.1128/iai.00703-13 ◽

2013 ◽

Vol 82 (1) ◽

pp. 275-285 ◽

Cited By ~ 35

Author(s):

Jens Jäger ◽

Sebastian Marwitz ◽

Jana Tiefenau ◽

Janine Rasch ◽

Olga Shevchuk ◽

...

Keyword(s):

Lung Tissue ◽

Legionella Pneumophila ◽

Human Lung ◽

Transcriptional Response ◽

Human Infection ◽

Bacterial Invasion ◽

Human Lung Tissue ◽

Content Type ◽

Tissue Explants ◽

Legionnaires Disease

ABSTRACTHistological and clinical investigations describe late stages of Legionnaires' disease but cannot characterize early events of human infection. Cellular or rodent infection models lack the complexity of tissue or have nonhuman backgrounds. Therefore, we developed and applied a novel model forLegionella pneumophilainfection comprising living human lung tissue. We stimulated lung explants withL. pneumophilastrains and outer membrane vesicles (OMVs) to analyze tissue damage, bacterial replication, and localization as well as the transcriptional response of infected tissue. Interestingly, we found that extracellular adhesion ofL. pneumophilato the entire alveolar lining precedes bacterial invasion and replication in recruited macrophages. In contrast, OMVs predominantly bound to alveolar macrophages. Specific damage to septa and epithelia increased over 48 h and was stronger in wild-type-infected and OMV-treated samples than in samples infected with the replication-deficient, type IVB secretion-deficient DotA−strain. Transcriptome analysis of lung tissue explants revealed a differential regulation of 2,499 genes after infection. The transcriptional response included the upregulation of uteroglobin and the downregulation of the macrophage receptor with collagenous structure (MARCO). Immunohistochemistry confirmed the downregulation of MARCO at sites of pathogen-induced tissue destruction. Neither host factor has ever been described in the context ofL. pneumophilainfections. This work demonstrates that the tissue explant model reproduces realistic features of Legionnaires' disease and reveals new functions for bacterial OMVs during infection. Our model allows us to characterize early steps of human infection which otherwise are not feasible for investigations.

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How the parasitic bacterium Legionella pneumophila modifies its phagosome and transforms it into rough ER: implications for conversion of plasma membrane to the ER membrane

Journal of Cell Science ◽

10.1242/jcs.114.24.4637 ◽

2001 ◽

Vol 114 (24) ◽

pp. 4637-4650 ◽

Cited By ~ 1

Author(s):

Lewis G. Tilney ◽

Omar S. Harb ◽

Patricia S. Connelly ◽

Camenzind G. Robinson ◽

Craig R. Roy

Keyword(s):

Legionella Pneumophila ◽

Mitochondrial Membranes ◽

Macrophage Infection ◽

Thin Sections ◽

Stage Process ◽

Legionnaires Disease ◽

Rough Er ◽

Membrane Changes ◽

Phagosomal Membrane

Within five minutes of macrophage infection by Legionella pneumophila, the bacterium responsible for Legionnaires’ disease, elements of the rough endoplasmic reticulum (RER) and mitochondria attach to the surface of the bacteria-enclosed phagosome. Connecting these abutting membranes are tiny hairs, which are frequently periodic like the rungs of a ladder. These connections are stable and of high affinity - phagosomes from infected macrophages remain connected to the ER and mitochondria (as they were in situ) even after infected macrophages are homogenized. Thin sections through the plasma and phagosomal membranes show that the phagosomal membrane is thicker (72±2 Å) than the ER and mitochondrial membranes (60±2 Å), presumably owing to the lack of cholesterol, sphingolipids and glycolipids in the ER. Interestingly, within 15 minutes of infection, the phagosomal membrane changes thickness to resemble that of the attached ER vesicles. Only later (e.g. after six hours) does the ER-phagosome association become less frequent. Instead ribosomes stud the former phagosomal membrane and L. pneumophila reside directly in the rough ER. Examination of phagosomes of various L. pneumophila mutants suggests that this membrane conversion is a four-stage process used by L. pneumophila to establish itself in the RER and to survive intracellularly. But what is particularly interesting is that L. pneumophila is exploiting a poorly characterized naturally occuring cellular process.

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Highlighting the Potency of Biosurfactants Produced by Pseudomonas Strains as Anti-Legionella Agents

BioMed Research International ◽

10.1155/2018/8194368 ◽

2018 ◽

Vol 2018 ◽

pp. 1-15 ◽

Cited By ~ 5

Author(s):

Clémence Loiseau ◽

Emilie Portier ◽

Marie-Hélène Corre ◽

Margot Schlusselhuber ◽

Ségolène Depayras ◽

...

Keyword(s):

Legionella Pneumophila ◽

Close Association ◽

Water Systems ◽

Antagonistic Activity ◽

Reverse Phase Hplc ◽

Reverse Phase ◽

Free Living ◽

Legionnaires Disease ◽

Culture Supernatants ◽

Multispecies Biofilms

Legionella pneumophila, the causative agent of Legionnaires’ disease, is a waterborne bacterium mainly found in man-made water systems in close association with free-living amoebae and multispecies biofilms. Pseudomonas strains, originating from various environments including freshwater systems or isolated from hospitalized patients, were tested for their antagonistic activity towards L. pneumophila. A high amount of tested strains was thus found to be active. This antibacterial activity was correlated to the presence of tensioactive agents in culture supernatants. As Pseudomonas strains were known to produce biosurfactants, these compounds were specifically extracted and purified from active strains and further characterized using reverse-phase HPLC and mass spectrometry methods. Finally, all biosurfactants tested (lipopeptides and rhamnolipids) were found active and this activity was shown to be higher towards Legionella strains compared to various other bacteria. Therefore, described biosurfactants are potent anti-Legionella agents that could be used in the water treatment industry although tests are needed to evaluate how effective they would be under field conditions.

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Peptidyl-Prolyl-cis/trans-Isomerases Mip and PpiB ofLegionella pneumophilaContribute to Surface Translocation, Growth at Suboptimal Temperature, and Infection

Infection and Immunity ◽

10.1128/iai.00939-17 ◽

2018 ◽

Vol 87 (1) ◽

Cited By ~ 4

Author(s):

J. Rasch ◽

C. M. Ünal ◽

A. Klages ◽

Ü. Karsli ◽

N. Heinsohn ◽

...

Keyword(s):

Legionella Pneumophila ◽

Acanthamoeba Castellanii ◽

Temperature Tolerance ◽

Lung Damage ◽

Atypical Pneumonia ◽

Content Type ◽

Wide Range ◽

Legionnaires Disease ◽

Environmental Fitness ◽

Sliding Motility

ABSTRACTThe gammaproteobacteriumLegionella pneumophilais the causative agent of Legionnaires’ disease, an atypical pneumonia that manifests itself with severe lung damage.L. pneumophila, a common inhabitant of freshwater environments, replicates in free-living amoebae and persists in biofilms in natural and man-made water systems. Its environmental versatility is reflected in its ability to survive and grow within a broad temperature range as well as its capability to colonize and infect a wide range of hosts, including protozoa and humans. Peptidyl-prolyl-cis/trans-isomerases (PPIases) are multifunctional proteins that are mainly involved in protein folding and secretion in bacteria. InL. pneumophilathe surface-associated PPIase Mip was shown to facilitate the establishment of the intracellular infection cycle in its early stages. The cytoplasmic PpiB was shown to promote cold tolerance. Here, we set out to analyze the interrelationship of these two relevant PPIases in the context of environmental fitness and infection. We demonstrate that the PPIases Mip and PpiB are important for surfactant-dependent sliding motility and adaptation to suboptimal temperatures, features that contribute to the environmental fitness ofL. pneumophila. Furthermore, they contribute to infection of the natural hostAcanthamoeba castellaniias well as human macrophages and human explanted lung tissue. These effects were additive in the case of sliding motility or synergistic in the case of temperature tolerance and infection, as assessed by the behavior of the double mutant. Accordingly, we propose that Mip and PpiB are virulence modulators ofL. pneumophilawith compensatory action and pleiotropic effects.

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Legionnaires' disease in the renal transplant unit of "Hospital das Clinicas, FMUSP": during a five year period (1988-1993)

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46651994000300007 ◽

1994 ◽

Vol 36 (3) ◽

pp. 231-236 ◽

Cited By ~ 3

Author(s):

Neusa Augusta de Oliveira Mazieri ◽

Cid Vieira Franco de Godoy ◽

Solange Figueiredo Alves ◽

Dahir Ramos de Andrade ◽

Ana Sara S. Levin ◽

...

Keyword(s):

Renal Transplant ◽

Legionella Pneumophila ◽

Treatment Interruption ◽

Immunofluorescence Assay ◽

High Susceptibility ◽

Water Decontamination ◽

Transplant Patients ◽

Antibody Titers ◽

Legionnaires Disease ◽

Renal Transplant Patients

Several reports have related Legionella pneumophila with pneumonia in renal transplant patients, however this association has not been systematically documented in Brazil. Therefore this paper reports the incidence, by serologycal assays, of Legionella pneumophila serogroup 1 in these patients during a five year period. For this purpose sera from blood samples of 70 hospitalized patients with pneumonia from the Renal Transplant Unit of Hospital das Clinicas, FMUSP collected at the acute and convalescent phase of infection were submitted to indirect immunofluorescence assay (IFA) to demonstrate anti-Legionella pneumophila serogroup 1 antibodies. Of these 70 patients studied during the period of 1988 to 1993,18 (25.71 %) had significant rises in specific antibody titers for Legionella pneumophila serogroup 1. Incidence was interrupted following Hospital water decontamination procedures, with recurrence of infections after treatment interruption. In this study, the high susceptibility (25.71%) of immunodepressed renal transplant patients to Legionella pneumophila serogroup 1 nosocomial infections is documented. The importance of the implementation and maintenance of water decontamination measures for prophylaxis of the infection is also clearly evident.

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Complete Genome Sequences of the HistoricalLegionella pneumophilaStrains OLDA and Pontiac

Genome Announcements ◽

10.1128/genomea.00866-16 ◽

2016 ◽

Vol 4 (4) ◽

Cited By ~ 3

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.

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