1887

Journal of Medical Microbiology logo

Volume 65, Issue 6

Rapid investigation of cases and clusters of Legionnaires' disease in England and Wales using direct molecular typing Free

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.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): Legionella pneumophila , nested SBT , outbreak investigation , PCR and SBT.
© 2016 © Crown copyright. Reproduced with the permission of the Controller of Her Majesty's Stationery
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000257
2016-06-01
2024-04-19
Loading full text...

Full text loading...

/deliver/fulltext/jmm/65/6/484.html?itemId=/content/journal/jmm/10.1099/jmm.0.000257&mimeType=html&fmt=ahah

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 Infect 142:1763–1777 [View Article][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 Surveill 17:20271[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 Microbiol 119:1158–1169 [View Article][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 Infect 144:796–802 [View Article][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 Dis 2002:37–43 [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 Med 297:1189–1197 [View Article][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 Microbiol 43:2047–2052 [View Article][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 Microbiol 47:981–987 [View Article][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 Dis 21:710–716 [View Article][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 One 9:e103852 [View Article][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 Microbiol 305:828–837 [View Article][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 Dis 31:2017–2028 [View Article][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 Infect 20:435–441 [View Article][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 Dis 34:1387–1393 [View Article][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 Surveill 17:20293[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 Microbiol 77:1708–1717 [View Article][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 Dis 14:1011–1021 [View Article][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 Microbiol 45:1965–1968 [View Article][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 Surveill 12: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 Surveill 19:20991 [View Article][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 Dis 46:1356–1364 [View Article][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 Surveill 15:19472[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 Infect 20:O13–19 [View Article][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 Dis 186:127–128 [View Article][PubMed]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000257
Loading
Rapid investigation of cases and clusters of Legionnaires' disease in England and Wales using direct molecular typing
J. Med. Microbiol. 65, 484 (2016); https://doi.org/10.1099/jmm.0.000257
/content/journal/jmm/10.1099/jmm.0.000257
/content/journal/jmm/10.1099/jmm.0.000257
Loading

Data & Media loading...

Supplements

Supplementary File 1

PDF

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error