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Epidemiology, Prevention and Control of Legionellosis: New Trends and Perspectives
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Epidemiology, Prevention and Control of Legionellosis: New Trends and Perspectives

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 September 2020) | Viewed by 23000

Special Issue Editors

Dr. Anna Psaroulaki

E-Mail Website
Guest Editor
Associate Professor, Department of Microbiology/Zoonoses, School of Medicine, University of Crete, Heraklion, Crete, Greece
Interests: microbial pathogenesis; antibiotics; antimicrobial resistance; epidemiology of infectious diseases; microbiology and eco-epidemiology of zoonotic pathogens; food/water-borne pathogens; public health
Special Issues, Collections and Topics in MDPI journals
Dr. Dimosthenis Chochlakis

E-Mail Website
Guest Editor
Unit of Food, Water and Environment, Laboratory of Clinical Microbiology and Microbial Pathogenesis, University of Crete, Heraklion, 71110 Stavrakia, Crete, Greece
Interests: microbiology; public health; water-borne diseases; epidemiology; neural networks; infection; diagnosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Legionellosis (first detected in the late 1970s) refers to a group of infections, which may present in variable forms ranging from mild to life-threatening types of pneumonia. It raises concerns regarding public health, since its incidence ranges between 10 and 15 cases per million of human population in Australia, Europe, and the United States of America.

The infection can be acquired through the inhalation of contaminated aerosols or by the aspiration of contaminated water in susceptible people, or during water births. The disease is quite prevalent among people of more than 50 in age and in males. It is usually recorded as community-acquired, travel-associated, or hospital-acquired pneumonia.

Outbreaks associated with the disease have been observed in poorly maintained artificial water systems, especially associated with air conditioning and industrial cooling, and water systems in public and private buildings.

Apart from the implementation of regular cleaning and disinfection and the use of other physical or chemical measures to reduce the growth of bacteria, some newer guidelines include the development and implementation of water safety plans, specific to each setting. Proper surveillance also includes the periodical sampling and culturing of water samples, which has been shown to be effective towards the prevention of new human cases especially in hospital units. In any case, the eradication of Legionella requires a better understanding of the ecology of bacterial and eukaryal species associated with Legionella-containing biofilms.

Additionally, the role of health professionals is crucial since they are charged with the early detection of cases, and reporting (Legionaires diseases remains largely underreported when it is not travel-associated). However, if better control of the disease and a more realistic recording of human cases is needed, then the development and approval of novel rapid-test methods for quantifying live Legionella in water samples and the development of new (preferably rapid) tests for the detection of more Legionella serogroups and species in human samples should be the goal. Furthermore, the use of modern molecular techniques for the typing of Legionella isolates, whether these are isolated from humans or from the environment, should be evaluated in order to record clones and strains that may cause human infection and epidemics.

Last but not least, the potential impact of global warming on the risk of exposure to Legionella and the consequent public health consequences should also be investigated.

Prof. Anna Psaroulaki
Dr. Dimosthenis Chochlakis
Guest Editors

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Keywords

  • Legionella
  • Surveillance
  • Water safety plans
  • Prevention
  • Control
  • Diagnosis/identification/typing
  • Disinfection methods.

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Published Papers (5 papers)

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Research

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6 pages, 1890 KiB  
Article
Differential Seasonality of Legionnaires’ Disease by Exposure Category
by Udo Buchholz, Doris Altmann and Bonita Brodhun
Int. J. Environ. Res. Public Health 2020, 17(9), 3049; https://doi.org/10.3390/ijerph17093049 - 28 Apr 2020
Cited by 5 | Viewed by 2342
Abstract
Legionnaires’ disease (LD) shows a seasonal pattern with most cases occurring in summer. We investigate if seasonality can be observed for all three exposure categories (community-acquired (CALD), travel-associated (TALD) and healthcare-associated (HCA)). Methods: LD cases (2005–2015) were classified by exposure categories and we [...] Read more.
Legionnaires’ disease (LD) shows a seasonal pattern with most cases occurring in summer. We investigate if seasonality can be observed for all three exposure categories (community-acquired (CALD), travel-associated (TALD) and healthcare-associated (HCA)). Methods: LD cases (2005–2015) were classified by exposure categories and we calculated the relative case ratio for each month from February to December using January as reference. The TALD relative case ratio was compared with flight frequencies. Results: Overall case numbers in Germany (N = 7351) peaked in August. CALD had a curve similar to all cases. TALD displayed a bimodal curve with peaks in June/July and October. The latter was attributable to LD cases aged 60+. The relative case ratio of TALD surpassed clearly that of CALD. The curve was similar to that of the relative flight frequencies, but was shifted by about one month. HCA showed no apparent seasonality. Conclusions: Although the overall seasonality in LD is heavily influenced by CALD, seasonal differences are more pronounced for TALD which may reflect travel behavior. The bimodal pattern of TALD is attributable to the curve among those aged 60+ and may reflect their preference to travel outside school holiday periods. Heightened vigilance for HCA cases is necessary throughout the entire year. Full article
(This article belongs to the Special Issue Epidemiology, Prevention and Control of Legionellosis: New Trends and Perspectives)
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6 pages, 271 KiB  
Article
Clinical Presentation of Community-Acquired Legionella Pneumonia Identified by Universal Testing in an Endemic Area
by Shruti Puri, Monique Boudreaux-Kelly, Jon D. Walker, Cornelius J. Clancy and Brooke K. Decker
Int. J. Environ. Res. Public Health 2020, 17(2), 533; https://doi.org/10.3390/ijerph17020533 - 15 Jan 2020
Cited by 5 | Viewed by 3203
Abstract
The rapid identification of Legionella pneumonia is essential to optimize patient treatment and outcomes, and to identify potential public health risks. Previous studies have identified clinical factors which are more common in Legionella than non-Legionella pneumonia, and scores have been developed to [...] Read more.
The rapid identification of Legionella pneumonia is essential to optimize patient treatment and outcomes, and to identify potential public health risks. Previous studies have identified clinical factors which are more common in Legionella than non-Legionella pneumonia, and scores have been developed to assist in diagnosing cases. Since a Legionella pneumonia outbreak at VA Pittsburgh in 2012, nearly all patients with pneumonia have been tested for Legionella. The purpose of this study was to evaluate distinguishing characteristics between Legionella and non-Legionella pneumonia with the application of universal testing for Legionella in all cases of community-acquired pneumonia. We performed a retrospective case-control study matching Legionella and non-Legionella pneumonia cases occurring in the same month. Between January 2013 and February 2016, 17 Legionella and 54 non-Legionella cases were identified and reviewed. No tested characteristics were significantly associated with Legionella cases after Bonferroni correction. Outcomes of Legionella and non-Legionella pneumonia were comparable. Therefore, in veterans who underwent routine Legionella testing in an endemic area, factors typically associated with Legionella pneumonia were non-discriminatory. Full article
(This article belongs to the Special Issue Epidemiology, Prevention and Control of Legionellosis: New Trends and Perspectives)
8 pages, 899 KiB  
Article
Legionnaires’ Disease Cases at a Large Community Hospital—Common and Underdiagnosed
by Jamie Spiegelman, Theresa Pedutem and Mary June Francisco
Int. J. Environ. Res. Public Health 2020, 17(1), 332; https://doi.org/10.3390/ijerph17010332 - 3 Jan 2020
Cited by 7 | Viewed by 4659
Abstract
Legionnaires’ disease (LD) is a severe pneumonia with a mortality rate of about 10%. The illness remains largely underdiagnosed with outbreaks occurring with alarming incidence. In this study, we assessed the frequency of Legionnaires’ disease among pneumonia cases treated at a large community [...] Read more.
Legionnaires’ disease (LD) is a severe pneumonia with a mortality rate of about 10%. The illness remains largely underdiagnosed with outbreaks occurring with alarming incidence. In this study, we assessed the frequency of Legionnaires’ disease among pneumonia cases treated at a large community hospital over a summer season. We invited all admitted patients diagnosed with pneumonia, able to provide a urine sample for an antigen test, presenting from May to October 2018, to enroll in our study; 35 patients were tested for the presence of Legionella. Out of 33 patients tested, 9 (28%) were positive for Legionella. Three sets of the 9 Legionella cases exhibited spatiotemporal clustering indicative of LD outbreaks. Only one of the 9 Legionella UAT-positive patients presented a sporadic case of LD. The number of pneumonia cases in our community confirmed to be LD was strikingly high (28%), compared to other survey studies that report between 3.7% and 14%. These results are consistent with previous knowledge that LD is underdiagnosed and support that routine testing should be considered for all possible LD cases, particularly in the summer months. Such testing is likely to prevent further cases of community acquired LD. Full article
(This article belongs to the Special Issue Epidemiology, Prevention and Control of Legionellosis: New Trends and Perspectives)
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Review

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18 pages, 1753 KiB  
Review
Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates—A Systematic Review
by Olga Pappa, Dimosthenis Chochlakis, Vassilios Sandalakis, Chrysa Dioli, Anna Psaroulaki and Athena Mavridou
Int. J. Environ. Res. Public Health 2020, 17(16), 5809; https://doi.org/10.3390/ijerph17165809 - 11 Aug 2020
Cited by 11 | Viewed by 4670
Abstract
The current systematic review investigates the antibiotic susceptibility pattern of Legionella pneumophila isolates from the 1980s to the present day, deriving data from clinical and/or water samples from studies carried out all over the world. Eighty-nine papers meeting the inclusion criteria, i.e., “ [...] Read more.
The current systematic review investigates the antibiotic susceptibility pattern of Legionella pneumophila isolates from the 1980s to the present day, deriving data from clinical and/or water samples from studies carried out all over the world. Eighty-nine papers meeting the inclusion criteria, i.e., “Legionella pneumophila” and “resistance to antibiotics”, were evaluated according to pre-defined validity criteria. Sixty articles referred to clinical isolates, and 18 articles reported water-related L. pneumophila isolates, while 11 articles included both clinical and water isolates. Several methods have been proposed as suitable for the determination of MICs, such as the E-test, broth and agar dilution, and disk diffusion methods, in vivo and in vitro, using various media. The E-test method proposed by the European Society of Clinical Microbiology and Infectious Diseases (EUCAST) seems to be the second most frequently used method overall, but it is the preferred method in the most recent publications (2000–2019) for the interpretation criteria. Erythromycin has been proved to be the preference for resistance testing over the years. However, in the last 19 years, the antibiotics ciprofloxacin (CIP), erythromycin (ERM), levofloxacin (LEV) and azithromycin (AZM) were the ones that saw an increase in their use. A decrease in the sensitivity to antibiotics was identified in approximately half of the reviewed articles. Full article
(This article belongs to the Special Issue Epidemiology, Prevention and Control of Legionellosis: New Trends and Perspectives)
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20 pages, 984 KiB  
Review
Water Management for Construction: Evidence for Risk Characterization in Community and Healthcare Settings: A Systematic Review
by Molly M. Scanlon, James L. Gordon, William F. McCoy and Melissa F. Cain
Int. J. Environ. Res. Public Health 2020, 17(6), 2168; https://doi.org/10.3390/ijerph17062168 - 24 Mar 2020
Cited by 21 | Viewed by 7404
Abstract
Construction activities are a known risk contributing to the growth and spread of waterborne pathogens in building water systems. The purpose of the study is to integrate evidence for categorizing construction activity risk factors contributing to waterborne disease in community and healthcare settings, [...] Read more.
Construction activities are a known risk contributing to the growth and spread of waterborne pathogens in building water systems. The purpose of the study is to integrate evidence for categorizing construction activity risk factors contributing to waterborne disease in community and healthcare settings, establish severity of such risk factors and identify knowledge gaps. Using a systematic review, the inclusion criteria were: (1) studies with disease cases suspected to be associated with construction activities and waterborne pathogens, and (2) active construction work described in a community or healthcare setting. Each construction activity risk factor was correlated across all studies with the number of disease cases and deaths to establish risk severity. The eligibility review and quantitative synthesis yielded 31 studies for inclusion (community, n = 7 and healthcare, n = 24). From 1965 to 2016, a total of 894 disease cases inclusive of 112 deaths were associated with nine construction activity risk factors and waterborne pathogens. The present study findings support the need for building owners, water management teams and public health professionals to address construction activity risk factors and the analysis of current knowledge deficiencies within the scope of an ongoing water management program. The impact of construction activities on waterborne disease is preventable and should no longer be considered incidental nor accidental. Full article
(This article belongs to the Special Issue Epidemiology, Prevention and Control of Legionellosis: New Trends and Perspectives)
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