Sequence-based typing of Legionella pneumophila strains isolated from hospital water distribution systems as a complementary element of risk assessment of legionellosis in Poland
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National Institute of Public Health/National Institute of Hygiene, Warsaw, Poland
Ann Agric Environ Med. 2013;20(3):436–440
Many factors affect the risk of Legionella infection, such as the design, construction and maintenance of water distribution systems, the presence of individuals who may be exposed and their vulnerability to infection, and the degree of water system colonization and properties of Legionella strains. For epidemiological investigations, two properties of the Legionella strains are usually determined: serotyping and genotyping (sequence-based typing, SBT). In Poland, data regarding legionellosis are fragmentary, despite the fact that this has been a notifiable disease since 2002. The number of reported cases is very low; moreover, the main method of diagnosis is serological examination (delayed diagnosis and cheaper methods), and only single cases of LD were confirmed by culture of bacteria. Therefore, after 10 years of mandatory reporting of the Legionella spp. infection in Poland, the real epidemiological situation is still unknown; however, risk assessment should be carried out, especially in hospitals. In the presented study, comparison of the sequence types of 111 isolated L. pneumophila strains (from hospital water systems) with those present in the EWGLI SBT data was undertaken for complex risk analysis as a complementary element. In total, strains of L. pneumophila belonging to 12 out of 19 STs determined in the presented study were previously reported to the EWGLI SBT database (ST1, ST42, ST59, ST81, ST87, ST114, ST152, ST191, ST371, ST421, ST461, ST520). Among these strains, only 7 STs were previously reported in the amount of ≥10 (mainly ST1, ST42, ST81). Analysis of EWGLI data were carried out and, proportionally, the highest percentage of hospital-acquired strains (clinical and environmental) was found for ST 81, ST421 and ST152, but the largest number was for ST1. Based on the EWGLI data and the presented results, it was found that persistent colonization of HWS of 3 hospitals by strains belonging to ST42, ST1, ST87 indicated an increased risk of legionellosis, especially ST42.
Joseph CA, Ricketts KD, on behalf of the European Working Group for Legionella Infections. Legionnaires’ disease in Europe 2007–2008. Euro Surveill. 2010; 15(8): pii=19493. http://www.eurosurveillance.or... ViewArticle.aspx?ArticleId=19493.
Joseph CA, Ricketts KD, Yadav R, Patel S, on behalf of the European Working Group for Legionella Infections. Travel-associated Legionnaires’ disease in Europe in 2009. Euro Surveill 2010; 15(41): pii=19683. http://www.eurosurveillance.or.... aspx?ArticleId=19683.
von Baum H, Ewig S, Marre R, Suttorp N, Gonschior S, Welte T, Luck C for the Competence Network for Community Acquired Pneumonia Study Group. Community-Acquired Legionella Pneumonia:New Insights from the German Competence Network for Community Acquired Pneumonia. Clin Infect Dis. 2008; 46: 1356–64.
Pancer K, Napiórkowska A, Gut W, Stypułkowka-Misiurewicz H. Demographic characteristics of reported cases of legionellosis in years 2005–2009 in Poland in comparison to EWGLI data. Przegl Epidemiol. 2011; 65: 433–439.
Dolezal P, Aili M, Tong J, Jiang J-H, Marobbio CM, et al. Legionella pneumophila Secretes a Mitochondrial Carrier Protein during Infection. PLoS Pathog. 2012; 8(1): e1002459. doi:10.1371/journal. ppat.1002459.
Guy SD, Worth LJ, Thursky KA, Francis PA, Slavin MA. Legionella pneumophila lung abscess associated with immune suppression. Int Med J. 2011; doi:10.1111/j.1445–5994.2011.02508.xi.
Jules M, Buchrieser C. Legionella pneumophila adaptation to intracellular life and the host response: Clues from genomics and transcriptomics. FEBS Letters. 2007; 581: 2829–2838.
Reichardt K, Jacobs E Roske I, Helbig JH. Legionella pneumophila carrying the virulenceassociated lipopolysaccharide epitope possesses two functionally different LPS components. Microbiology. 2010; 156: 2953–2961.
Rolando M, Buchrieser C. Post-translational modifications of host proteins by Legionella pneumophila: a sophisticated survival strategy. Future Microbiology. 2012; 7: 369–381.
Seeger EM, Thuma M, Fernandez-Moreira E, Jacobs E, Schmitz M, Helbig J. Lipopolysaccharide of Legionella pneumophila shed ina liquid culture as a nonvesicular fractionarrests phagosomematuration in amoeba andmonocytic host cells. FEMS. Microbiol Lett. 2010; 307: 113–119.
Steinert M. Pathogen–host interactions in Dictyostelium, Legionella, Mycobacterium and other pathogens. Seminars in Cell & Developmental Biology 2011; 22: 70–76.
Alvarez J, Dominguez A, Sabria M, Ruiz L, Torner N, Cayla J, et al. Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain, 1990—2004. Inter J Infect Dis. 2009; 13: e365–e370.
Borchardt J, Helbig JH, Lück PC. Occurrence and distribution of sequence types among Legionella pneumophila strains isolated from patients in Germany common features and differences to other regions of the world. Eur J Clin Microbiol Infect Dis. 2008; 27: 29–36.
Chasqueira MJ, Rodrigues L, Nascimento M, Marques T. Sequencebased and monoclonal antibody typing of Legionella pneumophila isolated from patients in Portugal during 1987–2008. Euro Surveill. 2009; 14(28): pii=19271. http://www.eurosurveillance.or.... aspx?ArticleId=19271.
Harrison TG, Afshar B, Doshi N, Fry NK, Lee JV. Distribution of Legionella pneumophila serogroups, monoclonal antibody subgroups and DNA sequence types in recent clinical and environmental isolates from England and Wales (2000–2008). Eur J Clin Microbiol Infect Dis. 2009; 28: 781–791.
Reimer AR, Au S, Schindle S, Bernard KA. Legionella pneumophila monoclonal antibody subgroups and DNA sequence types isolated in Canada between 1981 and 2009: Laboratory Component of National Surveillance. Eur J Clin Microbiol Infect Dis. 2010; 29: 191–205.