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Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The standard selective Legionella medium that contains cefamandole failed to grow legionella pneumophila serogroup 1, subtype Bellingham, from a sputum sample from a patient with nosocomial Legionnaires' disease; the isolate did grow on a similar selective medium that substitutes vancomycin for cefamandole. Two Bellingham isolates from this patient's hospital environment also failed to grow when tested on the cefamandole medium. We tested 106 additional L. pneumophila serogroup 1 isolates that belonged to nine different monoclonal antibody subtypes and demonstrated that susceptibility to cefamandole was rare (10%) and limited to the Bellingham subtype. The diagnosis of Legionnaires' disease may be missed unless the culture protocol includes both a nonselective medium and a selective medium that does not contain cefamandole. In vitro susceptibility to cefamandole also provided an epidemiologic marker that linked a water source for a patient to nosocomial Legionnaires' disease.
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PMID:Cefamandole-susceptible strains of Legionella pneumophila serogroup 1: implications for diagnosis and utility as an epidemiological marker. 131 43

Because of the ubiquity of Legionella isolates in aquatic habitats, epidemiologic evaluation of Legionella pneumophila strains is important in the investigation and subsequent control of nosocomial outbreaks of legionellosis. In this study, ribotyping and restriction enzyme analysis by pulsed-field gel electrophoresis (PFGE) were used to compare isolates of L. pneumophila obtained from patients and the environment during a nosocomial outbreak with unrelated control strains. Restriction enzyme analysis by PFGE resolved 14 different patterns among the L. pneumophila serogroup 1 and L. pneumophila serogroup 6 isolates involved in the study. Two of the patterns were observed in the three L. pneumophila serogroup 6 isolates from patients with confirmed nosocomial infections and environmental isolates from the potable water supply, which was, therefore, believed to be the source of the patients' infections. Three more patterns that were not present in isolates from patients with legionellosis were seen in isolates from the hospital environment, demonstrating the presence of multiple strains in the hospital environment. In the outbreak, one distinct pattern occurred among the L. pneumophila serogroup 1 isolates from patients with nosocomial infections, suggesting a common source; however, the source could not be determined. By comparison, ribotyping generated five patterns. However, some control strains of both L. pneumophila serogroups 1 and 6 possessed the same ribotypes as were present in the outbreak isolates. Both techniques were used successfully to subtype the isolates obtained during the investigation of the outbreak. Furthermore, restriction enzyme analysis by PFGE was useful for subdividing ribotypes and for distinguishing strains involved in the outbreak from epidemiologically unrelated strains.
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PMID:Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishing Legionella pneumophila isolates obtained during a nosocomial outbreak. 132 Jun 29

The objective of this study was to compare an indirect immunofluorescence assay with culture methods for the identification of Legionella pneumophila serogroups 1 to 6 in hot water samples taken from domestic environments. Hot water samples were obtained from the water heater, the shower heads, and the most frequently used faucet of 211 private houses. Concentrated water samples were inoculated on buffered charcoal yeast extract agar (BCYE) and on a semi-selective culture medium (GPV). Colonies with a morphology similar to that of Legionellaceae were subcultured on BCYE and on blood agar plates; those that grew on the former but not the latter were further characterized and identified by direct immunofluorescence techniques. The concentrated samples were also smeared on multiple-well microscope slides and tested by indirect immunofluorescence with monoclonal antibodies against L. pneumophila, serogroups 1 to 6. Of the houses studied, 30% were found to contain culturable L. pneumophila in at least one water sample, whereas 63% were positive by indirect immunofluorescence. The sensitivity of this assay compared with culture varied from 16.7-21.1%, and its specificity was between 76.7% and 88.3% depending on the sample source (water heater, shower heads, or faucet). In the 38 houses with at least one positive sample found by both immunofluorescence and culture, total or partial agreement between serogroups identified by both techniques was only 34%. The results obtained in this study strongly suggest that indirect immunofluorescence is not an adequate alternative for the identification of L. pneumophila in hot water systems.
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PMID:Comparison of culture methods and an immunofluorescence assay for the detection of Legionella pneumophila in domestic hot water devices. 136 87

German Standards Specification DIN 19,643 is at present under revision for health reasons and because of both negative and positive experiences gathered in practice. To enable adaptation of the standards specification to future developments, a Part I of the specification is being created comprising the demands to be made on the quality of the water and general demands on the construction and operation of swimming pools and tubs and basins in bath houses, e.g. in spas or municipal swimming pools. The subsequent parts of the new specification (Part 2 to Part n) concern the demands to be made on individual combinations of processes; these can be supplemented at any time in accordance with technical progress without requiring revision of the entire standards specification. Essential innovations are the reformulation of the required efficiency of disinfection, the introduction of the parameters Legionella pneumophila, trihalogen methane (THM) and the reduction of the limit value for chloramines. Technically speaking, the new features concern the automatic measurement of the auxiliary parameters of hygiene such as redox potential, pH value and free chlorine, automatic control of disinfectant additions, automatic filter rinsing with fluidization of the filter-bed to a prescribed minimum bed expansion, and the sight-glas at the filter container. The demands made on Jacuzzi and warm water spouted bed besins are integrated into the specification, thus obviating the need for German Standards Specification DIN 19,644.
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PMID:[Update of DIN 19.643--treatment and disinfection of swimming pool and bathing tub water]. 139 75

Comments are given on the present status of regulations concerning water in swimming pools and baths--1991--(in connection with the KOK regulations--1972--and the Federal German standard [DIN] No. 19643-1984-). Reference is made to microbiologic limits of Legionella pneumophila among others.
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PMID:[Draft of the swimming pool water regulation. Presentation, status: 17 September 1991, according to the federal hearing of 11 December 1991 in Bonn]. 139 77

Appearance of Legionella disease generally is underrated. Conclusions as to disease frequency from Legionella antibody investigations are not reliable. The number of microbes necessary to produce illness depends from individual preliminary conditions. In special areas of the hospital the rate of diseases caused by Legionella can be reduced by protection. In bathing areas generally the hitherto existing regulations of the Federal Health Authority are sufficient: Continual warm water temperature increases from 60 degrees C, chlorination if necessary, regular stepwise controls. Insufficient results are produced by intermittent temperature increases. Filters that are impermeable for microbes appear uneconomical for bathing areas.
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PMID:[Sanitation measures in evidence of Legionella]. 139 80

A patient undergoing esophageal dilatation for carcinoma of the esophagus suffered esophageal perforation and development of an empyema. Culture of pleural fluid yielded multiple organisms, including Legionella pneumophila serogroup 5. Epidemiologic investigation showed that the source of L pneumophila was a tap used by the nursing personnel to fill patients' water pitchers. Whole-cell restriction endonuclease analysis of DNA from the clinical and environmental isolates of L pneumophila serogroup 5 yielded identical patterns. Our findings suggest that L pneumophila was acquired by the patient at least 12 h prior to the procedure causing the esophageal perforation and empyema, suggesting that the organism can persist in an infectious form in the upper aerodigestive tract.
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PMID:Isolation of Legionella pneumophila serogroup 5 from empyema following esophageal perforation. Source of the organism and mode of transmission. 142 1

In October 1990 pneumonia due to Legionella pneumophila was diagnosed in two employees working in the area of Apulia, southern Italy, where artesian wells were in construction. Although the exposure to excavation has been associated with Legionnaires' disease, in our investigation the illness occurred only in those employees who were present when the water emerged from the ground under high pressure. On the basis of this report, water appears as the most likely reservoir of the organism and the main route of infection.
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PMID:Legionellosis associated with artesian well excavation. 142 78

Since 1988 the Frankfurt City Health Department examined the hot water systems of all public indoor swimming pools, old age homes and hospitals, and made subsequent checks on the corrective measures introduced. In the 6 public indoor swimming pools the percentage of positive legionella findings, after corrective measures has dropped since 1988: at the central hot-water supply units from 47% to 23%, and at the peripheral tap connections from 66% to 22%. The number of negative samples rose from 43% to 77%. Thus the favourable effect of the corrective measures is demonstrated. Since 1988 samples have been taken from the shower water at old age homes. An increase in negative findings could be shown (from 58% to 70%). From 1990, however, an increase of high-level legionella contamination (> 10,000 Legionella colonies per litre) was detected as well. In one home with a generally high legionella contamination level (up to 75,000 legionella colonies per litre) an investigation of the legionella antibodies was done in the blood of 44 residents whose medical history included fever or bronchial symptoms. In no case a previous infection could be demonstrated. However, there was one patient with a definite legionella pneumonia in the home: this patient usually had been showering for at least 20 minutes a day. Legionella were found in the hot water systems of 16 of the 17 hospitals in Frankfurt. In 1991 more than half to the 204 samples were legionella positive. 5% of the samples had legionella contamination levels of more than 100,000 per litre. Corrective measures have been taken.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Legionella contamination in warm water systems of a large German city]. 145 May 50

A series of nosocomial Legionella infections in a rehabilitation center is reported. In a three months period a total of 10 pneumonias with 3 deaths occurred (8 patients, 1 companion, 1 staff member). Serologic analysis proved additional Legionella infections within the nursing staff. The warm-water system was proved to be the source of infection by isolating Legionella pneumophila serogroup 1 subtype Pontiac both in warm-water and patients samples. The air conditioning system could not be ruled out as another (secondary) route of exposure because of shortcomings in construction. Conclusions about prevention and the course of the disease are discussed and standards for warm-water and air conditioning systems are proposed.
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PMID:[Case study of a Legionella epidemic in a rehabilitation clinic]. 145 37


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