Analysis of pathogen detection results of upper respiratory tract specimens from fever clinic patients

Objective: To explore the pathogen composition and distribution characteristics of pathogens in respiratory samples from patients with fever of unknown origin. Methods: A total of 96 respiratory samples of patients with unknown cause fever with respiratory symptoms were collected from four hospitals above grade II in Shijiazhuang area (Hebei Provincial Hospital of Traditional Chinese Medicine, Luancheng District People's Hospital, Luquan District People's Hospital, Shenze County Hospital) from January to April 2020, and multiplex-fluorescent polymerase chain reaction(PCR)was used to detect influenza A virus, influenza B virus, enterovirus, parainfluenza virus I/II/III/IV, respiratory adenovirus, human metapneumovirus, respiratory syncytial virus, human rhinovirus, human bocavirus, COVID-19, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, Pseudomonas aeruginosa, Streptococcus pneumoniae, Klebsiella pneumoniae, Group A streptococcus, Haemophilus influenzae, Staphylococcus aureus nucleic acid detection, the results were analyzed for chi-square. Results: A total of 8 pathogens were detected in the upper respiratory tract samples of 96 fever patients, including 1 kind of virus, 6 kinds of bacterias, and Mycoplasma pneumoniae. There were 12 viruses including influenza virus and parainfluenza virus, Legionella pneumophila and Chlamydia pneumoniae were not detected. The pathogen detection rates in descending order were Streptococcus pneumoniae (58/96, 60.42%), Haemophilus influenzae(38/96, 39.58%), Klebsiella pneumoniae (14/96, 14.58%), Staphylococcus aureus (10/96, 10.42%), Mycoplasma pneumoniae (8/96, 8.33%), Pseudomonas aeruginosa (6/96, 6.25%), Group A streptococcus (4/96, 4.17%) and human rhinovirus (2/96, 2.08%). The proportions of single-pathogen infection and multi-pathogen mixed infection in fever clinic patients were similar, 41.67% (40/96) and 45.83% (44/96), respectively, and 12.50% (12/96)of the cases had no pathogens detected. The infection rate of Mycoplasma pneumoniae in female patients with fever (21.43%) was higher than that in male patients with fever (2.94%) (P < 0.05). There was no statistical difference between the distribution of of other pathogens and gender and age(P > 0.05). Conclusions: The upper respiratory tract pathogens were mainly bacterial infections, and occasional human rhinovirus and Mycoplasma pneumonia infections. In clinical diagnosis and treatment, comprehensive consideration should be given to the pathogen detection.

Bacterial complications in patients with coronavirus infection, new diagnostic and therapeutic possibilities.

We present the case of a young patient who developed pneumonia during the COVID-19 outbreak. The course of the disease with involvement of interstitial lung tissue atypical for bacterial infections, the picture of infection markers could indicate SARS-CoV-2. The patient was tested by PCR method on admission with negative results. Due to the atypical follow-up of the disease, suggesting a severe course of SARS, PCR testing of the material collected by BAL was performed BIOFIRE® FILMARRAY® Pneumonia plus Panel (bioMérieux). Legionella pneumophilla and coronavirus genetic materials were found. We conclude that in the described case there was a bacterial co-infection, paved by virus infection. The similar radiological picture of the two cases of pneumonia, as well as the similar infectious response in the blood, specific for atypical infections, may pose a problem in the differential diagnosis. The study was able to confirm the bacterial etiology of pneumonia and introduce targeted treatment. The patient was discharged from the hospital. We believe that in any case of pneumonia of non-bacterial etiology, extending the diagnosis with a PCR pulmonary panel allows early and effective treatment of patients. In the treatment of patients with pulmonary interstitial lesions in the course of virus infections, one should always keep in mind the possibility of atypical co-infections.

Rebound mortality rate of Legionella pneumonia in Japan.

Legionella pneumonia is a fatal disease caused by Legionella pneumophila, a bacterium belonging to the genus Legionella. The incidence of this disease has been increasing since 2005 and has continued to increase following the COVID-19 pandemic in Japan. Furthermore, Legionella pneumonia mortality rates have increased slightly since the pandemic due to some plausible reasons. The increased proportion of older patients with legionellosis might affect it because advanced age is a major risk factor for disease mortality. Additionally, physicians were focused on COVID-19 while examining febrile patients; therefore, they might have missed the early diagnosis of other respiratory infections, including Legionella pneumonia.

RAPID IDENTIFICATION OF ETIOLOGICAL AGENTS OF RESPIRATORY TRACT INFECTIONS DURING THE COVID-19 PANDEMIC USING THE MULTIPLEX-PCR METHOD.

Objective. Most respiratory infections have similar symptoms, so it is clinically difficult to determine their etiology. This study aimed to show the importance of molecular diagnostics in identifying the etiological agent of respiratory infections, especially during the coronavirus disease 2019 (COVID-19) pandemic. Methods. A total of 849 samples from patients hospitalized at the University Clinical Center Kragujevac (from January 1 to August 1, 2022) were examined using automated multiplex-polymerase chain reaction (PCR) tests. The BioFire-FilmArray-Respiratory Panel 2.1 test was used for 742 nasopharyngeal swabs [identification of 19 viruses (including SARS-CoV-2) and four bacteria], while the BioFire-FilmArray-Pneumonia Panel was used [identification of 18 bacteria and nine viruses] (BioMerieux, Marcy l'Etoile, France) for 107 tracheal aspirates. The tests were performed according to the manufacturer's instructions, and the results were available within an hour. Results. In 582 (78.4%) samples, the BioFire-FilmArray-Respiratory Panel 2.1 plus test identified at least one pathogen. The rhinovirus (20.6%), SARS-CoV-2 (17.7%), influenza A (17.5%), respiratory syncytial virus (12.4%), and parainfluenza 3 (10.1%) were the most common. Other viruses were found less frequently, and Bordetella parapertussis was detected in one sample. In 85 (79.4%) samples, the BioFire-FilmArray-Pneumonia Panel test identified at least one bacterium or virus. The most prevalent bacteria were Staphylococcus aureus (42.4%), Haemophilus influenzae (41.2%), Streptococcus pneumoniae (36.5%), Moraxella catarrhalis (22.3%), and Legionella pneumophila (2.4%). Among viruses, rhinovirus (36.5%), adenovirus (23.5%), influenza A (11.8%), and the genus Coronavirus (4.7%), were detected. Conclusion. Multiplex-PCR tests improved the implementation of therapeutic and epidemiological measures, preventing the spread of the COVID-19 infection and Legionnaires' disease.Copyright © 2022, Serbian Medical Society. All rights reserved.

Characterization of secondary bacterial and fungal infections in ICU hospitalized patients with COVID-19: retrospective observational study

Introduction: We aimed to describe the incidence, risk factors, and clinical outcomes of bacterial and fungal co-infections and superinfections in intensive care patients with COVID-19 in a retrospective observational study. Method(s): A retrospective cohort of intensive care patients with confirmed SARS-CoV-2 by PCR was analysed from January to March 2021. This was contrasted to a control group of influenza-positive patients admitted during 2012-2022. Patient demographics, microbiology and clinical outcomes were analysed. Result(s): A total of 70 patients with confirmed SARS-CoV-2 were included;6 (8.6%) of 70 had early bacterial isolates identified rising to 42 (60%) of 70 throughout admission. Blood cultures, respiratory samples, and urinary samples were obtained from 66 (94.3%), 18 (25.7%) and 61 (87.1%) COVID-19 patients. Positive blood culture was identified in 13 patients (18.6%). Bacteraemia resulting from respiratory infection was confirmed in 3 cases (all ventilator-associated). Line-related bacteraemia was identified in 9 patients (6 Acinetobacter baumannii, 4 Enterococcus spp. and 1 Pseudomonas aeruginosa and 1 Micrococcus lylae). No concomitant pneumococcal, Legionella or influenza co-infection was detected. Invasive fungal infections with Aspergillus spp. were identified in 2 cases. Pneumococcal coinfections (7/68;10.3%) were identified in the control group of confirmed influenza infection;clinically relevant bacteraemias (6/68;8.8%), positive respiratory cultures (15/68;22.1%). The rate of hospital- acquired infections was 51.4% for COVID-19 and 27.9% for influenza. Longer intensive care stay, type 2 diabetes, obesity and hematologic diseases were independent risk factors for superinfections in the COVID-19 cohort. Conclusion(s): Respiratory coinfections occurred in influenza but not in COVID-19 patients. The rate of hospital-acquired infections (51.4% for COVID-19;27.9% for influenza) was unexpectedly high in both groups.

Severe pneumonia due to legionella and SARS-CoV-2 co-infection necessitating medical evacuation from a cargo ship.

Cargo ships are at risk of disease outbreaks like Legionella and SARS-CoV-2 due to their cramped and shared conditions. A case of medical evacuation due to co-infection of Legionella pneumophila with SARS-CoV-2 highlights the need for international infection control guidelines, information networks, and molecular epidemiological approaches for identifying infection routes.

All That Coughs Is Not COVID.

We report the case of a woman from the Bronx, New York, who presented to the emergency department (ED) in June 2020 with a febrile respiratory illness resembling coronavirus disease 2019 (COVID-19) but was ultimately diagnosed with Legionnaires' disease (LD). New York City (NYC) rapidly became an epicenter of the global COVID-19 pandemic in 2020. In the years since the pandemic started, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recurred in multiple waves and remain an important cause of viral respiratory illness. The bacteria Legionella pneumophila is often under-recognized as a cause of community-acquired pneumonia, yet it recurs each year in clusters, outbreaks, or as sporadic infections. Pneumonia caused by SARS-CoV-2 and Legionella can present similarly and may not be readily distinguished in the absence of diagnostic testing.

Advances in molecular diagnostic tests for community-acquired pneumonia

The use of a timely and appropriate antibiotic therapy, which requires early and accurate microorganisms' detection in pneumonia. Currently, the identification of microorganisms in pneumonia is limited by the low sensitivity and long response time of standard culture-based diagnostic tools. For this reason, treatment in pneumonia is empirical. An inadequate empirical treatment is related to poor outcomes in patients with pneumonia. The microbiological diagnosis is key to improve the outcomes in patient with pneumonia. Over the past years there was a significant advance in the molecular diagnosis of infectious diseases including pneumonia. Also the impact of the COVID-19 pandemic has impacted the development and application of these new molecular techniques. This review summarizes the advances in molecular diagnosis of community-acquired pneumonia.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Managing Building Water Disruptions in a Post-COVID World: Water Quality and Safety Risk Assessment Tool for Academic Institutions and School Settings

Fluctuating building occupancy during the COVID-19 pandemic contributed to poor water quality and safety conditions in building water distribution systems (BWDSs). Natural disasters, man-made events, or academic institutional calendars (i.e., semesters or holiday breaks) can disrupt building occupant water usage, which typically increases water age within a BWDS. High water age, in turn, is known to propagate poor water quality and safety conditions, which potentially exposes building occupants to waterborne pathogens (e.g., Legionella) associated with respiratory disease or hazardous chemicals (e.g., lead). Other influencing factors are green building design and municipal water supply changes. Regardless of the cause, an increasing number of water management policies require building owners to improve building water management practices. The present study developed a Water Quality and Safety Risk Assessment (WQSRA) tool to address gaps in building water management for academic institutions and school settings. The tool is intended to assist with future implementation of water management programs as the result of pending policies for the built environment. The WQSRA was modeled after water management practices created for controlling water contaminants in healthcare facilities. Yet, a novel WQSRA tool was adapted specifically for educational settings to allow building owners to evaluate risk from water hazards to determine an appropriate level of risk mitigation measures for implementation. An exemplar WQSRA tool is presented for safety, facility, industrial hygiene, and allied professionals to address current gaps in building water management programs. Academic institutions and school settings should examine the WQSRA tool and formulate an organization-specific policy to determine implementation before, during, and after building water-disruptive events associated with natural or man-made disasters.

Environmental Monitoring of Legionella in Hospitals in the Campania Region: A 5-Year Study.

Legionella is a pathogen that colonizes soils, freshwater, and building water systems. People who are most affected are those with immunodeficiencies, so it is necessary to monitor its presence in hospitals. The purpose of this study was to evaluate the presence of Legionella in water samples collected from hospitals in the Campania region, Southern Italy. A total of 3365 water samples were collected from January 2018 to December 2022 twice a year in hospital wards from taps and showers, tank bottoms, and air-treatment units. Microbiological analysis was conducted in accordance with the UNI EN ISO 11731:2017, and the correlations between the presence of Legionella and water temperature and residual chlorine were investigated. In total, 708 samples (21.0%) tested positive. The most represented species was L. pneumophila 2-14 (70.9%). The serogroups isolated were 1 (27.7%), 6 (24.5%), 8 (23.3%), 3 (18.9%), 5 (3.1%), and 10 (1.1%). Non-pneumophila Legionella spp. represented 1.4% of the total. Regarding temperature, the majority of Legionella positive samples were found in the temperature range of 26.0-40.9 °C. An influence of residual chlorine on the presence of the bacterium was observed, confirming that chlorine disinfection is effective for controlling contamination. The positivity for serogroups other than serogroup 1 suggested the need to continue environmental monitoring of Legionella and to focus on the clinical diagnosis of other serogroups.

Evaluation and analysis of rates of bacterial co-infections and antimicrobial usage in COVID-19 patients: a retrospective cohort analysis

Background: The coronavirus disease 2019 (COVID- 19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread over the world. Although there are minimal microbiological and antibiotic data on COVID-19, bacterial co-infections have been related to poor outcomes in respiratory viralinfections. Adequate antibiotic use in conformity withantibiotic stewardship (ABS) recommendations is necessary during the pandemic. Material and procedure: We conducted a retrospective single-center cohort analysis of 140 adulthospitalised patients (ages 17-99) with confirmed COVID-19 who were admitted between February 16, 2021, and April 22, 2021, and who were discharged onMay 6, 2021. From 140 COVID-19 participants, the following clinical data was gathered: Men made up 63.5 percent of the participants, with a median age of 63.5 years (range 17-99). Results: According to local ABS recommendations, the most commonly administered antibiotic regimen was ampicillin/sulbactam (41.5 percent) with a median length of 6 (range 1-13) days. Urine antigen testing for Legionella pneumophila and Streptococcus peumoniaewas negative in all of the patients. In critically ill patients hospitalised to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were discovered. Blood cultures obtained at admission had a diagnostic yield of 4.2 percent. Conclusion: While bacterial and fungal co-infections are rare in COVID-19 patients, they are widespread in critically ill individuals. More investigation into the impact of antimicrobial therapy on therapeutic success in COVID-19 patients is essential to prevent antibiotic abuse. COVID-19 management might be improved with the aid of ABS standards. It's also necessary to look at the microbiological patterns of infectious consequences in COVID-19 individuals who are severely unwell.

PREVENTIVNE MJERE KONTROLE Legionella U VODOOPSKRBNIM SUSTAVIMA TIJEKOM EPIDEMIJE

U ovom su članku opisane i sažete strategije i mjere koje bi se trebale primjenjivati u Hrvatskoj u svrhu sprječavanja kontaminacije vodoopskrbnih sustava pojedinih ustanova bakterijom Legionella tijekom pandemije COVID-19. Kolonizacija bakterije Legionella u vodovodnim instalacijama povećava rizik od zaraze ljudi, stoga je važno istaknuti da je ovaj problem javnog zdravstva još veći tijekom drugih epidemija. Legionella može uzrokovati vrlo ozbiljne vrste upale pluća, tzv. legionarsku bolest i manje opasnu pontijačku groznicu. Hrvatska će u svoje zakonodavstvo implementirati izmjenjenu EU Direktivu 2020/2184 o kvaliteti vode za ljudsku potrošnju koja po prvi put uključuje obvezu procjene rizika od bakterije Legionella. To bi trebalo pridonijeti u smanjenju zdravstvenih rizika ili komplikacija respiratornih infekcija (teške upale pluća) i smrtnosti tijekom drugih epidemija (COVID-19 ili sl.).Alternate abstract:This paper describes and summarizes the strategies and measures that should be applied in Croatia toprevent Legionella contamination in drinking water systems in buildings during the COVID-19 epidemic. Legionellacolonisation in drinking water installations increases the risk of infection for humans and it is important to pointout that this public health problem is even greater during other epidemics. Legionella can cause very severe typesof pneumonia called Legionnaires' disease and less serious illness Pontiac fever. Therefore, Croatia will implementthe new EU Directive 2020/2184 on the quality of water intended for human consumption into its legislation, whichfor the first time includes an obligation to assess the risk of Legionella.This should help reduce the health risk orcomplications of respiratory infections (severe pneumonia) and mortality during other epidemics (COVID-19 andsimilar).Alternate abstract:In diesem Beitrag werden die Strategien und Maßnahmen beschrieben undzusammengefasst, die in Kroatien angewendet werden sollen zum Zwecke der Vorbeugung der Kontamination vonWasserversorgungssystemen verschiedener Institutionen mit Legionella-Bakterien während der COVID-19-Pandemie.Die Ansiedlung von Legionella-Bakterien in Wasserinstallationen erhöht das Infektionsrisiko beim Menschen,deswegen ist es wichtig darauf hinzuweisen, dass dieses Problem des öffentlichen Gesundheitswesens noch größerwährend anderer Epidemien ist. Legionellen können sehr schwere Arten von Lungenentzündungen verursachen, diesgn. Legionärskrankheit und das weniger gefährliche Pontiac-Fieber. Kroatien wird durch seine Gesetze die Richtlinie(EU) 2020/2184 über die Qualität von Wasser für den menschlichen Gebrauch umsetzen, die zum ersten Mal dieAnforderung der Risikobewertung eines Versorgungssystems in Bezug auf Legionellen enthält. Das sollte helfen,die Gesundheitsrisiken oder Komplikationen von Atemweginfektionen (schwere Lungenentzündungen)sowie dieSterblichkeit während anderer Epidemien (COVID-19 und ähnliche) zu reduzieren.

Preventive measures for managing Legionella in drinking water systems during epidemics

This paper describes and summarizes the strategies and measures that should be applied in Croatia to prevent Legionella contamination in drinking water systems in buildings during the COVID-19 epidemic. Legionella colonisation in drinking water installations increases the risk of infection for humans and it is important to point out that this public health problem is even greater during other epidemics. Legionella can cause very severe types of pneumonia called Legionnaires' disease and less serious illness Pontiac fever. Therefore, Croatia will implement the new EU Directive 2020/2184 on the quality of water intended for human consumption into its legislation, which for the first time includes an obligation to assess the risk of Legionella. This should help reduce the health risk or complications of respiratory infections (severe pneumonia) and mortality during other epidemics (COVID-19 and similar).

Legionella Myocarditis Masquerading as Dual Chamber Cardiac Arrhythmia

Background Legionella pneumonia is a rare cause of myocarditis. Case 64-y.o male with CAD and PCI to LAD, DM and HTN presented to ER with mental status changes. On exam he was febrile and hypoxic.Presenting rhythm was Afib with frequent bouts of sustained and non-sustained stable posteroseptal VT treated with amiodarone and mexilitene. With right lung infiltrate on CXR and elevated WBC count, antibiotics were initiated for pneumonia. SARS COV-2 Ag and Influenza A & B was negative. Urine Ag for legionella was positive and was promptly treated with Levofloxacin. Coronary angiogram prior to discharge showed non-obstructive CAD. Decision-making Legionnaires' disease with myocarditis was suspected. Patient underwent CMR with late gadolinium enhancement (LGE) and Rest 82Rb perfusion and 18F-FDG PET/CT with high-fat dietary preparation scan for evaluation of legionella myocarditis. CMR revealed LVEF of 46%, with LGE and PET findings as described in the Figure. He was initiated on solumedrol for ongoing inflammation after completion of antibiotic therapy for Legionella pneumonia. Conclusion Our case highlights a systematic approach to differential diagnosis and use of multimodality imaging in legionella myocarditis presenting with dual chamber arrhythmia. There was good correlation between LGE inflammation/scar location and origin of VT, as well as active inflammation demonstrated by FDG PET imaging. The patient was successfully treated with antibiotics, steroids and anti-arrhythmic drugs. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Pathogenic characteristics of severe acute respiratory infection in adult inpatients in Yangpu District, Shanghai, 2019-2021

Objective: To understand the pathogenic spectrum and epidemiological characteristics of severe acute respiratory infection (SARI) in adult inpatients in Yangpu District, Shanghai, China, in order to explore strategies for the prevention and treatment of respiratory infectious diseases. Methods: Individual cases were from adult inpatients with SARI in Yangpu District, Shanghai, China from January 2019 to July 2021. Their respiratory samples were collected for etiological pathogen testing. Results: A total of 681 SARI cases were enrolled for sampling and lab testing. Among them, 79.00% were aged 60 years and older, and 75.48% had confirmed chronic disease history. A total of 163 infection inpatients (23.94%) were positive for at least one pathogen. The pathogens identified most frequently were influenza A virus (6.75%), followed by rhinovirus/enterovirus (3.23%), parainfluenza virus (PIV) (2.79%), Mycoplasma pneumoniae (2.35%), coronavirus (CoV) (2.06%). The positive rates of adenovirus (AdV), human metapneumovirus (hMPV), respiratory syncytial virus and bocavirus were all less than 2%. Bacterial strains were identified in eleven SARI cases, including Staphylococcus aureus and Pseudomonas aeruginosa (4 strains), Klebsiella pneumoniae (3 strains). Legionella pneumophila was detected in 9 cases (1.32%) and Bordetella pertussis in 5 cases (0.73%). Two pathogens were co-detected from 11 cases, accounting for 1.62% of 163 positive cases. The most common co-detected pathogens were influenza A virus and other pathogens, accounting for 54.55% of the mixed infection. The positive rates of pathogens were not significantly different between less than 60 years old and over 60 years old groups except for Bordetella pertussis, adenovirus and Mycoplasma pneumonia(P < 0.05). Influenza virus had epidemic peak in winter and spring, but not in summer from 2019 to 2021. Conclusion: Various respiratory pathogens are detected from adult SARI cases. It is mainly influenza virus, with co-detected pathogens and rare pathogens. This study provides helpful information for targeted prevention and control measures including vaccination.

An insight into the microbiology, epidemiology, and host cell biology of Legionella pneumophila: a review of literature

Legionnaires' disease (LD) is a type of severe pneumonia that mainly caused by bacteria of the genus Legionella. LD bacteria reside in the water systems of facilities where lack of water exchange or flow plays a crucial role in enhancing bacterial growth. The under-recognition of the dangers of Legionella along with easing of Coronavirus disease 2019 (COVID-19) lockdown restrictions and global reopening, pose a potential increased risk of developing LD. Various Legionella species can lead to legionellosis infections, including LD and Pontiac fever. Legionellosis cases is generally found in natural or artificial aquatic environments such as cooling towers, hot water tanks, or air conditioning. The bacteria elude the host's immune responses by various strategies, including releasing effector proteins. Thus, this review provides insight into the microbiology, epidemiology, and host cell biology of L. pneumophila, as well as an emphasis on the bacterial novel survival strategies of L. pneumophila. Also, suggests taking intensive actions towards closed buildings as a potential source of bacterial infection.

Impact of prolonged hotel closures during the COVID-19 pandemic on Legionella infection risks.

In general, it is accepted that water stagnation and lack or poor maintenance in buildings are risk factors for Legionella growth. Then, in theory, the prolonged hotel closures due to the COVID-19 pandemic may have increased the risk of Legionella infections. However, there are very few field studies comparing the level of Legionella colonization in buildings before the pandemic and the new situation created after the lockdown. The objective of this study was to analyze these differences in a group of hotels that experienced prolonged closures in 2020 due to the COVID-19 pandemic. We have studied the Legionella spp. results, analyzed by standard culture, from the domestic water distribution systems of 73 hotels that experienced closures (from 1 to >4 months) during 2020, immediately after the reopening. The results were compared with those obtained in similar samplings of 2019. For the comparative analysis, we divided the hotels in two groups: Group A that have suffered closures for ≤3 months and Group B that remained closed for more than 3 months, both in relation to the opening period of 2019. In the Group B (36 sites), the frequency of positive samples in the hot water system increased from 6.7% in 2019 to 14.0% in 2020 (p < 0.05). In the Group A (37 sites), no significant differences were observed. No statistically significant differences were observed in terms of positive sites (defined as hotels with at least 1 positive sample), Legionella spp. concentrations and prevalence of Legionella pneumophila sg1 between the samplings of the two periods studied. The results suggest that hotels that suffered the longest prolonged closures (> 3 months) could have carried a higher risk of exposure to Legionella in the domestic hot water system. These findings highlight the importance of adequate preopening cleaning and disinfection procedures for hotel water systems, and the convenience of considering the most effective disinfection methods especially for hot water systems and after prolonged closure periods.

Effect of the COVID-19 pandemic and state of emergency declarations on the relative incidence of legionellosis and invasive pneumococcal disease in Japan

Introduction: During the COVID-19 pandemic, the incidence of many droplet-transmitted infections decreased due to increased mask-wearing and social distancing. Contrastingly, there has been concern that COVID-19 countermeasures, such as lockdowns, may increase legionellosis incidence via water stagnation. During the pandemic in Japan, four state of emergency declarations were imposed between 2020 and 2021, which makes it particularly suitable to test this hypothesis. Methods: We use country-level surveillance data from the National Institute of Infectious Diseases to track the relative incidence of legionellosis compared to invasive pneumococcal disease (IPD) during the COVID-19 pandemic in Japan, with a focus on the periods just after state of emergency declarations were lifted. Results: The absolute number of legionellosis and IPD cases decreased in 2020 and 2021 compared to previous years. The average relative incidence of legionellosis as well as the variance of the relative incidence significantly increased during the pandemic compared to previous years. There were no increases in the relative incidence of legionellosis during the periods immediately following emergency declaration liftings, but the relative incidence did increase considerably during the first two states of emergency. Conclusions: COVID-19 countermeasures appear more effective at decreasing the incidence of human-to-human transmitted infections, such as IPD, compared to environmentally-transmitted infections, such as legionellosis. Though no evidence was found to suggest that legionellosis cases increased after state of emergency declarations, public health efforts should continue to emphasize the importance of routine sanitation and water system maintenance to prevent water stagnation and Legionella spp. contamination. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Legionella pneumophila: The Journey from the Environment to the Blood.

An outbreak of a potentially fatal form of pneumonia in 1976 and in the annual convention of the American Legion was the first time that Legionella spp. was identified. Thereafter, the term Legionnaires' disease (LD) was established. The infection in humans is transmitted by the inhalation of aerosols that contain the microorganisms that belong to the Legionellaceae family and the genus Legionella. The genus Legionella contains genetically heterogeneous species and serogroups. The Legionella pneumophila serogroup 1 (Lp1) is the most often detected strain in outbreaks of LD. The pathogenesis of LD infection initiates with the attachment of the bacterial cells to the host cells, and subsequent intracellular replication. Following invasion, Legionella spp. activates its virulence mechanisms: generation of specific compartments of Legionella-containing vacuole (LCV), and expression of genes that encode a type IV secretion system (T4SS) for the translocation of proteins. The ability of L. pneumophila to transmigrate across the lung's epithelium barrier leads to bacteremia, spread, and invasion of many organs with subsequent manifestations, complications, and septic shock. The clinical manifestations of LD depend on the bacterial load in the aerosol, the virulence factors, and the immune status of the patient. The infection has two distinct forms: the non- pneumatic form or Pontiac fever, which is a milder febrile flu-like illness, and LD, a more severe form, which includes pneumonia. In addition, the extrapulmonary involvement of LD can include heart, brain, abdomen, and joints.

A Case of Myositis in Patient with Atypical Bacterial Pneumonia

Case report - Introduction: Bacterial community-acquired atypical pneumonia is sometimes complicated by myositis or by renal parenchymal disease. They can present with myositis and present with muscle weakness, pain or swelling, and elevated muscle enzymes. We present the case of a patient with lower limb weakness and raised creatinine kinase with atypical pneumonia caused by Legionella pneumophila. Case report - Case description: A 76-year-old Caucasian man, who was previously fit and independent and walked 3 miles every day presented with a 1-week history of progressive leg weakness, and inability to mobilize. He had a fall and was on the floor for 2 hours. He had a background history of hypercholesterolemia and was on atorvastatin for 15 years. On his vital observation, he was found tachypnoeic, tachycardic, and hypoxic. He had a right upper lobe crackle but he didn't have respiratory symptoms. His muscle power in his leg was 3/5 with carpet burns on knees and elbow. Initial investigation showed raised inflammatory marker CRP 412mg/L, AKI stage 1, and CK 43400 IU/L. His CXR showed dense right upper lobe consolidation. Legionella urinary antigen was positive. Myositis myoblot, ANA, ANCA negative. COVID-19 swab negative. Treated with IV antibiotic, supplemental oxygen, and IV fluid. Transferred to ITU due to worsening of hypoxia and kidney function. Interestingly, the CK level had improved significantly within 48 hours along with clinical improvement in his symptoms. There was no role of steroid or immunosuppressant due to his significant clinical improvement. On day 7 he was off oxygen, kidney function improved, had physiotherapy, and transferred to ward and on day 10 he was ambulant and discharged home. Case report - Discussion: To date, very few case reports of myositis in a patient with atypical pneumonia have been reported. The mechanism underlying acute myositis in atypical pneumonia is still unknown. The present analysis points out that the organism underlying atypical bacterial pneumonia may occasionally invade the muscle tissue thereby inducing both myositis and secondary kidney damage. Case report - Key learning points: We should be aware of this rare complication of atypical pneumonia and the resolution of symptoms that occur with the treatment of pneumonia. This would avoid unnecessary investigation and use of steroid.