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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.
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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.
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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).
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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.
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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.
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Introduction: Legionellosis is the common name for infections caused by bacteria belonging to the genus Legionella. The most severe clinical presentation is an interstitial pneumonia, named Legionnaires' disease, caused by Legionella pneumophila. The disease is subject to mandatory reporting and laboratory tests are required to confirm the diagnosis. This article summarises the results of the National Surveillance System (NSS) for legionellosis for the year 2021, coordinated and managed by the Istituto Superiore di Sanita (ISS). This report highlights also the microbiological surveillance data from the national reference laboratory for legionellosis of the ISS. Materials and methods: The surveillance forms, filled in by the doctors who diagnose legionellosis, are analyzed by the NSS for possible sources of infection, clinical picture and etiological assessment. In parallel with the NSS there is a European Surveillance System for Travel associated Legionnaires 'disease, the European Legionnaires' Disease Surveillance Network (ELDSNet).
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This special issue includes 11 articles focusing on development of container laboratories in response to COVID-19;COVID-19 in Fiji;Pacific Regional Infectious Disease Association (PRIDA) - capacity-building for microbiology and infectious disease across the Pacific;meningococcal surveillance in Southeast Asia and the Pacific;tropical fever in remote tropics;movement of arboviruses between Indonesia and Western Australia;Rotavirus surveillance informs diarrhoea disease burden in the WHO Western-Pacific region;surveillance for One Health and high consequence veterinary pathogens (Brucellosis, Coxiellosis and Foot and Mouth Disease) in Southeast Asia - Lao PDR and Cambodia in focus and the importance of international partnerships;Avian influenza H5N1.
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Bilateral multilobar ground-glass opacities are characteristic features of COVID-19 pneumonia. However, the differential diagnosis of ground-glass opacities is challenging. The aim of this paper was to share our experiences with other colleagues. The first patient presented with anosmia and loss of taste. Legionella antigen in urine was positive. The second patient had bilateral ground-glass opacities, which predominantly involved the upper lung zones and lymphopenia. Radiological findings were the same with the radiological control of 8 months ago, and she had a diagnosis of sarcoidosis. The third patient complained of dyspnoea. The inspection of national health system records showed a histological diagnosis of nonspecific interstitial/organizing pneumonia. The fourth patient had findings suggestive of congestive heart failure such as bilateral pleural effusion, peribronchial cuffing, and interlobular septa thickening. The co-existence of multiple ill-defined centrilobular ground-glass opacities suggested a concomitant disease but lesions disappeared with furosemid infusion within 5 days. The fifth patient presented with only right upper lobe consolidation. The opacities did not exceed the horizontal fissure. The intact fissure suggested a bacterial aetiology, but PCR tests of the nasopharyngeal samples were positive for COVID-19. This finding suggested that pulmonary infiltrate of COVID-19 was inflammatory rather than infective in nature. In conclusion, old imaging studies were more useful in the differential diagnosis.
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Objective: To understand the change characteristics of respiratory pathogens in hospitalized children with respiratory tract infection in Shunyi district of Beijing from 2019 to 2020, and to provide basis for the prevention and treatment of respiratory tract diseases in children.
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Managing building water systems is complicated by the need to maintain hot water temperatures high enough to control the growth of Legionella spp. while minimizing the risk of scalding. This study assessed water quality management practices in large buildings in the United States. Surveys conducted with building water quality managers found that more than 85% of buildings have hot water temperatures that are consistent with scald risk mitigation guidelines (i.e., < 122..F/50..C). However, nearly two thirds and three quarters of buildings do not comply with the common temperature guidance for opportunistic pathogen control, i.e., water heater setpoint > 140..F (60..C) and recirculation loop > 122..F (50..C), respectively;median values for both setpoint and recirculation loop temperatures are 10..F (6..C) or more below temperatures recommended for opportunistic pathogen control. These observations suggest that many buildings are prone to Legionella spp. risk. The study also found that 27% of buildings do not comply with guidelines for time to equilibrium hot water temperature, over 33% fail to monitor temperature in the recirculation loop, more than 70% fail to replace or disinfect showerheads, more than 40% lack a written management plan, and only a minority conduct any monitoring of residual disinfectant levels or microbiological quality. Given the rise in Legionellosis infections in recent years, coupled with highlighted water quality concerns because of prolonged water stagnation in plumbing, such as in buildings closed due to COVID-19, current management practices, which appear to be focused on scald risk, may need to be broadened to include greater attention to control of opportunistic pathogens. To accomplish this, there is a need for formal training and resources for facility managers.
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Introduction: 2020 will be remembered as the year of the COVID-19 pandemic, which caused 2,107,166 cases and 74,159 deaths in Italy as of December 31st. At the same time, protective measures against COVID-19 have proved to be effective for other infectious pathogens, since we noticed the absence or reduction of some infectious diseases, such as measles and seasonal flu. Legionellosis may also have been affected by these measures. Legionellosis is a form of interstitial pneumonia subject to mandatory reporting and laboratory tests are required to confirm the diagnosis. This article summarises the results of the Italian National Surveillance System (INSS) for legionellosis, coordinated and managed by the Istituto Superiore di Sanita (ISS), for the year 2020. Furthermore, this report shows the microbiological surveillance data from the National Reference Laboratory for Legionellosis of the ISS. Materials and methods: The surveillance forms, filled in by the doctors who diagnose legionellosis, are analyzed by the NSS for possible sources of infection, clinical picture and etiological assessment. In parallel with the INSS there is a European Surveillance System for travel-associated Legionnaires' disease, the European Legionnaires' Disease Surveillance Network (ELDSNet).
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The European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) have published the EU One Health 2020 Zoonoses Report. Campylobacteriosis was the most reported zoonosis in the EU in 2020, with 120,946 cases compared to more than 220,000 the previous year. This was followed by salmonellosis, which affected 52,702 people, compared to 88,000 in 2019. The number of reported foodborne outbreaks fell by 47%, with the report acknowledging the impact of the COVID-19 pandemic in the drop in reported zoonotic diseases in humans. The next most commonly reported diseases were yersiniosis, with 5,668 cases, and infections caused by Shiga toxin-producing Escherichia coli, with 4,446 cases. Listeriosis was the fifth most reported zoonosis, mainly affecting people over the age of 64. Listeriosis and West Nile virus (WNV) infections were the diseases with the highest case fatality and hospitalisation rates, with most locally acquired human infections of WNV reported in Greece, Spain and Italy. The report also monitors foodborne outbreaks in the EU, events during which at least two people contract the same illness from the same contaminated food. A total of 3,086 foodborne outbreaks were reported in 2020, with Salmonella remaining the most frequently detected agent, causing around 23% of outbreaks. The most common sources of salmonellosis outbreaks were eggs, egg products and pig meat. The report also includes data on Mycobacterium bovis, Mycobacterium caprae, Brucella, Trichinella, Echinococcus, Toxoplasma gondii, rabies, Q fever and tularaemia.