Practical evaluation of molecular subtyping and phage typing in outbreaks of infection due to Salmonella enterica serotype typhimurium.

Identification and control of food-poisoning outbreaks due to salmonellosis depend on prompt microbiological diagnosis and subtyping to identify the causative strain. In Australia, Salmonella enterica subspecies enterica serotype typhimurium (S. typhimurium) is responsible for 40-70% of cases of human salmonellosis. Phage typing is the usual method of subtyping S. typhimurium, but on its own, has limitations. We compared it with three molecular subtyping methods using 100 isolates of S. typhimurium, representing four different phage types (PT 1, 9, 126 and 135) and comprising 74 isolates from three presumed outbreaks, 25 isolates from sporadic cases of salmonellosis and S. typhimurium ATCC 10428 (phage type 126). The isolates were divided into 11 subtypes by IS200 restriction fragment length polymorphism (RFLP) typing, four each by ribotyping and pulsed-field gel electrophoresis (PFGE) and 17 distinct strains using a combination of phage and molecular typing. Isolates from two presumed outbreaks were resolved into multiple strains, possibly explaining the failure to identify a common source for either during the original investigations. IS200 RFLP analysis was the most discriminatory and reproducible typing method. Several strains were identifiable within and shared between phage types 1, 9 and 126. Phage and IS200 RFLP typing together, would provide improved definition of S. typhimurium outbreaks.

Evaluation of the cleaning and disinfection efficacy of the DEKO-190; award-based automated washer/disinfector.

The DEKO-190 Washer-Disinfector combines both automatic washing and thermal disinfection functions and is designed for the decontamination of ward utensils (such as bedpans and urine bottles) and instruments used in minor surgery prior to sterilization. We undertook a microbiological evaluation of the disinfection efficacy of the machine, using its short wash plus disinfection programme and sealed suspensions of test organisms placed at various points within the instrument. Suspensions of Enterococcus faecalis and Poliovirus were totally inactivated, the counts of aerobic organisms within a stool specimen being reduced by a factor of 10(4)whilst spores of Clostridium perfringens were unaffected. The cleaning efficacy of the DEKO-190 was also evaluated under clinical conditions by visual inspection and was found to be satisfactory. Ward-based combined washer-disinfection machines, such as the DEKO-190, have the potential to improve the efficacy of cleaning protocols within healthcare institutions.

Pseudoepidemic of Legionella pneumophila serogroup 6 associated with contaminated bronchoscopes.

An investigation of a pseudoepidemic of Legionella pneumophila serogroup 6 contaminating bronchoalveolar lavage specimens traced the source to contaminated tap water used to rinse disinfected bronchoscopes. The problem recurred despite plumbing changes and the installation of filters in the endoscopy unit water system because of inadequate maintenance of the filters.

Rapid diagnosis of Legionella pneumophila serogroup 1 infection with the Binax enzyme immunoassay urinary antigen test.

The Binax legionella urinary antigen (LUA) enzyme immunoassay (Binax, Portland, Maine) was evaluated in 159 patients with suspected or proven legionellosis and 209 controls. A positive LUA test was found in 37% of patients with suspected legionellosis overall and in 83% of those with proven Legionella pneumophila serogroup 1 infection. The sensitivity of the LUA test was significantly greater than that of the direct fluorescent-antigen test (83 versus 42%; P < 0.0001) but not significantly different from that of culture (85%) or serology (91%); specificity was at least 99.5%.

Legionellosis linked with a hotel car park--how many were infected?

An outbreak of legionellosis associated with a hotel in Sydney, Australia, and the subsequent epidemiological and environmental investigations are described. Four cases of Legionnaires' disease were notified to the Public Health Unit. A cross-sectional study of 184 people who attended a seminar at the hotel was carried out. Serological and questionnaire data were obtained for 152 (83%) of these. Twenty-eight (18%) respondents reported symptoms compatible with legionellosis. Thirty-three subjects (22%) had indirect fluorescent antibody (IFA) titres to Legionella pneumophila serogroup 1 (Lp-1) of 128 or higher. The only site which those with symptoms of legionellosis and IFA titre > or = 128 were more likely to have visited than controls was the hotel car park (adjusted odds ratio [OR] 14.7, 95% confidence interval [CI]: 1.8-123.1). Those with symptoms compatible with legionellosis, but whose IFA titres were < 128 were also more likely to have visited the hotel car park (adjusted OR 4.4, 95% CI: 1.5-12.9). Seroprevalence of Lp-1 antibodies was higher in those who attended the seminar than in a population sample of similar age. Findings suggested that the 4 cases represented a small fraction of all those infected, and highlighted difficulties in defining illness caused by Lp-1 and in interpreting serology.

Legionnaires' disease in a renal transplant recipient.

A case of fatal Legionnaires' disease in an immunosuppressed renal transplant recipient is reported. Diagnosis was based on the antemortem culture of Legionella pneumophila from sputum and pleural aspirate.