Legionella colonisation in hot water systems in care homes from two Danish municipalities.

Legionnaires' disease is a serious health risk among the elderly. Water systems in care homes are therefore of particular interest. We investigated the levels of culturable Legionella in the hot water systems in care homes in two Danish municipalities. Two hundred and sixty-eight water samples from 98 care homes were evaluated. Contents of culturable Legionella counts were calculated, and correlations between temperature and colony-forming units (CFU/L) were analysed. Seventy-seven and 81%, respectively, of the care homes were colonised with Legionella in the two municipalities. Most care homes had less than 1,000 CFU/L, but 13 and 16% had more than 10,000 CFU/L. When including first flush samples, 27% of the care homes in Municipality 1 had Legionella levels above 10,000 CFU/L. Temperatures of ≥50 °C in Municipality 1 and ≥55 °C in Municipality 2 correlated with low levels of Legionella. The content of Legionella colonies was significantly higher in care homes in Municipality 1. However, a significantly higher proportion of taps in Municipality 2 had Legionella colonies. In conclusion, temperatures should be raised to 55 °C to avoid high Legionella levels. Test procedures should be evaluated, and the regular use of taps and routine testing for Legionella should be taken into consideration.

Development of a species-specific real-time PCR test for Chlamydia psittaci and its employment in the investigation of zoonotic transmission from racing pigeons in Denmark.

Species-specific detection of Chlamydia psittaci is challenging and all published PCR tests have so far shown deficiencies in specificity or sensitivity. The present investigation reports on the development of a species-specific real-time PCR assay for C. psittaci. The test is based on an 84 bp indel in a gene of unknown function that is unique to C. psittaci. The Cps-indel84-PCR assay was validated on a wide range of chlamydial and other bacterial strains as well as on clinical samples from animals and humans in two different diagnostic laboratories in Germany and Denmark. Furthermore, the test was employed for investigating samples from racing pigeon flocks in Denmark. The evaluation showed that the Cps-indel84-PCR assay has excellent test characteristics and is a highly reliable method for identifying C. psittaci in clinical samples both from humans and animals.

[Ornithosis is a diagnostic challenge].

Symptoms of ornithosis are often unspecific and vary in severity. This case report illustrates the challenges in diagnosing ornithosis. It also shows how easy it is to diagnose ornithosis by PCR analysis of a sputum sample and that it is not always possible to base the diagnosis on serology as our patient had negative serology tests even four weeks after hospitalization. The diagnosis was furthermore compounded by an underlying chronic lung disease. To diagnose patients with respiratory problems correctly it is important to analyse lower respiratory samples by PCR along with other diagnostic tests and to get a detailed medical history.

Detection of Legionella bozemanae, a new cause of septic arthritis, by PCR followed by specific culture.

Legionella bozemanae is a rare isolate in clinical specimens. We describe a case of joint infection due to L. bozemanae in an immunocompromised patient with dermatomyositis. Without the use of PCR screening or culture on specialized medium, the organism would not have been detected.

[Macrolide resistance in Mycoplasma pneumoniae by recurrence and extended illness]. / Makrolidresistens hos Mycoplasma pneumoniae ved recidiv og langvarigt sygeforløb.

A 36 year-old female with a Mycoplasma pneumoniae (MP) infection was treated with azithromycin. She recovered transitory, but experienced a relapse a few days later. After ten days she visited her general practitioner again; she was tired and weakened, had a debilitating dry cough and a weight loss of 6 kg. A throat swab was positive for MP by a polymerase chain reaction (PCR). It was investigated by sequencing and a mutation corresponding to a A2063G transition in domain V of the 23S rRNA known to be associated with macrolide resistance was detected. Twenty-two days later, MP could still be detected by PCR on a nasopharyngeal secretion.