As a type of
Humans ; Legionella/genetics* ; Legionella longbeachae/genetics* ; Legionellosis/drug therapy* ; Pneumonia/diagnosis* ; Retrospective Studies

Legionella species are abundant in the built environment and are increasingly recognized as a cause of Legionnaires' disease (LD). As the number of cases of Legionnaires' disease acquired by local communities in the Seoul metropolitan area in Korea has been increased, there was concern that changes in environmental factors could affect disease outbreaks. We described the association between climatic variables and occurrence of legionellosis in Korea and Legionella detection rate in Seoul area. A total of 418 cases of legionellosis were reported between 2014 and 2017. There was a seasonal peak in summer. LD continuously occurred from early spring to winter every year and rapidly increased in summer. In the regression analysis, the primary variables of interest- PM2.5 (µg/m³), NO₂ (ppb), and a number of the date of issue O₃ warning were not significant except for average temperature (R²=0.8075). The Legionella detection rate in Seoul, Korea showed a trend similar to precipitation (P=0.708, ANOVA). A relatively high proportion of Legionella detection rate was shown, especially cooling tower (17.7%) and public bath (19.3%). This finding is in line with current understanding of the ecological profile of this pathogen and supports the assertion that legionellosis occurs through contamination of water sources.
Baths ; Disease Outbreaks ; Epidemiology ; Korea ; Legionella ; Legionellosis ; Legionnaires' Disease ; Regression Analysis ; Seasons ; Seoul ; Water

The harshness of legionellosis differs from mild Pontiac fever to potentially fatal Legionnaire's disease. The increasing development of drug resistance against legionellosis has led to explore new novel drug targets. It has been found that phosphoglucosamine mutase, phosphomannomutase, and phosphoglyceromutase enzymes can be used as the most probable therapeutic drug targets through extensive data mining. Phosphoglucosamine mutase is involved in amino sugar and nucleotide sugar metabolism. The purpose of this study was to predict the potential target of that specific drug. For this, the 3D structure of phosphoglucosamine mutase of Legionella pneumophila (strain Paris) was determined by means of homology modeling through Phyre2 and refined by ModRefiner. Then, the designed model was evaluated with a structure validation program, for instance, PROCHECK, ERRAT, Verify3D, and QMEAN, for further structural analysis. Secondary structural features were determined through self-optimized prediction method with alignment (SOPMA) and interacting networks by STRING. Consequently, we performed molecular docking studies. The analytical result of PROCHECK showed that 95.0% of the residues are in the most favored region, 4.50% are in the additional allowed region and 0.50% are in the generously allowed region of the Ramachandran plot. Verify3D graph value indicates a score of 0.71 and 89.791, 1.11 for ERRAT and QMEAN respectively. Arg419, Thr414, Ser412, and Thr9 were found to dock the substrate for the most favorable binding of S-mercaptocysteine. However, these findings from this current study will pave the way for further extensive investigation of this enzyme in wet lab experiments and in that way assist drug design against legionellosis.
Computer Simulation* ; Data Mining ; Drug Delivery Systems ; Drug Design ; Drug Resistance ; Fever ; Legionella pneumophila* ; Legionellosis* ; Legionnaires' Disease ; Metabolism ; Phosphoglycerate Mutase

BACKGROUNDThe environmental sources associated with community-acquired or nosocomial legionellosis were not always detectable in the mainland of China and Hong Kong, China. The objective of this study was to illustrate the control measures implemented for nosocomial and community outbreaks of legionellosis, and to understand the environmental distribution of legionella in the water system in Hong Kong, China.

METHODSWe investigated the environmental sources of two cases of legionellosis acquired in the hospital and the community by extensive outbreak investigation and sampling of the potable water system using culture and genetic testing at the respective premises.

RESULTSThe diagnosis of nosocomial legionellosis was suspected in a patient presenting with nosocomial pneumonia not responsive to multiple beta-lactam antibiotics with subsequent confirmation by Legionella pneumophila serogroup 1 antigenuria. High counts of Legionella pneumophila were detected in the potable water supply of the 70-year-old hospital building. Another patient on continuous ambulatory peritoneal dialysis presenting with acute community-acquired pneumonia and severe diarrhoea was positive for Legionella pneumophila serogroup 1 by polymerase chain reaction (PCR) testing on both sputum and nasopharyngeal aspirate despite negative antigenuria. Paradoxically the source of the second case was traced to the water system of a newly commissioned office building complex. No further cases were detected after shock hyperchlorination with or without superheating of the water systems. Subsequent legionella counts were drastically reduced. Point-of-care infection control by off-boiled or sterile water for mouth care and installation of water filter for showers in the hospital wards for immunocompromised patients was instituted. Territory wide investigation of the community potable water supply showed that 22.1% of the household water supply was positive at a mean legionella count of 108.56 CFU/ml (range 0.10 to 639.30 CFU/ml).

CONCLUSIONSPotable water systems are open systems which are inevitably colonized by bacterial biofilms containing Legionella species. High bacterial counts related to human cases may occur with stagnation of flow in both old or newly commissioned buildings. Vigilance against legionellosis is important in healthcare settings with dense population of highly susceptible hosts.

Aged ; Aged, 80 and over ; Biofilms ; Community-Acquired Infections ; diagnosis ; epidemiology ; Female ; Hong Kong ; epidemiology ; Humans ; Legionellosis ; diagnosis ; epidemiology ; Male ; Water Microbiology

The genus Legionella is common in aquatic environments. Some species of Legionella are recognized as potential opportunistic pathogens for human, notably Legionella pneumophila that causes Legionellosis. During the summer season between June and August in 2010, we isolated 61 L. pneumophila from the bath facilities of public establishments of 25 wards in Seoul. The existence of 16S rRNA and mip gene of L. pneumophila was confirmed in the genome of the isolated strains by PCR. Among the 61 strains of L. pneumophila, thirty three isolates belong to serogroup 1 (54.1%), 13 isolates were serogroup 6 (21.3%), 9 isolates were serogroup 5 (14.8%), 3 isolates were serogroup 3 (4.9%), and 3 isolates were identified in serogroup 2 (4.9%). On pulsed-field gel electrophoresis (PFGE) analysis using SfiI, genetic types of L. pneumophila were classified into 8 (A to H) patterns by the band similarity with excess of 65%. Our results suggest the existence of serological and genetic diversity among the L. pneumophila isolates.
Baths ; Electrophoresis, Gel, Pulsed-Field ; Genetic Variation ; Genome ; Humans ; Legionella ; Legionella pneumophila ; Legionellosis ; Molecular Epidemiology ; Polymerase Chain Reaction ; Seasons

Many infectious diseases have emerged or re-emerged during the past 50 years in the Republic of Korea. Some of these are new infectious diseases delivered by new or newly recognized micro-organisms. Others are already known infectious diseases which have increased in frequency or have developed an expanded region of occurrence. Still others are infectious diseases that are caused by the same micro-organisms which are resistant to antibiotics, and therefore difficult to treat. Newly recognized Emerging Infectious Diseases (EIDs) include legionellosis, leptospirosis, tsutsugamushi diseases, Vibrio vulnificus sepsis, and brucellosis. New EIDs include acquired immunodeficiency syndrome, enterohemorrhagic E. coli infection, Creutzfeldt-Jacob disease. Of the EIDs occurred in the Republic of Korea during the past 50 years, healthcare-related infections, especially by antibiotic-resistant organisms, are the most important EIDs in terms of morbidity and mortality.
Acquired Immunodeficiency Syndrome ; Anti-Bacterial Agents ; Brucellosis ; Communicable Diseases ; Communicable Diseases, Emerging ; Enterohemorrhagic Escherichia coli ; Legionellosis ; Leptospirosis ; Republic of Korea ; Scrub Typhus ; Sepsis ; Vibrio vulnificus

BACKGROUND: Antimicrobial susceptibility of Legionella spp. has rarely been studied in Korea. Therefore, we aimed to determine the susceptibility of Legionella spp. to various antibiotics. METHODS: We assessed the antimicrobial susceptibility of 66 environmental and clinical Legionella isolates collected between January 2001 and December 2008 from Korea and Japan. The minimum inhibitory concentrations (MICs) of 6 antibiotics, namely, azithromycin, ciprofloxacin, clarithromycin, clindamycin, gatifloxacin, and gemifloxacin were determined by the broth microdilution method using buffered starch yeast extract broth. RESULTS: The MIC ranges of the 6 antibiotics used against the Legionella isolates were as follows: 0.004-0.062 microgram/mL (azithromycin), 0.002-0.5 microgram/mL (ciprofloxacin), 0.004-0.5 microgram/mL (clarithromycin), 0.12-4 microgram/mL (clindamycin), 0.002-0.12 microgram/mL (gatifloxacin), and 0.008-1 microgram/mL (gemifloxacin). CONCLUSIONS: Legionella spp. isolates from Korea and Japan were most susceptible to gatifloxacin. Azithromycin, clarithromycin, ciprofloxacin, and gemifloxacin were also effective for treating legionellosis.
Anti-Bacterial Agents/*pharmacology ; Azithromycin/pharmacology ; Ciprofloxacin/pharmacology ; Clarithromycin/pharmacology ; Clindamycin/pharmacology ; Drug Resistance, Bacterial ; Fluoroquinolones/pharmacology ; Humans ; Legionella/*drug effects/isolation & purification ; Legionellosis/diagnosis/microbiology ; Microbial Sensitivity Tests ; Naphthyridines/pharmacology

Legionella is a pathogenic bacteria associated to aquatic habit of natural and artificial environments. Clinical cases of legionellosis have been reported in Korea but there is a lack of information about the incidence of this bacterium on environmental sources. Thus, we investigated the contamination of Legionella on water supply systems in Gwangju, Korea, including cooling towers, public baths, hospitals and fountains. Legionella spp. were detected from 81 samples (16.9%) out of 480 samples collected and the major species of Legionella isolates was identified to L. pneumophila serogroup (sg) 1 (n=33). The result of PFGE pattern analysis for L. pneumophila sg 1 isolates was discriminated into 11 pulsotypes. In dendrogram of PFGE, the clusters of isolates from cooling tower were quite different from those derived from hot water system of public bath. Surveillance for 4 sentinel public baths showed that their water supply systems had been contaminated with Legionella spp. and L. pneumophila sg 5 or sg 6 was the major isolate. The similarity of its PFGE patterns was 92.3%, 96.6%, respectively. Thus, PFGE may be a useful tool in molecular epidemiology studies, and the monitor and control for water supply systems of public utilizing facilities will be able to provide a resolution for the reduction of Legionella infection.
Bacteria ; Baths ; Incidence ; Korea ; Legionella ; Legionellosis ; Molecular Epidemiology ; Nitriles ; Organothiophosphorus Compounds ; Pyrethrins ; Water ; Water Supply

Legionella is a pathogenic bacteria associated to aquatic habit of natural and artificial environments. Clinical cases of legionellosis have been reported in Korea but there is a lack of information about the incidence of this bacterium on environmental sources. Thus, we investigated the contamination of Legionella on water supply systems in Gwangju, Korea, including cooling towers, public baths, hospitals and fountains. Legionella spp. were detected from 81 samples (16.9%) out of 480 samples collected and the major species of Legionella isolates was identified to L. pneumophila serogroup (sg) 1 (n=33). The result of PFGE pattern analysis for L. pneumophila sg 1 isolates was discriminated into 11 pulsotypes. In dendrogram of PFGE, the clusters of isolates from cooling tower were quite different from those derived from hot water system of public bath. Surveillance for 4 sentinel public baths showed that their water supply systems had been contaminated with Legionella spp. and L. pneumophila sg 5 or sg 6 was the major isolate. The similarity of its PFGE patterns was 92.3%, 96.6%, respectively. Thus, PFGE may be a useful tool in molecular epidemiology studies, and the monitor and control for water supply systems of public utilizing facilities will be able to provide a resolution for the reduction of Legionella infection.
Bacteria ; Baths ; Incidence ; Korea ; Legionella ; Legionellosis ; Molecular Epidemiology ; Nitriles ; Organothiophosphorus Compounds ; Pyrethrins ; Water ; Water Supply

BACKGROUND: The frequent outbreak of legionellosis makes it critical to identify infection sources for the prevention and blockade of transmission of the disease. METHODS: Thirty-one strains of Legionella pneumophila isolated from the cooling towers of big buildings in Busan and Gyungsangnamdo Province areas, 12 strains of L. pneumophila from patients in Japan, and one type strain (L. pneumophila ATCC 33152) were used for molecular strain typing by using an infrequent-restriction-site polymerase chain reaction (IRS-PCR). RESULTS: Each strain revealed to have 7-16 bands of 200-1000 bp size. All 44 strains showed band patterns different from each other, except two strains sharing 90% homology. CONCLUSION: The molecular typing of Legionellaby IRS-PCR is an excellent and rapid method for discriminating strains; therefore, it should be useful in demonstrating the identity of possible outbreak strains.
Busan ; Humans ; Japan ; Legionella pneumophila* ; Legionella* ; Legionellosis ; Molecular Typing ; Polymerase Chain Reaction*