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      Combination of Heat Shock and Enhanced Thermal Regime to Control the Growth of a Persistent Legionella pneumophila Strain

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          Abstract

          Following nosocomial cases of Legionella pneumophila, the investigation of a hot water system revealed that 81.5% of sampled taps were positive for L. pneumophila, despite the presence of protective levels of copper in the water. A significant reduction of L. pneumophila counts was observed by culture after heat shock disinfection. The following corrective measures were implemented to control L. pneumophila: increasing the hot water temperature (55 to 60 °C), flushing taps weekly with hot water, removing excess lengths of piping and maintaining a water temperature of 55 °C throughout the system. A gradual reduction in L. pneumophila counts was observed using the culture method and qPCR in the 18 months after implementation of the corrective measures. However, low level contamination was retained in areas with hydraulic deficiencies, highlighting the importance of maintaining a good thermal regime at all points within the system to control the population of L. pneumophila.

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          Direct healthcare costs of selected diseases primarily or partially transmitted by water.

          F Zhou, L Stockman, Michael L. Hicks … (2012)
          Despite US sanitation advancements, millions of waterborne disease cases occur annually, although the precise burden of disease is not well quantified. Estimating the direct healthcare cost of specific infections would be useful in prioritizing waterborne disease prevention activities. Hospitalization and outpatient visit costs per case and total US hospitalization costs for ten waterborne diseases were calculated using large healthcare claims and hospital discharge databases. The five primarily waterborne diseases in this analysis (giardiasis, cryptosporidiosis, Legionnaires' disease, otitis externa, and non-tuberculous mycobacterial infection) were responsible for over 40 000 hospitalizations at a cost of $970 million per year, including at least $430 million in hospitalization costs for Medicaid and Medicare patients. An additional 50 000 hospitalizations for campylobacteriosis, salmonellosis, shigellosis, haemolytic uraemic syndrome, and toxoplasmosis cost $860 million annually ($390 million in payments for Medicaid and Medicare patients), a portion of which can be assumed to be due to waterborne transmission.
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            Acanthamoeba polyphaga resuscitates viable non-culturable Legionella pneumophila after disinfection.

            María García, Yousef Abu Kwaik, Carmen Pelaz … (2007)
            Amoebae are the natural hosts for Legionella pneumophila and play essential roles in bacterial ecology and infectivity to humans. When L. pneumophila colonizes an aquatic installation, it can persist for years despite repeated treatments with disinfectants. We hypothesized that freshwater amoebae play an important role in bacterial resistance to disinfectants, and in subsequent resuscitation of viable non-culturable (VNC) L. pneumophila that results in re-emergence of the disease-causing strain in the disinfected water source. Our work showed that in the absence of Acanthamoeba polyphaga, seven L. pneumophila strains became non-culturable after treatment by 256 p.p.m. of sodium hypochlorite (NaOCl). In contrast, intracellular L. pneumophila within A. polyphaga was resistant to 1024 p.p.m. of NaOCl. In addition, L. pneumophila-infected A. polyphaga exhibited increased resistance to NaOCl. When chlorine-sterilized water samples were co-cultured with A. polyphaga, the non-culturable L. pneumophila were resuscitated and proliferated robustly within A. polyphaga. Upon treatment by NaOCl, uninfected amoebae differentiated into cysts within 48 h. In contrast, L. pneumophila-infected A. polyphaga failed to differentiate into cysts, and L. pneumophila was never detected in cysts of A. polyphaga. We conclude that amoebic trophozoites protect intracellular L. pneumophila from eradication by NaOCl, and play an essential role in resuscitation of VNC L. pneumophila in NaOCl-disinfected water sources. Intracellular L. pneumophila within trophozoites of A. polyphaga block encystation of the amoebae, and the resistance of both organisms to NaOCl is enhanced. To ensure long-term eradication and complete loss of the VNC state of L. pneumophila, we recommend that Legionella-protozoa co-culture should be an important tool to ensure complete loss of the VNC state of L. pneumophila.
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              Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods.

              Gerdine Stout, Y. Lin, L Yu (2011)
              Hospital-acquired Legionnaires' disease is directly linked to the presence of Legionella in hospital drinking water. Disinfecting the drinking water system is an effective preventive measure. The efficacy of any disinfection measures should be validated in a stepwise fashion from laboratory assessment to a controlled multiple-hospital evaluation over a prolonged period of time. In this review, we evaluate systemic disinfection methods (copper-silver ionization, chlorine dioxide, monochloramine, ultraviolet light, and hyperchlorination), a focal disinfection method (point-of-use filtration), and short-term disinfection methods in outbreak situations (superheat-and-flush with or without hyperchlorination). The infection control practitioner should take the lead in selection of the disinfection system and the vendor. Formal appraisals by other hospitals with experience of the system under consideration is indicated. Routine performance of surveillance cultures of drinking water to detect Legionella and monitoring of disinfectant concentrations are necessary to ensure long-term efficacy.
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                Author and article information

                Contributors
                Lawrence S. Young: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): Pathogens
                Journal ID (iso-abbrev): Pathogens
                Journal ID (publisher-id): pathogens
                Title: Pathogens
                Publisher: MDPI
                ISSN (Electronic): 2076-0817
                Publication date (Electronic): 15 April 2016
                Publication date Collection: June 2016
                Volume: 5
                Issue: 2
                Electronic Location Identifier: 35
                Affiliations
                [1 ]Department of Civil Engineering, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada; ines.boppe@ 123456polymtl.ca (I.B.); michele.prevost@ 123456polymtl.ca (M.P.)
                [2 ]CIUSSSE—Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1G 2E8, Canada; skouame.chus@ 123456ssss.gouv.qc.ca (S.K.); linda.pinsonneault@ 123456usherbrooke.ca (L.P.); jracine.chus@ 123456ssss.gouv.qc.ca (J.R.)
                [3 ]Department of Microbiology and Infectious Diseases, Université de Sherbrooke, QC J1K 2R1, Canada; Philippe.Martin@ 123456USherbrooke.ca (P.M.); Louis.Valiquette@ 123456USherbrooke.ca (L.V.)
                Author notes
                [* ]Correspondence: emilie.bedard@ 123456polymtl.ca ; Tel.: +1-514-340-4711 (ext. 5223); Fax: +1-514-340-5918
                Article
                Publisher ID: pathogens-05-00035
                DOI: 10.3390/pathogens5020035
                PMC ID: 4931386
                PubMed ID: 27092528
                SO-VID: 76324ca0-396e-4e35-8ac7-7a9c980a3901
                Copyright © © 2016 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 15 March 2016
                Date accepted : 11 April 2016
                Categories
                Subject: Article

                Keywords: legionellosis,sanitary hot water,temperature diagnostic,legionella pneumophila,culture,quantitative polymerase chain reaction,copper concentration,hospital premise plumbing
                Data availability:
                Keywords: legionellosis, sanitary hot water, temperature diagnostic, legionella pneumophila, culture, quantitative polymerase chain reaction, copper concentration, hospital premise plumbing

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