Isolation of Legionella pneumophila from clinical & environmental ...

764 INDIAN J MED RES, JUNE 2010
Three important factors need to be mentioned.
Firstly, we have focused on a particular pathogen, but
in literature, concurrent infection particularly with
Streptococcus pneumoniae is well documented 24,25 .
Secondly, the fact that although culture is the most
sensitive method, but still it cannot detect all cases
since its sensitivity is 80 per cent 13 . And lastly, we have
not used other tests like urinary antigen testing or direct
fluorescent antibody stain which might have enhanced
the overall sensitivity of the microbiological diagnostic
workup. Our study highlights the importance of
environmental sampling of water and also the need for
introduction of routine laboratory testing for this not
so uncommon organism. Thus, a greater focus should
be placed on diagnosis of aetiology for early therapy
with appropriate antimicrobial substances. There is an
urgent need to find out the incidence of infection in
other parts of India to establish diagnostic setup for this
organism in referral hospitals.
Acknowledgment
Authors thank the physicians in the department of medicine and
the Emergency department for their co-operation, and acknowledge
Dr Sophie Jarraud of the French National Legionella Reference
Centre, Lyon, France, for providing the reference strain.
References
1. Costa J, Tiago I, da Costa MS, Verissimo A. Presence and
persistence of Legionella spp. in groundwater. Appl Environ
Microbiol 2005; 71 : 663-71.
2. Wallis L, Robinson P. Soil as a source of Legionella pneumophila
serogroup 1(Lp1). Aust NZ J Public Health 2005; 29 : 518-20.
3. Declerck P, Behets J, van Hoef V, Ollevier F. Detection of
Legionella spp. and some of their amoeba hosts in floating
biofilms from anthropogenic and natural aquatic environments.
Water Res 2007; 41 : 3159-67.
4. Darby J, Buising K. Could it be Legionella? Aus Fam Physician
2008; 37 : 812-5.
5. Vergis EN, Akbas E, Yu VL. Legionella as a cause of severe
pneumonia. Semin Respir Crit Care Med 2000; 21 : 295-304.
6. von Baum H, Ewig S, Marre R, Suttorp N, Gonschior S,
Welte T, et al. Competence Network for Community Acquired
Pneumonia Study Group. Community-acquired Legionella
pneumonia: new insights from the German competence network
for community acquired pneumonia. Clin Infect Dis 2008; 46 :
1356-64.
7. Haley CE, Cohen ML, Halter J, Meyer RD. Nosocomial
Legionnaires’ disease: continuing common-source epidemic at
Wadsworth Medical Center. Ann Intern Med 1979; 90 : 583-6.
8. Broome CV, Fraser DW. Epidemiologic aspects of legionellosis.
Epidemiol Rev 1979; 1 : 1-16.
9. Ng V, Tang P, Jamieson F, Guyard C, Low DE, Fisman DN.
Laboratory-based evaluation of legionellosis epidemiology in
Ontario, Canada, 1978 to 2006. BMC Infect Dis 2009; 9 : 68.
10. Sabria M, Modol JM, Garcia-Nunez M, Reynaga E, Pedro-Botet
ML, Sopena N, et al. Environmental cultures and hospitalacquired
Legionnaires’ disease: 5 year prospective study in 20
hospitals in Catalonia, Spain. Infect Control Hosp Epidemiol
2004; 25 : 1072-6.
11. Chaudhry R, Dhawan B, Dey AB. The incidence of Legionella
pneumophila: A prospective study in a tertiary care hospital in
India. Trop Doct 2000; 30 : 197-200.
12. Agrawal L, Dhunjibhoy KR, Nair KG. Isolation of Legionella
pneumophila from patients of respiratory tract disease and
environmental samples. Indian J Med Res 1991; 93 : 364-5.
13. Stout JE, Rihs JD, Yu VL. Legionella. In: Murray PR, Baron
EJ, Jorgensen JH, Pfaller MA, Yelken RH, editors. Manual
of clinical microbiology, vol. 2, 8th ed. Washington DC: ASM
Press; 2003. p. 809-23.
14. Vickers RM, Stout JE, Yu VL, Rihs JD. Manual of culture
methodology for Legionella. Semin Respir Infect 1987; 2 :
274-9.
15. Hebert GA. Hippurate hydrolysis by Legionella pneumophila.
J Clin Microbiol 1981; 13 : 240-2.
16. Yu VL, Stout JE. Community-acquired legionnaires’ disease:
implications for under diagnosis and laboratory testing. Clin
Infect Dis 2008; 46 : 1365-7.
17. Charles PG, Whitby M, Fuller AJ, Stirling R, Wright AA,
Korman TM, et al. The etiology of community-acquired
pneumonia in Australia: why penicillin plus doxycycline or a
macrolide is the most appropriate therapy. Clin Infect Dis 2008;
46 : 1513-21.
18. Lim WS, Macfarlane JT, Boswell TC, Harrison TG, Rose D,
Leinonen M, et al. Study of community acquired pneumonia
aetiology (SCAPA) in adults admitted to hospital: implications
for management guidelines. Thorax 2001; 56 : 296-301.
19. Yu VL, Greenberg RN, Zadekis N, Stout JE, Khashab MM,
Olson WH, et al. Levofloxacin efficacy in the treatment of
community-acquired legionellosis. Chest 2004; 125 : 135-9.
20. Sehulster L, Chinn RYW. Guidelines for environmental
infections control in health care facilities. Recommendations of
CDC and the Health Care Infections Control Practices Advisory
Committee (HICPAC). MMWR Morb Mortal Wkly Rep 2003;
52 : 1-42.
21. Ta AC, Stout JE, Yu VL, Wagener MM. Comparison of culture
methods for monitoring Legionella species in hospital potable
water systems and recommendations for standardization of
such methods. J Clin Microbiol 1995; 33 : 2118-23.
22. Goetz A, Yu VL. Nosocomical legionella infection. In: Mayhail
CG, editor. Hospital epidemiology and infection control.
Baltimore: Williams & Wilkins; 1996. p. 388-99.
23. Goetz AM, Stout JE, Jacobs SL, Fisher MA, Ponzer RE,
Drenning S, et al. Nosocomial legionnaires’ disease discovered
in community hospitals following cultures of the water system:
Seek and ye shall find. Am J Infect Control 1998; 26 : 8-11.
24. Brown RB, Sands M, Ryczak M. Community-acquired
pneumonia caused by mixed aerobic bacteria. Chest 1986; 90
: 810-4.
25. Wattanathum A, Chaoprasong C, Nunthapisud P, Chantaratchada
S, Limpairojn N, Jatakanon A, et al. Community-acquired
pneumonia in Southeast Asia: the microbial differences
between ambulatory and hospitalized patients. Chest 2003; 123
: 1512-9.
Reprint requests: Dr Abhijit Chaudhury, Additional Professor, Department of Microbiology, Sri Venkateswara Institute of Medical
Sciences, Tirupati 517 507, Andhra Pradesh, India
e-mail: ach1964@rediffmail.com