Abstract
Free-living amoebae in water supply systems harbor bacterial endosymbionts. Legionella pneumophila, the agent of Legionnaires' disease, was one of the first agents that was demonstrated to survive and multiply within amoebae. Similar bacteria, termed Legionella-like amoebal pathogens (LLAP's), were subsequently described and implicated in human respiratory tract infections. Amoebal co-cultivation/enrichment techniques and molecular methods (e.g., PCR) have elucidated a variety of alphaproteobacteria (e.g., Afipia, Bosea, Mesorhizobium, and Rasbobacterium species) and Chlamydia-like bacteria (e.g., Parachlamydia, Simkania, Protochlamydia, and Waddlia species) within free-living amoebae in hospital water systems. These agents are also able to survive and multiply within macrophages, pneumocytes, and lung fibroblasts. Sero-epidemiological studies and application of molecular technology to clinical specimens have revealed these agents as rare causes of community- and health care-associated pneumonia, particularly among immunocompromised patients. Additional studies have implicated these agents in other infectious processes. This article reviews these newly described microorganisms and the evidence for their roles in human infections and disease.
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