Abstract
Introduction: Legionella pneumophila can cause severe community acquired pneumonia which may be life threatening. This organism is found in aquatic environments and infection is acquired through inhalation of aerosols. Few studies conducted in Sri Lanka have confirmed the presence of this organism in cooling tower water in Sri Lanka. Published data regarding human cases of legionellosis in Sri Lanka is not available. Objective: To determine the prevalence of community acquired pneumonia due to L. pneumophila among patients who required hospital admission and assess the risk factors associated with this infection. Methods : The study was carried out from July 2014 to June 2015 at the Teaching Hospital, Peradeniya. Expectorated sputum or endotracheal secretions and urine specimen were collected within 24 hours of admission after obtaining consent from all adult patients admitted during the study period with community acquired pneumonia. Respiratory specimens, if obtained, were inoculated onto Buffered Charcoal Yeast Extract (BCYE) agar and were inoculated at 35 o C – 37 o C for 7 days and observed for typical colonies. Urine specimens were stored at -20 o C and ELISA test was performed for the detection of L. pneumophila serogroup 1a antigen. Results : Eighty urine specimens and 27 respiratory specimens were obtained form 80 patients. None of the respiratory specimens grew suspected colonies of L. pneumophila and all urine specimens were negative for L. pneumophila serogroup 1a antigen. Conclusion: L. pneumophila serogroup 1a was not identified as the pathogen responsible for community acquired pneumonia in this study sample.
Highlights
Legionella pneumophila can cause severe community acquired pneumonia which may be life threatening
L. pneumophila serogroup 1a was not identified as the pathogen responsible for community acquired pneumonia in this study sample
L. pneumophila was not isolated from any of the cultured respiratory specimens and none of the urine specimens tested were positive for L. pneumophila serogroup 1a urinary antigen
Summary
This study was initiated in July 2014 after obtaining approval from the Ethical Review Committee, Faculty of Medicine, University of Peradeniya. All the patients were found to have been started on an antibiotic at the time of specimen collection. A loopful of respiratory specimens were inoculated onto Charcoal Yeast Extract agar (CYE) (OXOID-UK) supplemented with Legionella BCYE growth supplement. Any iridescent colony 3-4 mm in size with cut glass appearance were identified using Gram stain, catalase and oxidase tests. Faintly staining, filamentous Gram negative bacilli which were catalase positive and oxidase negative were identified as L. pneumophila if positive on the hippurate hydrolysis test. Urine specimens were stored at -20 oC in duplicate and tested batch wise with a commercial ELISA kit (GRG Legionella pneumophila Ag (urine) -EIA-4205,USA) for the presence of L. pneumophila serogroup 1a urinary antigen. The results were interpreted according to the cut off values and instructions provided by the manufacturer
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