Abstract
Background: Legionella pneumophila is a waterborne organism that is increasingly recognized to cause community acquired and nosocomial pneumonia in humans. Domestic water systems have often been implicated as the source in outbreaks of Legionnaires’ disease. Legionella can survive under various conditions in various water sources and acquired antibiotic resistance to many routinely prescribed antibiotics. Routine monitoring of environmental water for Legionella species is proving helpful in reducing disease outbreak. Methods: A total of 260 of Legionella pneumophila isolates were isolated from environmental water sources from building facilities in Kuwait. The genetic diversity of the 102 isolates were analysis by the SBT method according to the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Legionella. The distribution of Legionella isolates was investigated according to geographical region. Results: The Legionella isolates were discriminated into 11 distinct SBT profiles, of which six (ST1223, ST1436, ST1555, ST1604, ST1718, and ST1719) were new to the ESGLI SBT database. L. pneumophila sg 7 was distributed broadly through Kuwait, accounting for 38.2% of the isolates and predominated in cooling towers water with unique sequence type to Kuwait. The second most dominant strain L. pneumophila sg 3 (32.4%), predominated in the bathroom. L. pneumophila sg 1 (18.3%), L. pneumophila sg 10 (6.9%), and L. pneumophila sg 4 (3.9%), predominated in the cooling towers. In SBT analysis, L. pneumophila sg 7 isolates were differentiated into 2 sequence types (STs), ST1718 (37.3 %) is the dominant ST in cooling tower. The unique allelic profile of ST1718, obtained from the cooling tower, was not found in the ESGLI SBT database. Conclusions: The findings of this study highlight the importance of understanding the epidemiology and ecology of L. pneumophila from public facilities in terms of public health. Furthermore, provide useful information for future epidemiological investigation of local and regional outbreaks of Legionnaires’ disease.
Highlights
Legionnaires’ disease (LD), usually is acquired by inhalation or aspiration of aerosol contaminated by Legionella species from environmental water sources, such as hot water supplies, cooling towers, and evaporative condensers
The Legionella isolates were discriminated into 11 distinct sequence-based typing (SBT) profiles, of which six (ST1223, ST1436, ST1555, ST1604, ST1718, and ST1719) were new to the ESGLI SBT database
In SBT analysis, L. pneumophila sg 7 isolates were differentiated into 2 sequence types (STs), ST1718 (37.3 %) is the dominant ST in cooling tower
Summary
Legionnaires’ disease (LD), usually is acquired by inhalation or aspiration of aerosol contaminated by Legionella species from environmental water sources, such as hot water supplies, cooling towers, and evaporative condensers. Legionella spp. are gram-negative bacteria that normally occupy natural aquatic environments, where they can survive as intracellular parasites of protozoa. It includes 52 species and over 70 different serogroups. Legionella pneumophila species accounts for approximately 90% of confirmed cases of legionellosis. The majority of communityacquired cases are caused by strains belonging to Legionella pneumophila serogroup 1, other non-L. pneumophila sg 1 strains, sg 2 to 15, accounted for 7.4% of cases [9,10]. The genetic diversity of L. pneumophila was related to horizontal gene transfer of mobile genetic elements among L. pneumophila strains, and between different Legionella species. The potential health risk of Legionella to humans is theoretically associated with cells densities above 104 to 105 CFU per liter of water [11,12]
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