Abstract
Although known as causes of community-acquired pneumonia and Pontiac fever, the global burden of infection caused by Legionella species other than Legionella pneumophila is under-recognised. Non-L. pneumophila legionellae have a worldwide distribution, although common testing strategies for legionellosis favour detection of L. pneumophila over other Legionella species, leading to an inherent diagnostic bias and under-detection of cases. When systematically tested for in Australia and New Zealand, L. longbeachae was shown to be a leading cause of community-acquired pneumonia. Exposure to potting soils and compost is a particular risk for infection from L. longbeachae, and L. longbeachae may be better adapted to soil and composting plant material than other Legionella species. It is possible that the high rate of L. longbeachae reported in Australia and New Zealand is related to the composition of commercial potting soils which, unlike European products, contain pine bark and sawdust. Genetic studies have demonstrated that the Legionella genomes are highly plastic, with areas of the chromosome showing high levels of recombination as well as horizontal gene transfer both within and between species via plasmids. This, combined with various secretion systems and extensive effector repertoires that enable the bacterium to hijack host cell functions and resources, is instrumental in shaping its pathogenesis, survival and growth. Prevention of legionellosis is hampered by surveillance systems that are compromised by ascertainment bias, which limits commitment to an effective public health response. Current prevention strategies in Australia and New Zealand are directed at individual gardeners who use potting soils and compost. This consists of advice to avoid aerosols generated by the use of potting soils and use masks and gloves, but there is little evidence that this is effective. There is a need to better understand the epidemiology of L. longbeachae and other Legionella species in order to develop effective treatment and preventative strategies globally.
Highlights
Known as causes of community-acquired pneumonia and Pontiac fever, the global burden of infection caused by Legionella species other than Legionella pneumophila is underrecognised
The public health aspects most specific to legionellosis caused by Legionella species other than L. pneumophila relate to L. longbeachae and exposure to gardening activities
The number and distribution of infections caused by L. longbeachae and other non-L. pneumophila legionellae are almost certainly markedly underestimated globally
Summary
The clinical spectrum of legionellosis caused by Legionella species other than L. pneu. Increasing immune suppression pre-existing lung dise factors has led some researchers to developage, scoring systems to increaseand recognition of Legionnaires’ disease, but none of these have been developed for non-L. pneumophila species or gained widespread acceptance as a clinical tool [32]. Non-L. pneumophila has been identified in cases of skin and soft tissue infection, septic arthritis and bacterial endocarditis [41,42,43,44,45,46,47,48,49,50] These cases may be severe and difficult to diagnose as legionellae are unexpected as the infecting organism. PCR and seroconversion [51]
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