vol21no7_pdf-version

Recommendations

Info

RESEARCHpresence of Legionella spp. in potting soil samples (14–16),and the use of amebal coculture techniques has shown promisingresults in recovering L. pneumophila SG1 sequencetype (ST) 46 (the third most frequently found ST in clinicalisolates) from samples with a high likelihood of microbialflora (17). At this time, potting soil samples collected byNLODP are not regularly being investigated by the amebalcoculture technique. These findings suggest that potting soilsamples from garden centers identified as potential sourcesof infection for patients with LD should be examined closely.Notwithstanding the extensive efforts by NLODP collaborators,the number of L. pneumophila SG1 strains thatcould be derived from investigated potential sources wasrelatively low (114 strains over 10 years). Despite systematicmethods of source identification by using a standardizedquestionnaire covering >20 source types, a source could notbe confirmed in most cases. Although the questionnaire isregularly evaluated and adjusted on the basis of new insightsconcerning reported sources of infection, it primarily coverssources identified from the literature, possibly explainingthe low success rate; actual sources of infection may not becaptured in the questionnaire. This hypothesis is supportedby the differences in genotype variation between clinicalisolates and environmental strains: one third of all culturepositivepatients with LD were infected by L. pneumophilaSG1 ST47, a rare finding in environmental samples.The experiences of NLODP show the importance of organizinga multidisciplinary collaboration in which MHSs,treating physicians, and microbiologic laboratories are representedand aware of the importance of different aspects ofsurveillance and source investigation for patients with LD.Our findings show the necessity of increasing awarenessamong various groups: physicians for diagnosis of LD,MHSs for extensive source identification, and laboratoriesfor performance of adequate diagnostics and collection ofclinical and environmental isolates. During 2002–2012,the number of reported patients with LD and the numberof identified clusters of patients did not change dramatically,which may suggest the limited effects of NLODP.However, one could argue that this relatively stable numberof patients with LD could have resulted from the program.Despite the rational, systematic approach used by NLODPduring this decade, most sources of LD infections wentundiscovered, stressing the need for evaluating other, yetunknown, potential sources of infection. Also, a need existsfor further investment in improving laboratory techniquesfor detection of Legionella spp. in clinical samples with ahigh background of microbial flora such as soil.AcknowledgmentsWe thank the public health physicians and nurses of the MHSsfor providing epidemiologic data and source identification results;the treating physicians and microbiologists for makingpatient isolates available for genotyping; and Jacqueline DeVries and Wim Houtenbos for their support with source investigations.Dr. Den Boer is a public health physician and epidemiologist atthe Regional Public Health Laboratory Kennemerland, Haarlem,the Netherlands. His research interests include prevention andcontrol of infectious diseases.References1. Fields BS, Benson RF, Besser RE. Legionella and Legionnaires’disease: 25 years of investigation. Clin Microbiol Rev. 2002;15:506–26. http://dx.doi.org/10.1128/CMR.15.3.506-526.20022. Torres A, Blasi F, Peetermans WE, Viegi G, Welte T. The aetiologyand antibiotic management of community-acquired pneumonia inadults in Europe: a literature review. Eur J Clin Microbiol Infect Dis.2014;33:1065–79. http://dx.doi.org/10.1007/s10096-014-2067-13. Joseph CA, Ricketts KD. Legionnaires’ disease in Europe2007–2008. Euro Surveill. 2010;15:19493.4. Beauté J, Zucs P, de Jong B; European Legionnaires’ DiseaseSurveillance Network. Legionnaires disease in Europe, 2009–2010.Euro Surveill. 2013;18:20417.5. Den Boer JW, Yzerman EP, Schellekens J, Lettinga KD,Boshuizen HC, Van Steenbergen JE, et al. A large outbreak ofLegionnaires’ disease at a flower show, the Netherlands, 1999.Emerg Infect Dis. 2002;8:37–43. http://dx.doi.org/10.3201/eid0801.0101766. Netherlands Ministry of Housing, Spatial Planning and theEnvironment. Water supply decree. Besluit van 26/10/2004 towijziging van het Waterleidingbesluit en het Besluithygiëne enveiligheid badinrichtingen en zwemgelegenheden (preventievan legionella in leidingwater). The Hague (the Netherlands):the Ministry; 2004.7. Sonder GJ, van den Hoek JA, Bovée LP, Aanhane FE,Worp J, De Ry van Beest Holle M, et al. Changes in prevention andoutbreak management of Legionnaires’ disease in the Netherlandsbetween two large outbreaks in 1999 and 2006. Euro Surveill.2008;13:18983.8. Den Boer JW, Verhoef L, Bencini MA, Bruin JP, Jansen R,Yzerman EP. Outbreak detection and secondary prevention ofLegionnaires’ disease: a national approach. Int J Hyg EnvironHealth. 2007;210:1–7. http://dx.doi.org/10.1016/j.ijheh.2006.07.0029. Bhopal RS. Geographical variation of Legionnaires’ disease:a critique and guide to future research. Int J Epidemiol.1993;22:1127–36. http://dx.doi.org/10.1093/ije/22.6.112710. Fry NK, Bangsborg JM, Bernander S, Etienne J, Forsblom B,Gaia V, et al. Assessment of intercentre reproducibility andepidemiological concordance of Legionella pneumophila serogroup1 genotyping by amplified fragment length polymorphism analysis.Eur J Clin Microbiol Infect Dis. 2000;19:773–80. http://dx.doi.org/10.1007/s10096000035911. Gaia V, Fry NK, Afshar B, Lück PC, Meugnier H, Etienne J, et al.Consensus sequence-based scheme for epidemiological typing ofclinical and environmental isolates of Legionella pneumophila.J Clin Microbiol. 2005;43:2047–52. http://dx.doi.org/10.1128/JCM.43.5.2047-2052.200512. Ratzow S, Gaia V, Helbig JH, Fry NK, Lück PC. Addition of neuA,the gene encoding N-acylneuraminate cytidylyl transferase,increases the discriminatory ability of the consensus sequencebasedscheme for typing Legionella pneumophila serogroup 1strains. J Clin Microbiol. 2007;45:1965–8. http://dx.doi.org/10.1128/JCM.00261-0713. Helbig JH, Bernander S, Castellani Pastoris M, Etienne J,Gaia V, Lauwers S, et al. Pan-European study on culture-proven1172 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015
Legionella Outbreak Detection, the NetherlandsLegionnaires’ disease: distribution of Legionella pneumophila serogroupsand monoclonal subgroups. Eur J Clin Microbiol Infect Dis.2002;21:710–6. http://dx.doi.org/10.1007/s10096-002-0820-314. Koide M, Saito A, Okazaki M, Umeda B, Benson RF. Isolation ofLegionella longbeachae serogroup 1 from potting soils in Japan.Clin Infect Dis. 1999;29:943–4. http://dx.doi.org/10.1086/52047015. Steele TW, Lanser J, Sangster N. Isolation of Legionella longbeachaeserogroup 1 from potting mixes. Appl Environ Microbiol.1990;56:49–53.16. Casati S, Gioria-Martinoni A, Gaia V. Commercial potting soils as analternative infection source of Legionella pneumophila and otherLegionella species in Switzerland. Clin Microbiol Infect.2009;15:571–5. http://dx.doi.org/10.1111/j.1469-0691.2009.02742.x17. Schalk JA, Docters van Leeuwen AE, Lodder WJ, De Man H,Euser SM, Den Boer JW, et al. Isolation of Legionella pneumophilafrom pluvial floods by amoebal coculture. Appl Environ Microbiol.2012;78:4519–21. http://dx.doi.org/10.1128/AEM.00131-12Address for correspondence: Jeroen W. Den Boer, Regional PublicHealth Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC,Haarlem, the Netherlands; email: j.denboer@streeklabhaarlem.nlEmerging Infectious Diseases • www.cdc.gov/eid • Vol. 21, No. 7, July 2015 1173
Page 3 and 4:
July 2015SynopsisOn the CoverMarian
Page 5 and 6:
1240 Gastroenteritis OutbreaksCause
Page 7 and 8:
SYNOPSISDisseminated Infections wit
Page 9 and 10:
Disseminated Infections with Talaro
Page 11 and 12:
Disseminated Infections with Talaro
Page 13 and 14:
Macacine Herpesvirus 1 inLong-Taile
Page 15 and 16:
Macacine Herpesvirus 1 in Macaques,
Page 17 and 18:
Page 19:
Page 23:
Malaria among Young Infants, Africa
Page 26 and 27:
RESEARCHFigure 3. Dynamics of 19-kD
Page 28 and 29: Transdermal Diagnosis of MalariaUsi
Page 30 and 31: RESEARCHFigure 2. A) Acoustic trace
Page 32 and 33: RESEARCHof malaria-infected mosquit
Page 34 and 35: Lack of Transmission amongClose Con
Page 36 and 37: RESEARCH(IFA) and microneutralizati
Page 38 and 39: RESEARCHoropharyngeal, and serum sa
Page 40 and 41: RESEARCH6. Assiri A, McGeer A, Perl
Page 42 and 43: RESEARCHadvanced genomic sequencing
Page 44 and 45: RESEARCHTable 2. Next-generation se
Page 46 and 47: RESEARCHTable 3. Mutation analysis
Page 48 and 49: RESEARCHReferences1. Baize S, Panne
Page 50 and 51: Parechovirus Genotype 3 Outbreakamo
Page 52 and 53: RESEARCHFigure 1. Venn diagramshowi
Page 54 and 55: RESEARCHTable 2. HPeV testing of sp
Page 56 and 57: RESEARCHFigure 5. Distribution of h
Page 58 and 59: RESEARCHReferences1. Selvarangan R,
Page 60 and 61: RESEARCHthe left lobe was sampled b
Page 62 and 63: RESEARCHTable 2. Middle East respir
Page 64 and 65: RESEARCHseroprevalence in domestic
Page 66 and 67: RESEARCHmeasure their current surve
Page 68 and 69: RESEARCHTable 2. States with labora
Page 70 and 71: RESEARCHFigure 2. Comparison of sur
Page 72 and 73: RESEARCH9. Centers for Disease Cont
Page 74 and 75: RESEARCHthe analyses. Cases in pers
Page 76 and 77: RESEARCHTable 3. Sampling results (
Page 80 and 81: Seroprevalence for Hepatitis Eand O
Page 82 and 83: RESEARCHTable 1. Description of stu
Page 84 and 85: RESEARCHTable 3. Crude and adjusted
Page 86 and 87: RESEARCHrates by gender or HIV stat
Page 88 and 89: RESEARCH25. Taha TE, Kumwenda N, Ka
Page 90 and 91: POLICY REVIEWDutch Consensus Guidel
Page 92 and 93: POLICY REVIEWTable 3. Comparison of
Page 94 and 95: POLICY REVIEW6. Botelho-Nevers E, F
Page 96 and 97: DISPATCHESFigure 1. Phylogenetic tr
Page 98 and 99: DISPATCHESSevere Pediatric Adenovir
Page 100 and 101: DISPATCHESTable 1. Demographics and
Page 102 and 103: DISPATCHES13. Kim YJ, Hong JY, Lee
Page 104 and 105: DISPATCHESTable. Alignment of resid
Page 106 and 107: DISPATCHESFigure 2. Interaction of
Page 108 and 109: DISPATCHESSchmallenberg Virus Recur
Page 110 and 111: DISPATCHESFigure 2. Detection of Sc
Page 112 and 113: DISPATCHESFigure 1. Histopathologic
Page 114: DISPATCHESFigure 2. Detection of fo
Page 117 and 118: Influenza Virus Strains in the Amer
Page 119 and 120: Novel Arenavirus Isolates from Nama
Page 121 and 122: Novel Arenaviruses, Southern Africa
Page 123 and 124: Readability of Ebola Informationon
Page 125 and 126: Readability of Ebola Information on
Page 127 and 128: Patients under investigation for ME
Page 129 and 130:
Patients under investigation for ME
Page 131 and 132:
Wildlife Reservoir for Hepatitis E
Page 133 and 134:
Asymptomatic Malaria and Other Infe
Page 135 and 136:
Asymptomatic Malaria in Children fr
Page 137 and 138:
Bufavirus in Wild Shrews and Nonhum
Page 139 and 140:
Bufavirus in Wild Shrews and Nonhum
Page 141 and 142:
Range Expansion for Rat Lungworm in
Page 143 and 144:
Slow Clearance of Plasmodium falcip
Page 145 and 146:
Slow Clearance of Plasmodium falcip
Page 147 and 148:
Gastroenteritis Caused by Norovirus
Page 149 and 150:
Ebola Virus Stability on Surfaces a
Page 151 and 152:
Ebola Virus Stability on Surfaces a
Page 153 and 154:
Outbreak of Ciprofloxacin-Resistant
Page 155 and 156:
Outbreak of S. sonnei, South KoreaT
Page 157 and 158:
Rapidly Expanding Range of Highly P
Page 159 and 160:
Cluster of Ebola Virus Disease, Bon
Page 161 and 162:
Cluster of Ebola Virus Disease, Lib
Page 163 and 164:
ANOTHER DIMENSIONThe Past Is Never
Page 165 and 166:
Measles Epidemic, Boston, Massachus
Page 167 and 168:
LETTERSInfluenza A(H5N6)Virus Reass
Page 169 and 170:
LETTERSsystem (8 kb-span paired-end
Page 171 and 172:
LETTERS3. Van Hong N, Amambua-Ngwa
Page 173 and 174:
LETTERSTable. Prevalence of Bartone
Page 175 and 176:
LETTERSavian influenza A(H5N1) viru
Page 177 and 178:
LETTERSprovinces and a total of 200
Page 179 and 180:
LETTERS7. Manian FA. Bloodstream in
Page 181 and 182:
LETTERSforward projections. N Engl
Page 183 and 184:
LETTERS3. Guindon S, Gascuel OA. Si
Page 185 and 186:
BOOKS AND MEDIAin the port cities o
Page 187 and 188:
ABOUT THE COVERNorth was not intere
Page 189 and 190:
Earning CME CreditTo obtain credit,
Page 191:
Emerging Infectious Diseases is a p
show all

vol21no7_pdf-version

Create successful ePaper yourself

Delete template?

Save as template?