Jaana Kusnetsov

Survival of Mycobacterium avium, Legionella pneumophila, Escherichia coli, and Caliciviruses in Drinking Water-Associated Biofilms Grown under High-Shear Turbulent Flow

ABSTRACT Most of the bacteria in drinking water distribution systems are associated with biofilms. In biofilms, their nutrient supply is better than in water, and biofilms can provide shelter against disinfection. We used a Propella biofilm reactor for studying the survival of Mycobacterium avium, Legionella pneumophila, Escherichia coli, and canine calicivirus (CaCV) (as a surrogate for human norovirus) in drinking water biofilms grown under high-shear turbulent-flow conditions. The numbers of M. avium and L. pneumophila were analyzed with both culture methods and with peptide nucleic acid fluorescence in situ hybridization (FISH) methods. Even though the numbers of pathogens in biofilms decreased during the experiments, M. avium and L. pneumophila survived in biofilms for more than 2 to 4 weeks in culturable forms. CaCV was detectable with a reverse transcription-PCR method in biofilms for more than 3 weeks. E. coli was detectable by culture for only 4 days in biofilms and 8 days in water, suggesting that it is a poor indicator of the presence of certain waterborne pathogens. With L. pneumophila and M. avium, culture methods underestimated the numbers of bacteria present compared to the FISH results. This study clearly proved that pathogenic bacteria entering water distribution systems can survive in biofilms for at least several weeks, even under conditions of high-shear turbulent flow, and may be a risk to water consumers. Also, considering the low number of virus particles needed to result in an infection, their extended survival in biofilms must be taken into account as a risk for the consumer.

Copper and silver ions more effective against Legionellae than against mycobacteria in a hospital warm water system

We studied the influence of electrolytically released copper and silver ions on the microbiological quality in a warm water system of a hospital. The concentration of nontuberculous mycobacteria was followed for three, and that of legionellae and other heterotrophic bacteria in the water for four years. The highest concentrations of copper and silver ions were 220 and 68 microg/l, respectively. Silver ion concentration of about 3 microg/l was sufficient to control the growth of legionellae in circulating warm water. The results showed that it is more difficult to eradicate legionellae from taps and showers: these points were colonized by a small number of legionellae after the metal ion concentrations were increased in the circulating water. A regular use of water eradicated legionellae from the shower. One tap was still used irregularly, and this may be a reason why it still contained small concentrations of legionellae also in the last years of the study. Mycobacteria were occasionally isolated from the circulating water and repeatedly from the shower, even when the metal concentrations were high. To control legionella bacteria in warm water systems, silver concentrations of only 3 microg/l are needed if all taps and showers of the system are regularly used. Such low copper and silver concentrations, however, are not efficient against nontuberculous mycobacteria or other heterotrophic bacteria.

Colonization of hospital water systems by legionellae, mycobacteria and other heterotrophic bacteria potentially hazardous to risk group patients

Occurrences of legionellae and nontuberculous mycobacteria were followed in water systems of a tertiary care hospital where nosocomial infections due to the two genera had been verified. The aim was to examine whether their occurrence in the circulating hot water can be controlled by addition of a heat‐shock unit in the circulation system, and by intensified cleaning of the tap and shower heads. One hot water system examined had an inbuilt heat‐shock system causing a temporary increase of temperature to 80u2003°C, the other was an ordinary system (60u2003°C). The heat‐shock unit decreased legionella colony counts in the circulating hot water (mean 35 cfu/l) compared to the ordinary system (mean 3.6×103 cfu/l). Mycobacteria constantly present in the incoming cold water (mean 260 cfu/l) were never isolated from the circulating hot water. Water sampled at peripheral sites such as taps and showers contained higher concentrations of legionellae, mycobacteria, and mesophilic and Gram‐negative heterotrophs than the circulating waters. The shower water samples contained the highest bacterial loads. The results indicate the need to develop more efficient prevention methods than the ones presently used. Prevention of mycobacteria should also be extended to incoming cold water.

Persistent Legionella pneumophila colonization of a hospital water supply: efficacy of control methods and a molecular epidemiological analysis

After a nosocomial outbreak caused by Legionella pneumophila serogroup 5, the hospital water distribution system, which was found to be colonized by L. pneumophila serogroups 5 and 6, was decontaminated by the superheat and flush method and by installing an additional heat‐shock unit in one of the hot water circuits. This unit exposed the recirculated water to a temperature of 80u2003°C. The efficacy of the decontamination measures was evaluated by monitoring the temperatures and legionella concentrations at different parts of the hot water distribution system. The genetic diversity of the colonizing legionella flora was examined using two genotyping methods: amplified fragment length polymorphism analysis (AFLP) and random amplified polymorphic DNA (RAPD) analysis. Selected serogroup 6 strains were also analyzed by sequence‐based typing (SBT). The results indicated that long‐term eradication of serogroup 5 strains was never achieved. Only one serogroup 6 strain was never isolated after the superheat and flush. In all, according to genetic fingerprints, the diversity of Legionella strains in a hospital water system remains stable over the years regardless of the use of recommended disinfection procedures.

Efficacy of three prevention strategies against legionella in cooling water systems

The efficacy of three different prevention strategies on legionella in cooling systems was studied. The strategies were as follows: (1) water temperature was lowered; (2) water quality was improved; or (3) the system was disinfected with polyhexamethylene biguanidechloride (PHMB) biocide or with 2‐bromo‐2‐nitropropane‐1,3‐diol (BNPD) biocide. Lowering of water temperature was the most effective method to reduce the concentration of legionella in cooling systems. Improving of water quality resulted in a transitory disinfection effect. The additions of PHMB or BNPD decreased the concentrations of both legionella and heterotrophic bacteria in cooling water. The effect of biocides, however, lasted at the most only a few months. If possible, lowering water temperature and improving the water quality should be the primary practices for controlling bacterial growth in cooling systems. Regular biocide treatments should be incorporated into the maintenance procedures if technical improvements cannot be done or if their efficiency is too low.

Physical, chemical and microbiological water characteristics associated with the occurrence of Legionella in cooling tower systems

Abstract The occurrence of Legionella in water of 30 cooling tower systems was studied, as well as the relationship of its occurrence with the physical, chemical and microbiological characteristics of the waters. The samples were concentrated by membrane filtration and one part of the concentrate was acid washed. Three types of culture media, MWY, CCVC and BCYEα were used. Fourteen (47%) of the cooling systems were Legionella -positive. Numbers of Legionella in the positive systems varied between 50 and 490,000 cfu/l. Legionella pneumophila was the dominant isolate, and the serogroups 6 and 1 were the commonest ones. There was no statistically significant difference in mean water temperature between the Legionella -positive (27°C) and -negative (24°C) systems. The total number of bacteria (AODC) was lower in the Legionella -positive than in the negative systems. Also the nutrient concentrations were generally lower in the Legionella -positive cooling systems. The results suggest that different factors regulate the occurrence of Legionella than that of overall bacterial populations in the cooling tower systems.

Nosocomial Legionella pneumophila serogroup 5 outbreak associated with persistent colonization of a hospital water system.

An outbreak of infections caused by Legionella pneumophila serogroup 5 was detected in a university hospital, and nosocomial reservoirs of the legionella epidemic were examined. Clinical isolates from two patients who had been affected by the L. pneumophila serogroup 5 outbreak, and from another patient with a legionella infection caused by the same serogroup 3 years later, were compared to L. pneumophila serogroup 5 isolates from the hospital water supply by two molecular methods, amplified fragment length polymorphism (AFLP) analysis and random amplified polymorphic DNA analysis (RAPD). Genotyping confirmed the epidemiological linkage of the first two patients, and linked their infections with the hospital water supply. The third clinical strain, which was also linked to the hospital water, was very similar to the epidemic strain. Even though the water distribution system was sanitized (superheat and flush sanitation), the epidemic strain was shown to be persisting in the hospital water outlets several years after its initial discovery.

Drinking water quality and formation of biofilms in an office building during its first year of operation, a full scale study.

Complex interactions existing between water distribution systems materials and water can cause a reduction in water quality and unwanted changes in materials, aging or corrosion of materials and formation of biofilms on surfaces. Substances leaching from pipe materials and water fittings, as well as the microbiological quality of water and formation of biofilms were evaluated by applying a Living Lab theme i.e. a research in a real life setting using a full scale system during its first year of operation. The study site was a real office building with one part of the building lined with copper pipes, the other with cross-linked polyethylene (PEX) pipes thus enabling material comparison; also differences within the cold and hot water systems were analysed. It was found that operational conditions, such as flow conditions and temperature affected the amounts of metals leaching from the pipe network. In particular, brass components were considered to be a source of leaching; e. g. the lead concentration was highest during the first few weeks after the commissioning of the pipe network when the water was allowed to stagnate. Assimilable organic carbon (AOC) and microbially available phosphorus (MAP) were found to leach from PEX pipelines with minor effects on biomass of the biofilm. Cultivable and viable biomass (heterotrophic plate count (HPC), and adenosine triphosphate (ATP)) levels in biofilms were higher in the cold than in the hot water system whereas total microbial biomass (total cell count (DAPI)) was similar with both systems. The type of pipeline material was not found to greatly affect the microbial biomass or Alpha-, Beta- and Gammaproteobacteria profiles (16s rRNA gene copies) after the first one year of operation. Also microbiological quality of water was found to deteriorate due to stagnation.

Two Legionnaires' disease cases associated with industrial waste water treatment plants: a case report

BackgroundFinnish and Swedish waste water systems used by the forest industry were found to be exceptionally heavily contaminated with legionellae in 2005.Case presentationWe report two cases of severe pneumonia in employees working at two separate mills in Finland in 2006. Legionella serological and urinary antigen tests were used to diagnose Legionnaires disease in the symptomatic employees, who had worked at, or close to, waste water treatment plants. Since the findings indicated a Legionella infection, the waste water and home water systems were studied in more detail. The antibody response and Legionella urinary antigen finding of Case A indicated that the infection had been caused by Legionella pneumophila serogroup 1. Case A had been exposed to legionellae while installing a pump into a post-clarification basin at the waste water treatment plant of mill A. Both the water and sludge in the basin contained high concentrations of Legionella pneumophila serogroup 1, in addition to serogroups 3 and 13. Case B was working 200 meters downwind from a waste water treatment plant, which had an active sludge basin and cooling towers. The antibody response indicated that his disease was due to Legionella pneumophila serogroup 2. The cooling tower was the only site at the waste water treatment plant yielding that serogroup, though water in the active sludge basin yielded abundant growth of Legionella pneumophila serogroup 5 and Legionella rubrilucens. Both workers recovered from the disease.ConclusionThese are the first reported cases of Legionnaires disease in Finland associated with industrial waste water systems.

Microbial reduction in wastewater treatment using Fe3+ and Al3+ coagulants and PAA disinfectant

Wastewater is an important source of pathogenic enteric microorganisms in surface water and a major contaminating agent of drinking water. Although primary and secondary wastewater treatments reduce the numbers of microorganisms in wastewater, significant numbers of microbes can still be present in the effluent. The aim of this study was to test the feasibility of tertiary treatment for municipal wastewater treatment plants (WWTPs) using PIX (FeCl3) or PAX (AlCl3) coagulants and peracetic acid (PAA) the disinfectant to reduce microbial load in effluent. Our study showed that both PIX and PAX efficiently reduced microbial numbers. PAA disinfection greatly reduced the numbers of culturable indicator microorganisms (Escherichia coli, intestinal enterococci, F-specific RNA coliphages and somatic DNA coliphages). In addition, pathogenic microorganisms, thermotolerant Campylobacter, Salmonella and norovirus GI, were successfully reduced using the tertiary treatments. In contrast, clostridia, Legionella, rotavirus, norovirus GII and adenovirus showed better resistance against PAA compared to the other microorganisms. However, interpretation of polymerase chain reaction (PCR) analysis results will need further studies to clarify the infectivity of the pathogenic microbes. In conclusion, PIX and PAX flocculants followed by PAA disinfectant can be used as a tertiary treatment for municipal WWTP effluents to reduce the numbers of indicator and pathogenic microorganisms.