Sjoerd M. Euser

Legionnaires' disease and Pontiac fever after using a private outdoor whirlpool spa

Abstract Pontiac fever and Legionnaires’ disease are regarded as clinically and epidemiologically distinct diseases, caused by bacteria of the genus Legionella. Although several outbreaks of either Pontiac fever or Legionnaires’ disease have been reported, they are rarely seen simultaneously. In this report we describe such a simultaneous outbreak of Pontiac fever and Legionnaires’ disease that occurred in the Netherlands. In August 2009, 1 patient with Legionnaires’ disease and 3 patients with Pontiac fever, all from a single family, were reported to the Municipal Health Service. All family members had been exposed to the private whirlpool spa in the garden of their home. A sampling investigation by the Legionella Source Identification Unit (LSIU) showed that a sample from the whirlpool spa, as well as a sample from the garden shower and 2 samples from a garden hose were positive for Legionella pneumophila serogroup 1, and genotyping results indicated the AFLP-type 004 Lyon (ST47) to be present in these samples.

Isolation of Legionella pneumophila from Pluvial Floods by Amoebal Coculture

ABSTRACT Viable Legionella pneumophila bacteria were isolated by amoebal coculture from pluvial floods after intense rainfall and from water collected at sewage treatment plants. Several isolated L. pneumophila strains belonged to sequence types that have been previously identified in patients.

Viable Legionella pneumophila bacteria in natural soil and rainwater puddles

For the majority of sporadic Legionnaires’ disease cases the source of infection remains unknown. Infection may possible result from exposure to Legionella bacteria in sources that are not yet considered in outbreak investigations. Therefore, potential sources of pathogenic Legionella bacteria—natural soil and rainwater puddles on roads—were studied in 2012.

Pragati: an empowerment programme for female sex workers in Bangalore, India.

Objectives : To describe the effects of a broad empowerment programme among female sex workers (FSWs) in Bangalore,1 1Meaning ‘progress’ (in Kannada – an Indian language) India, which seeks to develop the capacities of these women to address the issues that threaten their lives and livelihoods. Design : This study is based on a comprehensive, on-going HIV-prevention and empowering programme, known as Pragati, which reaches out to approximately 10,000–12,000 FSWs in Bangalore each year. The programme has been designed in collaboration with the sex worker community and provides a personalised set of services, which include STI prevention and treatment services, crisis-response facilities, de-addiction services, and microfinance support all of which have been tailored to adequately fulfil each womans needs. During the period examined by this study, the programme reached out to 20,330 individual FSWs [median (IQR) age 28 (24–35) years]. The programmes personal records of the participating FSWs were used for this descriptive study. Results : Between 2005 and 2010, the number of participating FSWs increased from 2,307 to 13,392. These women intensified their contact with the programme over time: the number of programme contacts increased from 10,351 in 2005 to 167,709 in 2010. Furthermore, data on the effects of crisis-response facilities, de-addiction and microfinance services, condom distribution schemes, and STI diagnosis and treatment showed an accumulating involvement of the participating FSWs in these programme services. Conclusion : This programme, which focuses on social and economic empowerment among FSWs, is successful in reaching and involving the target population.

An outbreak of a multiresistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) strain in a burn centre: the importance of routine molecular typing.

Here we report an outbreak among 17 patients caused by a single strain of a multiresistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) in a burn centre. The MR-MSSA strains were resistant to penicillin, ciprofloxacin, erythromycin, clindamycin and co-trimoxazole. Further analysis showed an increased prevalence of MR-MSSA carriership in S. aureus colonized patients admitted to the burn centre, from 0% in 2005 (0/118), 3.3% in 2006 (4/121), 6.1% in 2007 (6/99), to 7.8% in 2008 (7/90). Molecular typing with amplified fragment length polymorphism showed that all MR-MSSA isolates derived from burn centre patients had a unique genotype, and was different compared to isolates derived from other hospital patients. All healthcare workers (HCWs) who worked in the burn centre during the outbreak were screened for nasal carriage with MR-MSSA. One HCW tested positive for a genotype of MR-MSSA that was indistinguishable from the genotype found in samples of the burned patients. No new cases of MR-MSSA colonization or infection were identified after the colonized HCW stopped working at the burn centre. The routine practice of molecular typing of collected S. aureus strains from both patients and HCWs will help to detect nosocomial spread in a burn centre, and opens the possibility of a rapid, almost pre-emptive response.

Reduction in STIs in an empowerment intervention programme for female sex workers in Bangalore, India: the Pragati programme

Background/Objective The Pragati programme is an on-going empowerment programme for female sex workers (FSWs) working and living in Bangalore, India. Pragati aims to reduce transmission of HIV and sexually transmitted infections (STIs) among FSWs. This study describes the STI incidence rate, contact rate, and condom use during follow-up years. Design Between April 2005 and November 2010, 20,330 FSWs participated in the programme. Outcome measures were programme exposure (number of contacts per person-year), STI incidence rate, and condom use. All analyses were stratified by year of follow-up. STIs were diagnosed by syndromic case management in either programme or referral clinics. We restricted our analyses to the period between April 2005 and July 2008 (when the majority of STIs were diagnosed in programme clinics), in order to minimise the possible influence of differences in STI diagnosis between clinic types. Results Results showed a significant increase of programme exposure (p-value for trend < 0.001) and a significant decrease in the STI incidence rate (p-value for trend < 0.001) over the follow-up time (between April 2005 and July 2008). Reported condom use at last paid sex increased from 77.6% in year 1 to 100% in year 4 of follow-up (p-value for trend < 0.001). Conclusion Our data seem to suggest that the Pragati programme had a positive effect on the STI incidence rate and condom use, possibly as a result of increased programme exposure. We recommend for future studies to invest more in the study design, type of data collection, and recording mechanisms before starting with an intervention. Incorporation of empowerment strategies as an approach in HIV prevention programmes can have a beneficial effect on the lives and livelihoods of FSWs.Background/Objective The Pragati programme is an on-going empowerment programme for female sex workers (FSWs) working and living in Bangalore, India. Pragati aims to reduce transmission of HIV and sexually transmitted infections (STIs) among FSWs. This study describes the STI incidence rate, contact rate, and condom use during follow-up years. Design Between April 2005 and November 2010, 20,330 FSWs participated in the programme. Outcome measures were programme exposure (number of contacts per person-year), STI incidence rate, and condom use. All analyses were stratified by year of follow-up. STIs were diagnosed by syndromic case management in either programme or referral clinics. We restricted our analyses to the period between April 2005 and July 2008 (when the majority of STIs were diagnosed in programme clinics), in order to minimise the possible influence of differences in STI diagnosis between clinic types. Results Results showed a significant increase of programme exposure (p-value for trend < 0.001) and a significant decrease in the STI incidence rate (p-value for trend < 0.001) over the follow-up time (between April 2005 and July 2008). Reported condom use at last paid sex increased from 77.6% in year 1 to 100% in year 4 of follow-up (p-value for trend < 0.001). Conclusion Our data seem to suggest that the Pragati programme had a positive effect on the STI incidence rate and condom use, possibly as a result of increased programme exposure. We recommend for future studies to invest more in the study design, type of data collection, and recording mechanisms before starting with an intervention. Incorporation of empowerment strategies as an approach in HIV prevention programmes can have a beneficial effect on the lives and livelihoods of FSWs.

Results from the National Legionella Outbreak Detection Program, the Netherlands, 2002–2012

This program has provided insights into the transmission, diagnosis, source investigation, and genotypic strain characteristics of the disease.

Legionnaires' disease after using an industrial pressure test pump: a case report

IntroductionLegionnaires’ disease is an acute pneumonia caused by inhalation or aspiration of aerosols contaminated with Legionella bacteria. The majority (>90%) of Legionnaires’ disease cases are caused by the species Legionella pneumophila, and about 85% more specifically by L. pneumophila serogroup 1 that can be detected by a fast and easy to perform urinary antigen test. Previously reported sources of infection include cooling towers, plumbing systems of hospitals, and whirlpool spas, but for the majority of cases of Legionnaires’ disease the source of infection remains unknown.Case presentationA 52-year-old Caucasian man was admitted to a Dutch hospital with pneumonia, where a culture of the available bronchial lavage was found positive for L. pneumophila serogroup 3, confirming the diagnosis of Legionnaires’ disease. An environmental investigation identified a manually operated pressure test pump at the metal processing company where he worked as the source of infection: the water sample from the pump contained 9·8×103 colony forming units/L L. pneumophila, and sequence-based typing showed the same sequence type (ST93) for both the clinical and environmental strains.ConclusionThis case shows that Legionnaires’ disease can be acquired by exposure to relatively rare sources that are not considered in regular control and prevention measures.

Genome Analysis of Legionella pneumophila Strains Using a Mixed-Genome Microarray

Background Legionella, the causative agent for Legionnaires’ disease, is ubiquitous in both natural and man-made aquatic environments. The distribution of Legionella genotypes within clinical strains is significantly different from that found in environmental strains. Developing novel genotypic methods that offer the ability to distinguish clinical from environmental strains could help to focus on more relevant (virulent) Legionella species in control efforts. Mixed-genome microarray data can be used to perform a comparative-genome analysis of strain collections, and advanced statistical approaches, such as the Random Forest algorithm are available to process these data. Methods Microarray analysis was performed on a collection of 222 Legionella pneumophila strains, which included patient-derived strains from notified cases in the Netherlands in the period 2002–2006 and the environmental strains that were collected during the source investigation for those patients within the Dutch National Legionella Outbreak Detection Programme. The Random Forest algorithm combined with a logistic regression model was used to select predictive markers and to construct a predictive model that could discriminate between strains from different origin: clinical or environmental. Results Four genetic markers were selected that correctly predicted 96% of the clinical strains and 66% of the environmental strains collected within the Dutch National Legionella Outbreak Detection Programme. Conclusions The Random Forest algorithm is well suited for the development of prediction models that use mixed-genome microarray data to discriminate between Legionella strains from different origin. The identification of these predictive genetic markers could offer the possibility to identify virulence factors within the Legionella genome, which in the future may be implemented in the daily practice of controlling Legionella in the public health environment.

Evaluation of four screening protocols for detection of extended-spectrum β-lactamase-producing members of the Enterobacteriaceae.

Gram-negative bacteria expressing extended-spectrum b-lactamases (ESBLs) have emerged worldwide. In hospitals with a low ESBL prevalence, screening for ESBL carriage at admission may be useful in populations at risk for ESBL carriage, such as those from a facility with an ESBL outbreak or those from a geographical area with high ESBL prevalence. However, without accurate laboratory screening protocols, ESBL colonization may remain undetected, thereby favouring ESBL transmission.