Case series study of nosocomial Legionnaires’ disease in Apulia region (southern Italy): The role of different molecular methods in identifying the infection source: Infection source in nosocomial Legionnaires' disease

Osvalda De Giglio; Marilena D'Ambrosio; Carla Calia; Valentina Spagnuolo; Marta Oliva; Marco Lopuzzo; Francesca Apollonio; Francesco Triggiano; Giusy Diella; Maria Scaturro; Maria Luisa  Ricci; Maria Elena Caringella; Carla Maria Leone; Federica  Romanelli; Stefania Stolfa; Adriana  Mosca; Carlo Pazzani; Maria Teresa  Montagna

doi:10.23750/abm.v94iS3.15048

Case series study of nosocomial Legionnaires’ disease in Apulia region (southern Italy): The role of different molecular methods in identifying the infection source

Infection source in nosocomial Legionnaires' disease

Authors

Osvalda De Giglio Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy; Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Italy https://orcid.org/0000-0002-0297-9502
Marilena D'Ambrosio Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy https://orcid.org/0000-0001-7939-0504
Carla Calia Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70125 Bari, Italy https://orcid.org/0000-0001-5920-5260
Valentina Spagnuolo Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy https://orcid.org/0009-0008-9632-4865
Marta Oliva Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70125 Bari, Italy. https://orcid.org/0000-0002-3259-5198
Marco Lopuzzo Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy https://orcid.org/0009-0008-5290-1579
Francesca Apollonio Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy https://orcid.org/0009-0008-3886-5030
Francesco Triggiano Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy https://orcid.org/0009-0007-3858-3669
Giusy Diella Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Italy
Maria Scaturro Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
Maria Luisa Ricci Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; ESCMID Study Group for Legionella Infections (ESGLI), Basel, Switzerland
Maria Elena Caringella Azienda Ospedaliero Universitaria Policlinico di Bari, Hygiene Section, Piazza Giulio Cesare 11, Bari, Italy https://orcid.org/0009-0006-5358-4718
Carla Maria Leone Azienda Ospedaliero Universitaria Policlinico di Bari, Hygiene Section, Piazza Giulio Cesare 11, Bari, Italy https://orcid.org/0000-0003-0465-3781
Federica Romanelli Azienda Ospedaliero Universitaria Policlinico di Bari, section of Microbiologia e Virologia, Piazza Giulio Cesare 11, Bari, Italy https://orcid.org/0000-0002-5338-2159
Stefania Stolfa Azienda Ospedaliero Universitaria Policlinico di Bari, section of Microbiologia e Virologia, Piazza Giulio Cesare 11, Bari, Italy https://orcid.org/0000-0002-8856-4606
Adriana Mosca Azienda Ospedaliero Universitaria Policlinico di Bari, section of Microbiologia e Virologia, Piazza Giulio Cesare 11, Bari, Italy; Interdisciplinary Department of Medicine, Microbiology Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy
Carlo Pazzani Department of Biology, University of Bari Aldo Moro, Via Orabona 4, 70125 Bari, Italy https://orcid.org/0000-0003-0414-2965
Maria Teresa Montagna Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124 Bari, Italy; Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Interdisciplinary Department of Medicine, Hygiene Section, University of Bari Aldo Moro, Italy https://orcid.org/0000-0002-2958-5458

DOI: https://doi.org/10.23750/abm.v94iS3.15048

Keywords:

Legionella, Legionnaires’ disease, nosocomial infection, molecular epidemiology, molecular typing, PFGE, SBT

Abstract

Background and aim: Legionnaires’ disease is a severe form of pneumonia caused by the inhalation or aspiration of water droplets contaminated with Legionella pneumophila and other Legionella species. These bacteria are commonly found in natural habitats and man-made water systems. Legionnaires’ disease is a significant public health problem, especially in healthcare settings where patients may be exposed to contaminated environmental sources. Nosocomial outbreaks have been reported worldwide, leading to high morbidity and mortality rates, and increased healthcare costs. This study aimed to compare, the clonal relationship of clinical L. pneumophila strains from two different hospitals with L. pneumophila strains isolated from the water supply.

Methods: In the period from 2019 to 2021, clinical and environmental strains involved in three cases of legionellosis were compared by means of pulsed field gel electrophoresis and sequence based typing techniques.

Results: Our findings highlight the persistence of clonally distinct strains within each hospital examined. Furthermore, the L. pneumophila strains detected from hospital environmental sources were related to the clinical strains isolated, demonstrating the nosocomial origin of these cases.

Conclusions: Therefore, it is important to implement more accurate surveillance systems both for epidemiological studies and to check the effectiveness of remediation procedures. (www.actabiomedica.it)

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