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ABSTRACT: Legionellen kommen ubiquitär zumeist in Amöben im Biofilm technisierter Wassersysteme vor. Obwohl zwischenzeitlich mehr als
51Spezies bekannt sind, werden die meisten Erkrankungen durch Legionella pneumophila Serogruppe1 verursacht. Klinisch am bedeutsamsten ist die ambulant erworbene Legionellenpneumonie mit einer Inzidenz von
etwa 4% in Deutschland. Die meisten Legionellenfälle treten sporadisch auf. Die Diagnostik erfolgt durch die Anzucht von Legionellen
auf Spezialmedien, den Nachweis von Legionellen-DNA mittels PCR oder den Nachweis des Legionellen-Urin-Antigens. Prädisponiert
sind Patienten mit bestimmten Grunderkrankungen oder unter Immunsuppression sowie schwere Raucher. Männer sind häufiger betroffen.
Während ambulant führbare Patienten mit Legionellenpneumonie im Allgemeinen einen milden klinischen Verlauf zeigen, liegt
die Sterblichkeit bei hospitalisierten Patienten bei 11,2%. Momentan wird in Deutschland nur ein Bruchteil der Legionellosen
diagnostiziert und gemeldet.
Legionella are present in the environment as well as in biofilms of water installation systems. Most Legionella live in amoebae.
More than 51 different species of Legionella have been identified; however, most pneumonias are caused by Legionella pneumophila serogroup 1. Legionnaire’s disease has an incidence of about 4% in Germany. Most cases of Legionnaire’s disease are sporadic.
Microbiological identification of Legionella can be achieved by cultivation of Legionella spp. on specific media, performing
of Legionella-specific PCR from respiratory samples, or Legionella urinary antigen testing. Patients with severe underlying
diseases, patients receiving immunosuppression, and patients who are heavy smokers have a predisposition to Legionnaire’s
disease. Men are significantly more often affected. Whereas outpatients show a mild clinical course, mortality for hospitalized
patients is 11.2%. It can be assumed that only a minority of cases of Legionnaire’s disease is recognized and reported in
Germany.
SchlüsselwörterCAP–
Legionella pneumophila
–Diagnostik–Klinischer Verlauf–Legionellenpneumonie
KeywordsCAP–
Legionella pneumophila
–Diagnostic procedures–Clinical course–Legionella pneumonia
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 05/2012; 54(6):688-692. · 0.66 Impact Factor
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ABSTRACT: Legionnaires' disease is diagnosed predominantly by urinary antigen detection, and patient isolates are rarely available. The lipopolysaccharide (LPS) epitope pattern of isolates detected by monoclonal antibodies is an accepted marker for the phenotyping of L. pneumophila serogroup 1 strains into monoclonal subgroups. L. pneumophila LPS is the dominant antigen in patients' urinary specimens. By using commercially available microtiter wells coated with rabbit anti-Legionella serogroup 1 IgG as the catching antibody, LPS components in urine specimens were bound and detected separately by corresponding monoclonal antibodies of the Dresden Panel. The subtyping of LPS on urinary antigen molecules by using enzyme-linked immunosorbent assay (ELISA) allows deducing of first evidences for the identity/non-identity of environmental isolates and the legionellosis pathogen. Most importantly in our study, urinary antigen typing possesses high probability to distinguish (or does not distinguish) if the pathogen belongs to the MAb 3/1-negative L. pneumophila strains, which are widespread contaminants of water systems, but represent the minority of patient isolates.
European Journal of Clinical Microbiology 11/2011; 31(7):1673-7. · 2.86 Impact Factor
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M Freudenmann,
S Kurz,
H von Baum,
D Reick,
A M Schreff,
A Essig, C Lück,
T Gonser,
S O Brockmann,
G Härter,
B Eberhardt,
A Embacher,
C Höller
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ABSTRACT: Between December 2009 and the end of January 2010, the largest hitherto known outbreak of Legionella in Germany took place in the cities of Ulm and Neu-Ulm. Of a total of 64 patients involved, 60 patients had to be hospitalized, and 5 patients died from the infection. This event was caused by a wet cooling tower of a large air conditioning system in the city center of Ulm. The search for the source of the Legionella emission was extremely difficult, since these plants are neither notifiable nor subject to authorization in Germany. We report about the search for the source and the measures to control the outbreak. We also discuss communication and coordination during these investigations. Regulatory measures as proposed by the World Health Organization (WHO) and the European Network for Legionellosis (EWGLI) and already implemented in numerous other European countries would be desirable to prevent such outbreaks in the future.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 11/2011; 54(11):1161-9. · 0.66 Impact Factor
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ABSTRACT: Infectious agents are likely to play a role in the pathogenesis of chronic inflammatory diseases, including abdominal aortic aneurysms (AAAs). The goal of this study was to determine if Borrelia burgdorferi sensu lato (sl), a microorganism responsible for Lyme disease, is involved in the etiology of AAAs. The presence of serum antibodies against B. burgdorferi sl was measured with enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blotting in 96 AAA and 108 peripheral artery disease (PAD) patients. Polymerase chain reaction (PCR) was used for the detection of Borrelia-specific DNA in the aneurysm wall. Among AAA patients 34% and among PAD patients 16% were seropositive for B. burgdorferi sl antibodies (Fisher's exact test, p = 0.003; odds ratio [OR] 2.79; 95% confidence interval [CI] 1.37-5.85). In the German general population, 3-17% are seropositive for Borrelia antibodies. No Borrelia DNA was detected in the aneurysm wall. Our findings suggest a relationship between AAAs and B. burgdorferi sl. We hypothesize that the underlying mechanism for B. burgdorferi sl in AAA formation is similar to that by the spirochete Treponema pallidum; alternatively, AAAs could develop due to induced autoimmunity via molecular mimicry due to similarities between some of the B. burgdorferi sl proteins and aortic proteins.
European Journal of Clinical Microbiology 08/2011; 31(5):781-9. · 2.86 Impact Factor
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ABSTRACT: Legionella are present in the environment as well as in biofilms of water installation systems. Most Legionella live in amoebae. More than 51 different species of Legionella have been identified; however, most pneumonias are caused by Legionella pneumophila serogroup 1. Legionnaire's disease has an incidence of about 4% in Germany. Most cases of Legionnaire's disease are sporadic. Microbiological identification of Legionella can be achieved by cultivation of Legionella spp. on specific media, performing of Legionella-specific PCR from respiratory samples, or Legionella urinary antigen testing. Patients with severe underlying diseases, patients receiving immunosuppression, and patients who are heavy smokers have a predisposition to Legionnaire's disease. Men are significantly more often affected. Whereas outpatients show a mild clinical course, mortality for hospitalized patients is 11.2%. It can be assumed that only a minority of cases of Legionnaire's disease is recognized and reported in Germany.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 06/2011; 54(6):688-92. · 0.66 Impact Factor
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C Lück
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ABSTRACT: Legionellae are environmental bacteria that can be frequently isolated from technical water supply systems. The most prevalent species is Legionella pneumophila, especially serogroup 1. In the environment, legionellae multiply in amoebae. Since Legionella pneumonias cannot be distinguished from pneumonias caused by other microbial pathogens, special microbiological tests, e.g., urinary antigen assays, are essential to detect Legionella infections. All water supply systems to which the patient is exposed during the incubation time of 2 to 10 days might be the source of the infection. This can be confirmed or excluded by molecular typing of isolates from patients and the environment. The most commonly used techniques are monoclonal antibody typing and sequence-based typing (SBT). Some sequence types (ST) are frequently found among clinical strains but are seldom isolated from the environment, e.g., ST 23, 42, 47, 62, and 146. It is safe to assume that such strains are highly virulent. Conversely, it does not seem to be justified to dedicate the same awareness to all environmental Legionella strains.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 06/2011; 54(6):693-8. · 0.66 Impact Factor
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ABSTRACT: A total of 57 isolates of Legionella pneumophila were randomly selected from the German National Legionella strain collection and typed by monoclonal antibody subgrouping, seven-gene locus sequence-based typing (SBT) scheme and a newly developed variable element typing (VET) system based on the presence or absence of ten variable genetic elements. These elements were detected while screening a genomic library of strain Corby, as well as being taken from published data for PAI-1 (pathogenicity island) from strain Philadelphia. Specific primers were designed and used in gel-based polymerase chain reaction (PCR) assays. PCR amplification of the mip gene served as a control. The end-point was the presence/absence of a PCR product on an ethidium bromide-strained gel. In the present study, the index of discrimination was somewhat lower than that of the SBT (0.87 versus 0.97). Nevertheless, the results obtained showed as a 'proof of principle' that this simple and quick typing assay might be useful for the epidemiological characterisation of L. pneumophila strains.
European Journal of Clinical Microbiology 04/2010; 29(4):481-7. · 2.86 Impact Factor
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ABSTRACT: Currently an investigation is ongoing to explore and control an outbreak of Legionnaires disease, affecting 65 people as of 22 January 2010, in the cities of Ulm and Neu-Ulm, south-west Germany. A hitherto unidentified wet cooling system in these twin cities is considered as the most likely source of infection.
Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2010; 15(4):19472. · 6.15 Impact Factor
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ABSTRACT: Lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis serovar L1-3 was formerly a rare sexually transmitted disease in western countries. Recently, an outbreak of LGV and LGV proctitis among men who have sex with men (MSM) was reported from the Netherlands. We report two cases from Dresden, Germany, of white HIV1-infected MSM who presented in November 2004 with genital ulcers along with inguinal lymphadenitis (case 1) and ulcerative proctitis (case 2). The clinical picture and high titers of serum IgG and IgA antibodies pointed to infection with Chlamydia trachomatis. Appropriate specimens were positive for Chlamydia trachomatis with culture and PCR. Subsequent genotyping of the major outer membrane protein (MOMP) by restricted fragment length polymorphism confirmed serovar L2. Treatment with doxycycline for 3-4 weeks was effective. The incidence of LGV is increasing among MSM in Europe. Since most of the reported cases have been HIV1-infected and ulcerative STDs enhance HIV transmission, both health care providers and patients should be more aware of LGV.
Der Hautarzt 01/2007; 57(12):1095-100. · 0.58 Impact Factor
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ABSTRACT: Lymphogranuloma venereum (LGV), hervorgerufen durch Chlamydia trachomatis Serotyp L1-3 ist in den Industriestaaten eine seltene sexuell übertragbare Erkrankung. Kürzlich wurden Ausbrüche von LGV und LGV-Proktitis zunächst aus den Niederlanden berichtet. Wir berichten über 2 weiße, HIV-infizierte homosexuelle Männer, die sich im November 2004 mit genitalen Ulzera mit begleitender inguinaler Lymphknotenschwellung (Fall 1) bzw. einer LGV-Proktitis (Fall 2) vorgestellt hatten. Das klinische Bild und der Nachweis von spezifischen IgG- und IgA-Antikörpern im Serum deuteten auf eine Chlamydieninfektion hin. In entsprechendem Abstrichmaterial konnte Chlamydia trachomatis mittels Kultur und PCR nachgewiesen werden. Die nachfolgende Typisierung durch Restriktionsanalyse des MOMP (,,major outer membrane protein“) ergab bei beiden Patienten den Serotyp L2. Die Therapie mit Doxycyclin über 3-4 Wochen war erfolgreich. Die Inzidenz von LGV ist unter homosexuellen Männern in Europa deutlich angestiegen. Da die meisten berichteten Fälle gleichzeitig eine HIV-Infektion aufwiesen und ulzerative STDs das HIV-Übertragungsrisiko steigern, sollte verstärkt auch an diese Infektion gedacht werden.
Der Hautarzt 11/2006; 57(12):1095-1100. · 0.58 Impact Factor
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ABSTRACT: Intracerebral hemorrhage in leptospirosis is a rare event. We report on a fatal case of intracerebral hemorrhage complicating leptospirosis in a 47-year-old sewage drain worker. Since substantial thrombocytopenia was observed during the course of the disease, postmortem autopsy was performed to further elucidate the genesis of platelet destruction. Due to immunohistological findings, immunologically mediated thrombolysis was considered responsible for thrombocytopenia, whereas no signs of disseminated intravasal coagulopathy or deranged platelet production in the bone marrow were detected.
Infection 05/2002; 30(2):109-12. · 2.66 Impact Factor
