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Legionella

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Hanaan Ahmed
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14 views17 pages

Legionella

Uploaded by

Hanaan Ahmed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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MEDICAL BACTERIOLOGY II

Legionella pneumophila
Legionella pneumophila
Gram-negative bacilli
Pleomorphic
Staing poorly
Motile: single polar flagella
Non-capsulated
Fastidious, requiring cysteine
and iron
Aerobic Reservoir
Catalase + River/stream/
Facultative interacellular amoebae/air
Water organism condition/ Water
cooling tanks
Legionella pneumophila

Water
organism
Air condition related
infections

Mechanical
ventilation infections

Single polar flagella


Legionella pneumophila

Causative agent of type of epidemic


atypical pneumonia called
Legionnaire’s disease

First Recognised in 1977 in


Philadelphia (USA)

Outbreak among American legions.


TANSIMISSION(INHALATION)

The Legionella was first identified in


1976

Aerosols from contaminated air


conditioning

No human to human transmission


Sources of infection:
Legionella are widely distributed in natural
(lakes, rivers…) and artificial water systems,
Cooling towers, Shower, swimming pools

Medical respiratory equipment

The bacteria multiply inside free living


amoeba and survive with biofilms.
Legionnaire’s disease
It is community and hospital
acquired infection.
Risk factors:
Elderly >50years.
Immunocompromised (AIDS).
Smokers, alcohol intake
Diabetics.
Men> women.
Legionnaire disease
Pathogenesis:
Facultative intracellular pathogen.
Has ability multiplies in alveolar
macrophages.
Block phagosome – lysosome fusion.
Macrophage inhibitory protein (MIP)
facilitate phagocyte entry to specialized
vacuole
Endotoxin.
Clinical features:

Incubation period 2-10days.


Pneumonia
Respiratory distress
Dry cough.
High Fever.
Headache.
Confusion and and local neurological
signs.
Vomiting and diarrhea.
Mortality
10% in healthy individuals
Pontiac fever
Is mild, flulike form of Legionella infection
that does not result in pneumonia

– an acute, self-limited febrile illness with


an incubation of 24-36 hours

Symptoms include a high fever, chills,


malaise, myalgia, and headache which
lasts 2-5 days
Diagnosis of legionella
Sputum, Serum, Urine, Water

Gram staining: faint gram negative bacilli.


Culture: in buffered charcoal-yeast agar (BCYE)
medium supplemented with iron and cysteine
Optimum growth temp 35-36oC
Grow better at 5% CO2
Plates kept for least 10-14
days before discarded as
negative

Colonies “cut-glass”
appearance

or fluorescing blue-white
under UV light
Charcoal-Yeast extract agar plate culture of
Legionella pneumophilia - Circular off-white colonies
(day 6, at 36oC)
Lung cross-section of patient with
L. pneumophila infection
Gram-negative, coccoid rods
L. pneumophila stained using direct FA
technique (400x)
Diagnosis of legionella

Immunofluorescence staining.
Legionella urine antigen
PCR.
Legionnaire disease:
Treatment
Azithromycin
Erythromycin
Rifampin
Ciprofloxacin

produces B -lactamase, and so


penicillins and cephalosporins are
less effective.
Prevention

Chlorination of water

Heating >40°C followed by


cooling <20°C

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