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discussion
legionella bacteria Bacteria are naturally found in freshwater environments and can survive under a wide range of environmental conditions, typically growing best in warm water between 77°F and 113°F (25°C and 45°C) (1). Exposure to water outside of artificial systems is generally not considered a risk factor for Legionnaires’ disease. Legionnaires’ disease usually occurs after inhaling water droplets containing substances such as: legionella bacteria (However, aspiration is recognized as a route of infection) (2). Before the cases described in this report were observed, legionella bacteria It has been documented to be caused by aspiration from a near-drowning accident (3).
The incidence of Legionnaires’ disease has increased significantly over the past decade, reaching a peak of 2.71 per 100,000 people in 2018 (Four). Although most cases are not associated with a known source of infection, approximately 18% have reported exposures associated with health care facilities (Five). The Centers for Medicare and Medicaid Services requires all acute care hospitals to design and implement water management programs to control water growth and spread. legionella bacteria.§ Effective water management programs, along with strict adherence to infection control guidance, remain the best means of preventing healthcare-associated Legionnaires’ disease (6). Although solid organ transplantation is known to increase the risk of infection, legionella bacteriaNo infections through the organ itself have been reported so far, probably due to the required immunosuppressive therapy (2). As with all infections in transplant recipients, rapid identification is important to limit morbidity and mortality.
Despite the lack of confirmatory clinical or genomic evidence, three factors make the transplanted lung the likely source of infection in the two cases presented in this report. suggests.First of all, no legionella bacteria The species was identified in two patients. This could be explained by infection due to donor exposure to river water, which may contain more diverse substances. legionella bacteria Species compared to drinking water (7). Second, after reviewing records from the transplant facility, water quality parameters are within expected ranges and the hospital has identified any failures in the building’s water supply system, recent changes in water quality parameters, or other conditions that may increase the risk of infection. It was shown that these events were not reported.and legionella bacteria during this period. Finally, no other cases of Legionnaires’ disease were reported from this facility in the 12 months surrounding his two reported cases, and no other possible sources of exposure were identified. Given the closeness of the cluster over time, it is expected that additional cases will be identified if the source is a hospital facility’s water system or cooling tower.
Limitations
The findings of this report have at least three limitations. First, clinical specimens from donors for testing were not available. legionella bacteria.As a result, the presence of infectious diseases legionella bacteria The existence of a donor prior to organ donation could not be confirmed. Second, specimens from patients were not available for additional laboratory analyzes that could have better characterized the species and serotypes present. Additionally, heart and kidney transplant recipients did not receive any treatment. legionella bacteria– Specific tests. Finally, the transplant hospital building’s water system and cooling tower were not tested. legionella bacteria Before or immediately after a surgical procedure. Although the hospital’s water parameter data shows that the system is well maintained, legionella bacteria The possibility of bacteria in the water system at the time of transplantation cannot be excluded.
Implications for public health practice
This report advances our understanding of microbial risk assessment in recipients of organs from donors who died by drowning. Previous studies have documented the transmission of bacterial and fungal pathogens to transplant recipients when donors drown, resulting in outcomes such as bacterial and sometimes fatal fungal infections. did(8–Ten). The results of this study indicate that clinicians caring for patients who have received an organ from a donor who has experienced freshwater drowning should be alert to suspicion of Legionnaires’ disease, even if the donor does not have typical clinical symptoms. This suggests that the value should be kept high. In such patients, posttransplant antibiotics can be adjusted to include agents that combat atypical waterborne microorganisms. If an unexpected donor-derived infection is suspected, healthcare providers should report the case to the United Organ Sharing Network (OPTN) for investigation by DTAC and rapid evaluation and identification of potentially infected organs and tissues. should be reported to public health authorities.¶ Prompt evaluation by a prudent clinician allows for faster diagnosis and treatment of Legionnaires’ disease, which requires microbe-specific testing and increases the chance of full recovery.
