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Travel-associated infections caused by unusual serogroups of Legionella pneumophila identified using Legionella BIOCHIP slides in Turkey and Iraq.
Travel Med Infect Dis. 2016 May-Jun; 14(3):248-54.TM

Abstract

BACKGROUND

Although Legionella pneumophila serogroup 1 is the common disease causing serogroup, rare serogroups can also may cause legionellosis. A 54-year-old male patient (index case) reported that he had been on a religious trip (for visiting, tomb of Ali, which is important for Shias) to Iraq with a large group (50 shia pilgrims from Kars city of Turkey) two weeks prior to admission. Due to civil war, the hotel where the patient stayed in Iraq lacked proper hygiene. A large number of people in the travel group were experiencing the same symptoms. Other five cases were 2 males (ages; 50, 45) and 3 females including the wife of the index case (ages; 50, 28, 27).

METHOD

The detection of L. pneumophila IgG and IgM was performed by anti-L. pneumophila Indirect Immunofluorescent IgM, IgG kit. Legionella 1 biochip/verification BIOCHIP slides were used for serogrouping in Euroimmun AG, Leubeck, Germany.

RESULTS

In index case, L. pneumophila IgM was positive with a titer of 1/32 titer. IgG was negative with a 1/100 titer. Another case (28 year old female), had clinical symptoms identical to the index case. L. pneumophila IgM and IgG were positive with titers of 1/64 and 1/100, respectively. These two cases were diagnosed with Legionnaires' disease caused by L. pneumophila serogroup 12 (index case) and female (28-year-old) by serogroup 11. The other 4 cases were diagnosed with possible Pontiac fever caused by L. pneumophila serogroups 14 (wife of the index case), 4, and 6 whereas the serogroup of L. pneumophila detected in 27 years old female case could not be identified.

CONCLUSION

A major limitation of this work is the absence of genotyping and the serogroup difference between index case and his wife who shared the same hotel. We suggest that this serogroup difference may be caused by (for men and women) sitting separately in Islamic rules. On the other hand, the movement of people in the context of mutual visits between countries or neighboring countries for tourism-related (i.e., for religious events or visits to holy sites) or immigration-related reasons, may cause some epidemic diseases. This study reemphasized that not only L. pneumophila serogroup 1, but other rare serogroups might cause also legionellosis which may increase in frequency and cause regional epidemics. We propose that increased financial resources for improving the hygiene conditions and performing routine legionella surveillance studies in touristic hotels would be useful measures for legionellosis prevention and control.

Authors+Show Affiliations

Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: bzeybek@istanbul.edu.tr.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: peyuksel@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Istanbul, Turkey. Electronic address: dilekkeskin84@hotmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Chest Diseases, Istanbul, Turkey. Electronic address: suhail-sheikh@hotmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: drzaferhabip@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Istanbul, Turkey. Electronic address: drserapsahin@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: rcalskan@yahoo.com.Istanbul University, Institute of Experimental Medicine, Department of Immunology, Istanbul, Turkey. Electronic address: yagizmericaltun@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: kuskucu@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Istanbul, Turkey. Electronic address: drmahirc@yahoo.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: oykudinc@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: asiyekarakullukcu@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: sevgiergin@yahoo.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: suatsaribas@gmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Chest Diseases, Istanbul, Turkey. Electronic address: nail.yilmaz@hotmail.com.Istanbul University, Cerrahpasa School of Medicine, Department of Medical Microbiology, Istanbul, Turkey.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

27108684

Citation

Kocazeybek, Bekir S., et al. "Travel-associated Infections Caused By Unusual Serogroups of Legionella Pneumophila Identified Using Legionella BIOCHIP Slides in Turkey and Iraq." Travel Medicine and Infectious Disease, vol. 14, no. 3, 2016, pp. 248-54.
Kocazeybek BS, Yuksel P, Keskin D, et al. Travel-associated infections caused by unusual serogroups of Legionella pneumophila identified using Legionella BIOCHIP slides in Turkey and Iraq. Travel Med Infect Dis. 2016;14(3):248-54.
Kocazeybek, B. S., Yuksel, P., Keskin, D., Sheikh, S., Habip, Z., Yavuzer, S. S., Caliskan, R., Altun, Y. M., Kuskucu, M., Cengiz, M., Dinc, H. O., Karakullukcu, A., Ergin, S., Saribas, S., Yilmaz, N., & Tokman, H. B. (2016). Travel-associated infections caused by unusual serogroups of Legionella pneumophila identified using Legionella BIOCHIP slides in Turkey and Iraq. Travel Medicine and Infectious Disease, 14(3), 248-54. https://doi.org/10.1016/j.tmaid.2016.04.001
Kocazeybek BS, et al. Travel-associated Infections Caused By Unusual Serogroups of Legionella Pneumophila Identified Using Legionella BIOCHIP Slides in Turkey and Iraq. Travel Med Infect Dis. 2016 May-Jun;14(3):248-54. PubMed PMID: 27108684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Travel-associated infections caused by unusual serogroups of Legionella pneumophila identified using Legionella BIOCHIP slides in Turkey and Iraq. AU - Kocazeybek,Bekir S, AU - Yuksel,Pelin, AU - Keskin,Dilek, AU - Sheikh,Suhail, AU - Habip,Zafer, AU - Yavuzer,Serap Sahin, AU - Caliskan,Reyhan, AU - Altun,Yagız Meric, AU - Kuskucu,Mert, AU - Cengiz,Mahir, AU - Dinc,Harika Oyku, AU - Karakullukcu,Asiye, AU - Ergin,Sevgi, AU - Saribas,Suat, AU - Yilmaz,Nail, AU - Tokman,Hrisi Bahar, Y1 - 2016/04/19/ PY - 2015/03/05/received PY - 2016/03/31/revised PY - 2016/04/05/accepted PY - 2016/4/26/entrez PY - 2016/4/26/pubmed PY - 2017/4/14/medline KW - L. pneumophila serogroups KW - Legionellosis KW - Legionnaires' disease KW - Pontiac fever SP - 248 EP - 54 JF - Travel medicine and infectious disease JO - Travel Med Infect Dis VL - 14 IS - 3 N2 - BACKGROUND: Although Legionella pneumophila serogroup 1 is the common disease causing serogroup, rare serogroups can also may cause legionellosis. A 54-year-old male patient (index case) reported that he had been on a religious trip (for visiting, tomb of Ali, which is important for Shias) to Iraq with a large group (50 shia pilgrims from Kars city of Turkey) two weeks prior to admission. Due to civil war, the hotel where the patient stayed in Iraq lacked proper hygiene. A large number of people in the travel group were experiencing the same symptoms. Other five cases were 2 males (ages; 50, 45) and 3 females including the wife of the index case (ages; 50, 28, 27). METHOD: The detection of L. pneumophila IgG and IgM was performed by anti-L. pneumophila Indirect Immunofluorescent IgM, IgG kit. Legionella 1 biochip/verification BIOCHIP slides were used for serogrouping in Euroimmun AG, Leubeck, Germany. RESULTS: In index case, L. pneumophila IgM was positive with a titer of 1/32 titer. IgG was negative with a 1/100 titer. Another case (28 year old female), had clinical symptoms identical to the index case. L. pneumophila IgM and IgG were positive with titers of 1/64 and 1/100, respectively. These two cases were diagnosed with Legionnaires' disease caused by L. pneumophila serogroup 12 (index case) and female (28-year-old) by serogroup 11. The other 4 cases were diagnosed with possible Pontiac fever caused by L. pneumophila serogroups 14 (wife of the index case), 4, and 6 whereas the serogroup of L. pneumophila detected in 27 years old female case could not be identified. CONCLUSION: A major limitation of this work is the absence of genotyping and the serogroup difference between index case and his wife who shared the same hotel. We suggest that this serogroup difference may be caused by (for men and women) sitting separately in Islamic rules. On the other hand, the movement of people in the context of mutual visits between countries or neighboring countries for tourism-related (i.e., for religious events or visits to holy sites) or immigration-related reasons, may cause some epidemic diseases. This study reemphasized that not only L. pneumophila serogroup 1, but other rare serogroups might cause also legionellosis which may increase in frequency and cause regional epidemics. We propose that increased financial resources for improving the hygiene conditions and performing routine legionella surveillance studies in touristic hotels would be useful measures for legionellosis prevention and control. SN - 1873-0442 UR - https://www.unboundmedicine.com/medline/citation/27108684/Travel_associated_infections_caused_by_unusual_serogroups_of_Legionella_pneumophila_identified_using_Legionella_BIOCHIP_slides_in_Turkey_and_Iraq_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-8939(16)30031-X DB - PRIME DP - Unbound Medicine ER -