Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019.
<h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Udo Buchholz [verfasserIn] Heiko Juergen Jahn [verfasserIn] Bonita Brodhun [verfasserIn] Ann-Sophie Lehfeld [verfasserIn] Marina M Lewandowsky [verfasserIn] Franziska Reber [verfasserIn] Kristin Adler [verfasserIn] Jacqueline Bochmann [verfasserIn] Christina Förster [verfasserIn] Madlen Koch [verfasserIn] Yvonne Schreiner [verfasserIn] Fabian Stemmler [verfasserIn] Corinna Gagell [verfasserIn] Edith Harbich [verfasserIn] Sina Bärwolff [verfasserIn] Andreas Beyer [verfasserIn] Ute Geuß-Fosu [verfasserIn] Martina Hänel [verfasserIn] Patrick Larscheid [verfasserIn] Lukas Murajda [verfasserIn] Klaus Morawski [verfasserIn] Uwe Peters [verfasserIn] Raimund Pitzing [verfasserIn] Andreas von Welczeck [verfasserIn] Gudrun Widders [verfasserIn] Nicoletta Wischnewski [verfasserIn] Inas Abdelgawad [verfasserIn] Anke Hinzmann [verfasserIn] Denis Hedeler [verfasserIn] Birte Schilling [verfasserIn] Silvia Schmidt [verfasserIn] Jakob Schumacher [verfasserIn] Irina Zuschneid [verfasserIn] Iskandar Atmowihardjo [verfasserIn] Keikawus Arastéh [verfasserIn] Steffen Behrens [verfasserIn] Petra Creutz [verfasserIn] Johannes Elias [verfasserIn] Martina Gregor [verfasserIn] Stefan Kahl [verfasserIn] Henning Kahnert [verfasserIn] Viktor Kimmel [verfasserIn] Josefa Lehmke [verfasserIn] Pascal Migaud [verfasserIn] Agata Mikolajewska [verfasserIn] Verena Moos [verfasserIn] Maria-Barbara Naumann [verfasserIn] Wulf Pankow [verfasserIn] Hans Scherübl [verfasserIn] Bernd Schmidt [verfasserIn] Thomas Schneider [verfasserIn] Hartmut Stocker [verfasserIn] Norbert Suttorp [verfasserIn] Dorina Thiemig [verfasserIn] Carsten Gollnisch [verfasserIn] Uwe Mannschatz [verfasserIn] Walter Haas [verfasserIn] Benedikt Schaefer [verfasserIn] Christian Lück [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2020 |
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| Übergeordnetes Werk: |
In: PLoS ONE - Public Library of Science (PLoS), 2007, 15(2020), 11, p e0241724 |
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| Übergeordnetes Werk: |
volume:15 ; year:2020 ; number:11, p e0241724 |
| Links: |
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| DOI / URN: |
10.1371/journal.pone.0241724 |
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| Katalog-ID: |
DOAJ077288130 |
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| 100 | 0 | |a Udo Buchholz |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. |
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| 520 | |a <h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. | ||
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10.1371/journal.pone.0241724 doi (DE-627)DOAJ077288130 (DE-599)DOAJ0ee72d2495ce4ae99a17d25288f86cdd DE-627 ger DE-627 rakwb eng Udo Buchholz verfasserin aut Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. Medicine R Science Q Heiko Juergen Jahn verfasserin aut Bonita Brodhun verfasserin aut Ann-Sophie Lehfeld verfasserin aut Marina M Lewandowsky verfasserin aut Franziska Reber verfasserin aut Kristin Adler verfasserin aut Jacqueline Bochmann verfasserin aut Christina Förster verfasserin aut Madlen Koch verfasserin aut Yvonne Schreiner verfasserin aut Fabian Stemmler verfasserin aut Corinna Gagell verfasserin aut Edith Harbich verfasserin aut Sina Bärwolff verfasserin aut Andreas Beyer verfasserin aut Ute Geuß-Fosu verfasserin aut Martina Hänel verfasserin aut Patrick Larscheid verfasserin aut Lukas Murajda verfasserin aut Klaus Morawski verfasserin aut Uwe Peters verfasserin aut Raimund Pitzing verfasserin aut Andreas von Welczeck verfasserin aut Gudrun Widders verfasserin aut Nicoletta Wischnewski verfasserin aut Inas Abdelgawad verfasserin aut Anke Hinzmann verfasserin aut Denis Hedeler verfasserin aut Birte Schilling verfasserin aut Silvia Schmidt verfasserin aut Jakob Schumacher verfasserin aut Irina Zuschneid verfasserin aut Iskandar Atmowihardjo verfasserin aut Keikawus Arastéh verfasserin aut Steffen Behrens verfasserin aut Petra Creutz verfasserin aut Johannes Elias verfasserin aut Martina Gregor verfasserin aut Stefan Kahl verfasserin aut Henning Kahnert verfasserin aut Viktor Kimmel verfasserin aut Josefa Lehmke verfasserin aut Pascal Migaud verfasserin aut Agata Mikolajewska verfasserin aut Verena Moos verfasserin aut Maria-Barbara Naumann verfasserin aut Wulf Pankow verfasserin aut Hans Scherübl verfasserin aut Bernd Schmidt verfasserin aut Thomas Schneider verfasserin aut Hartmut Stocker verfasserin aut Norbert Suttorp verfasserin aut Dorina Thiemig verfasserin aut Carsten Gollnisch verfasserin aut Uwe Mannschatz verfasserin aut Walter Haas verfasserin aut Benedikt Schaefer verfasserin aut Christian Lück verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 15(2020), 11, p e0241724 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:15 year:2020 number:11, p e0241724 https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/article/0ee72d2495ce4ae99a17d25288f86cdd kostenfrei https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2020 11, p e0241724 |
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10.1371/journal.pone.0241724 doi (DE-627)DOAJ077288130 (DE-599)DOAJ0ee72d2495ce4ae99a17d25288f86cdd DE-627 ger DE-627 rakwb eng Udo Buchholz verfasserin aut Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. Medicine R Science Q Heiko Juergen Jahn verfasserin aut Bonita Brodhun verfasserin aut Ann-Sophie Lehfeld verfasserin aut Marina M Lewandowsky verfasserin aut Franziska Reber verfasserin aut Kristin Adler verfasserin aut Jacqueline Bochmann verfasserin aut Christina Förster verfasserin aut Madlen Koch verfasserin aut Yvonne Schreiner verfasserin aut Fabian Stemmler verfasserin aut Corinna Gagell verfasserin aut Edith Harbich verfasserin aut Sina Bärwolff verfasserin aut Andreas Beyer verfasserin aut Ute Geuß-Fosu verfasserin aut Martina Hänel verfasserin aut Patrick Larscheid verfasserin aut Lukas Murajda verfasserin aut Klaus Morawski verfasserin aut Uwe Peters verfasserin aut Raimund Pitzing verfasserin aut Andreas von Welczeck verfasserin aut Gudrun Widders verfasserin aut Nicoletta Wischnewski verfasserin aut Inas Abdelgawad verfasserin aut Anke Hinzmann verfasserin aut Denis Hedeler verfasserin aut Birte Schilling verfasserin aut Silvia Schmidt verfasserin aut Jakob Schumacher verfasserin aut Irina Zuschneid verfasserin aut Iskandar Atmowihardjo verfasserin aut Keikawus Arastéh verfasserin aut Steffen Behrens verfasserin aut Petra Creutz verfasserin aut Johannes Elias verfasserin aut Martina Gregor verfasserin aut Stefan Kahl verfasserin aut Henning Kahnert verfasserin aut Viktor Kimmel verfasserin aut Josefa Lehmke verfasserin aut Pascal Migaud verfasserin aut Agata Mikolajewska verfasserin aut Verena Moos verfasserin aut Maria-Barbara Naumann verfasserin aut Wulf Pankow verfasserin aut Hans Scherübl verfasserin aut Bernd Schmidt verfasserin aut Thomas Schneider verfasserin aut Hartmut Stocker verfasserin aut Norbert Suttorp verfasserin aut Dorina Thiemig verfasserin aut Carsten Gollnisch verfasserin aut Uwe Mannschatz verfasserin aut Walter Haas verfasserin aut Benedikt Schaefer verfasserin aut Christian Lück verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 15(2020), 11, p e0241724 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:15 year:2020 number:11, p e0241724 https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/article/0ee72d2495ce4ae99a17d25288f86cdd kostenfrei https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2020 11, p e0241724 |
| allfields_unstemmed |
10.1371/journal.pone.0241724 doi (DE-627)DOAJ077288130 (DE-599)DOAJ0ee72d2495ce4ae99a17d25288f86cdd DE-627 ger DE-627 rakwb eng Udo Buchholz verfasserin aut Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. Medicine R Science Q Heiko Juergen Jahn verfasserin aut Bonita Brodhun verfasserin aut Ann-Sophie Lehfeld verfasserin aut Marina M Lewandowsky verfasserin aut Franziska Reber verfasserin aut Kristin Adler verfasserin aut Jacqueline Bochmann verfasserin aut Christina Förster verfasserin aut Madlen Koch verfasserin aut Yvonne Schreiner verfasserin aut Fabian Stemmler verfasserin aut Corinna Gagell verfasserin aut Edith Harbich verfasserin aut Sina Bärwolff verfasserin aut Andreas Beyer verfasserin aut Ute Geuß-Fosu verfasserin aut Martina Hänel verfasserin aut Patrick Larscheid verfasserin aut Lukas Murajda verfasserin aut Klaus Morawski verfasserin aut Uwe Peters verfasserin aut Raimund Pitzing verfasserin aut Andreas von Welczeck verfasserin aut Gudrun Widders verfasserin aut Nicoletta Wischnewski verfasserin aut Inas Abdelgawad verfasserin aut Anke Hinzmann verfasserin aut Denis Hedeler verfasserin aut Birte Schilling verfasserin aut Silvia Schmidt verfasserin aut Jakob Schumacher verfasserin aut Irina Zuschneid verfasserin aut Iskandar Atmowihardjo verfasserin aut Keikawus Arastéh verfasserin aut Steffen Behrens verfasserin aut Petra Creutz verfasserin aut Johannes Elias verfasserin aut Martina Gregor verfasserin aut Stefan Kahl verfasserin aut Henning Kahnert verfasserin aut Viktor Kimmel verfasserin aut Josefa Lehmke verfasserin aut Pascal Migaud verfasserin aut Agata Mikolajewska verfasserin aut Verena Moos verfasserin aut Maria-Barbara Naumann verfasserin aut Wulf Pankow verfasserin aut Hans Scherübl verfasserin aut Bernd Schmidt verfasserin aut Thomas Schneider verfasserin aut Hartmut Stocker verfasserin aut Norbert Suttorp verfasserin aut Dorina Thiemig verfasserin aut Carsten Gollnisch verfasserin aut Uwe Mannschatz verfasserin aut Walter Haas verfasserin aut Benedikt Schaefer verfasserin aut Christian Lück verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 15(2020), 11, p e0241724 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:15 year:2020 number:11, p e0241724 https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/article/0ee72d2495ce4ae99a17d25288f86cdd kostenfrei https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2020 11, p e0241724 |
| allfieldsGer |
10.1371/journal.pone.0241724 doi (DE-627)DOAJ077288130 (DE-599)DOAJ0ee72d2495ce4ae99a17d25288f86cdd DE-627 ger DE-627 rakwb eng Udo Buchholz verfasserin aut Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. Medicine R Science Q Heiko Juergen Jahn verfasserin aut Bonita Brodhun verfasserin aut Ann-Sophie Lehfeld verfasserin aut Marina M Lewandowsky verfasserin aut Franziska Reber verfasserin aut Kristin Adler verfasserin aut Jacqueline Bochmann verfasserin aut Christina Förster verfasserin aut Madlen Koch verfasserin aut Yvonne Schreiner verfasserin aut Fabian Stemmler verfasserin aut Corinna Gagell verfasserin aut Edith Harbich verfasserin aut Sina Bärwolff verfasserin aut Andreas Beyer verfasserin aut Ute Geuß-Fosu verfasserin aut Martina Hänel verfasserin aut Patrick Larscheid verfasserin aut Lukas Murajda verfasserin aut Klaus Morawski verfasserin aut Uwe Peters verfasserin aut Raimund Pitzing verfasserin aut Andreas von Welczeck verfasserin aut Gudrun Widders verfasserin aut Nicoletta Wischnewski verfasserin aut Inas Abdelgawad verfasserin aut Anke Hinzmann verfasserin aut Denis Hedeler verfasserin aut Birte Schilling verfasserin aut Silvia Schmidt verfasserin aut Jakob Schumacher verfasserin aut Irina Zuschneid verfasserin aut Iskandar Atmowihardjo verfasserin aut Keikawus Arastéh verfasserin aut Steffen Behrens verfasserin aut Petra Creutz verfasserin aut Johannes Elias verfasserin aut Martina Gregor verfasserin aut Stefan Kahl verfasserin aut Henning Kahnert verfasserin aut Viktor Kimmel verfasserin aut Josefa Lehmke verfasserin aut Pascal Migaud verfasserin aut Agata Mikolajewska verfasserin aut Verena Moos verfasserin aut Maria-Barbara Naumann verfasserin aut Wulf Pankow verfasserin aut Hans Scherübl verfasserin aut Bernd Schmidt verfasserin aut Thomas Schneider verfasserin aut Hartmut Stocker verfasserin aut Norbert Suttorp verfasserin aut Dorina Thiemig verfasserin aut Carsten Gollnisch verfasserin aut Uwe Mannschatz verfasserin aut Walter Haas verfasserin aut Benedikt Schaefer verfasserin aut Christian Lück verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 15(2020), 11, p e0241724 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:15 year:2020 number:11, p e0241724 https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/article/0ee72d2495ce4ae99a17d25288f86cdd kostenfrei https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2020 11, p e0241724 |
| allfieldsSound |
10.1371/journal.pone.0241724 doi (DE-627)DOAJ077288130 (DE-599)DOAJ0ee72d2495ce4ae99a17d25288f86cdd DE-627 ger DE-627 rakwb eng Udo Buchholz verfasserin aut Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier <h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. Medicine R Science Q Heiko Juergen Jahn verfasserin aut Bonita Brodhun verfasserin aut Ann-Sophie Lehfeld verfasserin aut Marina M Lewandowsky verfasserin aut Franziska Reber verfasserin aut Kristin Adler verfasserin aut Jacqueline Bochmann verfasserin aut Christina Förster verfasserin aut Madlen Koch verfasserin aut Yvonne Schreiner verfasserin aut Fabian Stemmler verfasserin aut Corinna Gagell verfasserin aut Edith Harbich verfasserin aut Sina Bärwolff verfasserin aut Andreas Beyer verfasserin aut Ute Geuß-Fosu verfasserin aut Martina Hänel verfasserin aut Patrick Larscheid verfasserin aut Lukas Murajda verfasserin aut Klaus Morawski verfasserin aut Uwe Peters verfasserin aut Raimund Pitzing verfasserin aut Andreas von Welczeck verfasserin aut Gudrun Widders verfasserin aut Nicoletta Wischnewski verfasserin aut Inas Abdelgawad verfasserin aut Anke Hinzmann verfasserin aut Denis Hedeler verfasserin aut Birte Schilling verfasserin aut Silvia Schmidt verfasserin aut Jakob Schumacher verfasserin aut Irina Zuschneid verfasserin aut Iskandar Atmowihardjo verfasserin aut Keikawus Arastéh verfasserin aut Steffen Behrens verfasserin aut Petra Creutz verfasserin aut Johannes Elias verfasserin aut Martina Gregor verfasserin aut Stefan Kahl verfasserin aut Henning Kahnert verfasserin aut Viktor Kimmel verfasserin aut Josefa Lehmke verfasserin aut Pascal Migaud verfasserin aut Agata Mikolajewska verfasserin aut Verena Moos verfasserin aut Maria-Barbara Naumann verfasserin aut Wulf Pankow verfasserin aut Hans Scherübl verfasserin aut Bernd Schmidt verfasserin aut Thomas Schneider verfasserin aut Hartmut Stocker verfasserin aut Norbert Suttorp verfasserin aut Dorina Thiemig verfasserin aut Carsten Gollnisch verfasserin aut Uwe Mannschatz verfasserin aut Walter Haas verfasserin aut Benedikt Schaefer verfasserin aut Christian Lück verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 15(2020), 11, p e0241724 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:15 year:2020 number:11, p e0241724 https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/article/0ee72d2495ce4ae99a17d25288f86cdd kostenfrei https://doi.org/10.1371/journal.pone.0241724 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2020 11, p e0241724 |
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Udo Buchholz @@aut@@ Heiko Juergen Jahn @@aut@@ Bonita Brodhun @@aut@@ Ann-Sophie Lehfeld @@aut@@ Marina M Lewandowsky @@aut@@ Franziska Reber @@aut@@ Kristin Adler @@aut@@ Jacqueline Bochmann @@aut@@ Christina Förster @@aut@@ Madlen Koch @@aut@@ Yvonne Schreiner @@aut@@ Fabian Stemmler @@aut@@ Corinna Gagell @@aut@@ Edith Harbich @@aut@@ Sina Bärwolff @@aut@@ Andreas Beyer @@aut@@ Ute Geuß-Fosu @@aut@@ Martina Hänel @@aut@@ Patrick Larscheid @@aut@@ Lukas Murajda @@aut@@ Klaus Morawski @@aut@@ Uwe Peters @@aut@@ Raimund Pitzing @@aut@@ Andreas von Welczeck @@aut@@ Gudrun Widders @@aut@@ Nicoletta Wischnewski @@aut@@ Inas Abdelgawad @@aut@@ Anke Hinzmann @@aut@@ Denis Hedeler @@aut@@ Birte Schilling @@aut@@ Silvia Schmidt @@aut@@ Jakob Schumacher @@aut@@ Irina Zuschneid @@aut@@ Iskandar Atmowihardjo @@aut@@ Keikawus Arastéh @@aut@@ Steffen Behrens @@aut@@ Petra Creutz @@aut@@ Johannes Elias @@aut@@ Martina Gregor @@aut@@ Stefan Kahl @@aut@@ Henning Kahnert @@aut@@ Viktor Kimmel @@aut@@ Josefa Lehmke @@aut@@ Pascal Migaud @@aut@@ Agata Mikolajewska @@aut@@ Verena Moos @@aut@@ Maria-Barbara Naumann @@aut@@ Wulf Pankow @@aut@@ Hans Scherübl @@aut@@ Bernd Schmidt @@aut@@ Thomas Schneider @@aut@@ Hartmut Stocker @@aut@@ Norbert Suttorp @@aut@@ Dorina Thiemig @@aut@@ Carsten Gollnisch @@aut@@ Uwe Mannschatz @@aut@@ Walter Haas @@aut@@ Benedikt Schaefer @@aut@@ Christian Lück @@aut@@ |
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2020-01-01T00:00:00Z |
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DOAJ077288130 |
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englisch |
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<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ077288130</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230501195357.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230228s2020 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1371/journal.pone.0241724</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ077288130</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ0ee72d2495ce4ae99a17d25288f86cdd</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Udo Buchholz</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019.</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2020</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a"><h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. 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Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019 |
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Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. |
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Udo Buchholz Heiko Juergen Jahn Bonita Brodhun Ann-Sophie Lehfeld Marina M Lewandowsky Franziska Reber Kristin Adler Jacqueline Bochmann Christina Förster Madlen Koch Yvonne Schreiner Fabian Stemmler Corinna Gagell Edith Harbich Sina Bärwolff Andreas Beyer Ute Geuß-Fosu Martina Hänel Patrick Larscheid Lukas Murajda Klaus Morawski Uwe Peters Raimund Pitzing Andreas von Welczeck Gudrun Widders Nicoletta Wischnewski Inas Abdelgawad Anke Hinzmann Denis Hedeler Birte Schilling Silvia Schmidt Jakob Schumacher Irina Zuschneid Iskandar Atmowihardjo Keikawus Arastéh Steffen Behrens Petra Creutz Johannes Elias Martina Gregor Stefan Kahl Henning Kahnert Viktor Kimmel Josefa Lehmke Pascal Migaud Agata Mikolajewska Verena Moos Maria-Barbara Naumann Wulf Pankow Hans Scherübl Bernd Schmidt Thomas Schneider Hartmut Stocker Norbert Suttorp Dorina Thiemig Carsten Gollnisch Uwe Mannschatz Walter Haas Benedikt Schaefer Christian Lück |
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source attribution of community-acquired cases of legionnaires' disease-results from the german letriwa study; berlin, 2016-2019 |
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Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019. |
| abstract |
<h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. |
| abstractGer |
<h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. |
| abstract_unstemmed |
<h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation. |
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2024-07-04T00:38:36.326Z |
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<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ077288130</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230501195357.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230228s2020 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1371/journal.pone.0241724</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ077288130</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ0ee72d2495ce4ae99a17d25288f86cdd</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Udo Buchholz</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Source attribution of community-acquired cases of Legionnaires' disease-results from the German LeTriWa study; Berlin, 2016-2019.</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2020</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a"><h4<Introduction</h4<Sources of infection of most cases of community-acquired Legionnaires' disease (CALD) are unknown.<h4<Objective</h4<Identification of sources of infection of CALD.<h4<Setting</h4<Berlin; December 2016-May 2019.<h4<Participants</h4<Adult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.<h4<Main outcome measure</h4<Percentage of cases of CALD with attributed source of infection.<h4<Methods</h4<Analysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and Legionella in standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source (not directly from drinking water outlet), residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).<h4<Results</h4<Inclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25-93 years), 74 (67%) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them. Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain. A source was attributed by cluster evidence if at least two cases were exposed to the same source. Statistically significant general source types were attributed by calculating the population attributable risk (analytical-comparative evidence). We identified an external source in 16 (14%) cases, and RDW as source in 28 (25%). Wearing inadequately disinfected dentures was the only RnDW source significantly associated with cases (OR = 3.2, 95% CI 1.3 to 7.8) and led to an additional 8% of cases with source attribution, for a total of 48% of cases attributed.<h4<Conclusion</h4<Using the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. 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| score |
7.4002724 |