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Legionella pneumophila

Genetische Diversität von Patienten- und Umweltisolaten

Legionella pneumophila

Genetic diversity of patients and environmental isolates

  • Leitthema
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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Legionellen sind Umweltbakterien, die häufig aus Wasserversorgungssystemen isoliert werden können. Sowohl bei den Umwelt- als auch bei den klinischen Isolaten dominiert Legionella pneumophila und hierbei besonders die Serogruppe 1. Legionellen vermehren sich in Wassersystemen Biofilm-assoziiert in Protozoen (Amöben). Da Legionellenpneumonien klinisch nicht von Pneumonien durch andere Erreger abgrenzbar sind, können sie nur mittels spezieller mikrobiologischer Verfahren – zum Beispiel über einen Antigentest im Urin – erfasst werden. Bei einer Inkubationszeit von zwei bis zehn Tagen, kommen alle Wassersysteme, denen gegenüber die Patienten in dieser Zeit exponiert waren, als Infektionsquelle infrage. Im Einzelfall ist ein vermuteter Zusammenhang durch die Feintypisierung der Patientenisolate und der Legionellen aus den verdächtigen Wassersystemen zu belegen beziehungsweise auszuschließen. Hierzu werden monoklonale Antikörper und das Sequence-Based-Typing (SBT) als genetisches Fingerprint-Verfahren eingesetzt. Vergleicht man, wie häufig bestimmte Varianten als klinische Erreger und als Wasserisolat auftreten, so muss man bestimmten Sequenztypen (ST) eine hohe Virulenz zuschreiben. So sind zum Beispiel ST 23, 42, 47, 62 und 146 weltweit häufig als Erreger, selten jedoch unter Umweltisolaten gefunden worden. Es ist begründet, diesen virulenteren Varianten hohe Aufmerksamkeit zu widmen. Im Umkehrschluss scheint es nicht begründet, alle Legionella-Spezies in Wassersystemen im ambulanten Umfeld als gleichermaßen kritisch zu werten.

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.

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Danksagung

Eigene Untersuchungen wurden vom Robert-Koch-Institut (BMG Projekt 1369-351) und vom BMBF (Projekt 033R036) gefördert.

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  1. Institut für Medizinische Mikrobiologie und Hygiene, Konsiliarlabor für Legionella des RKI, Fiedlerstr. 42, 01307, Dresden, Deutschland

    C. Lück

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Lück, C. Legionella pneumophila . Bundesgesundheitsbl. 54, 693–698 (2011). https://doi.org/10.1007/s00103-011-1282-5

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