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      Legionella longbeachae infection in a persistent hand-wound after a gardening accident

      case-report

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          Abstract

          Introduction:

          Unlike other Legionella species, Legionella longbeachae has been associated with soil and potting composts instead of water systems, and it has caused pneumonia in gardeners.

          Case presentation:

          We report, to our knowledge, the first case of prolonged localized L. longbeachae infection in an accidental wound on the back of a hand caused by a broken flowerpot.

          Conclusion:

          Identification of L. longbeachae requires awareness and expertise, since commercial tests are most often specific for L. pneumophila.

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          Most cited references11

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          Legionella longbeachae and Legionellosis

          Reported cases of legionellosis attributable to Legionella longbeachae infection have increased worldwide. In Australia and New Zealand, L. longbeachae has been a known cause of legionellosis since the late 1980s. All cases for which a source was confirmed were associated with potting mixes and composts. Unlike the situation with other Legionella spp., L. longbeachae–contaminated water systems in the built environment that cause disease have not been reported. Spatially and temporally linked outbreaks of legionellosis associated with this organism also have not been reported. Sporadic cases of disease seem to be limited to persons who have had direct contact with potting soil or compost. Long-distance travel of the organism resulting in infection has not been reported. These factors indicate emergence of an agent of legionellosis that differs in etiology from other species and possibly in route of disease transmission.
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            Epidemiology of severe pneumonia caused by Legionella longbeachae, Mycoplasma pneumoniae, and Chlamydia pneumoniae: 1-year, population-based surveillance for severe pneumonia in Thailand.

            Legionella species, Mycoplasma pneumoniae, and Chlamydia pneumoniae are recognized as important causes of pneumonia in high-income countries, but their significance in middle-income countries, such as Thailand, is unknown. Population-based surveillance identified inpatient 3489 cases of clinically-defined pneumonia in a rural Thai province for 1 year. Patients who had a chest radiograph performed (for 2059 cases of pneumonia) were enrolled in an etiology study (which included 755 cases of pneumonia among 738 patients). Paired serum, nasopharyngeal swab, and urine specimens were obtained for diagnostic immunologic and molecular tests. Patients aged or=70 years (23-201 cases per 100,000 population). M. pneumoniae pneumonia had a similar age distribution, with an overall incidence of 6-44 cases per 100,000 population. These pathogens were associated with 15% of all cases of pneumonia. A nonsignificantly higher proportion of patients with pneumonia associated with L. longbeachae, compared with patients with pneumonia associated with M. pneumoniae or C. pneumoniae, required supplemental oxygen or mechanical ventilation (45% vs. 18%; P<.1). Among patients with atypical pneumonia, only 15% received antibiotics with activity against the associated pathogen. M. pneumoniae, C. pneumoniae, and L. longbeachae, but not L. pneumophila, are frequently associated with severe pneumonia in rural Thailand. Few patients receive antibiotics that cover atypical pathogens.
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              Does using potting mix make you sick? Results from a Legionella longbeachae case-control study in South Australia.

              A case-control study was performed in South Australia to determine if L. longbeachae infection was associated with recent handling of commercial potting mix and to examine possible modes of transmission. Twenty-five laboratory-confirmed cases and 75 matched controls were enrolled between April 1997 and March 1999. Information on underlying illness, smoking, gardening exposures and behaviours was obtained by telephone interviews. Recent use of potting mix was associated with illness (OR 4.74, 95% CI 1.65-13.55, P=0.004) in bivariate analysis only. Better predictors of illness in multivariate analysis included poor hand-washing practices after gardening, long-term smoking and being near dripping hanging flower pots. Awareness of a possible health risk with potting mix protected against illness. Results are consistent with inhalation and ingestion as possible modes of transmission. Exposure to aerosolized organisms and poor gardening hygiene may be important predisposing factors to L. longbeachae infection.
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                Author and article information

                Journal
                JMM Case Rep
                JMM Case Rep
                JMMCR
                JMM Case Reports
                Microbiology Society
                2053-3721
                December 2014
                1 December 2014
                : 1
                : 4
                : e004374
                Affiliations
                [ 1]Bacteriology Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
                [ 2]Eastern Finland Laboratory Centre Joint Authority Enterprise (ISLAB), Puijonlaaksontie 2, 70211 Kuopio, Finland
                [ 3]Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
                Author notes
                Correspondence Silja Mentula silja.mentula@ 123456thl.fi
                Article
                jmmcr004374
                10.1099/jmmcr.0.004374
                5415940
                28663819
                a3fe6592-c918-4ffa-a804-af1019426a7b
                © 2014 The Authors

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/).

                History
                : 7 September 2014
                : 22 October 2014
                Categories
                Case Report
                Soft Tissue

                extra-pulmonary,legionella,legionella longbeachae,soil,wound

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