臺灣博碩士論文加值系統

退伍軍人菌是一種在自然界中廣泛存在的細菌，可以在河流、湖泊和水庫等環境水源中找到，通常數量很少。退伍軍人菌從天然源頭進入構成人工水庫的場所（城鎮的水渠、單個建築物的供水系統等）。許多研究報告發現，退伍軍人菌的主要來源是大型建築物的飲用水系統包括醫院、療養院和旅館。退伍軍人菌是院內感染肺炎的常見病原菌，特別是出現在免疫功能低下的患者，其中嗜肺退伍軍人菌幾乎是所有確診病例的致病菌屬。退伍軍人症在臨床上仍有很大程度無法被完全診斷出來。本研究是2017~2020年在台灣經由環境監測採集水樣5,162件，將水樣250mL以標準程序檢測退伍軍人菌在供水系統管路中移生情況。乳膠凝集試驗和直接螢光抗體檢測退伍軍人菌進行血清分型。嗜肺性退伍軍人菌的分離率為91.8% (404/440)，嗜肺性退伍軍人菌第一血清型Lp1 為40.2% (177/440)、嗜肺性退伍軍人菌第六血清型Lp6 佔 24.3%  (107/440)，其次是嗜肺性退伍軍人菌第三血清型Lp3 (5.7%, 25/440)、嗜肺性退伍軍人菌第二血清型Lp2 (3.2%, 14/440)、嗜肺性退伍軍人菌第五血清型Lp5 (1.4%, 6/440) 和嗜肺性退伍軍人菌第七血清型 Lp7 (0.5% , 2/441)。非嗜肺性退伍軍人菌屬占 8.2% (36/440)。依據檢體來源，在供水系統中嗜肺性退伍軍人菌第一血清型Lp1 分離率為 39.4% (134/340)，非嗜肺性退伍軍人菌第一血清型分離率為 60.6% (206/340)。冷卻水塔中嗜肺性退伍軍人菌第一血清型Lp1 的分離率為 67.2% (43/66)，非嗜肺性退伍軍人菌第一血清型的隔離率為 48.8%(21/66)。對於嗜肺性退伍軍人菌第一血清型以外的退伍軍人病，除了嗜肺性退伍軍人菌第一血清型尿抗原檢測外，還應建立核酸檢測和微生物培養的實驗室診斷能力，以檢測退伍軍人症。顯然地開發更具廣譜的退伍軍人菌快速診斷試劑是當前迫切需求的目標。本項研究提供退伍軍人菌的持續監測計劃有利的基礎數據，期許在台灣退伍軍人症的預防和流行病學調查上做出更有意義的貢獻。

Legionella is a bacterium that is widespread and can be found in environmental water sources such as rivers, lakes, and reservoirs, frequently the number of Legionella is rare. From the natural source, it passes into sites that constitute an artificial reservoir (channeled water in towns, water systems in individual buildings, etc.). Numerous reports have demonstrated that the major sources for Legionnaires’ disease (LD) are the potable water systems of large buildings including hospitals, nursing homes, and hotels.  Legionella is a common cause of hospital-acquired pneumonia, especially for immunocompromised patients. Legionella pneumophila(Lp) is the species that accounts for almost all of the cases reported. In this study, a total of 5,162 water samples were collected and processed during the 2017~2020 period from environmental surveillance in Taiwan. Sample application by filtration of 250 mL water sample was used to enlarge the Legionella bacteria. Standardized processing and enumeration were followed. Latex antigen agglutination test and direct fluorescent antibody technique were used for serotyping of Legionella pneumophila.The isolation rate of Legionella pneumophila (Lp) was 91.8% (404/440);Lp1 was 40.2% (177/440) followed by Lp6 24.3% (107/440),Lp3(5.7%, 25/440), Lp2 (3.2%, 14/440), Lp5 (1.4%, 6/440) and Lp7 (0.5%, 2/441). Legionella species (non-Lp) comprised 8.2% (36/440). According to the water source, the Lp1 isolation rate was 39.4% (134/340) and the non-Lp1 isolation rate was 60.6% (206/340) in the water supply system. Lp1 isolation rate was 67.2% (43/66) and the non-Lp1 isolation rate was 48.8% (21/66) in the cooling tower. For LD with Legionella other than Lp1, PCR and culture laboratory diagnostic capability should be established to detect LD in addition to the Lp1 urinary antigen test. This underscores a pressing need for the development of a more inclusive Legionella rapid diagnosis. Our investigation provides useful fundamental data for programs of continuous monitoring of Legionella,which will make a significant contribution to the prevention of LD and epidemiological surveys in the event of LD outbreaks in Taiwan.

Table of Contents
Contents                                                                                                                page
Abstract ………………………….……………………………………………... i
Chinese Abstract…………………………….………………………………… iii
Table of Contents………………..……..…………………………..…………… v
List of Table…………………………..……………………………...…………. vii
List of Figure..………………………..……………………………...…………. viii
1.0 Introduction…………………..…………………..……………………….… 1
2.0 Literature Review…………………………….……………..….……… 3
2.1 Physiology And Ecology …………..………………….….……………... 3
2.2 Epidemiology …………..…………………..……….…………………… 4
2.3 Disease – Clinical Manifestations………….……………….….……… 6
2.3.1 Pontiac fever…………..…………………………………...… 7
2.3.2 Legionnaires’ Disease…………..……………………….……… 7
2.4 Legionnaires’ Disease Over Worldwide ..…………..………….…… 8


2.5 Legionnaires’ Disease In Taiwan………………………..…..…….… 10
3.0 Materials and Methods…..……………….……………………....………… 12
3.1 Sampling…..……….……………………………………….……….…… 12
3.2 Sampling Location………………..……………………………………… 12
3.3 Sample Procedure…………………………..…………………………… 12
3.4 Legionella identification…………………………………………….…… 13
4.0 Results…..………………………………………..……….………………… 14
4.1 Collected samples and isolates………………………………...………… 14
4.2 Serological distribution of Legionella species…………………………… 14
4.3 Legionella species according to sample type.………………………….… 14
4.4 Comparative distribution Legionella species in water system and cooling
tower……………………………………………………………………...15
5.0 Discussion…………………………………………………...……………… 16
6.0 Conclusion..………………………………………………………………… 21
7.0 References..………………………………………………………………… 22
List of Table
Contents                                                                                     page
Table 1 Thesampling location in Taiwan (2017~2020)...........................28
Table 2  Distributionof Legionella species isolatescollected from 
environmental surveillance, 2017~2020 in Taiwan……..........................30
Table 3  Distribution of Legionellaspecies according to sample source, 2017~2020…………..............................................................................   31
Table 4  Comparative distribution of Legionella species between water in cooling towers and water system(n = 440) …………...................…….................32
Table 5   Legionella serogroup fromenvironmental surveillance in Taiwan, 
compare between 2017~2020 and2013~2016............................................35
Table 6  DistributionLegionella serogroup from environmental surveillance in Taiwan.2017-2020 by year......................................................................    37





List of Figure
Contents                                                                               page
Figure 1 Trend chart of confirmed cases of Legionella, 
                Taiwan CDC 2005-2020............................................................................38
Figure 2  Distribution of Legionella isolation rate according to sample source,
                 2017-2020...................................................................................................39
Figure  3  Comparative distribution of Lp1/non-Lp1 between water in cooling towers
                  and water supply system…………..............................…………............40

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