跳到主要內容

臺灣博碩士論文加值系統

(44.212.99.248) 您好!臺灣時間:2023/01/28 12:42
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:薛瑞珍
研究生(外文):HSUEH, JUI-CHEN
論文名稱:台灣地區供水系統中退伍軍人菌血清型態調查
論文名稱(外文):Investigation of Legionella Speciation and Serotype from Environmental Water System in Taiwan
指導教授:廖麗貞廖麗貞引用關係卜樂妙
口試委員:林裕森奚明德
口試委員(外文):Yusen-Eason LinMing-Der,Shi
口試日期:2021-12-09
學位類別:碩士
校院名稱:國立高雄師範大學
系所名稱:生物科技系
學門:生命科學學門
學類:生物科技學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:英文
論文頁數:40
中文關鍵詞:退伍軍人症(LD)退伍軍人菌屬嗜肺性退伍軍人菌血清型
外文關鍵詞:Legionnaires’ disease (LD)Legionella speciesLegionella pneumophilaserogroup
相關次數:
  • 被引用被引用:0
  • 點閱點閱:67
  • 評分評分:
  • 下載下載:7
  • 收藏至我的研究室書目清單書目收藏:0
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
Al-Matawah, Q. A.,Al-Zenki, S. F., Qasem, J. A., Al-Waalan, T. E., & Ben Heji, A. H. (2012).Detection and Quantification of Legionella pneumophila from Water Systems inKuwait Residential Facilities. J Pathog,2012, 138389. https://doi.org/10.1155/2012/138389
 
Anbumani, S.,Gururajkumar, A., & Chaudhury, A. (2010, Jun). Isolation of Legionellapneumophila from clinical & environmental sources in a tertiary carehospital. Indian J Med Res, 131,761-764. https://www.ncbi.nlm.nih.gov/pubmed/20571163
 
Benin, A. L., Benson, R.F., Arnold, K. E., Fiore, A. E., Cook, P. G., Williams, L. K., Fields, B.,& Besser, R. E. (2002, Jan 15). An outbreak of travel-associatedLegionnaires disease and Pontiac fever: the need for enhanced surveillance oftravel-associated legionellosis in the United States. J Infect Dis, 185(2), 237-243. https://doi.org/10.1086/338060
 
Benitez, A. J., &Winchell, J. M. (2013, Jan). Clinical application of a multiplex real-time PCRassay for simultaneous detection of Legionella species, Legionella pneumophila,and Legionella pneumophila serogroup 1. JClin Microbiol, 51(1), 348-351. https://doi.org/10.1128/JCM.02510-12
 
Borella, P., Montagna,M. T., Stampi, S., Stancanelli, G., Romano-Spica, V., Triassi, M., Marchesi,I., Bargellini, A., Tato, D., Napoli, C., Zanetti, F., Leoni, E., Moro, M.,Scaltriti, S., Ribera D'Alcala, G., Santarpia, R., & Boccia, S. (2005,Oct). Legionella contamination in hot water of Italian hotels. Appl Environ Microbiol, 71(10),5805-5813. https://doi.org/10.1128/AEM.71.10.5805-5813.2005
 
Boshuizen, H. C.,Neppelenbroek, S. E., van Vliet, H., Schellekens, J. F., den Boer, J. W.,Peeters, M. F., & Conyn-van Spaendonck, M. A. (2001, Aug 15). SubclinicalLegionella infection in workers near the source of a large outbreak ofLegionnaires disease. J Infect Dis, 184(4),515-518. https://doi.org/10.1086/322049
 
Burnsed, L. J., Hicks,L. A., Smithee, L. M., Fields, B. S., Bradley, K. K., Pascoe, N., Richards, S.M., Mallonee, S., Littrell, L., Benson, R. F., Moore, M. R., &Legionellosis Outbreak Investigation, T. (2007, Jan 15). A large,travel-associated outbreak of legionellosis among hotel guests: utility of theurine antigen assay in confirming Pontiac fever. Clin Infect Dis, 44(2), 222-228. https://doi.org/10.1086/510387
 
Centers for Disease, C.,& Prevention, U. (2005, Feb 25). Legionnaires disease associated withpotable water in a hotel--Ocean City, Maryland, October 2003-February 2004. MMWR Morb Mortal Wkly Rep, 54(7),165-168. https://www.ncbi.nlm.nih.gov/pubmed/15729216
 
Chiang, C. S. (2018). Taiwan Center for Disease Control:MOHW107-CDC-C-315-124518.
 
Chien, S. T., Hsueh, J.C., Lin, H. H., Shih, H. Y., Lee, T. M., Ben, R. J., Chou, S. T., Fong, C. M.,Lin, Y. E., Tseng, L. R., & Chiang, C. S. (2010, Jun). Epidemiologicalinvestigation of a case of nosocomial Legionnaires' disease in Taiwan:implications for routine environmental surveillance. Clin Microbiol Infect, 16(6), 761-763. https://doi.org/10.1111/j.1469-0691.2009.02890.x
 
Colville, A., Crowley,J., Dearden, D., Slack, R. C., & Lee, J. V. (1993, Feb). Outbreak ofLegionnaires' disease at University Hospital, Nottingham. Epidemiology,microbiology and control. EpidemiolInfect, 110(1), 105-116. https://doi.org/10.1017/s0950268800050731
 
Correia, A. M.,Ferreira, J. S., Borges, V., Nunes, A., Gomes, B., Capucho, R., Goncalves, J.,Antunes, D. M., Almeida, S., Mendes, A., Guerreiro, M., Sampaio, D. A., Vieira,L., Machado, J., Simoes, M. J., Goncalves, P., & Gomes, J. P. (2016, Feb4). Probable Person-to-Person Transmission of Legionnaires' Disease. N Engl J Med, 374(5), 497-498. https://doi.org/10.1056/NEJMc1505356
 
Den Boer, J. W.,Yzerman, E. P., Schellekens, J., Lettinga, K. D., Boshuizen, H. C., VanSteenbergen, J. E., Bosman, A., Van den Hof, S., Van Vliet, H. A., Peeters, M.F., Van Ketel, R. J., Speelman, P., Kool, J. L., & Conyn-Van Spaendonck, M.A. (2002, Jan). A large outbreak of Legionnaires' disease at a flower show, theNetherlands, 1999. Emerg Infect Dis, 8(1),37-43. https://www.ncbi.nlm.nih.gov/pubmed/11749746
 
Diederen, B. M. (2008,Jan). Legionella spp. and Legionnaires' disease. J Infect, 56(1), 1-12. https://doi.org/10.1016/j.jinf.2007.09.010
 
Doleans, A., Aurell, H.,Reyrolle, M., Lina, G., Freney, J., Vandenesch, F., Etienne, J., & Jarraud,S. (2004, Jan). Clinical and environmental distributions of Legionella strainsin France are different. J ClinMicrobiol, 42(1), 458-460. https://doi.org/10.1128/JCM.42.1.458-460.2004
 
Dusserre, E., Ginevra,C., Hallier-Soulier, S., Vandenesch, F., Festoc, G., Etienne, J., Jarraud, S.,& Molmeret, M. (2008, Aug). A PCR-based method for monitoring Legionellapneumophila in water samples detects viable but noncultivable legionellae thatcan recover their cultivability. ApplEnviron Microbiol, 74(15), 4817-4824. https://doi.org/10.1128/AEM.02899-07
 
Edagawa, A., Kimura, A.,Doi, H., Tanaka, H., Tomioka, K., Sakabe, K., Nakajima, C., & Suzuki, Y.(2008, Dec). Detection of culturable and nonculturable Legionella species fromhot water systems of public buildings in Japan. J Appl Microbiol, 105(6), 2104-2114. https://doi.org/10.1111/j.1365-2672.2008.03932.x
 
European Centre forDisease Prevention and Control. (2011). Annualepidemiological report 2011-reporting on 2009 surveillance data and 2010epidemic intelligence data. ECDC.
 
European Centre for DiseasePrevention and Control. (2013). Legionnaires’disease in Europe, 2011 Surveillance report (Legionnaires’ disease inEurope, Issue. ECDC.
 
European Centre forDisease Prevention and Control. (2020). Legionnaires’disease -Annual Epidemiological Report for 2018. ECDC.
 
Faccini, M., Russo, A.G., Bonini, M., Tunesi, S., Murtas, R., Sandrini, M., Senatore, S., Lamberti,A., Ciconali, G., Cammarata, S., Barrese, E., Ceriotti, V., Vitaliti, S., Foti,M., Gentili, G., Graziano, E., Panciroli, E., Bosio, M., Gramegna, M., Cereda,D., Perno, C. F., Mazzola, E., Campisi, D., Aulicino, G., Castaldi, S.,Girolamo, A., Caporali, M. G., Scaturro, M., Rota, M. C., & Ricci, M. L.(2020, May). Large community-acquired Legionnaires' disease outbreak caused byLegionella pneumophila serogroup 1, Italy, July to August 2018. Euro Surveill, 25(20). https://doi.org/10.2807/1560-7917.ES.2020.25.20.1900523
 
Fields, B. S., Benson,R. F., & Besser, R. E. (2002, Jul). Legionella and Legionnaires' disease:25 years of investigation. Clin MicrobiolRev, 15(3), 506-526. https://doi.org/10.1128/CMR.15.3.506-526.2002
 
Fliermans, C. B.,Cherry, W. B., Orrison, L. H., Smith, S. J., Tison, D. L., & Pope, D. H.(1981, Jan). Ecological distribution of Legionella pneumophila. Appl Environ Microbiol, 41(1), 9-16. https://doi.org/10.1128/aem.41.1.9-16.1981
 
Garcia-Fulgueiras, A.,Navarro, C., Fenoll, D., Garcia, J., Gonzalez-Diego, P., Jimenez-Bunuales, T.,Rodriguez, M., Lopez, R., Pacheco, F., Ruiz, J., Segovia, M., Balandron, B.,& Pelaz, C. (2003, Aug). Legionnaires' disease outbreak in Murcia, Spain. Emerg Infect Dis, 9(8), 915-921. https://doi.org/10.3201/eid0908.030337
 
ISO11731: 2017, Water quality — Enumeration of Legionella. (2017).
 
Jarraud, S., Reyrolle,M., Meugnier, H., Forey, F., & Etienne, J. (2007, Feb). [Legionnairesdisease]. Presse Med, 36(2 Pt 2),279-287. https://doi.org/10.1016/j.lpm.2006.10.012 (Legionellose.)
 
Jespersen, S., Sogaard,O. S., Schonheyder, H. C., Fine, M. J., & Ostergaard, L. (2010, May 21).Clinical features and predictors of mortality in admitted patients withcommunity- and hospital-acquired legionellosis: a Danish historical cohortstudy. BMC Infect Dis, 10, 124. https://doi.org/10.1186/1471-2334-10-124
 
Lin, H., Xu, B., Chen,Y., & Wang, W. (2009, Feb). Legionella pollution in cooling tower water ofair-conditioning systems in Shanghai, China. J Appl Microbiol, 106(2), 606-612. https://doi.org/10.1111/j.1365-2672.2008.04031.x
 
Mekkour M, B. D. E.,Cohen N. (2012). Prevalence of Legionella pneumophila in production networksand distribution of domestic hot water in Morocco. World Environment, 2(2), 11-15.
 
Mercante, J. W., &Winchell, J. M. (2015, Jan). Current and emerging Legionella diagnostics forlaboratory and outbreak investigations. ClinMicrobiol Rev, 28(1), 95-133. https://doi.org/10.1128/CMR.00029-14
 
Napoli, C., Fasano, F.,Iatta, R., Barbuti, G., Cuna, T., & Montagna, M. T. (2010, Nov 2).Legionella spp. and legionellosis in southeastern Italy: disease epidemiologyand environmental surveillance in community and health care facilities. BMC Public Health, 10, 660. https://doi.org/10.1186/1471-2458-10-660
 
Ozerol, I. H.,Bayraktar, M., Cizmeci, Z., Durmaz, R., Akbas, E., Yildirim, Z., & Yologlu,S. (2006, Jan). Legionnaire's disease: a nosocomial outbreak in Turkey. J Hosp Infect, 62(1), 50-57. https://doi.org/10.1016/j.jhin.2005.04.018
 
Pearce, M. M.,Theodoropoulos, N., Mandel, M. J., Brown, E., Reed, K. D., & Cianciotto, N.P. (2012, Dec). Legionella cardiaca sp. nov., isolated from a case of nativevalve endocarditis in a human heart. IntJ Syst Evol Microbiol, 62(Pt 12), 2946-2954. https://doi.org/10.1099/ijs.0.039248-0
 
Phin, N., Parry-Ford,F., Harrison, T., Stagg, H. R., Zhang, N., Kumar, K., Lortholary, O., Zumla,A., & Abubakar, I. (2014, Oct). Epidemiology and clinical management ofLegionnaires' disease. Lancet Infect Dis,14(10), 1011-1021. https://doi.org/10.1016/S1473-3099(14)70713-3
 
Piao, Z., Sze, C. C.,Barysheva, O., Iida, K., & Yoshida, S. (2006, Feb). Temperature-regulatedformation of mycelial mat-like biofilms by Legionella pneumophila. Appl Environ Microbiol, 72(2),1613-1622. https://doi.org/10.1128/AEM.72.2.1613-1622.2006
 
Rafiee, M., Mesdaghinia,A., Hajjaran, H., Hajaghazadeh, M., Miahipour, A., & Jahangiri-Rad, M.(2014, May). The Efficacy of Residual Chlorine Content on the Control ofLegionella Spp. In Hospital Water Systems. IranJ Public Health, 43(5), 637-644. https://www.ncbi.nlm.nih.gov/pubmed/26060765
 
Sabria, M., & Yu, V.L. (2002, Jun). Hospital-acquired legionellosis: solutions for a preventableinfection. Lancet Infect Dis, 2(6),368-373. https://doi.org/10.1016/s1473-3099(02)00291-8
 
Stypulkowska-Misiurewicz,H., Pancer, K., Krogulska, B., & Matuszewska, R. (2007). [Outbreak ofhospital acquired Legionnaires' disease in patients of ophthalmic ward.Nosocomial Legionella infections for the first time observed in Poland]. Przegl Epidemiol, 61(4), 657-665. https://www.ncbi.nlm.nih.gov/pubmed/18572497(Ognisko choroby legionistow na oddziale okulistycznym. Szpitalne zakazenieLegionella pneumophila po raz pierwszy obserwowane w Polsce.)
 
Tossa, P.,Deloge-Abarkan, M., Zmirou-Navier, D., Hartemann, P., & Mathieu, L. (2006,Apr 28). Pontiac fever: an operational definition for epidemiological studies. BMC Public Health, 6, 112. https://doi.org/10.1186/1471-2458-6-112
 
Yu, P. Y., Lin, Y. E.,Lin, W. R., Shih, H. Y., Chuang, Y. C., Ben, R. J., Huang, W. K., Chen, Y. S.,Liu, Y. C., Chang, F. Y., Yen, M. Y., Liu, C. C., Ko, W. C., Lin, H. H., &Shi, Z. Y. (2008, Jul). The high prevalence of Legionella pneumophilacontamination in hospital potable water systems in Taiwan: implications for hospitalinfection control in Asia. Int J InfectDis, 12(4), 416-420. https://doi.org/10.1016/j.ijid.2007.11.008
 
Yu, V. L. (2001, Apr).Legionnaires' disease: seek and ye shall find. Cleve Clin J Med, 68(4), 318-322. https://doi.org/10.3949/ccjm.68.4.318
 Zietz,B., Wiese, J., Brengelmann, F., & Dunkelberg, H. (2001, Feb). Presence ofLegionellaceae in warm water supplies and typing of strains by polymerase chainreaction. Epidemiol Infect, 126(1),147-152. https://www.ncbi.nlm.nih.gov/pubmed/11293675 
連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top