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Mixed infection by Legionella pneumophila in outbreak patients.
[legionellosis]
During
the
molecular
epidemiological
study
of
a
legionellosis
outbreak
,
we
obtained
sequence
based
typing
(
SBT
)
profiles
from
uncultured
respiratory
samples
of
15
affected
patients
.
We
detected
several
distinct
allelic
profiles
some
of
which
were
a
mixture
of
alleles
present
in
the
more
common
profiles
.
Chromatograms
from
the
sequences
of
one
patient
with
mixed
profile
showed
polymorphisms
in
several
positions
,
which
could
result
from
the
simultaneous
presence
of
different
Legionella
variants
in
the
sample
.
In
order
to
test
this
possibility
,
we
cloned
PCR
amplification
products
from
six
loci
for
two
patients
with
a
mixed
profile
and
a
patient
with
a
pure
profile
.
After
obtaining
around
20
sequences
for
each
locus
of
three
patients
,
we
detected
several
variants
in
two
of
them
and
two
variants
in
the
third
one
.
In
summary
,
the
three
analyzed
patients
showed
evidence
of
more
than
one
Legionella
variant
during
the
acute
infection
.
These
results
indicate
that
probably
some
patients
were
infected
by
more
than
one
strain
,
which
could
be
due
to
co
-infection
from
the
same
environmental
source
or
,
alternatively
,
to
independent
infections
in
a
very
short
period
of
time
.
Although
our
data
can
not
discriminate
between
these
hypotheses
,
these
results
suggest
that
Legionella
infection
patterns
can
be
more
complex
than
previously
assumed
.
None
of
the
environmental
samples
analyzed
during
this
outbreak
was
even
similar
to
any
of
the
clinical
ones
.
