The Future of Pathogen Detection: A Panel Discussion on Legionella
This roundtable discussion features a panel of five experts who delve deeply into the advancements in the detection of Legionella, particularly through the innovative Mica system. The salient point of the episode is the critical need for rapid and accurate pathogen detection methodologies, which are essential for mitigating public health risks associated with waterborne pathogens.
The panelists explore the shortcomings of current detection methods, emphasizing the anxiety and delay that often accompany traditional practices. They further discuss the potential of new technologies not only to enhance efficiency but also to improve the reliability of results, thus enabling more proactive water management strategies. This episode serves as a significant discourse on the intersection of emerging technologies and public health, highlighting the imperative for ongoing innovation in pathogen detection.
The discourse encapsulates the urgent need for improved methodologies in detecting Legionella species, with particular focus on the advancements offered by the Mica system. The panelists, all seasoned industrial hygiene professionals in their respective fields, share their apprehensions regarding the limitations of current testing protocols, notably the delays inherent in traditional culture methods. One of the panel draws attention to the variability and inaccuracy that often plague lab results because of human error, advocating for the adoption of Mica's machine learning capabilities, which promise greater precision.
As the conversation unfolds, the experts explore the implications of rapid detection capabilities not only for Legionella but also for other potential pathogens that may emerge as public health threats. The dialogue emphasizes the necessity for a significant change in how environmental microbiological testing is approached, pointing out the importance of timely and reliable data in safeguarding public health. Ultimately, the panel agrees that embracing these technological advancements could significantly enhance the efficacy of water management plans and outbreak responses.
Takeaways:
- The time required to obtain reliable results in Legionella testing remains a critical concern, as it can lead to significant anxiety for stakeholders.
- The introduction of advanced technologies like Mica represents a significant advancement in detecting Legionella more rapidly and reliably than traditional methods.
- The panel discussed the importance of focusing on Legionella pneumophila, as it is responsible for the majority of Legionnaires' disease outbreaks.
- Current methodologies often experience variability in results, which is detrimental to effective risk assessment and management in water systems.
- The integration of machine learning in the Mica system aims to reduce human error, thereby increasing the accuracy of Legionella detection.
- Consultants emphasized the necessity for health departments to accept new testing methods for them to be effectively utilized in public health management.
Links referenced in this episode:
Claressa E. Lucas, Thomas H. Taylor, Barry S. Fields, Accuracy and precision of Legionella isolation by US laboratories in the ELITE program pilot study, Water Research, Volume 45, Issue 15, 2011, Pages 4428-4436, ISSN 0043-1354, https://doi.org/10.1016/j.watres.2011.05.030.
Romano Spica, V.; Borella, P.; Bruno, A.; Carboni, C.; Exner, M.; Hartemann, P.; Gianfranceschi, G.; Laganà, P.; Mansi, A.; Montagna, M.T.; et al. Legionnaires’ Disease Surveillance and Public Health Policies in Italy: A Mathematical Model for Assessing Prevention Strategies. Water 2024, 16, 2167. https://doi.org/10.3390/w16152167
LeChevallier, M.W. The Case for Monitoring for Legionella pneumophila in Drinking Water Distribution Systems. Water 2025, 17, 475. https://doi.org/10.3390/w17040475
Sarah A. Collier, Li Deng, Elizabeth A. Adam, Katharine M. Benedict, Elizabeth M. Beshearse, Anna J. Blackstock, Beau B. Bruce, Gordana Derado, Chris Edens, Kathleen E. Fullerton, Julia W. Gargano, Aimee L. Geissler, Aron J. Hall, Arie H. Havelaar, Vincent R. Hill, Robert M. Hoekstra, Sujan C. Reddy, Elaine Scallan, Erin K. Stokes, Jonathan S. Yoder, Michael J. Beach. Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States Emerging Infectious Diseases •www.cdc.gov/eid • Vol. 27, No. 1, January 2021.
DOI: https://doi.org/10.3201/eid2701.190676
Companies mentioned in this episode:
- HC3
- Ramboll
- Exposure Assessment Consulting
- Diamidex
- Aemtek
Transcript
You know, getting that in a, in a more rapid, I'll say scientific methodology to display the client or the facility that has an issue of this can be done much faster.
Speaker B:I do think that we, that Legionella is sucking a lot of the air out of them.
Speaker B:It's the elephant, right, because it gets the public attention, it gets the scrutiny.
Speaker B:But also because as Alice alluded to for MTMs, there's really not a good method.
Speaker C:We count all of them based on a lot of tests that have been done by our team to be sure to secure the fact that when we say that it's a positive result, a positive colony, it's indeed a positive colony.
Speaker D:It's.
Speaker D:It's really advanced method to eliminate human error there.
Speaker D:And another thing is sensitivity.
Speaker D:Sensitivity micrometer used.
Speaker D:Start with mammal filtration.
Speaker D:Same as ISO, but ISO method.
Speaker D:You know, sometimes from the memory you had to resuspend it into liquid and replace.
Speaker E:I would like to throw one out to them on Pneumophila and examining or only really focusing on Legionella pneumophila, any and all of the serotypes rather than the panoply of Legionella species.
Speaker F:Good morning, ladies and gentlemen, or good afternoon wherever you are in the world.
Speaker F:This is John here from HC3.
Speaker F:Today I have got an exciting panel of guests from the last episode that you listened to or you maybe watched.
Speaker F:It's coming up.
Speaker F:Then you'll know exactly who Sam is and Dave and Florence.
Speaker F:But we are joined today with two consultants and we're going to be talking about detection of Legionella, rapid detection of Legionella and the elite environmental Legionella isolation techniques.
Speaker F:Whether they are really elite labs have been certified elite.
Speaker F:But is there a weakness to this?
Speaker F:Is there a potential weakness?
Speaker F:And is Mica advanced building the bridges that didn't seem to exist?
Speaker F:Welcome, ladies and gentlemen, to another episode.
Speaker F:Guys, if I can just ask you, we all know who David is by now and Rob, if you would like to give a little, just a 12 minute introduction of who you are and then Alex and then we'll go through the rest.
Speaker F:Everybody else.
Speaker B:My name is Rob Rotersman.
Speaker B:I sit in Chicago, Illinois.
Speaker B:My background, I trained as an epidemiologist, but most of my career has been spent in industrial hygiene.
Speaker B:I work with a company, Ramboll, which is a large international engineering and consulting firm.
Speaker B:Currently I lead the industrial hygiene practice for Ramboll and spend a lot of my time doing Legionella work as a consultant, which could be either proactive program development for prevention and unfortunately sometimes it's reactive where we're getting involved with disease outbreaks or potentially even litigation support.
Speaker F:Thank you, Rob.
Speaker F:Alex, do you want to introduce yourself?
Speaker A:Sure.
Speaker A:My name is Alex Lebeau.
Speaker A:I own a company called Exposure Assessment Consulting in Orlando, Florida.
Speaker A:I do toxicology, risk assessment and industrial hygiene type work involving exposures to a number of different either chemicals or biological agents and determining the risk based on exposures to those.
Speaker A:As Rob says, sometimes we like to be proactive, but many of our applications are reactive.
Speaker A:So we're approaching this from the reactive side and evaluating the efficacy of the MIC today.
Speaker A:So I'm excited to be here.
Speaker A:Thank you.
Speaker F:You.
Speaker F:Awesome.
Speaker F:And Sam, would you like to introduce yourself to these gentlemen?
Speaker C:Yes.
Speaker C:So I'm Sam Ducan.
Speaker C: academic research group until: Speaker C: And in: Speaker F:And thank you for that, Sam.
Speaker F:Florence, if you would like to give them a little bit of background on you and AimTech.
Speaker D:Thank you.
Speaker D:My name is Florence Wu by training.
Speaker D:I'm a mycologist and about 20 years ago I started AMTAC.
Speaker D:We are analytical laboratory servicing the industrial hygienist and the environmental consultant in environmental microbiology testing.
Speaker D:We are aiha accurate lab and also in CDC elite Leginella PT program.
Speaker D:We have been doing Legionella testing for many years and I'm excited with this new technology which really increase our laboratory efficiency.
Speaker F:Thank you Florence.
Speaker F:Last but not least, certainly David, just give a little.
Speaker F:Everybody knows who you are, but there may be people out there that were.
Speaker F:I don't know who this guy is.
Speaker F:Give them a little bit.
Speaker E:I'm not sure.
Speaker E:But I do appreciate everyone joining us today.
Speaker E:Full disclosure, I've worked with Rob and Alex for many years serving on the volunteer committees, working sometimes for the same companies, going to school together.
Speaker E:It's a fairly small community of professionals at this level and you know, I really respect their opinions and feedback and input and really wanted to kind of get their questions.
Speaker E:You know what, what are other consultants thinking about where we're at with the current methodologies and laboratory capabilities for Legionella and the next wave of waterborne pathogens that we absolutely are going to have to be dealing with and then you know.
Speaker E:How we can move that forward and what are the most important things to consider As a consultant, when you're faced with either an outbreak situation or a post, you know, a routine assessment.
Speaker E:So thank you.
Speaker F:Thank you, David.
Speaker F:All right, so let's just start off, guys, because obviously this Mica advance has been a revolutionary step forward into.
Speaker F:Detection of Legionella and other pathogens.
Speaker F:Very quickly, it's taking the time down, but let's go back to what the problems are at the beginning.
Speaker F:So, Alex, Rob, Alex, I'll ask you first, what are the weaknesses in the current detection methods now that you have faced over the years?
Speaker A:Rob, you go ahead.
Speaker F:Rob, you go ahead.
Speaker F:Alex is struck.
Speaker A:You go ahead.
Speaker E:He's good at this.
Speaker F:He actually is.
Speaker B:As Alex alluded to earlier with the looking at it from a reactive side, when we get a phone call, whether it be a building owner or from a health department that believes there may be disease associated with a particular property, there's a lot of anxiety, right?
Speaker B:There's, there's a rushed response.
Speaker B:We get up, we drop what we're doing, we get on site as soon as we can and we do a risk assessment.
Speaker B:The biggest limitation, I think, with current culture methodology is the time it takes to get results back.
Speaker B:Because no matter how fast we respond and get on site and collect samples, there's sometimes up to a two week period of anxiety not knowing what those samples are going to come back at.
Speaker B:And then afterwards, when we maybe do mitigation and we're trying to validate or verify the effectiveness of the mitigation, again, we go into that waiting period.
Speaker B:So it becomes a cycle of time where people are nervous, building owners are nervous.
Speaker B:Obviously the people who have gotten ill want to know where the source of disease might have been.
Speaker B:So technical challenges aside, which there are technical challenges with the culture method limitations with the data, all that aside, the number one concern that I have is the time to get reliable and defensible data.
Speaker A:Rob, I agree with that.
Speaker A:Yeah, you know, what's, what's interesting is that, you know, depending, you know, not every facility or type is built the same or they're not going to react the same.
Speaker A:Sometimes, as Rob says, there'll be a flurry of activity and then we'll say, hey, come in and find out if we have a problem.
Speaker A:And you not only want to do that, but you have recommendations for them.
Speaker A:Say, okay, well, we recommend in the interim, you implement these, you know, potential control methods to make sure.
Speaker A:And sometimes folks don't want to do that.
Speaker A:They say, well, let's find out what we have first.
Speaker A:And then that lag time, as Rob Mentioned it'll be up to two weeks and then suddenly they may have a problem that they could have been doing something initially, but without the data they didn't want to.
Speaker A:So I think that's, you know, Rob said there's other issues, but I think the main one is the timing is getting people that information to make a decision faster and support your own decision and recommendations to the client themselves to help them understand this is needed for your facility.
Speaker E:Yeah, and let me tell you, we've all been faced with that and we've all taken different approaches to.
Speaker E:Having samples analyzed using multiple methods.
Speaker E:PCR or, you know, HPC has been used sometimes trying to get preliminary results from labs, and up until recently, most labs would simply ignore that request, you know, and then of course PCR held great promise.
Speaker E:But when I have used it, I've had to explain it away 9 times out of 10 it did not match or really even support much of the cultures.
Speaker E:Testing is my per, you know, my professional experience.
Speaker E:I'm curious what's been yours when trying to do paired or simultaneous PCR analysis along with culture.
Speaker B:I've personally avoided it based on my past experience where when you're trying to explain results to non technical people, too frequently you find yourself caught trying to explain the difference in analytical methods and why the results don't match.
Speaker B:And when you have a client or even sometimes health professionals who see potentially conflicting data, which is what we occasionally get from doing PCR and culture side by side, you get caught in the weeds trying to explain the methodologies and the limitations of the methodologies and not solving the problem.
Speaker B:So I personally have avoided trying to do both.
Speaker B:Sometimes it's requested and you do it, but.
Speaker B:It presents challenges.
Speaker E:Absolutely.
Speaker A:Yeah.
Speaker A:No, completely agree.
Speaker F:So guys, you've both had a chance to have a look at this microsystem.
Speaker F:No, you've never used it.
Speaker F:You've never, it's not something that you're acquainted with live, but you've had a chance to see the data and obviously Florence can talk a little bit about the testing that she had done and how she's used it in her, her lab.
Speaker F:But how do you guys feel about this new breakthrough?
Speaker F:What, what, what excites you and what questions do you have for Sam about the system?
Speaker B:You want to take a go, Alex?
Speaker A:Sure.
Speaker A:I mean, it's, it's, it's exciting because again, the time element is the biggest thing and not, you know, getting that in a more rapid, I'll say scientific methodology to display the client or the facility that has an issue of, you know, this is, this can be done much faster again, even at times, you know, David mentioned preliminaries.
Speaker A:You know, you can call up and get a preliminary and sometimes even the client will say, well, I want to wait for the final report.
Speaker A:Well, you know, that again, that's putting in additional time when you could be doing something.
Speaker A:So if you can get a final report, you know, in two days, that, that would be a great help for everyone involved, I think.
Speaker A:Not only the time element that's interesting here, but the, I'll say the reproducibility of it.
Speaker A:Now.
Speaker A:In undergrad, I started as a microbiology major, I worked in microbiology labs.
Speaker A:I understand the human variability in some of this and that's always to be expected.
Speaker A:There's going to be some human variability.
Speaker A:I would appreciate hearing from Sam and I saw the data and like more information of, you know, taking that element out and relying on the instrumentation itself to do that enumeration.
Speaker A:I think that's a very interesting aspect.
Speaker C:Okay, so thank you for the question because it's one of the key points of our solution.
Speaker C:Indeed, the main issue with the ISO method is the risk of the human to misread the plate, you know, and to, and to be not able to detect correctly Legionella within all the colony that are present.
Speaker C:And this is very important.
Speaker C:The second point is based on the ISO method, you need to pick up only three colony within the plate.
Speaker C:Even if you have 100, you pick up only three.
Speaker C:So which means that you may miss also some that look like maybe close to Legionella, but not really Legionella.
Speaker C:With our system, what we are doing is we enumerate all the microcolony of Legionella pneumophila in one shot based on our machine learning algorithm.
Speaker C:Which means that we count all the colony forming unit, you know, in a plate, not only three.
Speaker C:And after we make calculation and.
Speaker C:We count all of them based on a lot of tests that have been done by our team to be sure to secure the fact that when we say that it's a positive result, a positive colony, it's indeed a positive colony.
Speaker C:So we don't need to be trained when we use our system on this specific topic.
Speaker C:That is key because it's a machine that is doing the job, so with less human error.
Speaker C:And the consequence is when you use, when you take a sample and you split this sample in 10sub sample and you ask 10 people to perform the test, you have a variability using the ISO that is really significant.
Speaker C:It could be one order of magnitude or even two order of magnitude.
Speaker C:When you do exactly the same with mica, the variability is just 20%.
Speaker C:So it's a major advantage, you know, so which means that you could ship a sample to five different locations.
Speaker C:If they are using mica, all of them, you will have 20% of variation in between.
Speaker C:If you do the same with ISO, you will have a big surprise for sure.
Speaker C:Is it answering your question?
Speaker A:It did.
Speaker A:Thank you.
Speaker C:Thank you.
Speaker F:Rob, do you have any thoughts on.
Speaker C:That.
Speaker B:Going back to your original questions which were, I guess, advantages and maybe perceived, I would call it limitations, but questions I would have.
Speaker B:I mean, I looked at the studies in the literature and the technology seems strong.
Speaker B:The data that's been presented I think is convincing to me that this is a technology that we should be moving forward with.
Speaker B:One of the limitations and I think quite frequently as consultants, our client is typically a property owner.
Speaker B:But the end user of this data or the acceptability of this data from health departments or even in the course of litigation is a vital concern.
Speaker B:If we collect a sample and we're making recommendations and those recommendations are being submitted to an agency or being presented at trial or deposition.
Speaker B:We need to make sure, we need to know the questions that are come back at us and that they're going to be accepted.
Speaker B:So a question for you is, have we had health departments accept this data.
Speaker B:From consultants or building owners for decision making?
Speaker B:And one step further, has this data been used at a trial that we're aware of, and if so, has it been questioned or has it been accepted?
Speaker E:We're very early in that process.
Speaker E:Here in the U.S. so first, the first one being, have health departments seen this?
Speaker E:We've just literally gotten the first laboratory AIM tech with Florence wu's set up and ready to analyze the samples.
Speaker E:So that's, that's, you know, step one.
Speaker E:Beyond that, the health departments, the only time I've ever seen them not accept data is when it was not sent to an ELITE certified lab.
Speaker E:The laboratory certification is one thing.
Speaker E:The method they use, frankly, I've not seen them, you know, ignore it or set it aside.
Speaker E:New York, we'll talk about New York separately because they're in a little bit different category with some established rules, laws and regulations.
Speaker E:Beyond that, the fundamentals of this are sound and meet those requirements.
Speaker E:It's culture based.
Speaker E:It shows that.
Speaker E:The detectable organisms are viable and able to amplifier grow.
Speaker E:Second, pneumophila.
Speaker E:The reliability of Legionella pneumophila, that's the organism that actually is responsible for all the outbreaks we see today and Certainly historically over 99.9% of all outbreaks, there may be some, you know, the serotyping that is still going to have to happen.
Speaker E:And that's why you need to send these to an elite certified lab.
Speaker E:So that if and when serotyping is necessary or environmental isolates need to be pushed over to comparison with culture or clinical isolates, or you have to submit isolates for, to the health department, that still needs to be done by microbiology lab.
Speaker E:So we're very early on that curve.
Speaker E:And as of course, you know.
Speaker E:Trials, actual trials on Legionnaires disease cases are extremely rare.
Speaker E:They go to, you know, they get lawsuits all the time, depositions.
Speaker E:You know that.
Speaker E:But in my opinion, the bar is pretty low right now.
Speaker E:I'm, I'm literally over, you know, looking at data from a, you know, from a health department that is being, is the center of large litigation, multi parties and it was done by a state health office.
Speaker E:And it's what they relied upon and it is nonsense.
Speaker E:They literally say the method that they used was elite CDC method.
Speaker E:There's no elite CDC method.
Speaker E:So the understanding of even the health departments is.
Speaker E:Pretty scary.
Speaker E:But I will say that health departments have an, especially here in Florida, have adopted Legion Alert, which means that they are relying upon methodologies that only detect Legionella pneumophila at best, so that that ceiling has been breached.
Speaker E:You know, that's, that's done.
Speaker E:Florida Department of Health, they don't.
Speaker E: of their results since before: Speaker E:So, you know, having sat in the state health office and as a public health official, they don't have the regulatory authority to do anything here.
Speaker E:They can accept results or not.
Speaker E:They only have regulatory authority once an outbreak has been declared and they can either accept the results or not accept the results.
Speaker E:So in some ways they are, yes, the ones we have to please.
Speaker E:But in their point of view, not their job, not their job to assess methods, not their job to adopt or require or regulate.
Speaker E:And so we're kind of trying to read their minds and read the tea leaves as to whether they're going to accept it ultimately, will they begin using it themselves?
Speaker E:I think will be the baseline of whether or not public health officials do.
Speaker E:But I can tell you, compared to the existing laboratories and methodologies, it's, it's far superior and reliable.
Speaker E:And the bar is pretty low right now.
Speaker A:David.
Speaker A:Sorry about that.
Speaker C:One point, you know, sorry, I will add one point that is very Important is like David said, we deliver results in colony forming unit like the standard method.
Speaker C: the world that have been ISO: Speaker C:Which means that they have, I mean they are performed large number of tests where they compare the standard method to mica and they have been audited by third party person but have checked all the data and they confirm the equivalence of the two method for the enumeration of Legionera and Mophila.
Speaker C:Which means that now if a laboratory in US and if Florence want to be ISO 17 or 2 25, you know, certified, it will take just one month, you know, because they will have just performed 50 comparison and it will be down, you know, so which means that it would be equivalent and it will be certified as equivalent to the standard method for Legion de la.
Speaker E:Huge.
Speaker E:Huge.
Speaker E:Thank you.
Speaker A:Sorry, I had two questions following up on what David said.
Speaker A:So kind of aimed at both Sam and Florence.
Speaker A:So Sam, for you know, since you're working in from the European theater, has there been any European, I'll say equivalent health departments that have looked at this and, and given any thoughts or opinions on that?
Speaker A:That's the first question.
Speaker A:And second, can you discuss, you know, obviously it's working on and detecting pneumophila.
Speaker A:Can you discuss Florence if this is testing positive, how the serotyping goes beyond just the mica, how you would handle in the laboratory.
Speaker C:So I will start and Florence, you will continue.
Speaker C:So the first is we have been first validated by the AOAC in the US with QLab.
Speaker C:So which means that they have tested and certified the method.
Speaker C:And second, we have Dubai Central laboratory that have been certified, we have the Chinese laboratory that have been certified and validate as equivalent.
Speaker C:And we have the Chinese CDC that have test and publish the result in between the two solutions and that conclude that our method is more accurate than the isometer.
Speaker C:So this is one argument that show clearly that it's.
Speaker C:Now you could replace, I mean the standard method with our method.
Speaker C:Of course in some country is more complicated because you have guideline and regulation that oblige namely you know, to use a specific method which is not the case in the US or which is not the case in other country.
Speaker C:So in depending of the country.
Speaker C:Sorry.
Speaker C:So, but yes we, we have got green light from many different countries just right now we have installed an equipment in south of Africa.
Speaker C:And they were shocked, you know, when they test the method and now they will use instead of the standard method and they will deliver more accurate resume you know, for the second question, I would just give one information and Florence will be able to continue.
Speaker C:You know, when you.
Speaker C:With our solution, the technology is not.
Speaker C:Which means that if you have a positive sample on Legionella, you just have to put back the membrane on the plate, let the cell grow and they form colony.
Speaker C:And you could do the serotyping at the end.
Speaker C:So you are not losing time and you are not obliged to restart from the original sample to perform the serotyping.
Speaker C:Florence, if you want to add something.
Speaker D:I think you answered really well.
Speaker C:Okay, thank you.
Speaker D:I do want to add a couple of things.
Speaker D:One is.
Speaker D:When we evaluate analytical methods, some attributes are really important.
Speaker D:One is specificity.
Speaker D:That you detect what you target.
Speaker D:You not detect non target, meaning it does not yield false positive.
Speaker D:So the specificity using human eye is much less than using MICA method, which is using, you know, biotechnology.
Speaker D:The fluorescence labeling, it's.
Speaker D:It's really advanced method to eliminate human error there.
Speaker D:And another thing is sensitivity.
Speaker D:Sensitivity Micrometer used start with memory filtration.
Speaker D:Same as ISO, but ISO method.
Speaker D:You know, sometimes from the memory you have to resuspend it into liquid and replace.
Speaker D:And that handling.
Speaker D:It depends on the.
Speaker D:Membrane efficiency.
Speaker D:Sometimes you cannot wash it off.
Speaker D:We cannot wash off bacteria from memory.
Speaker D:So the more handling in analytical method is the source for accuracy and precision.
Speaker D:If you filter twice, you may not get the same result.
Speaker D:So I really like the aspect that MACA method that there's a less handling and that really help us to improve the precision of the method.
Speaker E:Yeah, and you know, that is so important.
Speaker E:The precision specificity of the method is in league with what we would expect from chemical analysis rather than microbiological, which we recognize.
Speaker E: And if you look back at the: Speaker E:It's only can you identify it and report it or not can you isolate it?
Speaker E:The enumeration they found that there they were on average 1.25 log under reporting.
Speaker E:And it goes right with Florence was talking about the more you handle that sample, the lower your results are going to be.
Speaker E:And so that's the average.
Speaker E:They were seeing over a three log range among laboratories using whatever methods they were going to use.
Speaker E:All culture based.
Speaker E:I mean that's where we're starting from now.
Speaker E:So I think people need to understand the existing methodologies and approaches.
Speaker E:Are.
Speaker E:We can call it the gold standard.
Speaker E:But maybe that moniker was.
Speaker E:Was given out too soon.
Speaker D:So this, you know, whenever I talk about Lindsay Nana, my thoughts go back to a project we did many years ago is still haunting me today because I, I know there is a Lindsinal line in the sample but we cannot recover it because the background is really high.
Speaker D:So when you do, when you do, you know, if you don't do a dilution or low dilution, the plate is covered.
Speaker D:When you do higher dilution, then suddenly your sensitivity is not there.
Speaker D:Right.
Speaker D:The background is higher than Leginalla.
Speaker D:And even we use, you know, all kind of treatment, heat treatment, ice age treatment, the selective agar, you still just cannot knock out that, you know, bacteria that cause the plate covering with colonies.
Speaker D:And at that time I wish that we had something that can specifically label your target bacteria for easy detection.
Speaker D:And we didn't look 3 colony, we probably looked at 300 colony try to find the Lindsinella.
Speaker D:But it was not successful.
Speaker E:Absolutely, absolutely.
Speaker E:I think this leapfrog, leapfrog technology is going to help get past some of those limitations.
Speaker E:Yeah.
Speaker E:Rob, you had, you had another follow up question, I think.
Speaker B:No, actually I think Alex stole my thunder.
Speaker B:I was going to ask the exact same question about international.
Speaker B:I mean obviously working for a larger international company.
Speaker B:We have people across Europe, some of which do occasionally do Legionella work and I understand the regulations to be much more strenuous than in the United States.
Speaker B:So my question was the same as Atlas's.
Speaker B:Yeah.
Speaker E:Regard to, I'm curious about sample volume.
Speaker E:So as a consultant, where do you fall on how much water, how much of a sample do you need to collect and what sensitivity, what detection limit do you think is needed, appropriate and required for your, for your progress?
Speaker A:So it's.
Speaker A:So I think it's going to be dependent, I mean, you know, David mentioned I had worked with him previously.
Speaker A:So I mean we've done previous work where we, you know, we collected a certain volume of sample of 250ml and use that as I think an effective volume.
Speaker A:But depending on the case and the matter, you know, sometimes if the health department is involved or sometimes if you think that as Rob mentioned, it's going to be in the legal proceeding sampling maybe a 1 liter volume as a standard methodology, you may default back to that too.
Speaker A:So I guess, you know, I'm presuming and you can talk about the data here is, you know, have you done any evaluation on, on for this particular method and I think you did it when I worked with David to show that there's any differences in detection with the volumes that are submitted for the samples.
Speaker C:So I mean, we have a very strong.
Speaker C: ml or: Speaker C:And it was not me, you know, it was published by the Chinese and the US lab, you know, that say that for cooling tower, where you have a lot of background.
Speaker C:We have no issue, you know, with interfering flora and we are able to detect them.
Speaker C:So which means that we don't, we are not stressed by interfering flora and we are very, very linear.
Speaker C:And the reason why is because we are counting microcolony.
Speaker C:So we are linear on the filter from 1 to 30,000 microcolony counted on the, on the membrane, you see.
Speaker C:So it's not like the petri dish where you are linear between 20 and 150 or 50 to 150, you know, and you need to make dilution and this dilution make, generate variability here with one membrane, one plate, because we use only one plate per sample, which is also a big advantage for the lab.
Speaker C:We are linear in a very wide range, you know, of quantity of microbes.
Speaker C:So which means that you have very low, I mean, I mean if you want to take very low number, you just have to filter 1 liter and your limit of detection will be 1 CFU in this 1 liter.
Speaker A:And, you know, you brought up something interesting and I saw the data and I was going to ask you about this.
Speaker A:You know, you talked about a lot of background.
Speaker A:You know, when you had, you identified in the cooling tower, was identified in complex water that was in the publications.
Speaker A:Sometimes.
Speaker A:And Rob and David could probably speak, you know, sometimes we will get told that, oh yes, that we regularly chlorinate or we have disinfectant in here.
Speaker A:When you actually find out maybe they haven't disinfected in some time, you know, maybe it's a decorative fountain or whatever it is when it's, when it's those scenarios like a cooling, unlike a cooling tower that, you know, probably has some disinfecting going on, hopefully.
Speaker A:Have you had any environmental samples that have been submitted that have been from sources that have been lacking any disinfectant for some time to see how the, the background interferes, if at all.
Speaker C:So it's a question for Florence, because me, I'm not, I mean, you know, I develop the solution and.
Speaker A:Sure.
Speaker A:No, I get it.
Speaker A:Yeah.
Speaker E:Yeah, well, actually we do, you know, Cooling towers, hot tubs are one.
Speaker E:Those are the big ones that we see or you know, sometimes just, you know, state of Maryland water doesn't have a lick of disinfectant left in it once it makes it air.
Speaker E:So, but, but yeah, we, we certainly see a lot of those and that's a, that's a major risk factor as well.
Speaker E:So yeah, the, the, the micro colony stage and jumping in early on the plates and using the GVP's that the GVPC also helps.
Speaker E:You still do acid treatment and heat treatment for hot for cooling towers samples.
Speaker E:But what was really interesting to me is for a cooling tower sample, in order to get a detection limit of 0.1 CFU per mil, again tenfold less than any of the, I'll say, actionable levels or even mentioned levels, all you need is 20 mils of the sample volume being used.
Speaker E:So we're talking lower, much lower levels needed to be submitted.
Speaker E:And for us consultants and our clients, that's smaller bottles, less space, lower volume, lower weight, lower shipping costs.
Speaker E:Being able to do that effectively right now, I think, you know, doing a 250mil sample gives you more than enough volume to, to do any of the analyses.
Speaker E:And, and Alex, you know, you inferred that, that assessment we did in Flint, Michigan, comparing this one liter versus the two 250s and there was, we actually saw again, better recovery, more, more reliable, more, more positives with the 250mil sample rather than the 1 liters.
Speaker B:So all the fun, all the fun of sampling is having a storage room full of coolers and carts.
Speaker E:I'm sorry, Florence, go ahead.
Speaker D:So the bottles are provided with neutralizing neutralizer that helps.
Speaker D:And also you think in that system, if Lindsay Nana can survive, they have certain.
Speaker D:The survivability during sampling, during the sample shipment.
Speaker D:Is there.
Speaker D:It's not like they're not that fragile.
Speaker D:So I don't think that will impact analytical method provided that a sample shipped with, you know, not without temperature abuse and the sample retention time is met.
Speaker D:Not, you know, within CDC says 72 hours.
Speaker D:We normally keep it at 24 or 48 hours.
Speaker D:So those factors help to improve the detectability.
Speaker E:Exactly, exactly.
Speaker E:So, you know, a lot of cooling tower folks are using.
Speaker E:So are using 100 mil bottles, 100 mil samples for, for those.
Speaker E:What's been your experience or what have you seen in data, not necessarily for outbreaks, but for routine sampling.
Speaker E:What are you seeing out there being used for sample collection and analysis?
Speaker D:So we do recommend clients to use 100 mil bottle for cooling hot water and use either 250 mil or 1 liter for drinking water.
Speaker D:And that's what we see.
Speaker D:Even with clean drinking water.
Speaker D:It'S difficult to filter entire 1 liter.
Speaker D:So, yeah, so normally the filter just stopped working after 400 mil or something.
Speaker D:So I think 200 mil is a good sample size.
Speaker D:And for cooling tile water, 100 mil is good, but if they want to sample more, it's also good that give us more sample to do the quality control or duplicate testing in the quality control process.
Speaker F:All right, guys, any other thoughts on this?
Speaker F:Rob, Alex, any other questions that you have in regard to the sampling or how Mica operates?
Speaker E:I would like to throw one out to him on Pneumophila and examining or only really focusing on Legionella pneumophila, any and all of the serotypes rather than the panoply of Legionella species.
Speaker E:And what do you think of the presumption or the public health guidance that if any Legionella can grow there, then it means Pneumophila can grow there?
Speaker E:What are your, what are your thoughts on that, Rob?
Speaker B:No, my thoughts are Pneumophila is responsible for the vast majority disease.
Speaker B:And if there's a methodology that can target that and give us results quickly.
Speaker B:I think that that is the way to go.
Speaker B:There may be instances and I think in one of the studies they found even in the validation of Mica there, there was a non Pneumophila identified.
Speaker B:I think that can be important in some cases, but for the vast majority of the projects we're involved with, focusing on Pneumophila is where we need to be.
Speaker D:Can I share some other aspects of that?
Speaker D:So imtac, we also do food safety testing.
Speaker D:So in food safety testing, we specifically target on food bone pathogens like Salmonella, Listeria, monocytosins, pathogenic E. Coli.
Speaker D:And the reason for that is.
Speaker D:Why you do testing.
Speaker D:You do testing to take actions.
Speaker D:So if you detect a pathogen, if you have a clear target, once you detect the pathogen, then the manufacturer have a plan to take action, not release the product, do retreat, something like that.
Speaker D:So the same thing, I think in the environmental testing, you need to know why you do the testing.
Speaker D:If you can take action, like if you detect Linginella pneumofola, you know, this is, you have a disease causing agent, then it's one set of action.
Speaker D:Right.
Speaker D:If you say just generic Linginella, you know, what is the next step in terms of action?
Speaker D:I think testing should be connected to your action level.
Speaker A:Agree.
Speaker B:I would also say Sometimes too, as consultants, when we have non Pneumophila species, even though some that we are fairly confident are non pathogenic, when those come up in lab results, you still have to explain to a layman or client that these are not necessarily high risk.
Speaker B:But look over here, the smaller concentration of the buffalo is the higher risk.
Speaker B:Right.
Speaker B:And sometimes if you get it out, if you don't have the noise associated with some of the non pathogenic species of Legionella in your sample results, the communication becomes easier, the actions become clear.
Speaker E:Yeah.
Speaker A:And Rob and David, you can correct me, even some state health departments that you need to educate on that, where you have to, where you have to say, you know, you're looking at the wrong thing.
Speaker E:I have seen clients run through the ringer for years for detections of low concentrations, transient levels of non pneumophilus species that have never been associated with an outbreak weren't the cause of the outbreak that they had.
Speaker E:And having to start all over again, re remediate a system, start from scratch, and I call it Legionella purgatory, you know, they just can't get out of it.
Speaker E:I've seen hospitals deal with it for three years.
Speaker E:You know, it's ludicrous.
Speaker E:Millions of dollars are spent chasing non pathogenic species.
Speaker E:We don't do this in any other arena.
Speaker E:And I have begun to ask the very straightforward question, what evidence do we have?
Speaker E:What study findings, results, EPI survey, anything that supports that presumption of non Pneumophilus species posing a public health risk.
Speaker E:And the answer I get back from every public health agency I've dealt with has been crickets.
Speaker E:And we've been able to move on to, we are going to monitor for Legionella pneumophila and that will be the target organism that we use to measure success or failure.
Speaker C:There are a publication that I just shared to David, I mean a few minutes ago that concluded exactly the same and it was a global publication coming from an Italian laboratory that have pulled together all the data coming from Italia during 25 years.
Speaker C:You know, and the conclusion of the, the, the article is it's more efficient to follow Lesionella no filler and compared to Legionella spp.
Speaker C:And you will save time and money for everybody.
Speaker C:Not only for, you know, for everybody, even for the state.
Speaker C:You know, if you want, David, you, you, you could share, I mean you could put on the publication on, on.
Speaker E:On the link, you know, absolutely, we'll share that, we'll share that, that public a link to that publication as well.
Speaker E: As the: Speaker E:So it's really, really good information, really good information on that.
Speaker E:And, you know, we need to push back and understand what is it we're asking.
Speaker E:If we're here to protect public health, then go after the organism that's actually causing disease.
Speaker E:And, you know, time and resources need to be spent on other aspects.
Speaker F:I think it's also something that you need to think about, ladies and gentlemen, as well, is that you're focusing on Legionella nemophila.
Speaker F:I get it.
Speaker C:Right.
Speaker F:But since we had the discussion yesterday, we know that Sam's machine identifies other pathogens.
Speaker F:And there's going to be.
Speaker F:There's going to come a time, as you as consultants Alex and Rob, where these other pathogens are going to reel their ugly head, whether it's ntms, whether it's Pseudomonas.
Speaker F:How do you guys feel about this moving forward with the data that you've seen for the MICA system and the potential change or impact it can make for the future?
Speaker F:Looking forward now, not just sticking on Legionella nemophila, but looking forward to, to the future and the potential of other outbreaks of other organisms such as ntms as well, where Sam has been working on or.
Speaker F:I don't want to blow anything out because I know we talked about it yesterday, but that is a possibility that Mica will develop further in the future in new pathogens.
Speaker C:Yeah, so just one sentence.
Speaker C:By end of next year, we will have, with the same device, the possibility to enumerate Pseudomonas ay regionosa.
Speaker C:You know, this is on the pipe.
Speaker C:And we will release the solution by end of the year.
Speaker C:So it will be just in one day with no need of confirmation.
Speaker C:So we reduce significantly the time, you know, with the same approach, you know, of machine learning, being able to lab to detect specifically Pseudomonasa erasmosa and in the coming years.
Speaker C:And I will not give a date, you know, because I know that I have.
Speaker C:Okay.
Speaker C:We are thinking to work on non tuberculosis mycobacterium because we have some proof of concept that we are able to do the same with ntm, you know, but it would be not for next year.
Speaker E:Well, if you need any environmental samples to try it out on.
Speaker E:I know, I know, I know where I can get a few.
Speaker A:I mean, I'm.
Speaker A:I'm excited by that opportunity, especially for the NTMs.
Speaker A:I mean, especially for how long those results take to get back and the lack of, I'll say general understanding of the potential hazard that they pose within the water systems.
Speaker A:And then you're looking at the slow growing and fast growing NTMs, and sometimes the lines are a little blurred there.
Speaker A:So if there's anything not to let a fire under you, but there's anything on that front that you can do, I think, I think that is we, as people who deal with the public health facility owners, would welcome that.
Speaker C:Yeah, it's there, but.
Speaker C:But today we are focused on leisurely.
Speaker C:You know, we.
Speaker A:There are lots of interesting aspects.
Speaker E:Yeah, yeah.
Speaker C:It took 10 years to develop for Legionella, so it will take some time, you know, and, you know, I'm scientific, you know, I'm coming from an academic research group, so I will not release a product If I'm not 100% sure of the product.
Speaker C:So it will take some years, you know, but, yes, we will do it.
Speaker D:So I think the.
Speaker D:I mean, Rob and Alex and David know much better than I do.
Speaker D:When you test Lindsinella, you really test the condition that Lindanella can grow.
Speaker D:Right.
Speaker D:Consider that condition.
Speaker D:That condition itself is a breeding ground for other bacteria as well.
Speaker D:So the significance of detecting Laginella is not limiting las nan itself.
Speaker D:It help us to improve the water system.
Speaker E:It is.
Speaker E:It is the interpretation of it.
Speaker E:You know, the one decent thing that's finally come out of CDC guidance has been when Legionella colonizes and grows in a building water system now it poses a health hazard or a public health risk.
Speaker E:Growing and then aerosolization, those are the big things.
Speaker E:And while that's true and that presumption of if bacterial growth can happen, then it could happen from any of these things.
Speaker E:The problem is the.
Speaker E:The snapshot.
Speaker E:We look, we come in and see these water systems, and I think it's just fundamentally, we as a industry don't know what the bug knows.
Speaker E:The microbes, they find a place.
Speaker E:And that we may not think is good because we've all seen it.
Speaker E:We've seen cooling tower water systems or decorative water features that were pristine and were just teeming with Legionella pneumophila.
Speaker E:And I've seen systems that I wouldn't let my dog bathe in that didn't have any detectable Legionella in it whatsoever.
Speaker E:So, you know, it may be a health hazard from other reasons, but, you know, for Legionella, it just doesn't match up.
Speaker E:So the specificity and the ability to rely upon those results, I think will help us tease that apart as we move forward.
Speaker E:Absolutely, absolutely.
Speaker E:Rob, you had a question or.
Speaker B:Yeah, no, I was Just maybe it was going back a little bit to the discussion of the, you know, pseudomonas and other contaminants.
Speaker B:I do think that we.
Speaker B:That Legionella is sucking a lot of the air out of them.
Speaker B:Just the elephant, right.
Speaker B:Because it gets the public attention, it gets the scrutiny, but also because, as Alice alluded to, for MTMs, there's really not a good method or easy method to test for.
Speaker B:And we're gonna.
Speaker B:We just start to discover concerns and problems when we start testing for things.
Speaker B:And I think a lot of people aren't testing because it's difficult and that if there was a reliable and easier method to use, the actual concerns with MTM will become much more apparent.
Speaker B:Yeah, we'll start seeing more people.
Speaker B:We'll start seeing more people sample for, and we'll recognize probably more of the.
Speaker B:Of the public health risk that it does present.
Speaker B:So, yeah, I was going back to a previous.
Speaker E:Well, there's a really.
Speaker E:There's a really good paper that looks at the cost of health care, you know, not specifically the number of cases or deaths, but the cost of healthcare, and showed that Legionella actually was ranking third in all of that, that Pseudomonas accounted for much more.
Speaker E:And then NTMS was again more than pseudomonas and Legionella combined, if I recall.
Speaker E:And that, you know, those aren't even reportable conditions.
Speaker E:So what, you know, there's no real, I'll say, established way in which CDC or public health officials decide what's going to become a reportable condition or not.
Speaker E:And I would.
Speaker E: , the crisis that happened in: Speaker E:And I think that prevented these other organisms from getting on there because the people at CDC and the epidemiologists saw, wow, this is really tough.
Speaker E:And, you know, we don't have the tools to do it.
Speaker E:But They've squandered nearly 50 years in establishing those surveillance programs.
Speaker E:And now we have billions of dollars spent annually.
Speaker E:On illnesses for which.
Speaker E:Well, it's just happening.
Speaker E:There's no proactive measures.
Speaker F:And in reality, David, and anybody.
Speaker C:You'Re.
Speaker F:Only one time away, one step away from the next crisis that could be the next Legionella.
Speaker F:So at the end of the day, it took one crisis to spark that.
Speaker F:There's another crisis around the corner.
Speaker F:And so it's better to be proactive rather than Reactive.
Speaker E:Absolutely agree.
Speaker F:Ladies and gentlemen, thank you for joining.
Speaker F:I keep saying ladies and gentlemen, but there is only one lady.
Speaker F:I had that yesterday, but blame it on my Scottish colloquialism.
Speaker F:Thank you for joining us here today.
Speaker F:This has been an insightful discussion.
Speaker F:I'm sure you guys as consultants have got a lot of to think about and mull over.
Speaker F:As a final thought, is it going to change the way that you do things?
Speaker F:We've only got a couple of minutes before we sign off, but Rob, Alex, give us your thought.
Speaker F:Is this breakthrough going to change the way that you do things moving forward?
Speaker B:My final thought is absolutely, because this goes back to the initial point of our discussion where our clients get cold feet and a lot of anxiety when it takes a long time to get data back.
Speaker B:And if we have a method that gets us answers quickly that we can act upon actionable answers, it's going to be a, it's going to provide us competitive advantage, quite, quite frankly, as a consultant.
Speaker B:And it's going to make our clients less nervous about collecting the samples to begin with because that waiting period is being taken away mostly.
Speaker A:No, I echo Rob's sentiments and additionally it may assist in pushing people to be more proactive and to develop water management plans.
Speaker A:Instead of saying you have to wait two weeks for results, if you can wait two days, your water management plan becomes more, I'll say, effective, probably in their eyes, to get an actual return on investment in a faster manner than saying two weeks of lag time.
Speaker A:So I think it's going to be a great help to us in this field.
Speaker E:Yeah.
Speaker E:And this may actually prevent Florence from having to put in prescriptions of Xanax into the bottles as they go out to the client so that their anxiety is taken care of in the wait period.
Speaker E:So maybe we can avoid that.
Speaker D:Yeah.
Speaker F:Guys, thank you for joining us today in this discussion of emerging pathogens.
Speaker F:Sam, Florence, Rob, Alex, David, it's been great having you.
Speaker F:A great insight discussion.
Speaker F:Like anything in any operation, intelligence is a fundamental basis of any success.
Speaker F:Your intelligence collation and the intelligence cycle is what basically is a make or break, the success of anything.
Speaker F:This breakthrough has now changed the game and you're getting raw intelligence quickly to the field from an operational way of thinking of things.
Speaker F:Guys, if you've got any questions out there for Sam, for Rob, Alex, Florence or David, please send them in to us@hc3fl.com.
Speaker F:If you are a consultant out there and you have got questions or you just want to get on the bandwagon, then make sure that you reach out.
Speaker F:We'll have under this discussion links to the documentation that we are talking about and anything else that we can find that you can get that will help you your resources.
Speaker F:Lady and gentlemen, thank you for joining us today.
Speaker F:Have a wonderful day and we shall catch you up in the next discussion.
Speaker E:Thanks.
Speaker F:God bless.
Speaker D:Thank you.
Speaker D:Thank you.
Speaker E:Sam.
