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Articles 691 - 720 of 1106
Full-Text Articles in Bacterial Infections and Mycoses
Cryptococcal Antigen Testing In An Integrated Medical System: Eastern Wisconsin, Marianne Klumph, Brian Hoeynck, Dennis J. Baumgardner
Cryptococcal Antigen Testing In An Integrated Medical System: Eastern Wisconsin, Marianne Klumph, Brian Hoeynck, Dennis J. Baumgardner
Journal of Patient-Centered Research and Reviews
Cryptococcosis is a serious environmentally acquired endemic fungal infection commonly associated with immunocompromised hosts. Little is known regarding frequency or distribution in Wisconsin. We explored the geodemographic and clinical features of patients tested with cryptococcal antigen tests (CrAg) — previously shown to be >90% sensitive and >90% specific — within a large health care system located in eastern Wisconsin. To examine this, we retrospectively analyzed 1465 CrAg tests on 1211 unique patients (female: 50.2%; white race: 73.9%; mean age: 53.7 ± 16.5 years). At least one CrAg result was positive in 23 of 1211 patients (1.9%). From these, 21 of …
Always Remember To Floss... Or Else, Arunmozhi (Sankavi) Aravagiri Md, Muhammad Zain Md, Rajesh Gulati Md
Always Remember To Floss... Or Else, Arunmozhi (Sankavi) Aravagiri Md, Muhammad Zain Md, Rajesh Gulati Md
Internal Medicine
No abstract provided.
Prevalence Of The Hypervirulent Nap1/Bi/027 Strain Of C. Difficile In Southwestern Virginia And Risk Factors Associated With Infection, Andrew O. Hanna, Anthony Baffoe-Bonnie, Shikha Vasudeva
Prevalence Of The Hypervirulent Nap1/Bi/027 Strain Of C. Difficile In Southwestern Virginia And Risk Factors Associated With Infection, Andrew O. Hanna, Anthony Baffoe-Bonnie, Shikha Vasudeva
Graduate Medical Education (GME) Resident and Fellow Research Day Posters
C. difficile infection (CDI) incidence has increased over the last several decades. The BI/NAP1/027 ribotype was discovered in 2005 and has since been responsible for multiple outbreaks in the US and Canada. This subtype of C. Difficile is known to be more virulent in vivo and produce more severe disease. Limited regional data of the prevalence of this ribotype is available, which could help guide treatment. Using infection control data from a large regional hospital and a VA medical center, this study documented the prevalence of the 027 ribotype in Southwest Virginia. Patients were included if they were tested at …
Cerium Oxide Nanoparticles And Beneficial Bacteria: Two Novel Treatments For Eradicating Bacteria Associated With Prosthetic Infection?, Etta Conteh
Honors Undergraduate Theses
The purpose of this thesis was to investigate new possible compounds that can be used to treat orthopedic implant infections caused by bacterial pathogens. Current treatment includes the use of antibiotics and the DAIR procedure, which stands for debridement, antibiotic therapy, irrigation, and retention. However, antibiotics are becoming less effective as a treatment due to bacteria gaining antibiotic resistance. Two bacterial species involved in orthopedic implant infections are P. aeruginosa and S. aureus. This thesis investigated cerium oxide nanoparticles and L. fermentum, a beneficial bacterium, as possible treatments to stop bacterial growth and the formation of biofilm. This …
Detection Of Point Mutations Conferring Gentamicin Resistance In Escherichia Coli Using A Split-G4 Probe, Michael J. Greenberg
Detection Of Point Mutations Conferring Gentamicin Resistance In Escherichia Coli Using A Split-G4 Probe, Michael J. Greenberg
Honors Undergraduate Theses
The objective of this project was to develop a DNA hybridization sensor that can detect the presence of E. coli and reveal its resistance to the drug gentamicin. This probe will enable rapid and user-friendly diagnostics of E. coli infections and analysis of bacterial gentamicin-susceptibility profile by interrogation of a fragment of E. coli 16S rRNA bearing a substitution in the gentamicin-resistant cells. The sensor is promising for the point-of-care use to provide a timely UTI diagnostic solution. A quick diagnosis of E. coli infection and antibiotic resistance is crucial for treatment. To design a hybridization probe, we proposed a …
The Role Of Manganese In Streptococcus Sanguinis, Tanya M. Puccio
The Role Of Manganese In Streptococcus Sanguinis, Tanya M. Puccio
Theses and Dissertations
Streptococcus sanguinis is primarily associated with oral health as a commensal bacterium. As an opportunistic pathogen, S. sanguinis is capable of colonizing heart valve vegetations, leading to the disease infective endocarditis. Previous studies from our lab have identified the high-affinity manganese transporter SsaACB as important for endocarditis virulence. The impact that manganese depletion has on S. sanguinis had never been evaluated and a secondary manganese transporter has not been identified. Thus, we employed the use of a fermentor to control large-scale growth over time and depleted manganese in an ΔssaACB mutant using a metal chelator, EDTA. The changes in …
Tick-Borne Infections In New Hampshire: An Evaluation Of The Diagnostic Process In A Local Patient Population, Katherine Anderson
Tick-Borne Infections In New Hampshire: An Evaluation Of The Diagnostic Process In A Local Patient Population, Katherine Anderson
Honors Theses and Capstones
Overall, approximately 95 percent of reported cases of vector-borne disease were associated with ticks, making these the most medically important group of arthropods in the United States.1 Despite the prevalence of tick-borne infections, the process for the diagnosis of this condition is not well studied. This study aims to analyze data from a pool of 100 patients who underwent testing for tick-borne disease in the same institution in Dover, New Hampshire during the most recent peak tick season of 2019. Information utilized in this study included: patient age, sex, location of testing (inpatient versus outpatient), diagnostic testing methods used …
Antibacterial, Antifungal, Antioxidant Activity And Polyphenol Content Of Aerial Parts And Bulbs Of Allium Schugnanicum., Saidbeg Satorov, F. Mirzoeva, Sh. Kurbonbekova, Sh. Satorov, M. Vakhidova, Vyacheslav Dushenkov
Antibacterial, Antifungal, Antioxidant Activity And Polyphenol Content Of Aerial Parts And Bulbs Of Allium Schugnanicum., Saidbeg Satorov, F. Mirzoeva, Sh. Kurbonbekova, Sh. Satorov, M. Vakhidova, Vyacheslav Dushenkov
Publications and Research
Objective: То study of antibacterial, antifungal and antioxidant activity, and content of polyphenols in the bulb and aerial parts of an endemic species of onion A. schugnanicum. Methods: An ethanol-based extract was prepared from fresh plants. Total polyphenolic content (Folin) and ABTS antioxidant capacity assays were used to characterized extracts. Extracts obtained from bulbs, peduncle, and seeds demonstrated antibacterial activity against the reference Staphylococcus aureus (ATCC 4929), Pseudomonas aeruginosa (ATCC 4930) and Klebsiella pneumoniae (ATCC 4927) strains, as well as against the hospital strains of the same types of bacteria, i.e. strains isolated from inpatient surgical patients. Results: The study …
Selenomonas Sputigena: Growth Conditions And Projected Virulence Factors Of An Emerging Oral Pathogen, Kayla A. Keller
Selenomonas Sputigena: Growth Conditions And Projected Virulence Factors Of An Emerging Oral Pathogen, Kayla A. Keller
Theses and Dissertations
Periodontal diseases are ubiquitous diseases. They can affect people through a chronic infection that happens over a lifetime, but also as an aggressive infection that afflicts the younger population. It not only results in tooth loss and a lower quality of life, but it can also lead to fatal secondary infections like cervical cancer, heart disease, and Alzheimer’s disease. This study looks at Selenomonas sputigena, an emerging oral pathogen, that has been hypothesized to contribute to periodontal disease. It has been linked to fatal septicemia and has been found in increased abundance within the oral biofilm during peak infection. …
Antifungal Defense Molecules From Bacterial Symbionts Of North American Trachymyrmex Ants, Georgia Scherer
Antifungal Defense Molecules From Bacterial Symbionts Of North American Trachymyrmex Ants, Georgia Scherer
CMC Senior Theses
Defensive symbioses, in which microbes provide molecular defenses for an animal host, hold great potential as untapped sources of therapeutically useful antibiotics. Fungus-growing ants use antifungal defenses from bacterial symbionts to suppress pathogenic fungi in their nests. Preliminary chemical investigations of symbiotic bacteria from this large family of ants have uncovered novel antifungal molecules with therapeutic potential, such as dentigerumycin and selvamicin.
In this study, the bacterial symbionts of North American Trachymyrmex fungus-growing ants are investigated for antifungal molecules. Plate-based bioassays using ecologically-relevant fungal pathogens confirmed that these bacteria have antifungal activity. In order to purify and identify the antifungal …
Determining The Antibacterial Activity And Mode Of Action Of Tirandamycin, Hailey Bouchard
Determining The Antibacterial Activity And Mode Of Action Of Tirandamycin, Hailey Bouchard
CMC Senior Theses
Tirandamycin is a small molecule natural product that has been isolated from various species of marine and terrestrial Streptomyces. The natural product has shown antibacterial activity against an array of Gram-positive and Gram-negative bacteria, showing promise as a pharmaceutical drug. Tirandamycin has 14 known derivatives, many of which have been created synthetically. Some of its derivatives are particularly potent against the high-risk bacteria vancomycin-resistant Enterococcus faecium, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pneumoniae and Escherichia coli. However, the antibacterial potency of these derivatives has not been tested systematically leading to the possibility of discovering more potent …
Understanding The Host Immune Response Against Pseudomonas Aeruginosa To Develop Novel Therapeutics And Vaccines, Emel Sen Kilic
Understanding The Host Immune Response Against Pseudomonas Aeruginosa To Develop Novel Therapeutics And Vaccines, Emel Sen Kilic
Graduate Theses, Dissertations, and Problem Reports (ETD)
Pseudomonas aeruginosa is a Gram-negative opportunistic bacterium that causes a broad range of acute and chronic infections. The high adaptability and emergence of multidrug-resistant strains of this bacterium pose a significant threat to human health. Particularly, pneumonia caused by this pathogen is associated with high morbidity and mortality in immunocompromised patients. To prevent these infections, we aimed to develop novel vaccine strategies by characterizing the host immune response against P. aeruginosa. During respiratory infections, P. aeruginosa first contacts with epithelial cells along the respiratory tract. Using RNA-sequencing, we were able to characterize transcriptional changes of the epithelial cells in …
Probiotics And The Prevention Of Clostridioides Difficile: A Review Of Existing Systematic Reviews, Andrea L. Onstad
Probiotics And The Prevention Of Clostridioides Difficile: A Review Of Existing Systematic Reviews, Andrea L. Onstad
All Graduate Theses, Dissertations, and Other Capstone Projects
Clostridioides difficile is the leading cause of infectious diarrhea (Vernaya et al., 2017). Probiotics have been proposed to provide a protective benefit against Clostridioides difficile infection (CDI). The objective of this literature review was to examine the research evidence pertaining to the use of probiotics for the prevention of CDI in individuals receiving antibiotic therapy. A systematic literature review of studies published between 2015 and 2019 was performed. Five databases were searched, which yielded 10 systematic reviews that met strict inclusion criteria. Overall, the majority of evidence indicated that probiotics versus no treatment, placebo, or usual care have the potential …
Impact Of Required Antibiotic Stop Dates And Indications On Length Of Treatment In Hospitalized Patients With Pneumonia, Amanda Haddad, Kathryn Hernando, Kayihura Manigaba, Abigail Antigua
Impact Of Required Antibiotic Stop Dates And Indications On Length Of Treatment In Hospitalized Patients With Pneumonia, Amanda Haddad, Kathryn Hernando, Kayihura Manigaba, Abigail Antigua
Infectious Disease
Purpose: The CDC Core Elements of Hospital Antibiotic Stewardship Programs recommends implementing policies to support optimal antibiotic prescribing including documentation of dose, duration and indication. On January 31, 2017, the study institution implemented new physician order entry screens in the electronic health record requiring the input of indication and duration on all antibiotic orders. The objective of this study is to determine if implementation of mandatory indication and duration for antibiotic orders decreases antibiotic duration of therapy in hospitalized patients with pneumonia.
Methods: This study was submitted to the Institutional Review Committee for approval. The clinical pharmacy surveillance platform, …
Impact Of Methicillin-Resistant Staphylococcus Aureus (Mrsa) Nasal Swab On Total Duration Of Mrsa Therapy For Pneumonia Patients, Darren D. Yum, Kayihura Manigaba, Danielle Gagne, Heather Ellis
Impact Of Methicillin-Resistant Staphylococcus Aureus (Mrsa) Nasal Swab On Total Duration Of Mrsa Therapy For Pneumonia Patients, Darren D. Yum, Kayihura Manigaba, Danielle Gagne, Heather Ellis
Infectious Disease
Purpose: Recent literature has highlighted MRSA nasal screening as a possible antimicrobial stewardship program tool for avoiding unnecessary empiric anti-MRSA therapy for pneumonia. MRSA is an important cause of pneumonia and clinicians must determine when empiric antimicrobial therapy directed toward this pathogen is needed. Negative MRSA nasal swab has been shown to have a high negative predictive value ( >95%) across different types of pneumonia. The objective of this study is to assess the impact of negative MRSA nasal swabs on the duration of anti-MRSA therapy in a community hospital setting.
Methods: This study will be submitted to the institutional …
Expert Search For "Antibiotics For The Urgent Management Of Symptomatic Irreversible Pulpitis, Symptomatic Apical Periodontitis, And Localized Acute Apical Abscess", Kelly K. O'Brien
Expert Search Strategies
This search strategy was constructed to support the research for the peer reviewed article listed above. Full article abstract:
Background
Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use.
Type of Studies Reviewed
The authors updated 2 preexisting systematic …
The Manipulation Of Host Transcription By The Ankh Effector Of Legionella., Juanita E. Von Dwingelo
The Manipulation Of Host Transcription By The Ankh Effector Of Legionella., Juanita E. Von Dwingelo
Electronic Theses and Dissertations
Legionella pneumophila is a Gram-negative facultative intracellular bacterium that can be found dispersed throughout freshwater environments, where it primarily parasitizes amoebae and other protozoan species. Humans are an accidental host for L. pneumophila, and infection occurs upon inhalation of aerosolized water droplets that contain the bacteria. L. pneumophila is the causative agent of Legionnaires’ Disease, which is the result of intracellular proliferation within alveolar macrophages. Pathogenesis of L. pneumophila is dependent on the Dot/Icm type 4 secretion system (T4SS) apparatus, which is comprised of 27 proteins and is responsible for translocating over 330 effector proteins into the host cell. Many …
The Relationship Between Biofilm Production And Human Respiratory Cell Attachment And Invasion By Acinetobacter Baumannii, Rachel A. Pearson
The Relationship Between Biofilm Production And Human Respiratory Cell Attachment And Invasion By Acinetobacter Baumannii, Rachel A. Pearson
Theses and Dissertations
Acinetobacter baumannii is an opportunistic gram-negative bacterial pathogen that causes many nosocomial infections in immunocompromised individuals. Common infections include catheter-associated urinary tract infections, ventilator-associated pneumonia, skin and soft tissue infections, and bloodstream infections that often lead to septicemia. Increasing multidrug resistance (MDR) in A. baumannii warrants new approaches to understanding its virulence mechanisms and pathogenicity. As a first step in infection, A. baumannii can attach to host cells, providing a surface for the bacteria to grow and perhaps facilitating biofilm formation and subsequent tissue invasion. In this study, we evaluated antibiotic resistance and characterized biofilm formation, attachment, invasion, and surface …
Quantitative Study Of The Antimicrobial Effects Of Silver On The Motility Of Escherichia Coli, Benjamin Russell
Quantitative Study Of The Antimicrobial Effects Of Silver On The Motility Of Escherichia Coli, Benjamin Russell
Graduate Theses and Dissertations
In recent decades, the number of antibiotic-resistant bacterial infections has grown to become a serious global threat. This rise can be attributed to the widespread misuse of antibiotics and the lack of newly developed drugs to fight resistant organisms. Novel bactericidal substances have, therefore, garnered significant research interest. Silver, due to its powerful antimicrobial effects, is one such substance. Silver is typically most effective in cationic form; however, advancements in nanotechnology have paved the way for the controlled fabrication of nano-silver. Silver nanoparticles have been shown to have increased antibacterial potency for a variety of reasons, including the release of …
Developments For The Treatment Of Invasive Infections Due To Multidrug-Resistant Acinetobacter Baumannii, David Laurent, Richard Drew, Dustin Wilson
Developments For The Treatment Of Invasive Infections Due To Multidrug-Resistant Acinetobacter Baumannii, David Laurent, Richard Drew, Dustin Wilson
The University of Louisville Journal of Respiratory Infections
Acinetobacter baumannii is a significant pathogen in healthcare settings (specifically prominent in healthcare- and ventilator-associated pneumonia) due primarily to its virulence and resistance to a wide variety of antimicrobial drug classes, including carbapenems (CRAB). Existing therapies (notably polymyxins, minocycline, tigecycline, amikacin, and sulbactam) often result in suboptimal tissue concentrations, high rates of toxicity, and increasing rates of resistance. Although utilizing combinations of antibiotics (specifically those containing colistin) have been employed, results have been mixed, and control trials are lacking. Eravacycline is a novel tetracycline with an improved pharmacokinetic profile and more potent activity against A. baumannii relative to tigecycline. Cefiderocol …
Prevalence Of Methicillin Resistant Staph Aureus Over Time In Resident Physicians, Lexus Dickson, Morgan Smith Md, Scott Gutovitz, Danielle Kocsis, Jean B. Wiggins, Steve Warrington Md, Stephen Thacker Md, Nayda Parisio Poldiak
Prevalence Of Methicillin Resistant Staph Aureus Over Time In Resident Physicians, Lexus Dickson, Morgan Smith Md, Scott Gutovitz, Danielle Kocsis, Jean B. Wiggins, Steve Warrington Md, Stephen Thacker Md, Nayda Parisio Poldiak
Emergency Medicine
No abstract provided.
A Case Of Transient Complete Av Block Caused By Infective Endocarditis With Abiotrophiadefectiva, Jung Yoon Do, Wilco Civil Sr, Urvish Patel, Jermaine Ekobena, Arun Abraham, Michael Strobbe
A Case Of Transient Complete Av Block Caused By Infective Endocarditis With Abiotrophiadefectiva, Jung Yoon Do, Wilco Civil Sr, Urvish Patel, Jermaine Ekobena, Arun Abraham, Michael Strobbe
Internal Medicine
No abstract provided.
Oral Fungal Microbiota: To Thrush And Beyond, Dennis J. Baumgardner
Oral Fungal Microbiota: To Thrush And Beyond, Dennis J. Baumgardner
Journal of Patient-Centered Research and Reviews
The oral microbiota is complex, multikingdom, interactive, and involves extensive biofilm formation. While dominated by bacteria, Candida is a frequent member of this microbiota; however, several other potentially pathogenic fungi (among around 100 identified species) appear to reside in some individuals, including Cryptococcus, Aspergillus, and Fusarium. Oral candidiasis may manifest as a variety of disease entities in normal hosts and in the immunocompromised. These include pseudomembranous candidiasis (thrush), hyperplastic or atrophic (denture) candidiasis, linear gingival erythema, median rhomboid glossitis, and angular cheilitis. The purpose of this review is to describe the oral fungal microbiota (ie, oral mycobiota), …
Listen To Your Heart, Or At Least Theirs: Maintaining A High Index Of Suspicion For Infective Endocarditis, Mollie Powell Do, Mahesh Setty Md
Listen To Your Heart, Or At Least Theirs: Maintaining A High Index Of Suspicion For Infective Endocarditis, Mollie Powell Do, Mahesh Setty Md
Emergency Medicine
After an endothelial injury, a fibrin and platelet cap forms. This cap is typically sterile but in times of infection can become colonized by microbes leading to a vegetation. When this occurs on the endothelium of the heart, it is termed infective endocarditis (IE). IE is a difficult diagnosis to make in the ED. The symptoms are vague. Classic exam findings are often absent, murmur auscultation can be challenging and there is not a single diagnostic test. A delayed or missed diagnosis can be fatal; therefore, it is essential that ED physicians maintain a high index of suspicion in high …
Spontaneous Fungal Peritonitis: A Rare Complication Of Ascites Secondary To Right Heart Failure: A Case Report, Saaah Siddiqui Md, Dharti R. Patel Md, Arshad M. Iqbal Md, Ateeq Mubarik Md, Salman Muddassir Md, Fahad Zafar Md
Spontaneous Fungal Peritonitis: A Rare Complication Of Ascites Secondary To Right Heart Failure: A Case Report, Saaah Siddiqui Md, Dharti R. Patel Md, Arshad M. Iqbal Md, Ateeq Mubarik Md, Salman Muddassir Md, Fahad Zafar Md
Internal Medicine
•Spontaneous fungal peritonitis (SFP) is an infection defined as a neutrophil count (> 250 cells/mL) in the ascitic fluid with the evidence of positive fungal culture (1) while excluding other intra-abdominal infections. SFP is not as common as spontaneous bacterial peritonitis and has higher mortality rates due to late recognition and difficulty in differentiation between SFP and SBP. (1,2). The common risk factors that have shown to increase the mortality for SFP include hepatorenal syndrome, patient on SBP prophylaxis, elevated APACHE II scores on admission, and elevated lactate levels (2,3). Candida albicans and Candida glabrata are the two …
Cavitary Lesion In An Immunocompromised Adult, Syed Talha Qasmi, Turuvekere Jayaram, Enrique Rincon
Cavitary Lesion In An Immunocompromised Adult, Syed Talha Qasmi, Turuvekere Jayaram, Enrique Rincon
Internal Medicine
No abstract provided.
Rare Infective Endocarditis Caused By Dental Source Due To Streptococcus Bovis Masquerading As Cardiac Failure, Ravish Patel, Pratikkumar Vekaria, Devin Vaishnani, Johnnie Mao, Asif Shah
Rare Infective Endocarditis Caused By Dental Source Due To Streptococcus Bovis Masquerading As Cardiac Failure, Ravish Patel, Pratikkumar Vekaria, Devin Vaishnani, Johnnie Mao, Asif Shah
Internal Medicine
No abstract provided.
Sterile Compounding: Regulations Addressed After The Meningitis Outbreak Of 2012, Kelly M. Dye, Tara M. Tokar, Halle M. Orlinski, Heather Helsel, Marcia M. Worley
Sterile Compounding: Regulations Addressed After The Meningitis Outbreak Of 2012, Kelly M. Dye, Tara M. Tokar, Halle M. Orlinski, Heather Helsel, Marcia M. Worley
Pharmacy and Wellness Review
No abstract provided.
Antimicrobial Stewardship Programs, Kevin Stack, Eric Stack, Stelios Theophanous, Anne Gentry, Jason M. Pogue
Antimicrobial Stewardship Programs, Kevin Stack, Eric Stack, Stelios Theophanous, Anne Gentry, Jason M. Pogue
Pharmacy and Wellness Review
Antimicrobial Stewardship Programs (ASPs) are becoming increasingly prevalent in the United States as concerns continue to mount regarding antimicrobial resistance and the lack of new, novel antibiotics being introduced. There are a multitude of factors that have contributed to the escalation in antimicrobial resistance, with some of the more common concerns being overly broad antimicrobial coverage and prolonged antimicrobial treatment amongst others. While antimicrobial resistance is a problem of international proportion, each health care institution remains responsible for assessing its own protocols pertinent to antimicrobial usage. ASPs have had unparalleled success in achieving their goals due to the collaboration of …
Legionnaires' Disease, A Rising Occurrence In The United States, Jennifer Harklerode, Olivia Henton, Myranda Smith, Rebecca Worden, Andrew Roecker
Legionnaires' Disease, A Rising Occurrence In The United States, Jennifer Harklerode, Olivia Henton, Myranda Smith, Rebecca Worden, Andrew Roecker
Pharmacy and Wellness Review
Legionella pneumophila, a microscopic bacterium usually responsible for a number of illnesses and fatalities, can eliminate a local population, a region or even a nation. In 1976, L. pneumophila was first discovered due to a number of cases presenting with pneumonia-like symptoms. These cases occurred in an isolated population attending an American Legion convention in Philadelphia, Pennsylvania, therefore lending to the name Legionella. Usually found in aquatic environments such as lakes, streams, cooling towers, air conditioning systems and hot tubs, its ability to thrive in artificial and natural environments makes it an ideal bacterium. L. pneumophila can be transmitted via …