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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2017.00477</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Microbiology</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>From Many Hosts, One Accidental Pathogen: The Diverse Protozoan Hosts of <italic>Legionella</italic></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Boamah</surname> <given-names>David K.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/497904/overview"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Zhou</surname> <given-names>Guangqi</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/216959/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Ensminger</surname> <given-names>Alexander W.</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x0002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/483043/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>O&#x00027;Connor</surname> <given-names>Tamara J.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>&#x0002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/473245/overview"/>
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<aff id="aff1"><sup>1</sup><institution>Department of Biological Chemistry, Johns Hopkins University School of Medicine</institution>, <addr-line>Baltimore, MD</addr-line>, <country>United States</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Biochemistry, University of Toronto</institution>, <addr-line>Toronto, ON</addr-line>, <country>Canada</country></aff>
<aff id="aff3"><sup>3</sup><institution>Department of Molecular Genetics, University of Toronto</institution>, <addr-line>Toronto, ON</addr-line>, <country>Canada</country></aff>
<aff id="aff4"><sup>4</sup><institution>Public Health Ontario</institution>, <addr-line>Toronto, ON</addr-line>, <country>Canada</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Hayley J. Newton, University of Melbourne, Australia</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Ascel Samba-Louaka, University of Poitiers, France; Ombeline Rossier, Universit&#x000E9; Paris-Sud, France</p></fn>
<fn fn-type="corresp" id="fn001"><p>&#x0002A;Correspondence: Tamara J. O&#x00027;Connor <email>toconno7&#x00040;jhmi.edu</email></p></fn>
<fn fn-type="corresp" id="fn002"><p>Alexander W. Ensminger <email>alex.ensminger&#x00040;utoronto.ca</email></p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>30</day>
<month>11</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection">
<year>2017</year>
</pub-date>
<volume>7</volume>
<elocation-id>477</elocation-id>
<history>
<date date-type="received">
<day>11</day>
<month>09</month>
<year>2017</year>
</date>
<date date-type="accepted">
<day>31</day>
<month>10</month>
<year>2017</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2017 Boamah, Zhou, Ensminger and O&#x00027;Connor.</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Boamah, Zhou, Ensminger and O&#x00027;Connor</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract><p>The 1976 outbreak of Legionnaires&#x00027; disease led to the discovery of the intracellular bacterial pathogen <italic>Legionella pneumophila</italic>. Given their impact on human health, <italic>Legionella</italic> species and the mechanisms responsible for their replication within host cells are often studied in alveolar macrophages, the primary human cell type associated with disease. Despite the potential severity of individual cases of disease, <italic>Legionella</italic> are not spread from person-to-person. Thus, from the pathogen&#x00027;s perspective, interactions with human cells are accidents of time and space&#x02014;evolutionary dead ends with no impact on <italic>Legionella</italic>&#x00027;s long-term survival or pathogenic trajectory. To understand <italic>Legionella</italic> as a pathogen is to understand its interaction with its natural hosts: the polyphyletic protozoa, a group of unicellular eukaryotes with a staggering amount of evolutionary diversity. While much remains to be understood about these enigmatic hosts, we summarize the current state of knowledge concerning <italic>Legionella</italic>&#x00027;s natural host range, the diversity of <italic>Legionella</italic>-protozoa interactions, the factors influencing these interactions, the importance of avoiding the generalization of protozoan-bacterial interactions based on a limited number of model hosts and the central role of protozoa to the biology, evolution, and persistence of <italic>Legionella</italic> in the environment.</p></abstract>
<kwd-group>
<kwd><italic>Legionella</italic></kwd>
<kwd>amoebae</kwd>
<kwd>protozoa</kwd>
<kwd>host range</kwd>
<kwd>environment</kwd>
<kwd><italic>Acanthamoebae</italic></kwd>
<kwd><italic>Hartmannella</italic></kwd>
<kwd><italic>Naegleria</italic></kwd>
</kwd-group>
<contract-num rid="cn001">1R21AI119580</contract-num>
<contract-num rid="cn002">RGPIN-2014-03641</contract-num>
<contract-sponsor id="cn001">National Institutes of Health<named-content content-type="fundref-id">10.13039/100000002</named-content></contract-sponsor>
<contract-sponsor id="cn002">Natural Sciences and Engineering Research Council of Canada<named-content content-type="fundref-id">10.13039/501100000038</named-content></contract-sponsor>
<counts>
<fig-count count="1"/>
<table-count count="2"/>
<equation-count count="0"/>
<ref-count count="140"/>
<page-count count="17"/>
<word-count count="11770"/>
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</front>
<body>
<sec id="s1">
<title>Predator vs. prey: <italic>legionella</italic> and its natural protozoan hosts</title>
<p>In the environment, bacteria are targets of predation by grazing protozoa (Hahn and H&#x000F6;fle, <xref ref-type="bibr" rid="B52">2001</xref>; Molmeret et al., <xref ref-type="bibr" rid="B88">2005</xref>). In response to predation, many bacteria have developed strategies to either avoid predation or survive, and in some cases, replicate within protozoa. As bacteria are destined to encounter a large number of protozoa species in nature, their fitness will be determined by the breadth and diversity of protozoa within which they are able to grow. Though many types of bacteria are able to replicate within protozoa (Greub and Raoult, <xref ref-type="bibr" rid="B50">2004</xref>), this behavior is best characterized in the bacterial pathogen <italic>Legionella</italic>, in particular <italic>Legionella pneumophila</italic>, which will be the major focus of this review.</p>
</sec>
<sec id="s2">
<title><italic>L. pneumophila</italic> in the environment</title>
<p><italic>L. pneumophila</italic> is ubiquitous in nature (Fliermans, <xref ref-type="bibr" rid="B41">1996</xref>; van Heijnsbergen et al., <xref ref-type="bibr" rid="B133">2015</xref>). While various species of <italic>Legionella</italic> have been isolated from soil and marine environments, freshwater systems serve as the major reservoirs of <italic>L. pneumophila</italic> (Fliermans, <xref ref-type="bibr" rid="B41">1996</xref>; van Heijnsbergen et al., <xref ref-type="bibr" rid="B133">2015</xref>). <italic>L. pneumophila</italic> can exist in a planktonic form however, it is more often found within mixed community biofilms (Mampel et al., <xref ref-type="bibr" rid="B83">2006</xref>). <italic>L. pneumophila</italic> intercalates into existing biofilms (Lau and Ashbolt, <xref ref-type="bibr" rid="B79">2009</xref>; Stewart et al., <xref ref-type="bibr" rid="B119">2012</xref>) where it acquires nutrients by forming synergistic relationships with other members of the biofilm (Tison et al., <xref ref-type="bibr" rid="B126">1980</xref>; Pope et al., <xref ref-type="bibr" rid="B100">1982</xref>; Bohach and Snyder, <xref ref-type="bibr" rid="B10">1983</xref>; Wadowsky and Yee, <xref ref-type="bibr" rid="B136">1983</xref>; Stout et al., <xref ref-type="bibr" rid="B121">1986</xref>; Stewart et al., <xref ref-type="bibr" rid="B119">2012</xref>; Koide et al., <xref ref-type="bibr" rid="B73">2014</xref>). <italic>L. pneumophila</italic> is also capable of surviving in nutrient-poor conditions by necrotrophic growth on dead cell masses (Temmerman et al., <xref ref-type="bibr" rid="B122">2006</xref>). Although, its interactions with other bacteria promote <italic>L. pneumophila</italic> survival in oligotrophic environments, intracellular growth within protozoa is likely the predominant mechanism of <italic>L. pneumophila</italic> proliferation in its natural habitat (Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>).</p>
</sec>
<sec id="s3">
<title>The impact of natural hosts on <italic>legionella</italic> persistence in the environment and pathogenesis</title>
<p>Protozoa function as natural reservoirs of <italic>L. pneumophila</italic> and promote disease in humans. The intracellular environment of the host cell protects <italic>L. pneumophila</italic> from harsh environmental conditions while providing a nutrient rich replicative niche (Greub and Raoult, <xref ref-type="bibr" rid="B50">2004</xref>; Abdel-Nour et al., <xref ref-type="bibr" rid="B1">2013</xref>). The ability of <italic>L. pneumophila</italic> to survive within amoebae also protects the bacteria from killing by water disinfection procedures (Plouffe et al., <xref ref-type="bibr" rid="B99">1983</xref>; King et al., <xref ref-type="bibr" rid="B72">1988</xref>; Kilvington and Price, <xref ref-type="bibr" rid="B70">1990</xref>; Biurrun et al., <xref ref-type="bibr" rid="B9">1999</xref>; Storey et al., <xref ref-type="bibr" rid="B120">2004</xref>; Bouyer et al., <xref ref-type="bibr" rid="B11">2007</xref>; Garc&#x000ED;a et al., <xref ref-type="bibr" rid="B44">2008</xref>; Cervero-Arag&#x000F3; et al., <xref ref-type="bibr" rid="B18">2014</xref>, <xref ref-type="bibr" rid="B17">2015</xref>), a reciprocal relationship that also enhances survival of the host (Garc&#x000ED;a et al., <xref ref-type="bibr" rid="B45">2007</xref>). As a consequence, <italic>L. pneumophila</italic> are commonly found in man-made potable water supply and distribution systems (Ikedo and Yabuuchi, <xref ref-type="bibr" rid="B63">1986</xref>; Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref>; Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref>; Fields et al., <xref ref-type="bibr" rid="B38">2002</xref>; Lasheras et al., <xref ref-type="bibr" rid="B78">2006</xref>; Brousseau et al., <xref ref-type="bibr" rid="B14">2013</xref>; Thomas et al., <xref ref-type="bibr" rid="B123">2014</xref>). Although, there is one reported case of probable human-to-human transmission of <italic>Legionella</italic> (Correia et al., <xref ref-type="bibr" rid="B24">2016</xref>), the vast majority of evidence suggests a non-communicable disease. Instead, human exposure predominantly occurs through the inhalation of contaminated water aerosols (Fields, <xref ref-type="bibr" rid="B36">1996</xref>), which can lead to pneumonic respiratory disease. <italic>L. pneumophila</italic> passaged through amoebae are more virulent in animal models of infection compared to bacteria grown in broth culture (Cirillo et al., <xref ref-type="bibr" rid="B21">1994</xref>, <xref ref-type="bibr" rid="B20">1999</xref>; Barker et al., <xref ref-type="bibr" rid="B6">1995</xref>; Brieland et al., <xref ref-type="bibr" rid="B13">1996</xref>; Gardu&#x000F1;o et al., <xref ref-type="bibr" rid="B46">2002</xref>). The earliest description of <italic>L. pneumophila</italic>&#x00027;s interaction with amoebae even proposed that an important route of human infection may be the inhalation of the pathogen in an amoebal-encapsulated state (Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>). Thus, the interaction of <italic>L. pneumophila</italic> with protozoa is a critical determinant in both the persistence of <italic>Legionella</italic> in environmental and man-made reservoirs, and the incidence and severity of disease.</p>
</sec>
<sec id="s4">
<title>The broad host range of <italic>L. pneumophila</italic></title>
<p>Many bacterial pathogens become highly specialized for growth in one or a small subset of hosts but few are able to grow in multiple hosts. Host jumping has been observed for some pathogens but often comes at a price, the inability to grow in the previous host (Ma et al., <xref ref-type="bibr" rid="B82">2006</xref>). In contrast, <italic>L. pneumophila</italic> exhibits an extensive host range replicating within a diverse array of protozoan hosts that span multiple phyla, from Amoebozoa (amoebae) to Percolozoa (excavates) to Ciliophora (ciliated protozoa) (Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>; Fields, <xref ref-type="bibr" rid="B36">1996</xref>). The ability to maintain such a broad host range is due to the assembly of a large cohort of genes that allow <italic>L. pneumophila</italic> to adapt to variations between hosts (O&#x00027;Connor et al., <xref ref-type="bibr" rid="B95">2011</xref>). Moreover, the ability to continually evolve and alter the composition of its virulence gene repertoire allows <italic>L. pneumophila</italic> to adapt to shifts in protozoan populations in their natural habitats (O&#x00027;Connor et al., <xref ref-type="bibr" rid="B95">2011</xref>). Since the discovery that <italic>L. pneumophila</italic> can survive and replicate within free-living amoeba (Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>), the relationship between <italic>L. pneumophila</italic> and its protozoa hosts has garnered significant attention, largely due to the important role of protozoa in the epidemiology of this pathogen. In this review, we expand on the early works of Rowbotham and Fields (Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>, <xref ref-type="bibr" rid="B107">1986</xref>; Fields, <xref ref-type="bibr" rid="B36">1996</xref>) to summarize the current knowledge of the host range of <italic>L. pneumophila</italic> in environmental reservoirs and the factors that impact the outcome of <italic>Legionella</italic>-protozoa interactions.</p>
</sec>
<sec id="s5">
<title>The different fates of <italic>L. pneumophila</italic> within protozoan hosts</title>
<p>While <italic>L. pneumophila</italic> has an extensive host range, the fate of the bacterium once it enters the host cell can vary greatly. Several protozoa are able to efficiently deliver <italic>L. pneumophila</italic> to the lysosome for degradation, resulting in the death of the bacterium (Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>). <italic>L. pneumophila</italic> predation by protozoa does not seem to be restricted to one particular group. While members of the Cercozoa phylum seem to be especially adept at digesting <italic>L. pneumophila</italic> (Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>), distantly related members of the Amoebozoa phylum (<italic>Cashia limacoides, Vannella platypodia</italic>, and <italic>Vexillifera bacillipedes</italic>) are also efficient at killing <italic>L. pneumophila</italic> (Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>). In contrast, many protozoa serve as hosts for <italic>L. pneumophila</italic> replication. In these cases, the <italic>Legionella</italic>-protozoa interaction is detrimental to the host: the bacteria multiply to high numbers and then kill the host as they exit the cell (Rowbotham, <xref ref-type="bibr" rid="B106">1983</xref>). Alternatively, <italic>L. pneumophila</italic> can be toxic to the host in the absence of replication, a protist version of food-poisoning (Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>). <italic>L. pneumophila</italic> within amoebae has been shown to inhibit both amoebae proliferation (Mengue et al., <xref ref-type="bibr" rid="B86">2016</xref>) and chemotactic motility (Simon et al., <xref ref-type="bibr" rid="B114">2014</xref>). The fates of the two organisms are not solely defined by this &#x0201C;it&#x00027;s you or me&#x0201D; relationship, as a number of intermediate outcomes have been observed. In response to extreme stress, amoebae undergo encystation, transforming into a dormant, highly resistant cyst form. While encystation restricts bacterial replication (Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>; Ohno et al., <xref ref-type="bibr" rid="B96">2008</xref>), <italic>L. pneumophila</italic> is able to survive the encystation process until more favorable conditions arise (Kilvington and Price, <xref ref-type="bibr" rid="B70">1990</xref>; Greub and Raoult, <xref ref-type="bibr" rid="B49">2003</xref>). Similarly, for some <italic>Legionella</italic>-protozoa pairs, <italic>L. pneumophila</italic> is resistant to grazing by the protozoan and thus survives within the host cell but fails to replicate (Smith-Somerville et al., <xref ref-type="bibr" rid="B116">1991</xref>). Alternatively, <italic>L. pneumophila</italic> can be packaged into multi-membrane vesicles that are distinct from the replication vacuole and expelled into the extracellular environment (Rowbotham, <xref ref-type="bibr" rid="B106">1983</xref>; Berk et al., <xref ref-type="bibr" rid="B8">1998</xref>; Hojo et al., <xref ref-type="bibr" rid="B56">2012</xref>; Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>). The release of <italic>Legionella</italic>-containing pellets has been observed in both the ciliated protozoa <italic>Tetrahymena</italic> spp. (Faulkner et al., <xref ref-type="bibr" rid="B35">2008</xref>; Hojo et al., <xref ref-type="bibr" rid="B56">2012</xref>) and the amoebal hosts <italic>Acanthamoeba castellanii</italic> and <italic>Acanthamoeba astronyxis</italic> (Bouyer et al., <xref ref-type="bibr" rid="B11">2007</xref>; Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>), and does not appear to coincide with bacterial replication. Whether this process is driven by the bacterium or the host is still unclear. The pellet compartment can protect <italic>L. pneumophila</italic> from environmental stress (Bouyer et al., <xref ref-type="bibr" rid="B11">2007</xref>; Koubar et al., <xref ref-type="bibr" rid="B74">2011</xref>) which would be beneficial during its transition between host cells and thus a potential mechanism to ensure its survival. Consistent with this idea, a functional Type IVb secretion system, a major <italic>L. pneumophila</italic> virulence factor required for lysosome avoidance and intracellular replication, appears to be important for the release of <italic>L. pneumophila</italic> in pellets (Berk et al., <xref ref-type="bibr" rid="B7">2008</xref>). Alternatively, the inability to digest the bacteria may simply trigger a host response that involves bacterial expulsion, as a similar phenomenon is observed with non-pathogenic <italic>Escherichia coli, Bacillus subtilis</italic>, and <italic>Mycobacterium luteus</italic> (Hojo et al., <xref ref-type="bibr" rid="B56">2012</xref>; Denoncourt et al., <xref ref-type="bibr" rid="B29">2014</xref>). Whether <italic>L. pneumophila</italic> resists predation or is expelled in pellets, the host is considered to be only partially restrictive due to the survival of <italic>L. pneumophila</italic> and its potential to transition to other host cells. Indeed, one might speculate that such intermediate host-bacterial interactions (resistance to protozoan predation in the absence of replication) might resemble the first evolutionary step toward becoming an intracellular pathogen.</p>
</sec>
<sec id="s6">
<title>Methods for defining protozoan hosts of <italic>legionella</italic></title>
<p>Protozoan hosts of <italic>Legionella</italic> are defined by two main techniques: co-culture and co-isolation. When combined with microscopy, co-culture techniques allow for the direct visualization of <italic>Legionella</italic> within host cells, and by analyzing infected cells over time, bacterial replication within a particular host provides direct experimental evidence of <italic>Legionella</italic> survival and replication. When combined with plating assays to monitor bacterial numbers, co-culture methods allow bacterial growth rates, maximum growth and the impact of bacterial dose and various external conditions on the interaction to be analyzed. However, while <italic>Legionella</italic> may be able to replicate in a given host under specific laboratory conditions, the experimental system may not reflect conditions encountered in the environment and thus, biologically relevant interactions that commonly occur in nature. Co-isolation studies attempt to address this issue by examining the co-existence of protozoa and <italic>Legionella</italic> in environmental samples. In rare cases, protozoa harboring <italic>Legionella</italic> have been isolated from environmental samples providing direct evidence of their interaction in the environment (Thomas et al., <xref ref-type="bibr" rid="B124">2006</xref>; Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref>; Kao et al., <xref ref-type="bibr" rid="B68">2013</xref>). More commonly, <italic>Legionella</italic> are identified by 16S sequencing of DNA extracts from bacteria isolated by <italic>Legionella</italic>-selective culture methods on bacteriological medium (Salloum et al., <xref ref-type="bibr" rid="B109">2002</xref>; Sheehan et al., <xref ref-type="bibr" rid="B112">2005</xref>) or enrichment through co-culture of environmental samples with amoebae (Pagnier et al., <xref ref-type="bibr" rid="B97">2008</xref>). Protozoa may be identified microscopically by fluorescence <italic>in situ</italic> hybridization (FISH) or the morphological appearance of trophozoites (Jacquier et al., <xref ref-type="bibr" rid="B65">2013</xref>; Muchesa et al., <xref ref-type="bibr" rid="B90">2014</xref>), or by 18S sequencing of DNA extracts following an amoebal enrichment step in which individual isolates are cultured on lawns of bacteria permissive to amoebal grazing (Greub and Raoult, <xref ref-type="bibr" rid="B50">2004</xref>; Delafont et al., <xref ref-type="bibr" rid="B28">2013</xref>; Muchesa et al., <xref ref-type="bibr" rid="B90">2014</xref>). Thus, while most co-isolation studies do not provide direct evidence of <italic>Legionella</italic> growth within the protozoa identified, they can be used to predict environmentally relevant interactions, to substantiate experimental findings from co-culture techniques and are likely to implicate new protozoan species as potential hosts of <italic>Legionella</italic>.</p>
</sec>
<sec id="s7">
<title>Experimentally defined protozoan hosts of <italic>L. pneumophila</italic></title>
<p>The initial discovery that <italic>L. pneumophila</italic> is capable of surviving and replicating in protozoa fostered a number of independent investigations to examine the host range of this bacterium (Table <xref ref-type="table" rid="T1">1</xref>). Co-culture methods in combination with various microscopy techniques demonstrated growth of <italic>L. pneumophila</italic> in diverse protozoan hosts encompassing several species of <italic>Acanthamoeba</italic> (<italic>A. castellanii, Acanthamoeba polyphaga</italic>, and <italic>Acanthamoeba palestinensis</italic>), <italic>Hartmannella</italic> (<italic>Vermamoeba vermiformis</italic>, formerly <italic>Hartmannella vermiformis</italic> and <italic>Hartmannella cantabridiensis</italic>) and <italic>Naegleria</italic> (<italic>Naegleria gruberi, Naegleria lovaniensis</italic>, and <italic>Naegleria jadini</italic>) as well as <italic>Tetrahymena pyrofomis, Echinamoeba exudans</italic>, and <italic>Tetramitus jugosus</italic> (formerly <italic>Vahlkampfia jugosus</italic>) (Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>, <xref ref-type="bibr" rid="B107">1986</xref>; Tyndall and Domingue, <xref ref-type="bibr" rid="B127">1982</xref>; Anand et al., <xref ref-type="bibr" rid="B4">1983</xref>; Barbaree et al., <xref ref-type="bibr" rid="B5">1986</xref>). While the list of hosts was dominated by three particular genera (<italic>Acanthamoeba, Hartmannella</italic>, and <italic>Naegleria</italic>), collectively it represented three different phyla Amoebozoa, Ciliophora, and Percolozoa and amongst them, four distantly related classes of protozoa, Discosea (<italic>Acanthamoebae</italic>), Tubulinea (<italic>Echinamoeba</italic> and <italic>Hartmannella</italic>), Heterolobosea (<italic>Naegleria</italic> and <italic>Tetramitus</italic>), and Oligohymenophorea (<italic>Tetrahymena</italic>) (Figure <xref ref-type="fig" rid="F1">1</xref>).</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p>Experimentally defined protozoan hosts of <italic>L. pneumophila</italic>.</p></caption>
<table frame="hsides" rules="groups">
<thead><tr>
<th valign="top" align="left"><bold>Protozoan species</bold></th>
<th valign="top" align="left"><bold>Protozoan strain</bold></th>
<th valign="top" align="left"><bold><italic>L. pneumophila</italic> serogroup (Sg): strain</bold></th>
<th valign="top" align="left"><bold>Fate of <italic>L. pneumophila</italic></bold></th>
<th valign="top" align="left"><bold>Experimental evidence</bold></th>
<th valign="top" align="left"><bold>References</bold></th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"><italic>Acanthamoeba</italic> spp.</td>
<td valign="top" align="left">AMI137, AMI116, AMI073, AMI191, Humidifier strain</td>
<td valign="top" align="left">Sg1: Lens</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Phase-contrast microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>; Dupuy et al., <xref ref-type="bibr" rid="B32">2016</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg2: Togus-1</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: Bloomington-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: Cambridge-2</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba</italic> sp. 155</td>
<td/>
<td valign="top" align="left">Sg1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Epifluorescence microscopy</td>
<td valign="top" align="left">Cervero-Arag&#x000F3; et al., <xref ref-type="bibr" rid="B18">2014</xref>, <xref ref-type="bibr" rid="B17">2015</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba astronyxis</italic></td>
<td valign="top" align="left">Isolate C37C6</td>
<td valign="top" align="left">Sg1: Philadelphia-1</td>
<td valign="top" align="left">Live cells are packaged in expelled pellets</td>
<td valign="top" align="left">Electron microscopy</td>
<td valign="top" align="left">Marciano-Cabral and Cabral, <xref ref-type="bibr" rid="B84">2003</xref>; Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba castellanii</italic></td>
<td valign="top" align="left">ATCC&#x000AE; 30234&#x02122;, CCAP 1534/2, L1501/2A, L501/2A, Neff</td>
<td valign="top" align="left">Sg1: JR32, Lens, Paris, Philadelphia-1, Philadelphia-2, Pontiac-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>; Holden et al., <xref ref-type="bibr" rid="B57">1984</xref>; Moffat and Tompkins, <xref ref-type="bibr" rid="B87">1992</xref>; Hilbi et al., <xref ref-type="bibr" rid="B55">2001</xref>; Bouyer et al., <xref ref-type="bibr" rid="B11">2007</xref>; Tyson et al., <xref ref-type="bibr" rid="B128">2013</xref>; Mengue et al., <xref ref-type="bibr" rid="B86">2016</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg2: Togus-1</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: Bloomington-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg4: Los Angeles</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg6: Oxford-1</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="left">Neff</td>
<td valign="top" align="left">Sg5: Dallas 1E</td>
<td valign="top" align="left">Live cells are packaged in expelled pellets</td>
<td valign="top" align="left">Electron microscopy</td>
<td valign="top" align="left">Berk et al., <xref ref-type="bibr" rid="B8">1998</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba lenticulata</italic></td>
<td valign="top" align="left">PD2</td>
<td valign="top" align="left">Sg1: AX71, Philadelphia-1, SC94, SC97</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting</td>
<td valign="top" align="left">Molmeret et al., <xref ref-type="bibr" rid="B89">2001</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg2: AX2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: AX52, AX54, AX82</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba palestinensis</italic></td>
<td/>
<td valign="top" align="left">Sg1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy, Epifluorescence microscopy, Phase contrast microscopy</td>
<td valign="top" align="left">Anand et al., <xref ref-type="bibr" rid="B4">1983</xref>; Harf et al., <xref ref-type="bibr" rid="B54">1997</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba polyphaga</italic></td>
<td valign="top" align="left">Ap-1, L1501/3A, Puschkarew</td>
<td valign="top" align="left">Sg1: AA100, Corby, Nottingham-8, Leeds 1A SAP, Leeds-4, Lp02, Philadelphia-2, Pontiac-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy, Phase-contrast microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref>, <xref ref-type="bibr" rid="B107">1986</xref>; Kilvington and Price, <xref ref-type="bibr" rid="B70">1990</xref>; Gao et al., <xref ref-type="bibr" rid="B43">1997</xref>; Buse and Ashbolt, <xref ref-type="bibr" rid="B16">2011</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg2: Oxford-2, Togus-1</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: Bloomington-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg4: Los Angeles-1</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: Cambridge-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg6</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg7: Dallas-5, Chicago-8</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg8: York-1, Concord-3</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td valign="top" align="left" style="border-top: thin solid #000000;">Puschkarew</td>
<td valign="top" align="left" style="border-top: thin solid #000000;">Sg5: Dallas 1E</td>
<td valign="top" align="left" style="border-top: thin solid #000000;">Intracellular Survival, Live cells are packaged in expelled pellets</td>
<td valign="top" align="left" style="border-top: thin solid #000000;">CFU counting, Electron microscopy</td>
<td valign="top" align="left" style="border-top: thin solid #000000;">Berk et al., <xref ref-type="bibr" rid="B8">1998</xref>; Buse and Ashbolt, <xref ref-type="bibr" rid="B16">2011</xref></td>
</tr>
<tr>
<td valign="top" align="left"><italic>Acanthamoeba royreba</italic></td>
<td/>
<td valign="top" align="left">Sg4: Los Angeles</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Bacteria cell count, Epifluorescence microscopy</td>
<td valign="top" align="left">Tyndall and Domingue, <xref ref-type="bibr" rid="B127">1982</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Balamuthia mandrillaris</italic></td>
<td valign="top" align="left">CDC-V039</td>
<td valign="top" align="left">Sg1: JR32, 130b</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Phase-contrast microscopy</td>
<td valign="top" align="left">Shadrach et al., <xref ref-type="bibr" rid="B111">2005</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Ciliophrya</italic> sp.</td>
<td/>
<td valign="top" align="left">Sg1: Corby</td>
<td valign="top" align="left">Intracellular survival</td>
<td valign="top" align="left">Epifluorescence microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Dictyostelium discoideum</italic></td>
<td valign="top" align="left">AX2, AX2-214, AX3</td>
<td valign="top" align="left">Sg1: Benidorm 030E, Corby, Philadelphia-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy</td>
<td valign="top" align="left">H&#x000E4;gele et al., <xref ref-type="bibr" rid="B51">2000</xref>; Solomon et al., <xref ref-type="bibr" rid="B117">2000</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Echinamoeba exudans</italic></td>
<td valign="top" align="left">SH274</td>
<td valign="top" align="left">Sg1: RI-243</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Electron microscopy</td>
<td valign="top" align="left">Fields et al., <xref ref-type="bibr" rid="B39">1989</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Hartmannella cantabrigiensis</italic></td>
<td/>
<td valign="top" align="left">Sg2: PR-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Electron microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: Leeds-10</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg7: Chicago-8, Dallas-5</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg8: York-1</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria</italic> spp.</td>
<td valign="top" align="left">AMI242, AMI117, AMI135, AMI161</td>
<td valign="top" align="left">Sg1: Lens</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting</td>
<td valign="top" align="left">Dupuy et al., <xref ref-type="bibr" rid="B32">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria fowleri</italic></td>
<td valign="top" align="left">Lee</td>
<td valign="top" align="left">Sg1: Lp02</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy</td>
<td valign="top" align="left">Newsome et al., <xref ref-type="bibr" rid="B94">1985</xref>; Buse and Ashbolt, <xref ref-type="bibr" rid="B16">2011</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: Bloomington-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg6: Chicago-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: Dallas 1E</td>
<td valign="top" align="left">Intracellular survival</td>
<td valign="top" align="left">CFU counting</td>
<td valign="top" align="left">Buse and Ashbolt, <xref ref-type="bibr" rid="B16">2011</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria gruberi</italic></td>
<td valign="top" align="left">1518/1E</td>
<td valign="top" align="left">Sg2: Togus-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Phase-contrast microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: Bloomington-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: Cambridge-2</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria jadini</italic></td>
<td valign="top" align="left">B1518/2</td>
<td valign="top" align="left">Sg2: Togus-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Phase-contrast microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B104">1980</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: Bloomington-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: Cambridge-2</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria lovaniensis</italic></td>
<td valign="top" align="left">TS</td>
<td valign="top" align="left">Sg1: Philadelphia-1, 130b</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Confocal microscopy, CFU counting, Bacteria cell count, Epifluorescence microscopy</td>
<td valign="top" align="left">Tyndall and Domingue, <xref ref-type="bibr" rid="B127">1982</xref>; Declerck et al., <xref ref-type="bibr" rid="B27">2005</xref>; Tyson et al., <xref ref-type="bibr" rid="B128">2013</xref>, <xref ref-type="bibr" rid="B129">2014</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg4: Los Angeles</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Oxytricha bifaria</italic></td>
<td/>
<td valign="top" align="left">Sg1: Corby</td>
<td valign="top" align="left">Intracellular survival</td>
<td valign="top" align="left">Epifluorescence microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Paramecium caudatum</italic></td>
<td valign="top" align="left">RB-1</td>
<td valign="top" align="left">Sg1: Philadelphia-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Fluorescence microscopy</td>
<td valign="top" align="left">Watanabe et al., <xref ref-type="bibr" rid="B137">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Stylonychia mytilus</italic></td>
<td/>
<td valign="top" align="left">Sg1: Corby</td>
<td valign="top" align="left">Intracellular survival</td>
<td valign="top" align="left">Epifluorescence microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr>
<td valign="top" align="left"><italic>Tetrahymena</italic> sp.</td>
<td/>
<td valign="top" align="left">Sg1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Epifluorescence microscopy</td>
<td valign="top" align="left">Barbaree et al., <xref ref-type="bibr" rid="B5">1986</xref>; Berk et al., <xref ref-type="bibr" rid="B7">2008</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg1: Lp02</td>
<td valign="top" align="left">Live cells are packaged in expelled pellets</td>
<td valign="top" align="left">Electron microscopy, Fluorescence microscopy</td>
<td valign="top" align="left">Berk et al., <xref ref-type="bibr" rid="B7">2008</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetrahymena pyriformis</italic></td>
<td valign="top" align="left">No. 500</td>
<td valign="top" align="left">Sg1: Philadelphia-1, 130b</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy</td>
<td valign="top" align="left">Fields et al., <xref ref-type="bibr" rid="B40">1984</xref>, <xref ref-type="bibr" rid="B37">1986</xref>; Cianciotto and Fields, <xref ref-type="bibr" rid="B19">1992</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: SC-6-C3</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetrahymena thermophila</italic></td>
<td valign="top" align="left">Mating type IV</td>
<td valign="top" align="left">Sg1: Philadelphia-1</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Light microscopy Electron microscopy</td>
<td valign="top" align="left">Kikuhara et al., <xref ref-type="bibr" rid="B69">1994</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg1: Philadelphia-2</td>
<td valign="top" align="left">Intracellular survival</td>
<td valign="top" align="left">CFU counting, Light microscopy Electron microscopy</td>
<td valign="top" align="left">Kikuhara et al., <xref ref-type="bibr" rid="B69">1994</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Inbred strain B, SB021</td>
<td valign="top" align="left">Sg1: JR32</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Electron microscopy; Live cells are packaged in expelled pellets</td>
<td valign="top" align="left">Hojo et al., <xref ref-type="bibr" rid="B56">2012</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetrahymena tropicalis</italic></td>
<td/>
<td valign="top" align="left">Sg1: Lens, Philadelphia-1</td>
<td valign="top" align="left">Live cells are packaged in expelled pellets</td>
<td valign="top" align="left">Electron microscopy</td>
<td valign="top" align="left">Faulkner et al., <xref ref-type="bibr" rid="B35">2008</xref>; Koubar et al., <xref ref-type="bibr" rid="B74">2011</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetrahymena vorax</italic></td>
<td valign="top" align="left">V2S</td>
<td valign="top" align="left">Sg1: Philadelphia-1</td>
<td valign="top" align="left">Intracellular survival</td>
<td valign="top" align="left">Electron microscopy, Fluorescence microscopy</td>
<td valign="top" align="left">Smith-Somerville et al., <xref ref-type="bibr" rid="B116">1991</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetramitus jugosus<xref ref-type="table-fn" rid="TN2"><sup>b</sup></xref></italic> (<italic>Vahlkampfia jugosa</italic>)</td>
<td/>
<td valign="top" align="left">Sg1: Leeds 4</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">Electron microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vermamoeba vermiformis<xref ref-type="table-fn" rid="TN1"><sup>a</sup></xref></italic> (<italic>Hartmannella vermiformis</italic>)</td>
<td valign="top" align="left">ATCC&#x000AE; 50256&#x02122;, CDC-19</td>
<td valign="top" align="left">Sg1: AA100, Lens, 130b Philadelphia-1, RI-243</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>; King et al., <xref ref-type="bibr" rid="B71">1991</xref>; Wadowsky et al., <xref ref-type="bibr" rid="B135">1995</xref>; Abu Kwaik, <xref ref-type="bibr" rid="B2">1996</xref>; Buse and Ashbolt, <xref ref-type="bibr" rid="B16">2011</xref>; Tyson et al., <xref ref-type="bibr" rid="B128">2013</xref>; Dupuy et al., <xref ref-type="bibr" rid="B32">2016</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: E-52, E-62</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg6: E-66, E-67</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg1: Lp02</td>
<td valign="top" align="left">Intracellular survival</td>
<td valign="top" align="left">CFU counting</td>
<td valign="top" align="left">Buse and Ashbolt, <xref ref-type="bibr" rid="B16">2011</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg3: Bloomington-2</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg5: Dallas 1E</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg6: Chicago-2,</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sg7: Dallas-5, PR-3</td>
<td/>
<td/>
<td/>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Willaertia magna</italic></td>
<td valign="top" align="left">c2c Maky, T5[S]44, Z503</td>
<td valign="top" align="left">Sg1: Lens, Paris, Philadelphia-1, 130b</td>
<td valign="top" align="left">Intracellular multiplication</td>
<td valign="top" align="left">CFU counting, Electron microscopy</td>
<td valign="top" align="left">Dey et al., <xref ref-type="bibr" rid="B30">2009</xref>; Tyson et al., <xref ref-type="bibr" rid="B129">2014</xref></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="TN1">
<label>a</label>
<p><italic>Vahlkampfia jugosa has been renamed Tetramitus jugosus (De Jonckheere and Brown, <xref ref-type="bibr" rid="B25">2005</xref>)</italic>.</p></fn>
<fn id="TN2">
<label>b</label>
<p><italic>Hartmannella vermiformis has been renamed Vermamoeba vermiformis (Smirnov et al., <xref ref-type="bibr" rid="B115">2011</xref>)</italic>.</p></fn>
</table-wrap-foot>
</table-wrap>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption><p>An 18S phylogenetic tree of the experimentally defined hosts of <italic>L. pneumophila</italic>. Evolutionary history was inferred using the Neighbor-Joining method based on an alignment of 18S rRNA sequences. Evolutionary analyses were performed using MEGA7 (Kumar et al., <xref ref-type="bibr" rid="B75">2016</xref>). Restrictive host species that do not support <italic>L. pneumophila</italic> replication or survival are indicated by lighter shading and the annotation &#x0201C;(&#x02212;)&#x0201D;. Taxonomic designations are based on the classification system outlined in Ruggiero et al. (<xref ref-type="bibr" rid="B108">2015</xref>).</p></caption>
<graphic xlink:href="fcimb-07-00477-g0001.tif"/>
</fig>
<p>Subsequent studies to investigate <italic>L. pneumophila</italic> pathogenesis have progressively expanded the list of protozoan hosts of this bacterium (Table <xref ref-type="table" rid="T1">1</xref> and Figure <xref ref-type="fig" rid="F1">1</xref>), including additional species of <italic>Acanthamoeba</italic> (<italic>Acanthamoeba lenticulata</italic> and <italic>Acanthamoeba royreba</italic>) and <italic>Naegleria</italic> (<italic>Naegleria fowleri</italic>) as well as more distantly related genera from their respective phyla such as <italic>Dictyostelium discoideum</italic> (H&#x000E4;gele et al., <xref ref-type="bibr" rid="B51">2000</xref>; Solomon et al., <xref ref-type="bibr" rid="B117">2000</xref>) and <italic>Balamuthia mandrillaris</italic> (Amoebozoa) (Shadrach et al., <xref ref-type="bibr" rid="B111">2005</xref>) and <italic>Willertia magna</italic> (Percolozoa) (Dey et al., <xref ref-type="bibr" rid="B30">2009</xref>; Tyson et al., <xref ref-type="bibr" rid="B129">2014</xref>). Similarly, a number of additional ciliated protozoa were identified that were permissive for <italic>L. pneumophila</italic> survival, including <italic>Tetrahymena</italic> spp. (<italic>Tetrahymena tropicalis</italic> and <italic>Tetrahymena vorax</italic>), <italic>Oxytricha bifaria, Stylonychia mytilus, Paramecium caudatum</italic> and a member of the <italic>Ciliophrya</italic> genus, and in one case <italic>L. pneumophila</italic> replication (<italic>Tetrahymena thermophila</italic>), greatly expanding representation from this group (Kikuhara et al., <xref ref-type="bibr" rid="B69">1994</xref>; Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref>; Watanabe et al., <xref ref-type="bibr" rid="B137">2016</xref>). The beneficial interaction of <italic>L. pneumophila</italic> with these organisms appears to be specific as members from each of the representative phyla were also identified that were highly restrictive to <italic>L. pneumophila</italic> survival (Figure <xref ref-type="fig" rid="F1">1</xref>): <italic>T. vorax</italic> (Ciliophora), <italic>A. astronyxis</italic>, and <italic>Cashia limocoides</italic> (Amoebozoa) and <italic>Solumitrus palustris</italic> (Percolozoa) (Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>; Smith-Somerville et al., <xref ref-type="bibr" rid="B116">1991</xref>; Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>). In addition, <italic>L. pneumophila</italic> was unable to grow in <italic>V. platypodia</italic> and <italic>V. bacillipedes</italic> (Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>), which form a distantly related clade of the Amoebozoa phyla (Figure <xref ref-type="fig" rid="F1">1</xref>). Similarly, of the members of the Cercozoa phylum examined so far, <italic>Cercomonas</italic> sp., <italic>Euglypha</italic> sp., and <italic>Paracercomonas</italic> sp., all three are restrictive for <italic>L. pneumophila</italic> growth (Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>; Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref>), suggesting that distinct orders and families within this class may be more restrictive than others. Thus, while the host range of <italic>L. pneumophila</italic> is vast, it does appear to have its limitations.</p>
</sec>
<sec id="s8">
<title>Suggested environmental hosts of <italic>L. pneumophila</italic></title>
<p>Protozoa in both natural and man-made environments can alter the composition of microbial communities by eliminating bacteria through predation or augmenting populations of bacteria that are capable of replicating within these organisms (Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref>). Co-isolation techniques have been used to describe the composition of these communities within natural fresh water systems such as hot springs, thermal spas, lakes, ponds, streams, and anthropogenic reservoirs, such as cooling towers, industrial and private water networks and compost facilities. <italic>L. pneumophila</italic> is capable of surviving an array of physical conditions including temperatures ranging from 6 to 63&#x000B0;C (Fliermans et al., <xref ref-type="bibr" rid="B42">1981</xref>). Thermal springs have been of particular interest as they boast characteristically high water temperatures, providing optimal conditions for <italic>L. pneumophila</italic> growth (Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref>; Ji et al., <xref ref-type="bibr" rid="B66">2014</xref>; Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref>). Artificial aquatic reservoirs are of considerable epidemiological significance and typically support higher numbers of bacteria compared to natural water systems (Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref>), likely due to higher average water temperatures (Ikedo and Yabuuchi, <xref ref-type="bibr" rid="B63">1986</xref>; Fields et al., <xref ref-type="bibr" rid="B38">2002</xref>; Lasheras et al., <xref ref-type="bibr" rid="B78">2006</xref>). The results of these population level analyses have validated many of the co-culture defined hosts of <italic>L. pneumophila</italic> while identifying several additional potential hosts (Table <xref ref-type="table" rid="T2">2</xref>).</p>
<table-wrap position="float" id="T2">
<label>Table 2</label>
<caption><p>Suggested protozoan hosts of <italic>L. pneumophila</italic>.</p></caption>
<table frame="hsides" rules="groups">
<thead><tr>
<th valign="top" align="left"><bold>Protozoa</bold></th>
<th valign="top" align="left"><bold>Environment source</bold></th>
<th valign="top" align="left"><bold>Identification method used</bold></th>
<th valign="top" align="left"><bold>References</bold></th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left"><italic>Acanthamoebidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba</italic> spp.</td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Kurtz et al., <xref ref-type="bibr" rid="B77">1982</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Drinking water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Marciano-Cabral et al., <xref ref-type="bibr" rid="B85">2010</xref>; Valster et al., <xref ref-type="bibr" rid="B131">2011</xref>; Ji et al., <xref ref-type="bibr" rid="B66">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rohr et al., <xref ref-type="bibr" rid="B103">1998</xref>; Steinert et al., <xref ref-type="bibr" rid="B118">1998</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Industrial water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy; Sequence analysis</td>
<td valign="top" align="left">Scheikl et al., <xref ref-type="bibr" rid="B110">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref>; Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref>; Ji et al., <xref ref-type="bibr" rid="B66">2014</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba castellanii</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba hatchetti</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Hospital water network</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Hsu et al., <xref ref-type="bibr" rid="B60">2015</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba jacobsi</italic></td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba lenticulata</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba palestinensis</italic></td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Kao et al., <xref ref-type="bibr" rid="B68">2013</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Acanthamoeba polyphaga</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Not specified</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Hsu et al., <xref ref-type="bibr" rid="B59">2009</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Amoebidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Aspidiscidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Bodonidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Cashia limacoides</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Not specified</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Centropyxis</italic> sp.</td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Ciliophrya</italic> sp.</td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Colpodidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Comandonia operculata</italic></td>
<td valign="top" align="left">Hospital water network</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Cyclidium</italic> spp.</td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Barbaree et al., <xref ref-type="bibr" rid="B5">1986</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Diphylleia rotans</italic></td>
<td valign="top" align="left">Sewage treatment systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B132">2010</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Echinamoeba</italic> spp.</td>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rohr et al., <xref ref-type="bibr" rid="B103">1998</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Echinamoeba exudans</italic></td>
<td valign="top" align="left">Drinking water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B131">2011</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Fields et al., <xref ref-type="bibr" rid="B39">1989</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Echinamoeba thermarum</italic></td>
<td valign="top" align="left">Drinking water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B131">2011</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B132">2010</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Euglypha</italic> sp.</td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Filamoeba nolandi</italic></td>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Flamella balnearia</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
<tr>
<td valign="top" align="left"><italic>Hartmannellidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Hartmannella</italic> spp.</td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Kurtz et al., <xref ref-type="bibr" rid="B77">1982</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Fields et al., <xref ref-type="bibr" rid="B39">1989</xref>; Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref>; Nahapetian et al., <xref ref-type="bibr" rid="B92">1991</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">FISH; Identified morphologically via microscopy</td>
<td valign="top" align="left">Zbikowska et al., <xref ref-type="bibr" rid="B139">2014</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Hartmannella cantabrigiensis</italic></td>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>; Fields et al., <xref ref-type="bibr" rid="B39">1989</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Learamoeba waccamawenis</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Mayorella</italic> spp.</td>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Steinert et al., <xref ref-type="bibr" rid="B118">1998</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria</italic> spp.</td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Barbaree et al., <xref ref-type="bibr" rid="B5">1986</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Drinking water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Marciano-Cabral et al., <xref ref-type="bibr" rid="B85">2010</xref>; Ji et al., <xref ref-type="bibr" rid="B66">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Nahapetian et al., <xref ref-type="bibr" rid="B92">1991</xref>; Rohr et al., <xref ref-type="bibr" rid="B103">1998</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Industrial water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Scheikl et al., <xref ref-type="bibr" rid="B110">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref>; Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref>; Ji et al., <xref ref-type="bibr" rid="B66">2014</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">FISH; Identified morphologically via microscopy</td>
<td valign="top" align="left">Zbikowska et al., <xref ref-type="bibr" rid="B139">2014</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria australiensis</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Huang and Hsu, <xref ref-type="bibr" rid="B61">2010</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria fowleri</italic></td>
<td valign="top" align="left">Thermal saline bath</td>
<td valign="top" align="left">FISH; Identified morphologically via microscopy</td>
<td valign="top" align="left">Zbikowska et al., <xref ref-type="bibr" rid="B140">2013</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">FISH; Identified morphologically via microscopy</td>
<td valign="top" align="left">Zbikowska et al., <xref ref-type="bibr" rid="B139">2014</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria gruberi</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Hsu et al., <xref ref-type="bibr" rid="B60">2015</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria lovaniensis</italic></td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Huang and Hsu, <xref ref-type="bibr" rid="B61">2010</xref>; Kao et al., <xref ref-type="bibr" rid="B68">2013</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Naegleria pagei</italic></td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Huang and Hsu, <xref ref-type="bibr" rid="B61">2010</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Neoparamoeba</italic> spp.</td>
<td valign="top" align="left">Drinking water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B131">2011</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B132">2010</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Oxytricha bifaria</italic></td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Paravahlkampfia ustiana</italic><xref ref-type="table-fn" rid="TN3"><sup>a</sup></xref> (<italic>Vahlkampfia ustiana</italic>)</td>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Pleuronematidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Rhinosporidium</italic> sp.</td>
<td valign="top" align="left">Tap water system</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B132">2010</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Saccamoeba</italic> spp.</td>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rohr et al., <xref ref-type="bibr" rid="B103">1998</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Singhamoeba horticola</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Stenamoeba</italic> spp.</td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr>
<td valign="top" align="left"><italic>Stenamoeba limacina</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Stylonychia mytilus</italic></td>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetrahymenidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetrahymena</italic> spp.</td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Barbaree et al., <xref ref-type="bibr" rid="B5">1986</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetramitu</italic>s spp.</td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Tetramitus enterica</italic><xref ref-type="table-fn" rid="TN4"><sup>b</sup></xref> (<italic>Vahlkampfia enterica</italic>)</td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vahlkampfia</italic> spp.</td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Drinking water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Marciano-Cabral et al., <xref ref-type="bibr" rid="B85">2010</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref>; Rohr et al., <xref ref-type="bibr" rid="B103">1998</xref>; Steinert et al., <xref ref-type="bibr" rid="B118">1998</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref>; Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vahlkampfia avara</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vannella</italic> spp.</td>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rohr et al., <xref ref-type="bibr" rid="B103">1998</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vannella platypodia</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Not specified</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vermamoeba vermiformis</italic><xref ref-type="table-fn" rid="TN5"><sup>c</sup></xref> (<italic>Hartmannella vermiformis</italic>)</td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref>, <xref ref-type="bibr" rid="B22">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Drinking water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B131">2011</xref>; Ji et al., <xref ref-type="bibr" rid="B66">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Hospital water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>; Fields et al., <xref ref-type="bibr" rid="B39">1989</xref>; Breiman et al., <xref ref-type="bibr" rid="B12">1990</xref>; Rohr et al., <xref ref-type="bibr" rid="B103">1998</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Thomas et al., <xref ref-type="bibr" rid="B124">2006</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Industrial water networks</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Scheikl et al., <xref ref-type="bibr" rid="B110">2014</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref>, <xref ref-type="bibr" rid="B60">2015</xref>; Ji et al., <xref ref-type="bibr" rid="B66">2014</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Kao et al., <xref ref-type="bibr" rid="B68">2013</xref></td>
</tr>
<tr>
<td/>
<td/>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B132">2010</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Tap water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Valster et al., <xref ref-type="bibr" rid="B132">2010</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vexillifera bacillipedes</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Not specified</td>
<td valign="top" align="left">Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Vorticellidae</italic></td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Identified morphologically via microscopy</td>
<td valign="top" align="left">Yamamoto et al., <xref ref-type="bibr" rid="B138">1992</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Willaertia</italic> spp.</td>
<td valign="top" align="left">Cooling towers</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref></td>
</tr>
<tr>
<td/>
<td valign="top" align="left">Natural water systems</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Declerck et al., <xref ref-type="bibr" rid="B26">2007</xref></td>
</tr>
<tr style="border-top: thin solid #000000;">
<td valign="top" align="left"><italic>Willaertia magna</italic></td>
<td valign="top" align="left">Compost facilities</td>
<td valign="top" align="left">Sequence analysis</td>
<td valign="top" align="left">Conza et al., <xref ref-type="bibr" rid="B23">2013</xref></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="TN3">
<label>a</label>
<p><italic>Vahlkampfia ustiana has been renamed Paravahlkampfia ustiana</italic>.</p></fn>
<fn id="TN4">
<label>b</label>
<p><italic>Vahlkampfia enterica has been renamed Tetramitus enterica</italic>.</p></fn>
<fn id="TN5">
<label>c</label>
<p><italic>Hartmannella vermiformis has been renamed Vermamoeba vermiformis (Smirnov et al., <xref ref-type="bibr" rid="B115">2011</xref>)</italic>.</p></fn>
</table-wrap-foot>
</table-wrap>
<p>There is tremendous concordance between co-culture-confirmed <italic>Legionella</italic>-protozoa interactions and the results of co-isolation studies (Tables <xref ref-type="table" rid="T1">1</xref>, <xref ref-type="table" rid="T2">2</xref>). With the exception of <italic>Balamuthia</italic> and <italic>Dictyostelium</italic>, all protozoan genera shown to support intracellular growth in laboratory co-culture studies reside with <italic>L. pneumophila</italic> in the environment (Table <xref ref-type="table" rid="T2">2</xref>). While this is not surprising for <italic>Acanthamoeba, Hartmannella</italic>, and <italic>Naegleria</italic>, as these are some of the most abundant protozoa in nature, in many cases co-isolation studies identified the same species of these genera. In particular, three of the protozoa identified, <italic>A. palestinensis, N. lovaniensis</italic>, and <italic>V. vermiformis</italic> that had been shown to support <italic>L. pneumophila</italic> replication in co-culture experiments (Anand et al., <xref ref-type="bibr" rid="B4">1983</xref>; Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>; Declerck et al., <xref ref-type="bibr" rid="B27">2005</xref>; Thomas et al., <xref ref-type="bibr" rid="B124">2006</xref>) were isolated from water samples harboring <italic>L. pneumophila</italic> (Kao et al., <xref ref-type="bibr" rid="B68">2013</xref>). Similarly, amoebal enrichment assays resulted in the isolation of <italic>Acanthamoeba jacobsi</italic> harboring <italic>L. pneumophila</italic> directly from a thermal spring water sample (Hsu et al., <xref ref-type="bibr" rid="B58">2011</xref>). These results identify <italic>A. jacobsi</italic> as a new host of <italic>L. pneumophila</italic> and provide direct evidence of an interaction between <italic>L. pneumophila</italic> and these four protozoan hosts in the environment. The lack of co-isolation of <italic>L. pneumophila</italic> with either <italic>Balamuthia</italic> or <italic>Dictyostelium</italic> species is likely because these protozoa are typically found in soil and the majority of samples analyzed were isolated from aquatic environments (Dunnebacke et al., <xref ref-type="bibr" rid="B31">2004</xref>; Vadell and Cavender, <xref ref-type="bibr" rid="B130">2007</xref>). The high degree of correlation between the co-culture and co-isolation studies supports the role of these organisms as natural hosts of <italic>L. pneumophila</italic> in environmental reservoirs.</p>
<p>Co-isolation studies predict a number of additional phyla and classes of protozoa may support <italic>L. pneumophila</italic> survival or growth (Table <xref ref-type="table" rid="T2">2</xref>). In addition to the Amoebozoa, Ciliophora, and Percolozoa phyla, protozoa from Apusozoa (<italic>Diphylleia rotans</italic>), Cercozoa (<italic>Euglypha</italic> sp.), Euglenozoa (<italic>Bodonidae</italic> sp.), and Opsithokonta (<italic>Rhinosporidium</italic> sp.) were identified. Two additional classes of protozoa from previously identified phyla are also represented, Variosea (<italic>Flamella balnearia</italic>) and Oligohymenophorea with representatives encompassing four different families spanning three orders within this group. For those classes of protozoa already identified as hosts by co-culture experiments, three additional orders, Thecamoebida (<italic>Stenamoeba limacina</italic>), Arcellinida (<italic>Centropyxis</italic> sp.), and Sporadotricina (<italic>Aspidiscidae</italic> family) and five genera (<italic>Comandonia operculata, C. limacoides, Paravahlkampfia ustiana, Learamoeba waccamawenis</italic>, and <italic>Singhamoeba horticola</italic>) were identified. Finally, of the known hosts of <italic>L. pneumophila</italic> from co-culture experiments, additional species of <italic>Acanthamoeba</italic> (<italic>A. jacobsi</italic>), <italic>Naegleria</italic> (<italic>Naegleria pagei</italic> and <italic>Naegleria australiensis</italic>), <italic>Tetramitus</italic> (<italic>Tetramius enterica</italic>), and <italic>Vahlkampfia</italic> (<italic>Valkampfia avara</italic>) were also isolated. Combined, co-isolation and co-culture experiments represent 7 of the 8 phyla of the protozoa kingdom, 12 of the 41 classes within these phyla and 21 of the 82 defined orders, demonstrating the tremendous diversity amongst <italic>L. pneumophila</italic> hosts.</p>
<p>Protozoa more commonly found associated with <italic>L. pneumophila</italic> in environmental reservoirs may indicate that they are more likely to be true hosts of the bacterium. While the <italic>Acanthamoeba</italic> spp., <italic>Naegleria</italic> spp., <italic>Vahlkampfia</italic> spp., and <italic>Hartmannella</italic> spp. (including <italic>Vermamoeba vermifomis</italic>) are commonly found in multiple sources (Table <xref ref-type="table" rid="T2">2</xref>), particular protozoa appear to co-reside with <italic>L. pneumophila</italic> in more than one environmental sample (Table <xref ref-type="table" rid="T2">2</xref>). <italic>A</italic>. <italic>hatchetti, A</italic>. <italic>polyphaga, H</italic>. <italic>cantabrigensis, N</italic>. <italic>fowleri, N</italic>. <italic>lovaniensis, Neoparamoeabe</italic> sp., and <italic>Willertia</italic> sp. have been isolated from both natural and man-made water sources (Table <xref ref-type="table" rid="T2">2</xref>), suggesting that these protozoa may function as hosts of <italic>L. pneumophila</italic> in both natural reservoirs and potable water. Both <italic>E. exudans</italic> and <italic>Echinamoeba thermarum</italic> have been identified in more than one potable water sample (Table <xref ref-type="table" rid="T2">2</xref>), suggesting these amoebae may play more prominent roles in the epidemiology of <italic>L. pneumophila</italic>. A higher incidence of specific protozoa with <italic>L. pneumophila</italic> may indicate a stronger likelihood that these protozoa are responsible for the persistence of <italic>L. pneumophila</italic> in environmental reservoirs.</p>
<p>Not all protozoa species isolated from the same environmental source are hosts of <italic>L. pneumophila</italic>. Of several species of free-living amoeba collected from a cooling tower, only <italic>A. polyphaga</italic> supported intracellular growth of <italic>L. pneumophila</italic> whereas <italic>L. pneumophila</italic> failed to replicate within <italic>C. limacoides, V. platypodia</italic>, and <italic>V. bacillipedes</italic> (Rowbotham, <xref ref-type="bibr" rid="B107">1986</xref>). Similarly, of several ciliated protozoa species in biofilm samples isolated from a thermal spa, <italic>L. pneumophila</italic> was able to infect <italic>Ciliophrya</italic> sp., <italic>O. bifaria</italic>, and <italic>S. mytilus</italic>, but no intracellular bacteria were detected within <italic>Euglypha</italic> sp. or <italic>Centropyxis</italic> sp. (Rasch et al., <xref ref-type="bibr" rid="B101">2016</xref>). Thus, <italic>L. pneumophila</italic> is able to persist in environments comprised of both <italic>L. pneumophila</italic>-restrictive and permissive protozoan hosts. The relative abundancy of <italic>L. pneumophila</italic> in different environmental niches may reflect mixed populations of these two types of protozoa. Alternatively, in some circumstances <italic>L. pneumophila</italic> may deplete entire populations of permissive hosts, enriching for resistant species of protozoa that remain. Thus, the absence of certain types of protozoa may not necessarily rule them out as contributors to <italic>L. pneumophila</italic> growth and persistence in the environment.</p>
<p>The distribution of protozoa between the types of water sources examined (natural water reservoirs, cooling towers, potable water distribution system, and compost sites; Table <xref ref-type="table" rid="T2">2</xref>) was relatively uniform with a few notable exceptions. Amoebozoa and Percolozoa, making up the majority of the protozoa identified, were found in all water sources. Amoebozoa were more predominant in cooling towers and potable water systems. The lower abundance of Percolozoa in cooling towers coincided with a higher abundance of Ciliophora (ciliated protozoa) whereas in potable water, an enrichment in organisms from the Tubulinea class of Amoebozoa, in particular <italic>Echinamoeba</italic> was observed. In contrast, fewer members of the Discosea class were reported and in particular, no members of the Centramoebida order despite their presence in all other sites. The perseverance of <italic>L. pneumophila</italic> within various water environments despite variation in the protozoa composition demonstrates the highly adaptive nature of this bacterium to fluctuations in host population dynamics.</p>
</sec>
<sec id="s9">
<title>Metagenomics</title>
<p>Although co-isolation studies provide valuable insights into the microbial communities that support <italic>L. pneumophila</italic>, these methods cannot adequately define the full diversity of these communities (Kunin et al., <xref ref-type="bibr" rid="B76">2008</xref>). While enrichment steps are often necessary to identify low abundance organisms, they create experimental bottlenecks and biases by selecting against protozoa that cannot be cultured using standard protocols (Hugenholtz and Tyson, <xref ref-type="bibr" rid="B62">2008</xref>; Gomez-Alvarez et al., <xref ref-type="bibr" rid="B47">2012</xref>) and <italic>Legionella</italic> isolates with host specificities that do not overlap with amoebal species commonly used in these techniques (Evstigneeva et al., <xref ref-type="bibr" rid="B34">2009</xref>). Metagenome-based analyses may circumvent the limitations inherent to culture-based approaches and provide a more comprehensive, unbiased profile of these communities (Hugenholtz and Tyson, <xref ref-type="bibr" rid="B62">2008</xref>; Gomez-Alvarez et al., <xref ref-type="bibr" rid="B48">2009</xref>). For example, metagenomic studies of samples from three separate watersheds showed both a high level of diversity in the population of <italic>Legionella</italic> (encompassing 15 different species) and a correlation between the levels of Amoebozoa present in the water and the abundance of <italic>Legionella</italic> isolates (Peabody et al., <xref ref-type="bibr" rid="B98">2017</xref>). Monitoring the abundance of <italic>Legionella, Hartmannella</italic>, and <italic>Naegleria</italic> from two environmental water sources over the course of a standard water purification procedure suggested a correlation between the abundance of <italic>Legionella</italic> and <italic>Naegleria</italic>, but not <italic>Hartmannella</italic> (Lin et al., <xref ref-type="bibr" rid="B80">2014</xref>). In general however, metagenomics studies have been somewhat difficult to interpret. Often individual sites are dominated by one or a few amoebal species and the relative abundance of <italic>L. pneumophila</italic> is extremely low compared to other bacteria (Liu et al., <xref ref-type="bibr" rid="B81">2012</xref>; Delafont et al., <xref ref-type="bibr" rid="B28">2013</xref>): these features make it difficult to correlate the presence of <italic>L. pneumophila</italic> with specific protozoa. As the sensitivity and depth of metagenomics analysis improves, metagenomics will most certainly be a source of tremendous insight into the full repertoire of protozoan hosts of <italic>L. pneumophila</italic>.</p>
</sec>
<sec id="s10">
<title>Factors affecting the outcome of <italic>legionella</italic>-protozoa interactions</title>
<p>The outcome of the interaction between <italic>L. pneumophila</italic> and protozoa can be influenced by a number of factors; the identity of the host cell, variations in the predatory behavior or feeding preferences of the host, the strain or species of the bacterium, the relative abundance of the two organisms, the external environment, and other microorganisms.</p>
<p>The identity of the host cell can greatly impact the outcome of the infection. While some hosts are permissive for <italic>L. pneumophila</italic> replication, others are restrictive, either impeding bacterial growth or in extreme cases, survival (Amaro et al., <xref ref-type="bibr" rid="B3">2015</xref>). The maximum amount and rate of <italic>L. pneumophila</italic> growth between hosts can vary significantly (Declerck et al., <xref ref-type="bibr" rid="B27">2005</xref>). For example, <italic>L. pneumophila</italic> can achieve up to 10,000-fold growth in <italic>A. castellanii</italic> but only 10-fold growth in <italic>N. lovaniensis</italic> over the same time period (Declerck et al., <xref ref-type="bibr" rid="B27">2005</xref>). Similarly, <italic>L. pneumophila</italic> strain Paris grows robustly in <italic>A. castellanii</italic> and <italic>V. vermiformis</italic> but is defective for growth in <italic>W. magna</italic> (Dey et al., <xref ref-type="bibr" rid="B30">2009</xref>). Moreover, the differential growth of <italic>L. pneumophila</italic> Paris varies between different strains of <italic>W</italic>. <italic>magna</italic>, with robust growth in strain T5[S]44 (Tyson et al., <xref ref-type="bibr" rid="B129">2014</xref>) but failure to grow in strains c2c Maky or Z502 (Dey et al., <xref ref-type="bibr" rid="B30">2009</xref>). Thus, some hosts are more optimal than others for <italic>L. pneumophila</italic> survival and replication.</p>
<p>The predatory behavior and feeding preferences of the host can also influence <italic>Legionella</italic>-protozoa interactions. For example, the <italic>L. pneumophila</italic> auto-inducer LAI-1 disrupts chemotactic migration of <italic>D</italic>. <italic>discoideum</italic> (Simon et al., <xref ref-type="bibr" rid="B113">2015</xref>) and promotes <italic>L. pneumophila</italic> uptake in both <italic>D</italic>. <italic>discoideum</italic> and <italic>A</italic>. <italic>castellanii</italic> (Tiaden et al., <xref ref-type="bibr" rid="B125">2010</xref>). By restricting amoebal movement, <italic>L. pneumophila</italic> may localize feeding to the site of the bacteria&#x02014;such modulation may also enrich for specific types of amoebae that support <italic>L. pneumophila</italic> replication. The LAI-1 biosynthesis genes are not conserved in all <italic>Legionella</italic> species (Burstein et al., <xref ref-type="bibr" rid="B15">2016</xref>) suggesting that individual species may differentially promote their interaction with amoebae or do so via different mechanisms. Consistent with this idea, the host cell receptors that mediate <italic>L. pneumophila</italic> adhesion to <italic>V</italic>. <italic>vermiformis, A</italic>. <italic>castellanii, A</italic>. <italic>polyphaga</italic>, and <italic>N</italic>. <italic>lovaniensis</italic> and the underlying mechanisms governing bacterial uptake vary between these amoebal hosts (Venkataraman et al., <xref ref-type="bibr" rid="B134">1997</xref>; Harb et al., <xref ref-type="bibr" rid="B53">1998</xref>; Declerck et al., <xref ref-type="bibr" rid="B27">2005</xref>, <xref ref-type="bibr" rid="B26">2007</xref>). As a consequence, bacterial uptake can vary between protozoa. Indeed, <italic>A</italic>. <italic>castellanii</italic> has been shown to ingest <italic>L. pneumophila</italic> with much greater efficiency than <italic>N</italic>. <italic>lovaniensis</italic> (Declerck et al., <xref ref-type="bibr" rid="B27">2005</xref>). Variations in sensing, targeting, adhesion and phagocytosis of bacteria can influence the affinity, specificity, frequency and duration with which <italic>L. pneumophila</italic> interacts with specific protozoa and thus, the impact of their cohabitation on the persistence of <italic>L. pneumophila</italic> in environmental reservoirs.</p>
<p>The genetic composition of the bacterium can greatly impact its fate within the host cell, as the survival and replication of different strains and species of <italic>Legionella</italic> can vary dramatically. Despite the growth defect of <italic>L. pneumophila</italic> Paris in <italic>Willertia magna</italic>, both the <italic>L. pneumophila</italic> Philadelphia-1, Lens and 130b strains are able to replicate in this amoebal host (Dey et al., <xref ref-type="bibr" rid="B30">2009</xref>; Tyson et al., <xref ref-type="bibr" rid="B129">2014</xref>). Similarly, comparisons between clinical and environmental isolates of <italic>L. pneumophila</italic> showed that while one clinical isolate was highly adept at growing in <italic>A. lenticulata</italic> another was severely defective and the relative amounts of replication of the environmental isolates in this host were somewhere in between (Molmeret et al., <xref ref-type="bibr" rid="B89">2001</xref>). Similar differences are observed between species of <italic>Legionella</italic>. While <italic>L. pneumophila, Legionella steelei, Legionella dumoffii</italic>, and <italic>Legionella norrlandica</italic> are able to grow within <italic>A</italic>. <italic>castellanii</italic>, several other species including <italic>Legionella longbeachae, Legionella jordanis</italic>, and <italic>Legionella anisa</italic> are unable to do so (Neumeister et al., <xref ref-type="bibr" rid="B93">1997</xref>; Edelstein et al., <xref ref-type="bibr" rid="B33">2012</xref>; Rizzardi et al., <xref ref-type="bibr" rid="B102">2014</xref>). Thus, the fate of both the bacterium and the host cell is greatly determined by the inherent properties of each organism.</p>
<p>The outcome of a <italic>Legionella</italic>-protozoa interaction is not only influenced by their respective identities but the relative abundance of each organism. For instance, when <italic>L. pneumophila</italic> is present at low levels they are digested for nutrients by <italic>Tetrahymena</italic> sp. but when the bacteria reach a threshold concentration, they are packaged into vesicles and secreted in pellets (Berk et al., <xref ref-type="bibr" rid="B7">2008</xref>; Hojo et al., <xref ref-type="bibr" rid="B56">2012</xref>). The greater the number of bacteria present, the greater the production and secretion of these bacterial pellets. Similar packaging and secretion of other types of bacteria (Denoncourt et al., <xref ref-type="bibr" rid="B29">2014</xref>) suggests this may be a mechanism by which protozoa compensate for over-eating, or stock-pile food (Hojo et al., <xref ref-type="bibr" rid="B56">2012</xref>).</p>
<p>The external environment can have a profound effect on <italic>Legionella</italic>-protozoa interactions. For example, temperature can greatly impact the intracellular fate of <italic>L. pneumophila</italic>. Although, intracellular replication of <italic>L. pneumophila</italic> in <italic>A. castellanii</italic> occurs at a range of temperatures (Rowbotham, <xref ref-type="bibr" rid="B105">1981</xref>), intracellular growth is significantly reduced at lower temperatures (Ohno et al., <xref ref-type="bibr" rid="B96">2008</xref>). Within more restrictive hosts, such as <italic>A</italic>. <italic>polyphaga</italic>, intracellular replication only occurs at higher temperatures whereas below 25&#x000B0;C, <italic>L. pneumophila</italic> is readily consumed (Nagington and Smith, <xref ref-type="bibr" rid="B91">1980</xref>). In contrast, in <italic>Tetrahymena</italic> spp. <italic>L. pneumophila</italic> exhibits robust intracellular growth at 35&#x000B0;C (Fields et al., <xref ref-type="bibr" rid="B40">1984</xref>; Barbaree et al., <xref ref-type="bibr" rid="B5">1986</xref>; Kikuhara et al., <xref ref-type="bibr" rid="B69">1994</xref>) but at lower temperatures, <italic>L. pneumophila</italic> is packaged into vesicles and secreted into the environment (Faulkner et al., <xref ref-type="bibr" rid="B35">2008</xref>; Koubar et al., <xref ref-type="bibr" rid="B74">2011</xref>). The factors affecting intracellular growth of <italic>L. pneumophila</italic> are not mutually exclusive, as different combinations of the strain of <italic>L. pneumophila</italic>, the host cell type and temperature can significantly alter intracellular growth of the bacterium (Buse and Ashbolt, <xref ref-type="bibr" rid="B16">2011</xref>).</p>
<p>Much of the research examining <italic>Legionella</italic>-protozoa interactions has focused on specific bacterial-host pairings, which cannot address the impact of other organisms on these interactions. <italic>L. pneumophila</italic> naturally inhabits complex microbial communities, which could have both positive and negative impacts on <italic>L. pneumophila</italic> survival and population dynamics. For example, <italic>A</italic>. <italic>castellanii</italic> harboring the endosymbiont <italic>Neochlamydia S13</italic> are unable to support <italic>L. pneumophila</italic> replication despite efficient uptake and lack of degradation in the lysosome (Ishida et al., <xref ref-type="bibr" rid="B64">2014</xref>). The impact of <italic>Neochlamydia S13</italic> on <italic>L. pneumophila</italic> replication is specific because <italic>L. pneumophila</italic> is able to replicate in <italic>A</italic>. <italic>castellanii</italic> infected with the endosymbiont <italic>Protochlamydia R18</italic>. Moreover, curing <italic>A</italic>. <italic>castellanii</italic> of <italic>Neochlamyida S13</italic> restores intracellular growth of <italic>L. pneumophila</italic>, suggesting that the presence of the endosymbiont renders <italic>A</italic>. <italic>castellani</italic> resistant to <italic>L. pneumophila</italic> pathogenesis. In contrast, <italic>L. pneumophila</italic> has been shown to promote the intracellular growth of <italic>Brucella neotomae</italic> when the two pathogens share the same vacuole (Kang and Kirby, <xref ref-type="bibr" rid="B67">2017</xref>). While sharing resources does not appear to affect <italic>L. pneumophila</italic>, it is conceivable that <italic>L. pneumophila</italic> may similarly benefit from the activities of other bacteria when it finds itself in more restrictive protozoan hosts.</p>
</sec>
<sec id="s11">
<title>Future directions</title>
<p>A critical challenge in understanding the molecular mechanisms of <italic>L. pneumophila</italic> pathogenesis, evolution and environmental persistence is the staggering diversity of the protozoan hosts that support <italic>L. pneumophila</italic> replication. Indeed, such diversity is thought to be responsible for shaping <italic>L. pneumophila</italic> into a generalist pathogen with a broad host range&#x02014;a feature clearly important for pathogenesis in humans. Rather than having a single, defined &#x0201C;natural host,&#x0201D; <italic>L. pneumophila</italic> wanders from host to host and is constantly shaped by these disparate interactions. Such a lifestyle is a challenge for researchers studying these bacteria: (1) many protozoa remain poorly characterized, difficult to culture, and/or unsequenced; (2) the shear diversity of protozoa and complexity of natural interactions makes experimental analysis of phenotypes under &#x0201C;physiologically relevant&#x0201D; conditions extremely daunting (which hosts should be used and under what chemical and physical conditions should the interaction be studied?); and (3) how can non-binary interactions with mixed bacterial and host populations be examined in a reproducible and informative fashion? Given the importance of protozoa to <italic>L. pneumophila</italic> biology (and pathogen evolution in general), we strongly advocate efforts for the sequencing and detailed study of these organisms. While it is enticing to retreat to the comfort of studying <italic>Legionella</italic>-host interactions in mammalian macrophages and perhaps one or two model protozoa, an exciting, informative, frustrating, and messy reality remains largely unexplored. Perhaps once the diversity of bacterial-protozoan behaviors is better understood, a panel of model hosts could be chosen not based on ease of culture, but instead to capture the greatest breadth of this diversity.</p>
</sec>
<sec id="s12">
<title>Author contributions</title>
<p>TO, DB, AE, and GZ wrote the manuscript. GZ and AE generated the phylogenetic tree.</p>
<sec>
<title>Conflict of interest statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</sec>
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<ack><p>We thank Jason Park, Sara Rego, Soma Ghosh, and Mohammad Hossain for thoughtful review of the manuscript. This work was supported by the National Institutes of Health, Grant 1R21AI119580-01 (TO) and the Natural Sciences and Engineering Research Council of Canada, Grant RGPIN-2014-03641 (AE).</p>
</ack>
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