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Nosocomial legionella pneumonia: demonstration of potable water as the source of infection

Published online by Cambridge University Press:  15 May 2009

B. Ruf ,
D. Schürmann ,
I. Horbrach ,
K. Seodel  and
H. D. Pohle
B. Ruf
Affiliation:
II. Department of Internal Medicine, Rudolf Virchow University Hospital (Wedding), Freie Universität, Berlin, Federal Republic of Germany (FRG)
D. Schürmann
Affiliation:
II. Department of Internal Medicine, Rudolf Virchow University Hospital (Wedding), Freie Universität, Berlin, Federal Republic of Germany (FRG)
I. Horbrach
Affiliation:
Department of Microbiology, Robert Koch Institute, Federal Health Office, Berlin, FRG
K. Seodel
Affiliation:
Institute for Water, Soil and Air Hygiene, Federal Health Office, Berlin, FRG
H. D. Pohle
Affiliation:
II. Department of Internal Medicine, Rudolf Virchow University Hospital (Wedding), Freie Universität, Berlin, Federal Republic of Germany (FRG)
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From January 1983 until December 1985, 35 cases of sporadic nosocomial legionella pneumonia, all caused by Legionella pneumophila, were diagnosed in a university hospital. L. pneumophila serogroup (SG) 1 was cultured from 12 of the 35 cases and compared to corresponding L. pneumophila SG 1 isolates from water outlets in the patients' immediate environment by subtyping with monoclonal antibodies. The corresponding environmental isolates were identical to 9 out of 12 (75%) of those from the cases. However, even in the remaining three cases identical subtypes were found distributed throughout the hospital water supply. From the hospital water supply four different subtypes of L. pneumophila SG 1 were isolated, three of which were implicated in legionella pneumonia. Of 453 water samples taken during the study 298 (65.8%) were positive for legionellae. Species of Legionella other than L. pneumophila have not been isolated. This may explain the exclusiveness of L. pneumophila as the legionella pneumonia-causing agent. Our results suggest that the water supply system was the source of infection.

Type
Research Article
Information
Epidemiology & Infection , Volume 101 , Issue 3 , December 1988 , pp. 647 - 654
Copyright
Copyright © Cambridge University Press 1988

References

REFERENCES

Bartlett, C. L. R., Macrae, A. D. & Macfarlane, J. T. (1986) Environmental Sources of Infection and Modes of Transmission In Legionella Infections(eds. Bartlett, C. L. R., Macrae, A. D. & Macfarlane, J. T.), pp. 90–115. London: Edward Arnold.Google Scholar
Bartlett, C. L. R., Macrae, A. D. & Macfarlane, J. T. (1986b)Surveillance, Control and Prevention. In Legionella Infections (eds. Bartlett, C. L. R., Macrae, A. D. & Macfarlane, J. T.), pp. 120–147. London: Edward Arnold.Google Scholar
Bartlett, C. L. R., Macrae, A. D. & Macfarlane, J. T. (1986) Appendix: The Environmental Reservoir of Legionella. Potential Sources and Routes of Infection. In Legionella Infections (eds. Bartlett, C. L. R., Macrae, A. D. & Macfarlane, J. T.), pp. 151–154. London: Edward Arnold.Google Scholar
Badenoch, J., The Committee of Inquiry (1986). First report of the committee of inquiry into the outbreak of Legionnaires' disease in Stafford in April, 1985. London: Her Majesty's Stationery Office.Google Scholar
Broome, C. (1984) State of the art lecture. Current issues in epidemiology of legionellosis, 1983. In Legionella. Proceedings of the 2nd International Symposium (eds. Thornsberry, C., Balows, A., Feely, J. C. & Jakubowski, W.), pp. 294–296. Washington D.C.: American Society for Microbiology.Google Scholar
Cherry, W. B., Pittman, B., Harris, P. P., Hebert, G. A., Thomason, B. M., Thacker, L. & Weaver, R. E. (1978). Detection of Legionnaires' disease bacteria by direct immuno-fluorescent staining. Journal of Clinical Microbiology 8, 329–338.CrossRefGoogle Scholar
Dennis, P. J., Bartlett, C. L. R. & Wright, A. E. (1984) Compraison of isolation mcthods for Legionella spp. In Legionella. Proceedings fo the 2nd Interdnational Sysmposium (eds. Thornsberry, C., Balows, A., Feeley, J. C. & Jakubowski, W.). pp. 294–296. Washington D.C.: American Society for Microbiology.Google ScholarPubMed
Dennis, P. J., Green, D. & Jones, B. P. C. (1984). A note on the temperature tolerance of Legionella. Journal of Applied Bacteriology 56, 349–350.CrossRefGoogle ScholarPubMed
Edelstein, P. H. (1981). Improved semiselective medium for isolation of Legionella pneumophila from contaminated clinical and environmental specimens. Journal of Clinical Microbiology 14. 298–303.CrossRefGoogle ScholarPubMed
Edelstein, P. H. (1986). Control of Legionella in hospitals. Journal of Hospital Infection 8, 109–115.CrossRefGoogle ScholarPubMed
Edelstein, P. H.., Nakahama, C., Tobin, J. O., Calarco, K., Beer, K. B.., Jolly, J. R. & Selander, R. K. (1986). Paleoepidemiologic investigation of Legionnaires disease at Wadsworth veterans administration hospital by using three typing methods for comparision of legionellae from clinical and environmental sources. Journal of Clinical Microbiology 23, 1121–1126.CrossRefGoogle Scholar
Fehrenbach, F. J., Horbach, I., Ruf, B., Schurmann, D. & Pohle, H. D. (1986). Rapid detection of Legionella antigen in tissues and body fluids. Israel Journal of Medical Sciences 22, 706–710.Google ScholarPubMed
Garbe, P. L., Davis, B. J., Weisfeld, J. S., Markowitz, L., Miner, P., Garrity, F., Barbaree, J. M. & Reinggold, A. L. (1985). Nosocomial Legionnaires' disease: epidemiologic demonstration of cooling towers as a source. Journal of the American Medical Association 254. 521–524.CrossRefGoogle ScholarPubMed
Hanrahan, J. P., Morse, D. L., Scharf, V. B., Debbie, J. G., Schmid, G. P., Mckinney, R. M. & Shayegani, M. (1987). A community hospital outbreak of legionellosis. Transmission by potable hot water. American Journal of Epidemiology 125. 639–649.CrossRefGoogle ScholarPubMed
Johnson, J. T., Best, M. G., Goetz, A., WickerH., Yu H., Yu, V., L., Vickers, R. M., Wagner, R. & Woo, A. (1985). Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet ii, 298–300.CrossRefGoogle Scholar
Joly, J. R., Mckinney, R. M., Tobin, J. O., Bibb, W. F., Watkins, I. D. & Ramsay, D. (1986). Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. Journal of Clinical Microbiology 23, 768–771.CrossRefGoogle ScholarPubMed
Kohler, R. B., Winn, W. C. JR & Wheat, L. J. (1984). Onset and duration of urinary antigen excretion in Legionnaires' disease. Journal of Clinical Microbiology 20, 605–607.CrossRefGoogle ScholarPubMed
Massanari, R. M., Helms, C., Zeitler, R., Streed, S., Gilchrist, M., Hall, N., Hausler, W. Jr, Johnson, W., Wintermeyer, L., Muhs, J. S., Hierholzer, W. J. Jr, (1984) In Legionella. Proceedings of the 2nd International Symposium (eds. Thornsberry, C., Balows, A., Feeley, J. C. & Jakubowski, W.), pp. 334–336. Washington, D.C.: American Society for Microbiology.Google Scholar
Meenhorst, P. L., Reinggold, A. L., Groothuis, D. G., Gorman, G. W., Wilkinson, H. W., Mckinney, R. M., Feeley, J. C., Brenner, D. J. & VanFurth, R. (1985). Water-related nosocomial pneumonia caused by Legionella pneumophila serogroups 1 and 10. Journal of Infectious Diseases 152, 356–364.CrossRefGoogle ScholarPubMed
Muder, R. R., Yu, V. L., Mcclure, J. K., Kroboth, F. J., Kominos, S. D. & Lumish, R. M. (1983). Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study. Journal of the American Medical Association 23, 3184–3188.CrossRefGoogle Scholar
Muder, R. R., Yu, V. L., & Woo, A. H. (1986). Mode of transmission of Legionella pneumophila. Archives of Internal Medicine 146, 1607–1612.CrossRefGoogle ScholarPubMed
Neill, M. A., Gorman, G. W., Gilbert, C., Roussel, A. W., Hightower, A. W., Mckinney, R. M. & Broome, C. V. (1985). Nosocomial legionellosis, Paris, France. Evidence for transmission by potable water. American Journal of Medicine 78, 581–588.CrossRefGoogle ScholarPubMed
Parry, M. F., Stampleman, L. & Hutchinson, J. H. (1985). Waterborne Legionella bozemanii and nosocomial pneumonia in immunosuppressed patients. Annals of Internal Medicine 103. 205–210.CrossRefGoogle ScholarPubMed
Reingold, A. L., Thomason, B. M., Brake, B. J., Thacker, L., Wilkinson, H. W. & Kuritsky, J. N. (1984). Legionella pneumonia in the United States: the distribution of serogroups and species causing human illness. Journal of Infectious diseases 149. 819.CrossRefGoogle ScholarPubMed
Rudin, J. E. & Wing, E. J. (1986). Prospective study of pneumonia: L'nexpected incidence of legionellosis. Southern Medical Journal 79, 417–419.CrossRefGoogle ScholarPubMed
Ruf, B., Schurmann, D., Horbach, I., Fehrenbach, F. J. & Pohle, H. D. (1988). The incidence of legionellosis. A one-year prospective study in a large community hospital. Lung. In press.Google Scholar
Shands, K. N., Ho, J. L., Meyer, R. D., Gorman, G. W., Edelstein, P. H., Mallinson, G. F.., Finegolds, S. M. & Fraser, D. W. (1985). Potable water as a source of Legionnaires' disease. Journal of the American Medical Association 253, 1412–1416.CrossRefGoogle ScholarPubMed
Stout, J. E., Yu, V. L. & Best, M. G. (1985). Ecology of Legionella pneumophila within water distribution systems. Applied and Environmental Microbiology 49, 221–228.CrossRefGoogle ScholarPubMed
Timbury, M., Donaldson, J. R., Mccartney, A. C., Fallon, R. J., Sleigh, J. D., Lyon, D.., Orange, G. V.., Baird, D. R.., Winter, J. & Wilson, T. S. (1986). Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects. Journal of Hygiene 97. 393–403.CrossRefGoogle Scholar
Vu, V. L., Kroboth, F. J., Shonnard, J., Brown, A., Mcdearman, S. & Magnussen, M. (1982). Legionnaires' disease: new clinical perspective from a prospective pneumonia study. American Journal of Medicine 73. 357–361.Google Scholar
Wilkinson, H. (1987). Hospital laboratory diagnosis of Legionella infections. Atlanta. U.S.A.: Centers for Disease Control.Google Scholar