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Outbreak of Legionnaires' disease on a cruise ship linked to spa-bath filter stones contaminated with Legionella pneumophila serogroup 5

Published online by Cambridge University Press:  05 September 2005

F. KURA ,
J. AMEMURA-MAEKAWA ,
K. YAGITA ,
T. ENDO ,
M. IKENO ,
H. TSUJI ,
M. TAGUCHI ,
K. KOBAYASHI ,
E. ISHII  and
H. WATANABE
F. KURA
Affiliation:
Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan
J. AMEMURA-MAEKAWA
Affiliation:
Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan
K. YAGITA
Affiliation:
Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
T. ENDO
Affiliation:
Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
M. IKENO
Affiliation:
Department of infectious Diseases, Hyogo Prefectural Institute of Public Health and Environmental Sciences, Kobe, Japan
H. TSUJI
Affiliation:
Department of infectious Diseases, Hyogo Prefectural Institute of Public Health and Environmental Sciences, Kobe, Japan
M. TAGUCHI
Affiliation:
Department of infectious Diseases, Osaka Prefectural Institute of Public Health, Osaka, Japan
K. KOBAYASHI
Affiliation:
Department of infectious Diseases, Osaka Prefectural Institute of Public Health, Osaka, Japan
E. ISHII
Affiliation:
Department of Microbiology, Osaka City Institute of Public Health and Environmental Sciences, Osaka, Japan
H. WATANABE
Affiliation:
Department of Bacteriology, National Institute of Infectious Diseases, Tokyo, Japan
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Abstract

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In January 2003, two cases of Legionnaires' disease associated with a ship's cruise were registered in the database of National Epidemiological Surveillance of Infectious Diseases. A 70-year-old male heavy smoker with mild emphysema contracted the disease during a cruise. Legionella pneumophila serogroup (sg) 5 was isolated from the patient's sputum and the ship's indoor spa. The isolate from the spa matched the patient's isolate by genotyping performed by pulsed-field gel electrophoresis (PFGE). The second case was in a 73-year-old female. During epidemiological investigation, a third case of Legionnaire's disease in a 71-year-old male was subsequently diagnosed among passengers on the same ship on the following cruise. Environmental investigation revealed that porous natural stones (Maifanshi) in the filters of the spas had harboured L. pneumophila, a phenomenon which has not been reported except in Japan. This is the first documented evidence of L. pneumophila sg 5 infection on a ship and of porous stones as a source of Legionella infection.

Type
Research Article
Information
Epidemiology & Infection , Volume 134 , Issue 2 , April 2006 , pp. 385 - 391
Copyright
2005 Cambridge University Press