Skip to main content
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1988 Dec;101(3):647–654. doi: 10.1017/s0950268800029526

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

B Ruf 1, D Schürmann 1, I Horbach 1, K Seidel 1, H D Pohle 1
PMCID: PMC2249416  PMID: 3215293

Abstract

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.

Full text

PDF
647

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cherry W. B., Pittman B., Harris P. P., Hebert G. A., Thomason B. M., Thacker L., Weaver R. E. Detection of Legionnaires disease bacteria by direct immunofluorescent staining. J Clin Microbiol. 1978 Sep;8(3):329–338. doi: 10.1128/jcm.8.3.329-338.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Dennis P. J., Green D., Jones B. P. A note on the temperature tolerance of Legionella. J Appl Bacteriol. 1984 Apr;56(2):349–350. doi: 10.1111/j.1365-2672.1984.tb01359.x. [DOI] [PubMed] [Google Scholar]
  3. Edelstein P. H. Improved semiselective medium for isolation of Legionella pneumophila from contaminated clinical and environmental specimens. J Clin Microbiol. 1981 Sep;14(3):298–303. doi: 10.1128/jcm.14.3.298-303.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Edelstein P. H., Nakahama C., Tobin J. O., Calarco K., Beer K. B., Joly J. R., Selander R. K. Paleoepidemiologic investigation of Legionnaires disease at Wadsworth Veterans Administration Hospital by using three typing methods for comparison of legionellae from clinical and environmental sources. J Clin Microbiol. 1986 Jun;23(6):1121–1126. doi: 10.1128/jcm.23.6.1121-1126.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fehrenbach F. J., Horbach I., Ruf B., Shurmann D., Pohle H. D. Rapid detection of Legionella antigen in tissues and body fluids. Isr J Med Sci. 1986 Oct;22(10):706–710. [PubMed] [Google Scholar]
  6. Garbe P. L., Davis B. J., Weisfeld J. S., Markowitz L., Miner P., Garrity F., Barbaree J. M., Reingold A. L. Nosocomial Legionnaires' disease. Epidemiologic demonstration of cooling towers as a source. JAMA. 1985 Jul 26;254(4):521–524. doi: 10.1001/jama.254.4.521. [DOI] [PubMed] [Google Scholar]
  7. Hanrahan J. P., Morse D. L., Scharf V. B., Debbie J. G., Schmid G. P., McKinney R. M., Shayegani M. A community hospital outbreak of legionellosis. Transmission by potable hot water. Am J Epidemiol. 1987 Apr;125(4):639–649. doi: 10.1093/oxfordjournals.aje.a114577. [DOI] [PubMed] [Google Scholar]
  8. Johnson J. T., Yu V. L., Best M. G., Vickers R. M., Goetz A., Wagner R., Wicker H., Woo A. Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet. 1985 Aug 10;2(8450):298–300. doi: 10.1016/s0140-6736(85)90349-6. [DOI] [PubMed] [Google Scholar]
  9. Joly J. R., McKinney R. M., Tobin J. O., Bibb W. F., Watkins I. D., Ramsay D. Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. J Clin Microbiol. 1986 Apr;23(4):768–771. doi: 10.1128/jcm.23.4.768-771.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kohler R. B., Winn W. C., Jr, Wheat L. J. Onset and duration of urinary antigen excretion in Legionnaires disease. J Clin Microbiol. 1984 Oct;20(4):605–607. doi: 10.1128/jcm.20.4.605-607.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Meenhorst P. L., Reingold A. L., Groothuis D. G., Gorman G. W., Wilkinson H. W., McKinney R. M., Feeley J. C., Brenner D. J., van Furth R. Water-related nosocomial pneumonia caused by Legionella pneumophila serogroups 1 and 10. J Infect Dis. 1985 Aug;152(2):356–364. doi: 10.1093/infdis/152.2.356. [DOI] [PubMed] [Google Scholar]
  12. Muder R. R., Yu V. L., McClure J. K., Kroboth F. J., Kominos S. D., Lumish R. M. Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study. JAMA. 1983 Jun 17;249(23):3184–3188. [PubMed] [Google Scholar]
  13. Muder R. R., Yu V. L., Woo A. H. Mode of transmission of Legionella pneumophila. A critical review. Arch Intern Med. 1986 Aug;146(8):1607–1612. [PubMed] [Google Scholar]
  14. Neill M. A., Gorman G. W., Gibert C., Roussel A., Hightower A. W., McKinney R. M., Broome C. V. Nosocomial legionellosis, Paris, France. Evidence for transmission by potable water. Am J Med. 1985 Apr;78(4):581–588. doi: 10.1016/0002-9343(85)90399-7. [DOI] [PubMed] [Google Scholar]
  15. Parry M. F., Stampleman L., Hutchinson J. H., Folta D., Steinberg M. G., Krasnogor L. J. Waterborne Legionella bozemanii and nosocomial pneumonia in immunosuppressed patients. Ann Intern Med. 1985 Aug;103(2):205–210. doi: 10.7326/0003-4819-103-2-205. [DOI] [PubMed] [Google Scholar]
  16. Reingold A. L., Thomason B. M., Brake B. J., Thacker L., Wilkinson H. W., Kuritsky J. N. Legionella pneumonia in the United States: the distribution of serogroups and species causing human illness. J Infect Dis. 1984 May;149(5):819–819. doi: 10.1093/infdis/149.5.819. [DOI] [PubMed] [Google Scholar]
  17. Rudin J. E., Wing E. J. Prospective study of pneumonia: unexpected incidence of legionellosis. South Med J. 1986 Apr;79(4):417–419. doi: 10.1097/00007611-198604000-00007. [DOI] [PubMed] [Google Scholar]
  18. Shands K. N., Ho J. L., Meyer R. D., Gorman G. W., Edelstein P. H., Mallison G. F., Finegold S. M., Fraser D. W. Potable water as a source of Legionnaires' disease. JAMA. 1985 Mar 8;253(10):1412–1416. [PubMed] [Google Scholar]
  19. Stout J. E., Yu V. L., Best M. G. Ecology of Legionella pneumophila within water distribution systems. Appl Environ Microbiol. 1985 Jan;49(1):221–228. doi: 10.1128/aem.49.1.221-228.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Timbury M. C., 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. Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects. J Hyg (Lond) 1986 Dec;97(3):393–403. doi: 10.1017/s0022172400063580. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Yu V. L., Kroboth F. J., Shonnard J., Brown A., McDearman S., Magnussen M. Legionnaires' disease: new clinical perspective from a prospective pneumonia study. Am J Med. 1982 Sep;73(3):357–361. [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES