Skip to main content
PMC home page
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1993 Feb;110(1):105–116. doi: 10.1017/s0950268800050731

Outbreak of Legionnaires' disease at University Hospital, Nottingham. Epidemiology, microbiology and control.

A Colville 1, J Crowley 1, D Dearden 1, R C Slack 1, J V Lee 1
PMCID: PMC2271972  PMID: 8432314

Abstract

Twelve patients in a large teaching hospital contracted Legionnaires' disease over a period of 11 months. The source was a domestic hot water system in one of the hospital blocks, which was run at a temperature of 43 degrees C. Five different subtypes of Legionella pneumophila serogroup 1 have been isolated from water in different parts of the hospital, over a period of time. Only one subtype, Benidorm RFLP 14, was implicated in disease. Circumstantial evidence suggested that the outbreak may have been due to recent colonization of the hot water system with a virulent strain of Legionella pneumophila. The outbreak was controlled by raising the hot water temperature to 60 degrees C, but careful surveillance uncovered two further cases in the following 30 months. Persistent low numbers of Legionella pneumophila were isolated from the domestic hot water of wards where Legionnaires' disease had been contracted, until an electrolytic unit was installed releasing silver and copper ions into this supply.

Full text

PDF
105

Selected References

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

  1. Bartlett C. L., Kurtz J. B., Hutchison J. G., Turner G. C., Wright A. E. Legionella in hospital and hotel water supplies. Lancet. 1983 Dec 3;2(8362):1315–1315. doi: 10.1016/s0140-6736(83)91203-5. [DOI] [PubMed] [Google Scholar]
  2. Dennis P. J., Taylor J. A., Fitzgeorge R. B., Bartlett C. L., Barrow G. I. Legionella pneumophila in water plumbing systems. Lancet. 1982 Apr 24;1(8278):949–951. doi: 10.1016/s0140-6736(82)91944-4. [DOI] [PubMed] [Google Scholar]
  3. Dournon E., Bibb W. F., Rajagopalan P., Desplaces N., McKinney R. M. Monoclonal antibody reactivity as a virulence marker for Legionella pneumophila serogroup 1 strains. J Infect Dis. 1988 Mar;157(3):496–501. doi: 10.1093/infdis/157.3.496. [DOI] [PubMed] [Google Scholar]
  4. Dowling J. N., Saha A. K., Glew R. H. Virulence factors of the family Legionellaceae. Microbiol Rev. 1992 Mar;56(1):32–60. doi: 10.1128/mr.56.1.32-60.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ezzeddine H., Van Ossel C., Delmée M., Wauters G. Legionella spp. in a hospital hot water system: effect of control measures. J Hosp Infect. 1989 Feb;13(2):121–131. doi: 10.1016/0195-6701(89)90018-2. [DOI] [PubMed] [Google Scholar]
  6. Fischer-Hoch S. P., Smith M. G., Colbourne J. S. Legionella pneumophila in hospital hot water cylinders. Lancet. 1982 May 8;1(8280):1073–1073. doi: 10.1016/s0140-6736(82)92127-4. [DOI] [PubMed] [Google Scholar]
  7. Fisher-Hoch S. P., Bartlett C. L., Tobin J. O., Gillett M. B., Nelson A. M., Pritchard J. E., Smith M. G., Swann R. A., Talbot J. M., Thomas J. A. Investigation and control of an outbreaks of legionnaires' disease in a district general hospital. Lancet. 1981 Apr 25;1(8226):932–936. doi: 10.1016/s0140-6736(81)91626-3. [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. Macfarlane J. T., Finch R. G., Ward M. J., Macrae A. D. Hospital study of adult community-acquired pneumonia. Lancet. 1982 Jul 31;2(8292):255–258. doi: 10.1016/s0140-6736(82)90334-8. [DOI] [PubMed] [Google Scholar]
  11. Macrae A. D., Lewis M. J. Legionnaires' disease in Nottingham. Lancet. 1977 Dec 10;2(8050):1225–1226. doi: 10.1016/s0140-6736(77)90459-7. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Moiraghi Ruggenini A., Castellani Pastoris M., Dennis P. J., Barral C., Sciacovelli A., Carle F., Bolgiani M., Passarino G., Mingrone M. G., Passi C. Legionella pneumophila in a hospital in Torino, Italy. A retrospective one-year study. Epidemiol Infect. 1989 Feb;102(1):21–29. doi: 10.1017/s0950268800029642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. O'Mahony M. C., Stanwell-Smith R. E., Tillett H. E., Harper D., Hutchison J. G., Farrell I. D., Hutchinson D. N., Lee J. V., Dennis P. J., Duggal H. V. The Stafford outbreak of Legionnaires' disease. Epidemiol Infect. 1990 Jun;104(3):361–380. doi: 10.1017/s0950268800047385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Plouffe J. F., Para M. F., Maher W. E., Hackman B., Webster L. Subtypes of Legionella pneumophila serogroup 1 associated with different attack rates. Lancet. 1983 Sep 17;2(8351):649–650. doi: 10.1016/s0140-6736(83)92531-x. [DOI] [PubMed] [Google Scholar]
  16. Ribeiro C. D., Burge S. H., Palmer S. R., Tobin J. O., Watkins I. D. Legionella pneumophila in a hospital water system following a nosocomial outbreak: prevalence, monoclonal antibody subgrouping and effect of control measures. Epidemiol Infect. 1987 Jun;98(3):253–262. doi: 10.1017/s0950268800062002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ruf B., Schürmann D., Horbach I., Seidel K., Pohle H. D. Nosocomial legionella pneumonia: demonstration of potable water as the source of infection. Epidemiol Infect. 1988 Dec;101(3):647–654. doi: 10.1017/s0950268800029526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Saunders N. A., Harrison T. G., Haththotuwa A., Kachwalla N., Taylor A. G. A method for typing strains of Legionella pneumophila serogroup 1 by analysis of restriction fragment length polymorphisms. J Med Microbiol. 1990 Jan;31(1):45–55. doi: 10.1099/00222615-31-1-45. [DOI] [PubMed] [Google Scholar]
  19. 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]
  20. Tobin J. O., Beare J., Dunnill M. S., Fisher-Hoch S., French M., Mitchell R. G., Morris P. J., Muers M. F. Legionnaires' disease in a transplant unit: isolation of the causative agent from shower baths. Lancet. 1980 Jul 19;2(8186):118–121. doi: 10.1016/s0140-6736(80)90005-7. [DOI] [PubMed] [Google Scholar]
  21. Watkins I. D., Tobin J. O., Dennis P. J., Brown W., Newnham R., Kurtz J. B. Legionella pneumophila serogroup 1 subgrouping by monoclonal antibodies--an epidemiological tool. J Hyg (Lond) 1985 Oct;95(2):211–216. doi: 10.1017/s0022172400062641. [DOI] [PMC free article] [PubMed] [Google Scholar]

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

RESOURCES