Skip to main content
NCBI home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1997 Jul;35(7):1800–1804. doi: 10.1128/jcm.35.7.1800-1804.1997

The role of arbitrarily primed PCR in identifying the source of an outbreak of Legionnaires' disease.

C G Whitney 1, J Hofmann 1, J M Pruckler 1, R F Benson 1, B S Fields 1, U Bandyopadhyay 1, E F Donnally 1, C Giorgio-Almonte 1, L A Mermel 1, S Boland 1, B T Matyas 1, R F Breiman 1
PMCID: PMC229845  PMID: 9196197

Abstract

An outbreak of community-acquired Legionnaires' disease (LD) occurred in Providence, R.I., in fall 1993. To find the outbreak source, exposures of 17 case patients were compared to those of 33 matched controls. Case patients were more likely than controls to have visited a section of downtown (area A) during the 2 weeks before illness (11 [65%] versus 9 [27%]; matched odds ratio, 6.5; P = 0.01). Water samples were cultured from 27 aerosol-producing devices within area A. Legionella pneumophila serogroup 1 isolates underwent monoclonal antibody (MAb) subtyping and arbitrarily primed PCR (AP-PCR). All four L. pneumophila serogroup 1 isolates available from case patients who visited area A had identical MAb and AP-PCR patterns. Among 14 environmental isolates, 5 had MAb patterns that matched the case patient isolates, but only 1 had a matching AP-PCR pattern. This investigation implicates a cooling tower in area A as the outbreak source and illustrates the usefulness of AP-PCR for identifying sources of LD outbreaks.

Full Text

The Full Text of this article is available as a PDF (358.6 KB).

Selected References

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

  1. Addiss D. G., Davis J. P., LaVenture M., Wand P. J., Hutchinson M. A., McKinney R. M. Community-acquired Legionnaires' disease associated with a cooling tower: evidence for longer-distance transport of Legionella pneumophila. Am J Epidemiol. 1989 Sep;130(3):557–568. doi: 10.1093/oxfordjournals.aje.a115370. [DOI] [PubMed] [Google Scholar]
  2. Aguero-Rosenfeld M. E., Edelstein P. H. Retrospective evaluation of the Du Pont radioimmunoassay kit for detection of Legionella pneumophila serogroup 1 antigenuria in humans. J Clin Microbiol. 1988 Sep;26(9):1775–1778. doi: 10.1128/jcm.26.9.1775-1778.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Barbaree J. M., Gorman G. W., Martin W. T., Fields B. S., Morrill W. E. Protocol for sampling environmental sites for legionellae. Appl Environ Microbiol. 1987 Jul;53(7):1454–1458. doi: 10.1128/aem.53.7.1454-1458.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Benson R. F., Thacker W. L., Daneshvar M. I., Brenner D. J. Legionella waltersii sp. nov. and an unnamed Legionella genomospecies isolated from water in Australia. Int J Syst Bacteriol. 1996 Jul;46(3):631–634. doi: 10.1099/00207713-46-3-631. [DOI] [PubMed] [Google Scholar]
  5. Blatt S. P., Parkinson M. D., Pace E., Hoffman P., Dolan D., Lauderdale P., Zajac R. A., Melcher G. P. Nosocomial Legionnaires' disease: aspiration as a primary mode of disease acquisition. Am J Med. 1993 Jul;95(1):16–22. doi: 10.1016/0002-9343(93)90227-g. [DOI] [PubMed] [Google Scholar]
  6. Breiman R. F., Cozen W., Fields B. S., Mastro T. D., Carr S. J., Spika J. S., Mascola L. Role of air sampling in investigation of an outbreak of legionnaires' disease associated with exposure to aerosols from an evaporative condenser. J Infect Dis. 1990 Jun;161(6):1257–1261. doi: 10.1093/infdis/161.6.1257. [DOI] [PubMed] [Google Scholar]
  7. Breiman R. F., Fields B. S., Sanden G. N., Volmer L., Meier A., Spika J. S. Association of shower use with Legionnaires' disease. Possible role of amoebae. JAMA. 1990 Jun 6;263(21):2924–2926. [PubMed] [Google Scholar]
  8. Cordes L. G., Fraser D. W., Skaliy P., Perlino C. A., Elsea W. R., Mallison G. F., Hayes P. S. Legionnaires' disease outbreak at an Atlanta, Georgia, Country Club: evidence for spread from an evaporative condenser. Am J Epidemiol. 1980 Apr;111(4):425–431. doi: 10.1093/oxfordjournals.aje.a112917. [DOI] [PubMed] [Google Scholar]
  9. Dondero T. J., Jr, Rendtorff R. C., Mallison G. F., Weeks R. M., Levy J. S., Wong E. W., Schaffner W. An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower. N Engl J Med. 1980 Feb 14;302(7):365–370. doi: 10.1056/NEJM198002143020703. [DOI] [PubMed] [Google Scholar]
  10. Fenstersheib M. D., Miller M., Diggins C., Liska S., Detwiler L., Werner S. B., Lindquist D., Thacker W. L., Benson R. F. Outbreak of Pontiac fever due to Legionella anisa. Lancet. 1990 Jul 7;336(8706):35–37. doi: 10.1016/0140-6736(90)91532-f. [DOI] [PubMed] [Google Scholar]
  11. 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]
  12. Gomez-Lus P., Fields B. S., Benson R. F., Martin W. T., O'Connor S. P., Black C. M. Comparison of arbitrarily primed polymerase chain reaction, ribotyping, and monoclonal antibody analysis for subtyping Legionella pneumophila serogroup 1. J Clin Microbiol. 1993 Jul;31(7):1940–1942. doi: 10.1128/jcm.31.7.1940-1942.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. 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]
  14. Hoge C. W., Breiman R. F. Advances in the epidemiology and control of Legionella infections. Epidemiol Rev. 1991;13:329–340. doi: 10.1093/oxfordjournals.epirev.a036076. [DOI] [PubMed] [Google Scholar]
  15. Jernigan D. B., Hofmann J., Cetron M. S., Genese C. A., Nuorti J. P., Fields B. S., Benson R. F., Carter R. J., Edelstein P. H., Guerrero I. C. Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa. Lancet. 1996 Feb 24;347(9000):494–499. doi: 10.1016/s0140-6736(96)91137-x. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. Keller D. W., Hajjeh R., DeMaria A., Fields B. S., Pruckler J. M., Benson R. S., Kludt PE Lett S. M., Mermel L. A., Giorgio C., Breiman R. F. Community outbreak of Legionnaires' disease: an investigation confirming the potential for cooling towers to transmit Legionella species. Clin Infect Dis. 1996 Feb;22(2):257–261. doi: 10.1093/clinids/22.2.257. [DOI] [PubMed] [Google Scholar]
  18. Kohler R. B., Wheat L. J., French M. L., Meenhorst P. L., Winn W. C., Jr, Edelstein P. H. Cross-reactive urinary antigens among patients infected with Legionella pneumophila serogroups 1 and 4 and the Leiden 1 strain. J Infect Dis. 1985 Nov;152(5):1007–1012. doi: 10.1093/infdis/152.5.1007. [DOI] [PubMed] [Google Scholar]
  19. Mahoney F. J., Hoge C. W., Farley T. A., Barbaree J. M., Breiman R. F., Benson R. F., McFarland L. M. Communitywide outbreak of Legionnaires' disease associated with a grocery store mist machine. J Infect Dis. 1992 Apr;165(4):736–739. doi: 10.1093/infdis/165.4.xxxx. [DOI] [PubMed] [Google Scholar]
  20. Mangione E. J., Remis R. S., Tait K. A., McGee H. B., Gorman G. W., Wentworth B. B., Baron P. A., Hightower A. W., Barbaree J. M., Broome C. V. An outbreak of Pontiac fever related to whirlpool use, Michigan 1982. JAMA. 1985 Jan 25;253(4):535–539. [PubMed] [Google Scholar]
  21. Marston B. J., Lipman H. B., Breiman R. F. Surveillance for Legionnaires' disease. Risk factors for morbidity and mortality. Arch Intern Med. 1994 Nov 14;154(21):2417–2422. [PubMed] [Google Scholar]
  22. Martin D., Austin H. An efficient program for computing conditional maximum likelihood estimates and exact confidence limits for a common odds ratio. Epidemiology. 1991 Sep;2(5):359–362. doi: 10.1097/00001648-199109000-00008. [DOI] [PubMed] [Google Scholar]
  23. Miller L. A., Beebe J. L., Butler J. C., Martin W., Benson R., Hoffman R. E., Fields B. S. Use of polymerase chain reaction in an epidemiologic investigation of Pontiac fever. J Infect Dis. 1993 Sep;168(3):769–772. doi: 10.1093/infdis/168.3.769. [DOI] [PubMed] [Google Scholar]
  24. Nichol K. L., Parenti C. M., Johnson J. E. High prevalence of positive antibodies to Legionella pneumophila among outpatients. Chest. 1991 Sep;100(3):663–666. doi: 10.1378/chest.100.3.663. [DOI] [PubMed] [Google Scholar]
  25. Plouffe J. F., File T. M., Jr, Breiman R. F., Hackman B. A., Salstrom S. J., Marston B. J., Fields B. S. Reevaluation of the definition of Legionnaires' disease: use of the urinary antigen assay. Community Based Pneumonia Incidence Study Group. Clin Infect Dis. 1995 May;20(5):1286–1291. doi: 10.1093/clinids/20.5.1286. [DOI] [PubMed] [Google Scholar]
  26. Pruckler J. M., Mermel L. A., Benson R. F., Giorgio C., Cassiday P. K., Breiman R. F., Whitney C. G., Fields B. S. Comparison of Legionella pneumophila isolates by arbitrarily primed PCR and pulsed-field gel electrophoresis: analysis from seven epidemic investigations. J Clin Microbiol. 1995 Nov;33(11):2872–2875. doi: 10.1128/jcm.33.11.2872-2875.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. 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]
  28. Sanden G. N., Cassiday P. K., Barbaree J. M. Rapid immunodot technique for identifying Bordetella pertussis. J Clin Microbiol. 1993 Jan;31(1):170–172. doi: 10.1128/jcm.31.1.170-172.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Schoonmaker D., Heimberger T., Birkhead G. Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishing Legionella pneumophila isolates obtained during a nosocomial outbreak. J Clin Microbiol. 1992 Jun;30(6):1491–1498. doi: 10.1128/jcm.30.6.1491-1498.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Spitalny K. C., Vogt R. L., Orciari L. A., Witherell L. E., Etkind P., Novick L. F. Pontiac fever associated with a whirlpool spa. Am J Epidemiol. 1984 Dec;120(6):809–817. doi: 10.1093/oxfordjournals.aje.a113953. [DOI] [PubMed] [Google Scholar]
  31. Wilkinson H. W., Reingold A. L., Brake B. J., McGiboney D. L., Gorman G. W., Broome C. V. Reactivity of serum from patients with suspected legionellosis against 29 antigens of legionellaceae and Legionella-like organisms by indirect immunofluorescence assay. J Infect Dis. 1983 Jan;147(1):23–31. doi: 10.1093/infdis/147.1.23. [DOI] [PubMed] [Google Scholar]
  32. Yu V. L. Could aspiration be the major mode of transmission for Legionella? Am J Med. 1993 Jul;95(1):13–15. doi: 10.1016/0002-9343(93)90226-f. [DOI] [PubMed] [Google Scholar]
  33. van Belkum A., Struelens M., Quint W. Typing of Legionella pneumophila strains by polymerase chain reaction-mediated DNA fingerprinting. J Clin Microbiol. 1993 Aug;31(8):2198–2200. doi: 10.1128/jcm.31.8.2198-2200.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES