Potable water as a cause of sporadic cases of community-acquired legionnaires' disease.

BACKGROUND The environmental sources of sporadic, community-acquired legionnaires' disease are largely unknown, and culturing of water sources after identification of a case is currently not recommended. We conducted a prospective study of sporadic cases of community-acquired legionnaires' disease to determine whether the environmental reservoirs could be identified. METHODS We cultured samples of potable water obtained from sources to which each of 20 patients with culture-confirmed, community-acquired legionnaires' disease had been exposed during the two weeks before the onset of symptoms. Monoclonal-antibody subtyping and restriction-endonuclease analysis were performed on the legionella isolates recovered from both the patients and the associated environmental cultures. RESULTS For 8 of the 20 patients, isolates of Legionella pneumophila with identical subtypes were identified in cultures from both the patient and the potable water to which the patient had been exposed. The environmental reservoirs linked to the infections were the water supplies of two private residences, two nursing homes, two hospital outpatient clinics, and an industrial plant. CONCLUSIONS Potable-water supplies that harbor L. pneumophila are an important source of community-acquired legionnaires' disease. Future studies should include attempts to identify the environmental sources of this infection.

[1]  J. Alegre,et al.  Legionella pneumophila. A cause of severe community-acquired pneumonia. , 1991, Chest.

[2]  S. Fontecchio,et al.  Community-acquired bacterial pneumonia requiring admission to hospital. , 1983, American journal of infection control.

[3]  P W Muraca,et al.  Disinfection of water distribution systems for legionella: a review of application procedures and methodologies. , 1990, Infection control and hospital epidemiology.

[4]  L. Saravolatz,et al.  Reduction in Legionella pneumophila through heat flushing followed by continuous supplemental chlorination of hospital hot water. , 1990, The Journal of infectious diseases.

[5]  V. Yu,et al.  Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study. , 1983, JAMA.

[6]  R. Wadowsky,et al.  Effect of temperature, pH, and oxygen level on the multiplication of naturally occurring Legionella pneumophila in potable water , 1985, Applied and environmental microbiology.

[7]  R. Weaver,et al.  Detection of Legionnaires disease bacteria by direct immunofluorescent staining , 1978, Journal of clinical microbiology.

[8]  V. Yu,et al.  Manual of culture methodology for Legionella. , 1987, Seminars in respiratory infections.

[9]  W. Martin,et al.  Proliferation of Legionella pneumophila as an intracellular parasite of the ciliated protozoan Tetrahymena pyriformis , 1984, Applied and environmental microbiology.

[10]  R. Duncan,et al.  Investigation of Legionella pneumophila in Drinking Water , 1988 .

[11]  V. Yu,et al.  Legionnaires' disease in the work environment: implications for environmental health. , 1988, American Industrial Hygiene Association journal.

[12]  M. Delmée,et al.  Legionella spp. in a hospital hot water system: effect of control measures. , 1989, The Journal of hospital infection.

[13]  J. Joly.  Legionella and domestic water heaters in the Quebec City area. , 1985, Canadian Medical Association journal.

[14]  V. Yu,et al.  LEGIONELLACEAE IN THE HOSPITAL WATER-SUPPLY Epidemiological Link with Disease and Evaluation of a Method for Control of Nosocomial Legionnaires' Disease and Pittsburgh Pneumonia , 1983, The Lancet.

[15]  J. Bates.  Microbial Etiology of Pneumonia , 1989 .

[16]  J. Macfarlane,et al.  HOSPITAL STUDY OF ADULT COMMUNITY-ACQUIRED PNEUMONIA , 1982, The Lancet.

[17]  M. Para,et al.  Prevalence and significance of Legionella pneumophila contamination of residential hot-tap water systems. , 1985, The Journal of infectious diseases.

[18]  V L Yu,et al.  Ecology of Legionella pneumophila within water distribution systems , 1985, Applied and environmental microbiology.

[19]  M. Collins,et al.  Prevalence of Legionnaires' disease in pneumonia patients admitted to a Danish department of infectious diseases. , 1986, Scandinavian journal of infectious diseases.

[20]  D. Ramsay,et al.  Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies , 1986, Journal of clinical microbiology.

[21]  L. Tompkins,et al.  Molecular epidemiology of Legionella species by restriction endonuclease and alloenzyme analysis , 1987, Journal of clinical microbiology.

[22]  A. Nelson,et al.  INVESTIGATION AND CONTROL OF AN OUTBREAK OF LEGIONNAIRES' DISEASE IN A DISTRICT GENERAL HOSPITAL , 1981, The Lancet.

[23]  V. Yu,et al.  Factors predisposing to Legionella pneumophila colonization in residential water systems. , 1988, Archives of environmental health.

[24]  V L Yu,et al.  Determinants of Legionella pneumophila Contamination of Water Distribution Systems: 15-Hospital Prospective Study , 1987, Infection Control.