Pontiac fever due to Legionella micdadei from a whirlpool spa: possible role of bacterial endotoxin.

During January 1998, a cluster of illnesses occurred among hotel guests in Wisconsin. Ill persons had been exposed to the hotel's whirlpool spa and swimming pool. Symptoms included headache, fever, chills, myalgia, shortness of breath, and fatigue. A diagnosis of Pontiac fever was made, based on serologic evidence of acute infection with Legionella micdadei. High concentrations of heterotrophic bacteria were recovered from the spa, despite apparently high disinfectant levels. L. micdadei was isolated from the swimming pool filter and water from the spa after heat enrichment but not from pools and spas at nearby hotels. Water from hotel pools and spas was tested to determine endotoxin levels; water from the spa of the implicated hotel contained the highest concentration of endotoxin (14,400 endotoxin units/mL). Additional studies are needed to determine the role of endotoxin from legionellae or other bacteria in the pathogenesis of Pontiac fever.

[1]  M. Kuusi,et al.  A whirlpool associated outbreak of Pontiac fever at a hotel in Northern Sweden , 2001, Epidemiology and Infection.

[2]  J. Mccammon,et al.  "Lifeguard lung": endemic granulomatous pneumonitis in an indoor swimming pool. , 1998, American journal of public health.

[3]  H. Northoff,et al.  Low Endotoxic Potential of Legionella pneumophilaLipopolysaccharide due to Failure of Interaction with the Monocyte Lipopolysaccharide Receptor CD14 , 1998, Infection and Immunity.

[4]  M. Faber,et al.  An outbreak of Pontiac fever among children following use of a whirlpool. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  H. Northoff,et al.  Low endotoxic potential of Legionella pneumophila lipopolysaccharide due to failure of interaction with the monocyte lipopolysaccharide receptor CD14. , 1998, Infection and immunity.

[6]  P. Enright,et al.  Cross-sectional follow-up of a flu-like respiratory illness among fiberglass manufacturing employees: endotoxin exposure associated with two distinct sequelae. , 1995, American journal of industrial medicine.

[7]  J. Butler,et al.  Use of polymerase chain reaction in an epidemiologic investigation of Pontiac fever. , 1993, The Journal of infectious diseases.

[8]  R. Breiman,et al.  Incubation of water samples containing amoebae improves detection of legionellae by the culture method , 1992, Applied and environmental microbiology.

[9]  J. Barbaree,et al.  Virulence of a Legionella anisa strain associated with Pontiac fever: an evaluation using protozoan, cell culture, and guinea pig models , 1990, Infection and immunity.

[10]  P. Collier,et al.  LOCHGOILHEAD FEVER: OUTBREAK OF NON-PNEUMONIC LEGIONELLOSIS DUE TO LEGIONELLA MICDADEI , 1989, The Lancet.

[11]  A. Schwartz,et al.  Lack of antibodies to Legionella pneumophila and Legionella micdadei in hemodialysis patients. , 1989, Scandinavian journal of urology and nephrology.

[12]  Remillard Jf,et al.  Quantitation of endotoxin in products using the LAL kinetic turbidimetric assay. , 1987 .

[13]  T. Novitsky,et al.  Quantitation of endotoxin in products using the LAL kinetic turbidimetric assay. , 1987, Progress in clinical and biological research.

[14]  L A Herwaldt,et al.  A new Legionella species, Legionella feeleii species nova, causes Pontiac fever in an automobile plant. , 1984, Annals of internal medicine.

[15]  J. Feeley,et al.  Pontiac fever: isolation of the etiologic agent (Legionella pneumophilia) and demonstration of its mode of transmission. , 1981, American journal of epidemiology.

[16]  C. Broome,et al.  Validation of Legionella pneumophila indirect immunofluorescence assay with epidemic sera , 1981, Journal of clinical microbiology.

[17]  A. Sovijärvi,et al.  [An epidemic of bath-water fever--endotoxin alveolitis?]. , 1981, Duodecim; laaketieteellinen aikakauskirja.

[18]  T. Rowbotham.  PONTIAC FEVER EXPLAINED? , 1980, The Lancet.

[19]  R. Rylander,et al.  ENDOTOXIN AND BATH-WATER FEVER , 1980, The Lancet.

[20]  J. Fink,et al.  Hypersensitivity pneumonitis and Legionnaires' disease. , 1980, The American review of respiratory disease.