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Chapter 74 : Sporadic Community-Acquired Legionnaires' Disease and Contaminated Domestic Hot Water Supplies

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Sporadic Community-Acquired Legionnaires' Disease and Contaminated Domestic Hot Water Supplies, Page 1 of 2

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Abstract:

Domestic water supply, and particularly electric hot water systems, have been associated with colonization, and potential clinical implications have been suggested. In an effort to establish a link between sporadic legionellosis and hot water system colonization, patients hospitalized with documented sporadic community-acquired legionellosis (CAL) at Maisonneuve-Rosemont hospital in Montéral, Canada, were prospectively investigated. Only three culture-confirmed cases of CAL were established during the 30-month prospective epidemiological surveillance study. An epidemiological link between those patients' pneumonia and their contaminated home hot water tank was established in only one patient. The first water samples from this patient's home were obtained 45 days after the patient's admission to the hospital. Additional water samples from the hot water tank taken 14 weeks after the patient's admission showed a persistence in the system of the same isolate, underlying the long-term sustained colonization of contaminated hot water systems. Debilitation by chronic alcoholism and smoking, as well as recent plumbing repair and frequent exposures to aerosols generated from the shower head, likely played predominant physiopathological roles in the patient's acquisition of Legionnaires' disease. A study by the authors focused on severe CAL that required hospitalization and found a very low incidence linked to contaminated hot water tanks. Individual risk factors (i.e., smoking, age, chronic lung diseases) and immunoincompetence rather than environmental factors likely represent the major contributing factors in the acquisition of severe sporadic Legionnaires' disease.

Citation: Laverdière M, Habel F, Joly J, Bernier F, Riendeau G, DeCarolis E. 2002. Sporadic Community-Acquired Legionnaires' Disease and Contaminated Domestic Hot Water Supplies, p 360-363. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch74

Key Concept Ranking

Legionella pneumophila
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Water
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Figures

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FIGURE 1

Restriction endonuclease analysis of isolates from patient 2 and from his home water samples. Lane 1, DNA ladder; lane 2, patient's isolate: LP-1; lane 3, domestic hot water tank; lane 4, kitchen faucet; lane 5, bathroom faucet; lane 6, shower head (swab); lane 7, shower head (swab); lane 8, DNA ladder; lane 9, domestic hot water tank (1 month later); lane 10, LP-1 OLDA control no. 1 (Quebec City); lane 11, LP-1 OLDA control no. 2 (Québec City no. 2); lane 12, LP-1 OLDA control no. 3 (Pittsburgh); lane 13, LP-1 OLDA control no. 4 (Pittsburgh); lane 14, DNA ladder.

Citation: Laverdière M, Habel F, Joly J, Bernier F, Riendeau G, DeCarolis E. 2002. Sporadic Community-Acquired Legionnaires' Disease and Contaminated Domestic Hot Water Supplies, p 360-363. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch74
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References

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1. Alary, M.,, and J. R. Joly. 1991. Risk factors for contamination of domestic hot water systems by legionellae. Appl. Environ. Microbiol. 57:23602367.
2. Lee, T. C.,, J. E. Stout,, and V. L. Yu. 1988. Factors predisposing to Legionella pneumophila colonization in residential water systems. Arch. Environ. Health 43:5962.
3. Stout, J. E.,, V. L. Yu,, P. Muraca,, J. R. Joly,, N. Troup,, and L. S. Tompkins. 1992. Potable water as a cause of sporadic cases of community-acquired Legionnaires' disease. N. Engl. J. Med. 326:151155.
4. Straus, W. L.,, J. F. Plouffle,, T. M. File,, H. B. Lipman,, B. H. Hackman,, S. J. Salstrom,, R. F. Benson,, R. F. Breiman, and Ohio Legionnaires' Disease Group. 1996. Risk factors for domestic acquisition of Legionnaires'disease. Arch. Intern. Med. 156:16851692.
5. Tompkins, L. S.,, N.J. Troup,, T. Wood,, W. Bibb,, and R. M. McKinney. 1986. Molecular epidemiology of Legionella species by restriction endonuclease and alloenzymes analysis. J. Clin. Microbiol. 25:18751880.
6. Winn, W. C., 1999. Legionella, p. 572585. In P. R. Murray,, E. J. Baron,, M. A. Pfaller,, F. C. Tenover,, and R. H. Yolken (ed.), Manual of Clinical Microbiology, 7th ed. American Society for Microbiology, Washington, D.C.
7. Witherel, L. E.,, R. W. Duncan,, K. M. Stone,, L. J. Statton,, L. Orclari,, S. Kuppel,, and D. A. Jilson. 1988. Investigation of Legionella pneumophila in drinking water. Am. Water Works Assoc. J. 80:8793.
8. Yu, V. L. 1993. Could aspiration be the major mode of transmission for Legionella? Am. J. Med. 95:1315.

Tables

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TABLE 1

Culture results for from patients' lower respiratory tract secretions and domestic water samples from their respective residences

Citation: Laverdière M, Habel F, Joly J, Bernier F, Riendeau G, DeCarolis E. 2002. Sporadic Community-Acquired Legionnaires' Disease and Contaminated Domestic Hot Water Supplies, p 360-363. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch74
Generic image for table
TABLE 2

Distribution of species and serogroups isolated in water samples from 371 domestic hot water tanks

Citation: Laverdière M, Habel F, Joly J, Bernier F, Riendeau G, DeCarolis E. 2002. Sporadic Community-Acquired Legionnaires' Disease and Contaminated Domestic Hot Water Supplies, p 360-363. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch74

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