A Case of Legionnaires' Disease Caused by Aspiration of Ice Water

Abstract

The authors discuss the case of a 79-year-old patient who suffered from a swallowing disorder and developed Legionnaires' disease 2 days after her dismissal from an orthopedics ward, where she had recovered from hip surgery. To determine the source of the Legionnaires' disease, the authors performed an environmental investigation, which included a national, standardized questionnaire and a microbiological investigation of suspected sources. The investigation revealed ice from an ice-making machine in the hospital as the most probable source of the infection through aspiration, even though the hospital had rigorously adhered to strict assessment and decontamination schedules. The infectious serogroup was one that was not common to the area. From the data available, the authors inferred that a dose of 1-2000 colony-forming units might have caused Legionnaires' disease in this patient.

Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations

“…Aspiration of water containing Legionella has also been suggested to be a common transmission route (102), although the frequency with which this occurs is unclear. Reports have suggested that immunocompromised patients in health care settings may be at risk from contaminated respiratory equipment (103)(104)(105)(106)(107)(108); in these specific instances, the use of sterile potable water may be advised (109)(110)(111).…”

Aetiology, source and prevention of waterborne healthcare-associated infections: a review

“…Legionella typing was performed in 33 out of 47 articles (72.3 %), mainly by PFGE (Venezia et al , 1994; Marrie et al , 1995; Mermel et al , 1995; Chang et al , 1996; Green et al , 1996; Lück et al , 1998; Campins et al , 2000; Knirsch et al , 2000; Trübel et al , 2002; Levy et al , 2003; Torii et al , 2003; Ozerol et al , 2006; Gudiol et al , 2007; Brûlet et al , 2008; Palmore et al , 2009) and amplified fragment length polymorphism (Campins et al , 2000; Jonas et al , 2000; Perola et al , 2002a; Bencini et al , 2005; Johansson et al , 2006; Fendukly et al , 2007; Mencacci et al , 2011). Other DNA fragment-based methods such as randomly amplified polymorphic DNA (Hoebe et al , 1998; Trübel et al , 2002; Perola et al , 2002a), restriction enzyme analysis (Lück et al , 1994; Bangsborg et al , 1995; Jonas et al , 2000), arbitrarily primed PCR (Berthelot et al , 1998; Jonas et al , 2000) and RFLP (Darelid et al , 1994) were less frequently reported.…”

Airborne Legionella bacteria from pulp waste treatment plant: aerosol particles characterized as aggregates and their potential hazard

“…Immunosuppressive patients would probably be infected at even lower doses (Bauer et al 2008). Bencini et al (2005) estimated an infective dose of 1-2,000 CFU causing Legionnaires' disease in an elderly patient. Furthermore, the aerosol infectious dose of L. pneumophila is strain dependent (Dennis and Lee 1988;Jepras et al 1985), where doses of 10 3 -10 6 viable cells are reported.…”