An Outbreak of Pontiac Fever Related to Whirlpool Use, Michigan 1982

Abstract

Fourteen of 23 female members of a church group experienced an acute self-limited illness characterized by chills, fever, chest pain, cough, and nausea, consistent with the diagnosis of Pontiac fever. All 14 affected women had used a whirlpool located in the women's locker room during a racquetball party. Legionella pneumophila serogroup 6 was isolated from the women's whirlpool. Nine of 14 cases showed a seroconversion to heat-fixed antigen prepared from the L pneumophila serogroup 6 isolate. Aerosol size studies show that the whirlpool aerator produced water droplets small enough to travel deep into the tracheobronchial tree but large enough to transport L pneumophila. This outbreak demonstrated that Pontiac fever may be associated with L pneumophila serogroup 6, that whirlpools can serve as a reservoir for these organisms, and that seroconversion can occur in the absence of illness.

First Sporadic Cases of Non-pneumonic Legionellosis, Pontiac Fever in Japan.

“…These findings indicated that both were sporadic community-acquiredcases but not epidemics. Here, wereported the first sporadic cases of Pontiac fever in Japan, although Pontiac fever has been found in many epidemics (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). It is important to recognize such cases associated with acute onset of high fever, and the late development of bilateral pleural effusion, which in the present cases, was not responsive to the typical antibiotic therapy.…”

“…Pontiac fever, non-pneumonic legionellosis has been found in many recent epidemics (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Girod et al discussed that not only epidemics but also sporadic cases of nonpneumonicillness mayrepresent a bridge between subclinical illness and pneumonia.…”

“…Pontiac fever has been associated with six species of Legionella, which arepneumophila serogroup 1 (1, 4-6, 16), 6 (7,9) and 7 (14), L. anisa (12), Lfeeleii (8), and L. micdadei ( 1 0, 1 1 ). Our serological findings suggested that seroconversions to L. pneumophila were detected in both cases with crossreactions (17) among L. serogroups but not L. species.…”

“…Legionnaires' disease, a severe pneumonicdisease affects not only elderly or immunocompromised individuals but also immunologically normal ones. On the other hand, Pontiac fever which is a selflimited influenza-like state without pneumonia, has been found in many recent epidemics (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). It has rarely been found in sporadic cases ( 1).…”

Public Whirlpools—The Epidemiology and Microbiology of Disease

“…Legionella pneumophila serogroup 6 was found to be the cause of t wo Pontiac lever outbreaks associated with whirlpools. 1 In one investigation, the duration of fever was directly related to length of exposure to the aerosols created bythe induced water turbulence of the whirlpool bath. Limited studies on aerosol particles generated in aerated water suggest the droplets in the air over a whirlpool are small enough (0.5 to 8.0 u.m) to be inhaled and reach the lungs; droplets of 2 u,m or larger could cany Legionella, if present.…”