Case of Legionnaires’ disease in a neonate following a home birth in a heated birthing pool, England, June 2014

“…Samples were analysed by the PHE Food, Water and Environmental Microbiology (FW&E) laboratories using a method based on ISO 11 731 and by a recently validated (ISO TS 12 869:2012) quantitative polymerase chain reaction (qPCR) method for Legionella species, L. pneumophila and L. pneumophila sg1 [11]. Elizabethkingia meningoseptica, an opportunistic pathogen that can cause infections in infants [14] was identified by culture and matrix-assisted laser desorption ionization-time of flight (MALDI-ToF) as the major contaminant [9]. Quantitative PCR testing revealed four samples to be L. pneumophila sg1 positive.…”

Section: Environmental Investigationmentioning

confidence: 99%

Heated birthing pools as a source of Legionnaires' disease

et al. 2015

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In June 2014 Public Health England confirmed a case of Legionnaires' disease (LD) in a neonate following birth at home in a hired birthing pool incorporating a heater and a recirculation pump which had been filled in advance of labour. The case triggered a public health investigation and a microbiological survey of an additional ten heated birthing pools hired or recently hired to the general public across England. The birthing pool used by the parent of the confirmed case was identified as the source of the neonate's infection following detection of Legionella pneumophila ST48 in both patient and environmental samples. Legionella species were detected by quantitative polymerase chain reaction but not culture in a further three pools together with other opportunistic pathogens identified by culture and matrix-assisted laser desorption ionization-time of flight (MALDI-ToF) mass spectrometry. A Patient Safety Alert from NHS England and Public Health England was issued stating that heated birthing pools filled in advance of labour should not be used for home births. This recommendation remains in place. This investigation in conjunction with other recent reports has highlighted a lack of awareness regarding the microbiological safety of heated birthing pools and their potential to be a source of LD and other opportunistic infections. Furthermore, the investigation raised important considerations with regards to microbiological sampling and testing in such incidents. Public health authorities and clinicians should consider LD in the differential diagnosis of severe respiratory infection in neonates within 14 days of a water birth.

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“…Series and single cases of ECLS for severe Legionella pneumonia in adult patients have been reported, 6-8 but, to our knowledge, only 1 case of ECMO support for neonatal Legionella infection is reported in the literature with no mention of outcome. 16 Query of the Extracorporeal Life Support Organization registry (1990-2014) identified 2 neonatal cases (9 and 17 days of life) and 2 infants with Legionella pneumonia supported with venovenous or venoarterial ECMO with no survivors. In the most recent retrospective study of 12 adult patients with Legionella pneumonia treated with VV-ECMO, 75% of patients were successfully weaned off ECLS, with 67% survival to discharge, 6 compared with 25% survival in a previous study of 8 confirmed cases.…”

Section: Figurementioning

confidence: 99%

Severe Neonatal Legionella Pneumonia: Full Recovery After Extracorporeal Life Support

et al. 2015

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Legionella pneumophila is responsible for hospital or community-acquired pneumonia. Neonatal legionellosis is associated with rapidly severe clinical course and high mortality rates. We describe a case of hospital-acquired Legionella pneumonia in a newborn with undiagnosed tracheoesophageal fistula and acute respiratory failure requiring venovenous extracorporeal membrane oxygenation support before fistula repair. Standardized multiplex polymerase chain reaction assay allowed early diagnosis. Extracorporeal life support associated with appropriate antibiotic therapy, surfactant, and steroid therapy was effective in achieving complete recovery. This is the first report of successful neonatal extracorporeal life support for respiratory failure secondary to L pneumophila.

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Case of Legionnaires’ disease in a neonate following a home birth in a heated birthing pool, England, June 2014

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Cited by 13 publications

References 6 publications

Evaluation ofLegionellareal-time PCR against traditional culture for routine and public health testing of water samples

Evaluation ofLegionellareal-time PCR against traditional culture for routine and public health testing of water samples

Heated birthing pools as a source of Legionnaires' disease

Severe Neonatal Legionella Pneumonia: Full Recovery After Extracorporeal Life Support

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