Exposure to Legionellaceae at a hot spring spa: a prospective clinical and serological study

Abstract

SUMMARYFollowing the occurrence of five cases of Legionnaires' disease among patients and therapists at a French hot spring spa, a series of cleansing procedures and an epidemiological study were undertaken. During a 3-month period, the spring water was repeatedly sampled. Serum samples were taken from 689 randomly selected patients, 230 therapists, 134 administrative staff and a control group of 904 blood donors.Legionellaceae were present in the spring water at concentrations of 103-105 colony forming units/l. Fifteen different species or serogroups were isolated with Legionella pneumophila serogroups 3 and 1 predominating. No clinical cases of Legionnaires disease were observed during the study. However, 11% of the therapists and 5 % of the patients either had a high titre of antibody ( > 256) to at least one species or serogroup or seroconverted during the study. Mean antibody titres in the three study groups were significantly higher than those in the blood donors against 11 of the 32 legionella antigens tested. Nine of these 11 antigens corresponded to species or serogroups isolated from the spring water. The highest mean antibody titres in all three study groups were against L. pneumophila serogroup 3, the most common legionella in the spring water.These findings have important implications for the maintenance of adequate standards of hygiene, bacteriological sampling and clinical surveillance in this and similar establishments.

Legionella Pneumonia due to Exposure to 24-hour Bath Water Contaminated by Legionella pneumophila Serogroup-5

“…However, strains of Legionella pneumophila other than serogroup-1 have also been reported to be the causative agents of Legionella pneumonia, the sources of infection with which seem to be the waters of hot spring spas (6,15). The reason for this difference in causative agents is considered to be differences in bacterial distribution in the environment (3,15,16).…”

Legionellosis linked with a hotel car park – how many were infected?

“…They include outbreaks associated with a hot spa [6], fountains [7], a grocery mist machine [8], hot water systems [9], whirlpool baths on a cruise ship [10] as well as evaporative condensers and cooling towers [11,12].…”

Hot Spring Bath and Legionella Pneumonia: An Association Confirmed by Genomic Identification.

“…Yabuuchi et al investigated the distribution of Legionella in Japanese hot spring spa water and reported that 84 (62%) of 135 hot springs investigated harbored the organism (21). Serological studies from France (22) and Portugal (23) showed that Legionella antibody titers were increased in persons whohad been exposed to hot spring spa water contaminated with the bacteria. Our result supports the circumstantial evidence that the patient was infected with L. pneumophila serogroup 6 and developed severe pneumoniafollowing aspiration of the hot spring spa water.…”