Legionnaires’ disease after using an industrial pressure test pump: a case report

Abstract

IntroductionLegionnaires’ disease is an acute pneumonia caused by inhalation or aspiration of aerosols contaminated with Legionella bacteria. The majority (>90%) of Legionnaires’ disease cases are caused by the species Legionella pneumophila, and about 85% more specifically by L. pneumophila serogroup 1 that can be detected by a fast and easy to perform urinary antigen test. Previously reported sources of infection include cooling towers, plumbing systems of hospitals, and whirlpool spas, but for the majority of cases of Legionnaires’ disease the source of infection remains unknown.Case presentationA 52-year-old Caucasian man was admitted to a Dutch hospital with pneumonia, where a culture of the available bronchial lavage was found positive for L. pneumophila serogroup 3, confirming the diagnosis of Legionnaires’ disease. An environmental investigation identified a manually operated pressure test pump at the metal processing company where he worked as the source of infection: the water sample from the pump contained 9·8×103 colony forming units/L L. pneumophila, and sequence-based typing showed the same sequence type (ST93) for both the clinical and environmental strains.ConclusionThis case shows that Legionnaires’ disease can be acquired by exposure to relatively rare sources that are not considered in regular control and prevention measures.

Confirmed and Potential Sources of Legionella Reviewed

“…After the literature search was conducted, some studies were published that reported on (potential) sources of Legionella that were not represented in this review or that supplied information that significantly changed the LOE assigned to a potential source. Euser et al 255 identified a manually operated pressure test pump as the infection source for a sporadic LD case. Environmental and clinical isolates were matched by SBT.…”

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

“…; Euser et al . ). The control of Legionella in water systems is supported by national and international guidelines including the UKs Health and Safety Executive (HSE) Approved Code of Practice L8 and Technical Guidance HSG 274 (Health and Safety Executive ).…”