Legionella viability was monitored during heat shock treatment at 70°C by a flow cytometric assay (FCA). After 30 min of treatment, for 6 of the 12 strains tested, the FCA still detected 10 to 25% of cells that were viable but nonculturable (VBNC). These VBNC cells were able to produce ATP and to be resuscitated after culture on amoebae.Legionellae are widespread in natural and manmade aquatic habitats. Sources of contamination are aerosols from showerheads, air-cooling towers, and other systems distributing water. To prevent outbreaks, surveillance of Legionella environmental contamination by use of culture methods has been set up for hot sanitary water systems in collective settings such as hospitals, hotels, and thermal spas (4). However, the findings of environmental surveillance do not always correlate with the occurrence of Legionnaires' disease, since the concentration of Legionella bacteria in environmental samples is largely underestimated when culture on GVPC medium (8,11,12), the reference method required by current norms (1, 16), is used. The existence of viable but nonculturable (VBNC) bacteria (13,21,24), which reduce the sensitivity of culture-based assays, has been demonstrated. Analysis of membrane integrity in order to distinguish between viable and dead cells in various bacterial species has been proposed (2, 14, 17, 19); some of these assays are based on double staining combining Syto 9 and propidium iodide (PI) (6, 9, 26). To date, only three studies dealing with the detection of Legionella cells by flow cytometry have been reported (15,27,29), and none of them analyzed the presence of VBNC cells, which was undertaken in this study.The flow cytometric assay (FCA) was performed on a BD FACSCanto II flow cytometer (Becton Dickinson Biosciences, Le Pont-de-Claix, France). A threshold was applied on the FL1 channel to eliminate background noise, and analyses were performed at a low flow rate setting. The concentrations of the two dyes were adjusted for the optimal discrimination of green-and red-fluorescing bacteria. One microliter of 2.3 mM Syto 9 and 5 l of 1-mg/ml PI (Invitrogen SARL, Cergy Pontoise, France) were used for cell staining. A cytogram was generated for each different Legionella strain; unstained cells and double staining of sterilized water were used to define the background noise (data not shown).During a heat shock treatment from 0 to 60 min at 70°C, the concentration of dead cells increased proportionally with the duration of heat exposure. As shown for Legionella pneumophila serogroup 1 (sg 1) in Fig. 1, the bacteria could be segregated within three regions: dead cells stained with PI were located in the P1 region (Fig. 1, dot plot at 60 min); bacteria with intact membranes that were stained with Syto 9 were used to delineate the P2 region (Fig. 1, dot plot at 0 min); and a third population, located in the P3 region and appearing as early as 1 min after the beginning of the heat shock, represented an intermediate physiological state that could correspond to cells that were st...