Skip to main content
Log in

Nosocomial legionellosis in three heart-lung transplant patients: Case reports and environmental observations

  • Article
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

Organ transplant recipients are at high risk of contracting Legionnaires' disease in a hospital environment contaminated with legionellae. This study describes the first cases of culture-verifiedLegionella infections with an established link to potable hospital water in Denmark; three patients operated on at the Cardiopulmonary Transplant Unit, Rigshospitalet, Copenhagen, became infected with legionellae. Environmental and clinical isolates ofLegionella pneumophila serogroups 1 and 6 were investigated by restriction enzyme analysis and ribotyping. An ice machine located in the kitchen of the intensive care unit was implicated as a source of infection in two of the three cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Le Saux NM, Sekla L, McLeod J, Parker S, Rush D, Jeffery JR, Brunham RC: Epidemic of nosocomial Legionnaires' disease in renal transplant recipients: a case-control and environmental study. Canadian Medical Association Journal 1989, 140: 1047–1053.

    PubMed  Google Scholar 

  2. Hofflin JM, Potasman I, Baldwin JC, Oyer PE, Stinson EB, Remington JS: Infectious complications in heart transplant recipients receiving cyclosporine and corticosteroids. Annals of Internal Medicine 1987, 106: 209–219.

    PubMed  Google Scholar 

  3. Harrison TG, Taylor AG (ed): A laboratory manual forLegionella. John Wiley, Chichester, 1988.

    Google Scholar 

  4. Wilkinson HW, Reingold AL, Brake BJ, McGiboney DL, Gorman GW, Broome CV: Reactivity of serum from patients with suspected legionellosis against 29 antigens ofLegionellaceae andLegionella-like organisms by indirect immunofluorescence assay. Journal of Infectious Diseases 1983, 147: 23–31.

    PubMed  Google Scholar 

  5. Fehrenbach FJ, Horbach I, Ruf B, Schürmann D, Pohle H: Rapid detection of legionella antigen in tissues and body fluids. Israel Journal of Medical Science 1986, 22: 706–710.

    Google Scholar 

  6. Joly JR, McKinney RM, Tobin JO, Bibb WF, Watkins ID, Ramsay D: Development of a standardized subgrouping scheme forLegionella pneumophila serogroup 1 using monoclonal antibodies. Journal of Clinical Microbiology 1986, 23: 768–771.

    PubMed  Google Scholar 

  7. Gerner-Smidt P: Ribotyping of theAcinetobacter calcoaceticus-Acinetobacter baumannii complex. Journal of Clinical Microbiology 1992, 30: 2680–2685.

    PubMed  Google Scholar 

  8. Redd SC, Schuster DM, Quan J, Plikaytis BD, Spika JS, Cohen ML: Legionellosis in cardiac transplant recipients: results of a nationwide study. Journal of Infectious Diseases 1988, 158: 651–655.

    PubMed  Google Scholar 

  9. Horbach I, Fehrenbach FJ: Legionellosis in heart transplant recipients. Infection 1990, 18: 361–363.

    PubMed  Google Scholar 

  10. Fuller J, Levinson MM, Kline JR, Copeland J: Legionnaires' disease after heart transplantation. Annals of Thoracic Surgery 1985, 39: 308–311.

    PubMed  Google Scholar 

  11. Edelstein PH: Control of Legionella in hospitals. Journal of Hospital Infection 1986, 8: 109–115.

    PubMed  Google Scholar 

  12. Schulze-Röbbecke, Jung KD, Pullman H, Hundgeburth J: Control ofLegionella pneumophila in a hospital hot water system. Zentralblatt für Hygiene 1990, 190: 84–100.

    Google Scholar 

  13. Struelens MJ, Maes N, Rost F, Deplano A, Jacobs F, Liesnard C, Bornstein N, Grimont F, Lauwers S, McIntyre MP, Serruys E: Genotypic and phenotypic methods for the investigation of a nosocomialLegionella pneumophila outbreak and efficacy of control measures. Journal of Infectious Diseases 1992, 166: 22–30.

    PubMed  Google Scholar 

  14. Marrie TJ, Haldane D, Macdonald S, Clarke K, Fanning C, Le Fort-Jost S, Bezanson G, Joly J: Control of endemic nosocomially Legionnaires' disease by using sterile potable water for high risk patients. Epidemiology and Infection 1991, 107: 591–605.

    PubMed  Google Scholar 

  15. Stout JE, Yu V, Muraca P: Isolation ofLegionella pneumophila from the cold water of hospital ice machines: implications for origin and transmission of the organism. Infection Control 1985, 6: 141–146.

    PubMed  Google Scholar 

  16. Garbe PL, Davis BJ, Weisfield JS, Markowitz L, Miner P, Garrity F, Barbaree JM, Reingold AL: Nosocomial Legionnaires' disease: epidemiologic demonstration of cooling towers as a source. Journal of the American Medical Association 1985, 254: 521–524.

    PubMed  Google Scholar 

  17. Blatt SP, Parkinson MD, Pace E, Hoffman P, Dolan D, Lauderdale P, Zajac RA, Melcher GP: Nosocomial Legionnaires' disease: aspiration as a primary mode of disease acquisition. American Journal of Medicine 1993, 95: 16–22.

    PubMed  Google Scholar 

  18. Dournon E, Bure A, Desplaces N, Carette MF, Mayaud C: Legionnaires' disease related to gastric lavage with tap water. Lancet 1982, i: 797–798.

    Google Scholar 

  19. Farrant JM, Drury AEC, Thompson RPH: Legionnaires' disease following immersion in a river. Lancet 1988, ii: 460.

    Google Scholar 

  20. Yu V: Could aspiration be the major mode of transmission forLegionella? American Journal of Medicine 1993, 95: 13–15.

    PubMed  Google Scholar 

  21. Marrie TJ, Bezanson G, Haldane DJM, Burbridge S: Colonisation of the respiratory tract withLegionella pneumophila for 63 days before the onset of pneumonia. Journal of Infection 1992, 24: 81–86.

    PubMed  Google Scholar 

  22. Bridge JA, Edelstein PH: Oropharyngeal colonization withLegionella pneumophila. Journal of Clinical Microbiology 1983, 18: 1108–1112.

    PubMed  Google Scholar 

  23. O'Brien S, Bhopal RS: Legionnaires' disease: the infective dose paradox. Lancet 1993, 342: 5–6.

    PubMed  Google Scholar 

  24. Marrie TJ, Bezanson G, Fox J, Kuehn R, Haldane D, Burbridge S: Dynamics ofLegionella pneumophila in the potable water of one floor of a hospital. In: Barbaree JM, Breiman R, Dufour A (ed.):Legionella. Current status and emerging perspectives. American Society for Microbiology, Washington DC, 1993, p. 238–240.

    Google Scholar 

  25. Marrie TJ, Haldane D, Bezanson G, Peppard R: Each water outlet is a unique ecological niche forLegionella pneumophila. Epidemiology and Infection 1992, 108: 261–270.

    PubMed  Google Scholar 

  26. Katz SM, Hammel JM, Matus JP, Poropatich R, Katz J: A self-limited febrile illness produced in guinea pigs associated with oral administration ofLegionella pneumophila. Gastroenterology 1988, 95: 1575–1581.

    PubMed  Google Scholar 

  27. Weeratna R, Marrie TJ, Logan SM, Hoskin D, Hoffman PS, Yates L, Burbridge S, Haldane D, Bezanson G: Legionnaires' disease in cardiac transplant patients: a cell-mediated immune response develops despite cyclosporine therapy. Journal of Infectious Diseases 1993, 168: 521–522.

    PubMed  Google Scholar 

  28. Saunders NA, Harrison TG, Haththotuwa A, Kachwalla N, Taylor AG: A method for typing strains ofLegionella pneumophila serogroup 1 by analysis of restriction fragment length polymorphisms. Journal of Medical Microbiology 1990, 31: 45–55.

    PubMed  Google Scholar 

  29. Colding H, Bangsborg JM, Fiehn N-E, Bennekov T, Bruun B: Ribotyping for differentiatingFlavobacterium meningosepticum isolates from clinical and environmental sources. Journal of Clinical Microbiology 1994, 32: 501–505.

    PubMed  Google Scholar 

  30. Schoonmaker D, Heimberger T, Birkhead G: Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishingLegionella pneumophila isolates obtained during a nosocomial outbreak. Journal of Clinical Microbiology 1992, 30: 1491–1498.

    PubMed  Google Scholar 

  31. Edelstein PH, Beer KB, DeBoynton ED: Influence of growth temperature on virulence ofLegionella pneumophila. Infection and Immunity 1987, 55: 2701–2705.

    PubMed  Google Scholar 

  32. Rogers JE, Eisenstein BI, Engleberg NC: Spontaneous changes in lipopolysaccharide and monoclonal antibody binding in a single line ofLegionella pneumophila serogroup 1 cells. In: Barbaree JM, Breiman RF, Dufour A (ed.):Legionella. Current status and emerging perspectives. American Society for Microbiology, Washington DC, 1993, p. 73–74.

    Google Scholar 

  33. Harrison TG, Saunders NA, Haththotuwa A, Hallas G, Birtles RJ, Taylor AG: Phenotypic variation amongst genotypically homogenousLegionella pneumophila serogroup 1 isolates: implications for the investigation of outbreaks of Legionnaires' disease. Epidemiology and Infection 1990, 104: 171–180.

    PubMed  Google Scholar 

  34. Harrison TG, Saunders NA, Haththotuwa A, Doshi N, Taylor AG: Further evidence that genotypically closely related strains can express different serogroup specific antigens. Journal of Medical Microbiology 1992, 37: 155–161.

    PubMed  Google Scholar 

  35. Goetz A, Yu VL: Screening for nosocomial legionellosis by culture of the water supply and targeting of high-risk patients for specialized laboratory testing. American Journal of Infection Control 1991, 19: 63–66.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bangsborg, J.M., Uldum, S., Jensen, J.S. et al. Nosocomial legionellosis in three heart-lung transplant patients: Case reports and environmental observations. Eur. J. Clin. Microbiol. Infect. Dis. 14, 99–104 (1995). https://doi.org/10.1007/BF02111866

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02111866

Keywords

Navigation