Skip to main content
SpringerLink
Log in

Colonization of Legionella species in Turkish baths in hotels in Alanya, Turkey

  • Published:
Environmental Monitoring and Assessment Aims and scope Submit manuscript

Abstract

This study evaluated the prevalence of Legionella species in water samples collected from Turkish baths in hotels in Alanya, Turkey, from August 2003 to September 2013. Water samples were collected in 100-mL sterile containers and then concentrated by filtration. Heat treatment was used to eliminate other microorganisms from the samples, which were then spread on Legionella-selective-buffered charcoal yeast extract alpha (BCYE-α) agar and on BCYE-α agar supplemented with glycine, vancomycin, polymyxin, and cycloheximide. Cysteine-dependent colonies were identified by latex agglutination. In total, 135 samples from 52 hotels with Turkish baths were evaluated. Legionella species were identified in 11/52 (21.2 %) hotels and 18/135 (13.3 %) samples. The most frequently isolated species was Legionella pneumophila, with most isolates belonging to serogroups 6 (55.6 %) and 1 (22.2 %). The colony count was <100 colony-forming units (CFU) mL−1 in nine samples, from 100 to 1000 CFU mL−1 in six samples, and >1000 CFU mL−1 in three samples. These findings suggest that the hot water systems of Turkish baths in hotels must be viewed as a possible source of travel-associated Legionnaires’ disease, and preventative measures should be put in place.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Ahmed, M., Laza-Stanca, V., & Mustfa, N. (2013). Legionella pneumophila outbreak related to a display spa pool at a retail unit. Thorax, 68, A189–190.

    Article  Google Scholar 

  • Akbas E, Dalkılınc I, Gozalan A, Guvener E. Legionella spp in plumbing systems of hotels: a study in Aegean and Mediterranean coasts. Flora  1999; 4:258–266.

  • Alim, A., Hakgüdener, Y., & Poyraz, O. (2002). Legionella pneumophila in thermal pools of hot springs in the central Anatolian district. Mikrobiyol Bülteni, 36, 237–246.

    Google Scholar 

  • Alim, A., Doğan Tomul, Z., Ataş, A. D., & Güneş, T. (2007). Investigation of Legionella spp. from the Turkish baths in Sivas. Flora (Turkish Journal of Infectious Disease and Clinical Microbiology), 12, 103–107.

    Google Scholar 

  • Aydin, S., Aydin, S., Kuloglu, T., Yilmaz, M., Kalayci, M., Sahin, I., et al. (2013). Alterations of irisin concentrations in saliva and serum of obese and normal-weight subjects, before and after 45 min of a Turkish bath or running. Peptides, 50, 13–18.

    Article  CAS  Google Scholar 

  • Bagbanci, M. B. (2013). Investigation of installation systems and structural failures of ottoman baths in Bursa, Turkey. International Journal of Academic Research Part A, 5, 213–218.

    Article  Google Scholar 

  • Castiglia, R. B. F., & Bevilacqua, M. G. (2008). The Turkish baths in Elbasan: architecture, geometry and wellbeing. Nexus Network Journal, 10, 307–322.

    Article  Google Scholar 

  • Castellani Pastoris, M., Benedetti, P., Greco, D., Volpi, E., Billo, N., Fehrenbach, F. J., et al. (1992). Six cases of travel-associated Legionnaires’ disease in Ischia involving four countries. Infection, 20, 73–77.

    Article  CAS  Google Scholar 

  • Den Boer, J. W., Yzerman, E., Van Belkum, A., Vlaspolder, F., & Van Breukelen, F. J. (1998). Legionnaire’s disease and saunas. Lancet, 351, 114.

    Article  Google Scholar 

  • Erdogan, H., & Arslan, H. (2007). Colonization of Legionella species in hotel water systems in Turkey. Journal of Travel Medicine, 14, 369–373.

  • Erdogan, H., & Arslan, H. (2013). Evaluation of a Legionella outbreak emerged in a recently opening hotel. Mikrobiyol Bulteni, 47, 240–249.

    Article  Google Scholar 

  • Erdogan, H., Erdogan, A., Lakamdayali, H., Yilmaz, A., & Arslan, H. (2010). Travel-associated Legionnaires’ disease: clinical features of 17 cases and a review of the literature. Diagnostic Microbiology and Infectious Disease, 68, 297–303.

    Article  Google Scholar 

  • EWGLI technical guidelines for the investigation, control and prevention of travel associated Legionnaires’ disease. Available at: http://ecdc.europa.eu/en/activities/surveillance/eldsnet/documents/ewgli-technical-guidelines.pdf (Accessed 7 March 2014)

  • Fields, B. S., Benson, R. F., & Besser, R. E. (2002). Legionella and Legionnaires’ disease: 25 years of investigation. Clinical Microbiology Reviews, 15, 506–526.

    Article  Google Scholar 

  • Goksugur, N., Karabay, O., & Kocoglu, E. (2006). Mycological flora of the Hammams, traditional Turkish bath. Mycoses, 49, 411–414.

    Article  Google Scholar 

  • Hannuksela, M. L., & Ellahham, S. (2001). Benefits and risks of sauna bathing. The American Journal of Medicine, 110, 118–126.

    Article  CAS  Google Scholar 

  • Helbig, J. H., Bernander, S., Castellani Pastoris, M., Etienne, J., Gaia, V., Lauwers, S., et al. (2002). Pan-European study on culture-proven Legionnaires’ disease: distribution of Legionella pneumophila serogroups and monoclonal subgroups. European Journal of Clinical Microbiology and Infectious Disease, 21, 710–716.

    Article  CAS  Google Scholar 

  • Martinelli, F., Carasi, S., Scarcella, C., & Speziani, F. (2001). Detection of Legionella pneumophila at thermal spas. The New Microbiologica, 24, 259–264.

    CAS  Google Scholar 

  • Napoli, C., Fasano, F., Latta, R., Barbuti, G., Cuna, T., & Montagna, M. T. (2010). Legionella spp. and legionellosis in southern Italy: disease epidemiology and environmental surveillance in community and healthcare facilities. BMC Public Health, 10, 660.

    Article  Google Scholar 

  • Obrien, S. J., & Bhopal, R. S. (1993). Legionnaires’ disease—the infective dose paradox. Lancet, 342, 5–6.

    Article  CAS  Google Scholar 

  • Phi, N., Parry-Ford, F., Harrison, T., Stagg, H. R., Zhang, N., Kumar, K., et al. (2014). Epidemiology and clinical management of Legionnaires’ disease. Lancet Infectious Disease, 14, 1011–1021.

    Article  Google Scholar 

  • Surman-Lee, S., Fields, B., Hornei, B., Ewig, S., Exner, M., Tartakovsky, I., et al. (2007). Ecology and environmental sources of Legionella. In J. Bartram, Y. Chartier, J. V. Lee, K. Pond, & S. Surman-Lee (Eds.), Legionella and the prevention of legionellosis (pp. 29–38). Geneva: World Health Organization.

    Google Scholar 

  • Unubol, M., Meltem Sonmez, H., Gunes, Z., & Aksu, H. (2010). The effect of Turkish bath on QT dispersion. Anadolu Kardiyoloji Dergisi, 10, 216–219.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Sibel Ozturk, D. Ali Akilli and Burcu Dobrisan for their assistance in collecting and processing the water samples.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Departments of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Baskent University, Ankara, Turkey

    Haluk Erdogan & Hande Arslan

Authors
  1. Haluk Erdogan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hande Arslan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Haluk Erdogan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erdogan, H., Arslan, H. Colonization of Legionella species in Turkish baths in hotels in Alanya, Turkey. Environ Monit Assess 187, 235 (2015). https://doi.org/10.1007/s10661-015-4444-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10661-015-4444-3

Keywords

Search

Navigation