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Outbreak of Legionnaires' disease associated with a supermarket mist machine

  • I. BARRABEIG (a1), A. ROVIRA (a1), M. GARCIA (a2) (a3), J. M. OLIVA (a1), A. VILAMALA (a4), M. D. FERRER (a5), M. SABRIÀ (a2) (a3) and A. DOMÍNGUEZ (a6) (a7)...
Summary
SUMMARY

An outbreak of Legionnaires' disease affected 12 customers of a supermarket in a town in Catalonia, Spain, between August and November 2006. An epidemiological and environmental investigation was undertaken. Preliminary investigation showed that all patients had visited the same supermarket in this town where a mist machine was found in the fish section. Water samples were collected from the machine and from the supermarket's water distribution system when high-risk samples were excluded. Environmental samples from the mist machine and clinical samples from two patients tested positive for L. pneumophila serogroup 1 and had the same molecular pattern. The PFGE pattern detected in the clinical and mist-machine isolates had never previously been identified in Catalonia prior to the outbreak and has not been identified since. Four days after turning off the machine, new cases ceased appearing. Molecular study supports the hypothesis that the mist machine from the fish section of the supermarket was the source of infection. We believe it is essential to include exposure to mist machines in any legionellosis epidemiological survey.

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Corresponding author
*Author for correspondence: I. Barrabeig M.D., Epidemiological Surveillance Unit of Costa Ponent, Department of Health, Generalitat de Catalonia, Av. de la Granvia, 8-10, 5th floor, 08902 l'Hospitalet de Llobregat, Barcelona. (Email: ibarrabeig@catsalut.cat)
References
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1.Bartlett JG, et al. Community-acquired pneumonia in adults: guidelines for management. The Infectious Diseases Society of America. Clinical Infectious Diseases 1998; 26: 811838.
2.Smolinski MS, Hamburg MA, Ledergerg J (eds). Microbial Threats to Health: Emergence, Detection and Response. Washington: National Academic Press, 2003.
3.Sopena N, et al. Prospective study of community-acquired pneumonia of bacterial etiology in adults. European Journal of Clinical Microbiology & Infectious Diseases 1999; 18: 852858.
4.Alvarez-Sánchez B, et al. Prognostic factors and etiology in patients with severe community-acquired pneumonia admitted at the ICU. Spanish multicenter study. Study Group on Severe Community-Acquired Pneumonia in Spain. Medicina Clínica (Barcelona) 1998; 111: 650654.
5.Benin AL, Benson RF, Besser RE. Trends in legionnaire's disease, 1980–1998: declining mortality and new patterns of diagnosis. Clinical Infectious Diseases 2002; 35: 10391046.
6.Fernandez N, et al. Legionellosis. Clinical manifestations, diagnosis and treatment. Medicina Clínica (Barcelona) 2002; 119: 2932.
7.Carbonne A, Astagneau P. How to reduce the risk of Legionnaires' disease? La Revue de Praticien 2005; 55: 19831989.
8.Schlech WF 3rd, et al. Legionnaires' disease in the Caribbean. An outbreak associated with a resort hotel. Archives of Internal Medicine 1985; 145: 20762079.
9.Castellani Pastoris M, et al. Legionnaires' disease on a cruise ship linked to the water supply system: clinical and public health implications. Clinical Infectious Diseases 1999; 28: 3941.
10.Dondero TJ Jr., et al. An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower. New England Journal of Medicine 1980; 302: 365370.
11.Brown CM, et al. A community outbreak of Legionnaires' disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure. International Journal of Epidemiology 1999; 28: 353359.
12.Cordes GC, et al. Legionnaires' disease outbreak at an Atlanta, Georgia, country club: evidence for spread from an evaporative condenser. American Journal of Epidemiology 1980; 111: 425431.
13.Breiman RF, et al. Role of air sampling in investigation of an outbreak of Legionnaires' disease associated with exposure to aerosols from an evaporative condenser. Journal of Infectious Diseases 1990; 161: 12571261.
14.Jernigan DB, et al. Outbreak of Legionnaires' disease among cruise ship passengers exposed to a contaminated whirlpool spa. Lancet 1996; 347: 494499.
15.Benkel DH, et al. Outbreak of Legionnaires' disease associated with a display whirlpool spa. International Journal of Epidemiology 2000; 28: 10921098.
16.Sabria M, et al. A community outbreak of Legionnaires' disease: evidence of a cooling tower as the source. Clinical Microbiology and Infection 2006; 12: 642647.
17.Jansà JM, et al. An outbreak of Legionnaires' disease in an inner city district: importance of the first 24 hours in the investigation. International Journal of Tuberculosis and Lung Disease 2002; 6: 831838.
18.Sala Ferré MR, et al. A community outbreak of Legionnaires' disease associated with a cooling tower in Vic and Gurb, Catalonia (Spain) in 2005. European Journal of Clinical Microbiology & Infectious Diseases 2009; 28: 153159.
19.Fernández JA, et al. Clinical study of an outbreak of Legionnaire's disease in Alcoy, Southeastern Spain. European Journal of Clinical Microbiology & Infectious Diseases 2002; 21: 729735.
20.García-Fulgueiras A, et al. Legionnaires' disease outbreak in Murcia, Spain. Emerging Infectious Diseases 2003; 9: 915921.
21.Castilla J, et al. A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality. Epidemiology and Infection 2008; 136: 823832.
22.Alvarez J, et al. Impact of the Legionella urinary antigen test on epidemiological trends in community outbreaks of legionellosis in Catalonia, Spain. 1990–2004. International Journal of Infectious Diseases 2009; 13: e365–370.
23.Royal Decree 865/2003 of 4 July. Establishing the health and hygiene standards for the prevention and control of Legionnaires' disease. Official State Gazette (BOE) number 171 – 18/06/2003.
24.ISO 11731: 1998. Water Quality – detection and enumeration of Legionella.
25.Ragull S, et al. Legionella pneumophila in cooling towers: fluctuations in counts, determination of genetic variability by pulsed-field gel electrophoresis (PFGE), and persistence of PFGE patterns. Applied and Environmental Microbiology 2007; 73: 53825384.
26.Sanchez I, et al. Genotypic variability and persistence of Legionella pneumophila PFGE patterns in 34 cooling towers from two different areas. Environmental Microbiology 2008; 10: 395399.
27.Mahoney FJ, et al. Communitywide outbreak of Legionnaires' disease associated with a grocery store mist machine. Journal of Infectious Diseases 1992; 165: 736739.
28.Hahné S, Pankhania B. Legionella from Welsh hotel guests indistinguishable from humidifier isolates. Eurosurveillance 2000; 4 (pii=1617). (http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=1617).
29.Yu VL, Stout JE. Community-acquired legionnaires disease: implications for underdiagnosis and laboratory testing [Editorial Commentary]. Clinical Infectious Diseases 2008; 46: 13651367.
30.von Baum H, et al. Community-acquired Legionella pneumonia: new insights for the German Competence Network for Community Acquired Pneumonia. Clinical Infectious Diseases 2008; 46: 13561364.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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