Skip to main content
    • Aa
    • Aa

Relationship between Legionella spp. and antibody titres at a therapeutic thermal spa in Portugal

  • G. Rocha (a1), A. Veríssimo (a2), R. Bowker (a3), N. Bornstein (a4) and M. S. Da Costa (a5)...

The presence of Legionella spp. in the water of a Portuguese spa was ascertained during the spa season, between May and November. Simultaneously the prevalance of anti-legionella antibodies in people attending the spa was also investigated. The antibody titres of 172 randomly selected patients and 42 therapists were determined, and compared with a control group of 503 blood donors. Legionellae were present in the spa water at low concentrations, generally lower than 103 c.f.u./1. A total of 92 strains representing eight different species or serogroups were isolated; the predominant isolates belonged to Legionella pneumophila serogroup 6 and to L. londiniensis.

During the study, no clinical cases of Legionnaires' disease were observed, and the antibody titres were generally low in the groups studied. However, the antibody titres of the patients increased slightly during their stay at the spa, approaching the values for the therapists. Mean antibody titres in the groups related with the spa were significantly higher than those in the blood donors against five of the seven legionella antigens tested. The largest number of elevated antibody titres in the exposed groups were to the L. pneumophila sg 5 and sg 6 antigens.

Corresponding author
* Author for correspondence: M. S. da Costa, Departamento de Bioquímica, Apartado 3126, Universidade de Coimbra, 3000 Coimbra, Portugal.
Hide All
1.Orrison LH, Cherry WB, Milan D. Isolation of Legionella pneumophila from cooling tower water by filtration. Appl Environ Microbiol 1981; 41: 1202–5.
2.Negrón-Alvíra A, Pérez-Suarez I, Hazen TC. Legionella spp. in Puerto Rico cooling towers. Appl Environ Microbiol 1988; 54: 2331–4.
3.Tison DL, Seidler RJ. Legionella incidence and density in potable drinking water supplies. Appl Environ Microbiol 1983; 45: 337–9.
4.Hsu SC, Martin R, Wentworth BB. Isolation of Legionella species from drinking water. Appl Environ Microbiol 1984; 48: 830–2.
5.States SJ, Conley LF, Kuchta JM et al. , Survival and multiplication of Legionella pneumophila in municipal drinking water systems. Appl Environ Microbiol 1987; 53: 979–86.
6.Tobin RS, Ewan P, Walsh K, Dutka B. A survey of Legionella pneumophila in water in 12 Canadian cities. Wat Res 1986; 20: 495501.
7.Brown A, Yu VL, Magnussen MH, Vickers RM, Garrity GM, Elder EM. Isolation of the Pittsburgh pneumonia agent from a hospital shower. Appl Environ Microbiol 1982; 43: 725–6.
8.Wadowsky RM, Yee RB, Mezmar L, Wing EJ, Bowling JN. Hot water systems as sources of Legionella pneumophila in hospital and nonhospital plumbing fixtures. Appl Environ Microbiol 1982; 43: 1104–10.
9.Barbaree JM, Gorman GW, Martin WT, Fields BS, Morril WE. Protocol for sampling environmental sites for Legionellae. Appl Environ Microbiol 1987; 53: 1454–8.
10.Veríssimo A, Vesey G, Rocha GM et al. , A hot water supply as the source of Legionella pneumophila in incubators of a neonatology unit. J Hosp Infect 1990; 15: 255–63.
11.Colbourne JS, Dennis PJ. Distribution and persistence of Legionella in water systems. Microbiol Sci 1985; 2: 40–3.
12.Lee JV, West AA. Survival and growth of Legionella species in the environment. J Appl Bacteriol 1991; 70 symp Suppl: 121s–9s.
13.Mangione EJ, Remis RS, Tait KA et al. , An outbreak of Pontiac fever related to whirlpol use. Michigan 1982. J Amer Med Ass 1985; 253: 535–9.
14.Goldberg DJ, Wrench JG, Collier PW et al. , Lochgoilhead fever: outbreak of nonpneumonic legionellosis due to Legionella micdadei. Lancet 1989; 1: 316–8.
15.Morris GK, Patton CM, Feeley JC et al. , Isolation of the Legionnaires' disease bacterium from environmental samples. Ann Intern Med 1979; 90: 664–6.
16.Fliermans CB, Cherry WB, Orrison LH, Smith SJ, Tison DL, Pope DH. Ecological distribution of Legionella pneumophila. Appl Environ Microbiol 1981; 41: 916.
17.Ortiz-Roque CM, Hazen TC. Abundance and distribution of Legionellaceae in Puerto Rican waters. Appl Environ Microbiol 1987; 53: 2231–6.
18.Veréssimo A, Marrão G, Gomes da Silva FG, Costa MS. Distribution of Legionella spp. in hydrothermal areas in continental Portugal and the island of São Miguel, Azores. Appl Environ Microbiol 1991; 57: 2921–7.
19.Marrão G, Veríssimo A, Bowker RG, Costa MS. Biofilms as major sources of Legionella spp. in hydrothermal areas and their dispersion into stream water. FEMS Microbiol Ecol 1993; 12: 2533.
20.Steele TW, Moore CV, Sangster N. Distribution of Legionella longbeachae serogroup 1 and other Legionellae in potting soils in Australia. Appl Environ Microbiol 1990; 56: 2984–8.
21.Tison DL, Baross JA, Seidler RJ. Legionella in aquatic habitats in the Mount Saint Helens blast zone. Curr Microbiol 1983; 9: 345–8.
22.Plouffe JF, Webster LR, Hackman B. Relationship between colonization of hospital buildings with Legionella pneumophila and hot water temperatures. Appl Environ Microbiol 1983; 46: 769–70.
23.Groothuis DG, Veenendaal HR, Dijkstra HL. Influence of temperature on the number of Legionella pneumophila in hot water systems. J Appl Bacteriol 1985; 59: 529–36.
24.Wadowsky RM, Wolford R, McNamara AM, Yee RB. Effect of temperature, pH, and oxygen level on the multiplication of naturally occurring Legionella pneumophila in potable water. Appl Environ Microbiol 1985; 49: 1197–205.
25.Barker J, Brown MRW. Trojan horses of the microbial world: protozoa and survival of bacterial pathogens in the environment. Microbiol 1994; 140: 1253–9.
26.Joly JR. Monitoring for the presence of Legionella: where, when, and how? In: Barberee JM, Breiman RF, Dufour AP, eds. Legionellae, Current status and emerging perspectives. Washington, D.C.: Am Soc Microbiol 1993: 211–6.
27.Bornstein N, Marmet D, Surgot M et al. , Exposure to Legionellaceae at a hot spring spa: a prospective clinical and serological study. Epidemiol Infect 1989; 102: 31–6.
28.Dennis PJL. Isolation of Legionellae from environmental specimens. In: Harrison TG, Taylor AG, eds. A laboratory manual for Legionella. Chichester: John Wiley and Sons. 1988: 3144.
29.Watkins ID, Tobin J O'H, Dennis PJ, Brown W, Newnham RS, Kurtz JB. Legionella pneumophila serogroup 1 subgrouping by monoclonal antibodies – an epidemiological tool. J Hyg 1985; 95: 211–6.
30.American Public Health Association. Standard methods for the examination of water and wastewater, 16th ed.Washington, D.C: Am Publ Hlth Assoc: 1985.
31.Taylor AG, Harrison TG, Dighero MW, Bradstreet CMP. False positive reactions in the indirect fluorescent antibody test for Legionnaires' disease eliminated by use of formolised yolk sac antigen. Ann Intern Med 1979; 90: 686–9.
32.Wilkinson HW, Fikes BJ, Cruce DD. Indirect immunofluorescence test for serodiagnosis of Legionnaires' disease: evidence for serogroup diversity of Legionnaires' disease bacterial antigens and for multiple specificity of human antibodies. J Clin Microbiol 1979; 9: 379–83.
33.Miller RD, Kenepp KA. Risk assessments for legionnaires disease based on routine surveillance of cooling towers for legionellae. In: Barberee JM, Breiman RF, Dufour AP. eds. Legionellae, Current status and emerging perspectives. Washington, D.C.: Am Soc Microbiol 1993: 40–3.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 3 *
Loading metrics...

Abstract views

Total abstract views: 39 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th October 2017. This data will be updated every 24 hours.