title: Hot spring bath and Legionella pneumonia: an association confirmed by genomic identification.
abstract: A 59-year-old man developed pneumonia 9 days after bathing in a hot spring spa. Bilateral shadows on his chest radiograph rapidly progressed after admission. He was successfully treated with erythromycin and rifampicin. Legionella pneumophila serogroup 6 was recovered from an intratrachial specimen and a significant elevation was observed in a paired indirect fluorescent antibody to Legionella. Persistent slight fever and chest rentogenographic shadows resolved after administering low-dose prednisolone to treat organizing pneumonia shown by transbronchial lung biopsy. The same serotype of Legionella was recovered from the water of the hot spring spa where the man had bathed. When the extracted DNA of these two strains showed identical restriction fragments by pulsed-field gel electrophoresis, we had direct evidence that hot spring spas can be a source of Legionella pneumonia.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University.
authors.forename: Isao
authors.initials: I
authors.lastname: Ito
authors.forename: Junko
authors.initials: J
authors.lastname: Naito
authors.forename: Seizo
authors.initials: S
authors.lastname: Kadowaki
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ishida
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Hongo
authors.forename: Ling
authors.initials: L
authors.lastname: Ma
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ishii
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Keizo
authors.initials: K
authors.lastname: Yamaguchi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D001494:Baths / Q000009:adverse effects*; D004269:DNA, Bacterial / Q000032:analysis*; D004197:Disease Reservoirs; D016521:Electrophoresis, Gel, Pulsed-Field; D004917:Erythromycin / Q000627:therapeutic use; D005798:Genes, Bacterial; D006801:Humans; D016952:Legionella pneumophila / Q000235:genetics / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome; D014871:Water Microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular; D004269:DNA, Bacterial; D004917:Erythromycin; D012293:Rifampin