title: [A major outbreak of Legionnaire's disease due to a public bathhouse: clinical examination].
abstract: The largest epidemic outbreak of legionnaires' disease occurred in Japan, where there were 45 cases, including three deaths. There was a high degree of homology at the genetic level between Legionella pneumophila sero-group 1 isolated from two patients and water samples collected from a public bath, and this highlighted the public bath visited by the patients as the source of the infection. We report our clinical observations of 34 cases with a pneumonia type (20 definite and 14 probable) of the 42 cases for whom a diagnosis was made and follow-up care was subsequently provided at our hospital or hospital-affiliated facilities, out of the initial total of 45 cases. Twenty-one cases had underlying diseases, but the disease was mild in all patients. Three cases showed different neuropsychiatric symptoms such as reduced capacity for memorization, somnolence or delirium. Diarrhea was found in three cases, and relative bradycardia in ten. Clinical laboratory test results indicated that a severe inflammatory reaction, renal or hepatic dysfunction, an electrolyte abnormality and abnormal urinalysis were common in the 34 cases. Chest radiography showed a shadow suggestive of infection of the pulmonary parenchyma with multilobar involvement in most cases and pleural effusion in nine cases.
authors.affiliation: Fifth Department of Internal Medicine, Tokyo Medical University, 1 Ami-cho, Inashiki-gun, Ibaraki 300-0332, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hisanaga
authors.initials: H
authors.lastname: Yagyu
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Tsuchida
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sudou
authors.forename: Osamu
authors.initials: O
authors.lastname: Watanabe
authors.forename: Kiwamu
authors.initials: K
authors.lastname: Kioi
authors.forename: Koji
authors.initials: K
authors.lastname: Kishi
authors.forename: Shuji
authors.initials: S
authors.lastname: Oh-ishi
authors.forename: Toshio
authors.initials: T
authors.lastname: Kiguchi
authors.forename: Keizo
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsuoka
mesh_terms: D001494:Baths; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016952:Legionella pneumophila / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D014871:Water Microbiology