title: [Legionella pneumonia which occurred in a private whirlpool bath user].
abstract: A 88 year old female with active rheumatoid arthritis treated by low dose of prednisolone and methotrexate was admitted to our hospital because of severe bilateral pulmonary infiltration and acute respiratory distress syndrome. On admission, she had consciousness disturbance and was intubated because of severe respiratory failure. We heard from her family of her habit she had taking a private whirlpool bath 2 or 3 times everyday. So, we suspected a Legionella pneumophila infection. We started intravenous erythromycin (EM) (1,500mg/day) and methylprednisolone pulse therapy (1,000mg x 3days) and full controlled mechanical ventilation supported with PEEP. Her respiratory failure was gradually improved and she was discharged on the 44 the hospital day. Legionella pneumophila (serogroup 6) was isolated in her sputum by B-CYE alpha culture. Legionella pneumophila (serogroup 6) was isolated in her private whirlpool bath too. Both samples revealed the same by genetic analysis with pulse field gel electrophoresis (PFGE). This is the first adult case of Legionella pneumophila pneumonia infected from a private whirlpool bath confirmed by genetic analysis. We should always suspect Legionella pneumonia as one of the severe community-acquired pneumonia, because Legionella pneumophila were frequently detected among various water sources including the private whirlpool bath.
authors.affiliation: Department of Rheumatology, Kitasato University School of Medicine.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishikawa
authors.forename: Jun
authors.initials: J
authors.lastname: Okada
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Kondo
authors.forename: Youko
authors.initials: Y
authors.lastname: Takayama
authors.forename: Keisuke
authors.initials: K
authors.lastname: Sunagawa
authors.forename: Tadako
authors.initials: T
authors.lastname: Enari
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ishii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications; D001494:Baths / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000209:etiology*; D014871:Water Microbiology