title: [The largest outbreak of legionellosis in Japan associated with spa baths: epidemic curve and environmental investigation].
abstract: In July 2002, a large outbreak of legionellosis occurred in a bathhouse with spa facilities in Miyazaki Prefecture. Two hundred-ninety-five patients (including suspected cases) that had pneumonia and/or symptoms of fever, cough and so forth were reported; 37% of them were hospitalized and seven people died. In environmental investigations, Legionella pneumophila serogroups (SGs) land 8, L. dumoffii, L. londiniensis, some other Legionella species and many kinds of amoeba were isolated from 55 samples of bathtub water, tank water, filters and so forth in the spa facilities. The dominant isolates from the bathtab waters belonged to L. londiniensis, L. dumoffii and L. pneumophila SG1, and their maximum concentrations were 1.5 x 10(6), 5.2 x 10(5) and 1.6 x 10(5) cfu/100 mL, respectively. L. pneumophila SG1 strains isolated from bathtub water, tank water, filters and sputa of patients showed a indistinguishable DNA fingerprint pattern by pulsed-field gel electrophoresis (PFGE), confirming that the source of infection was the spa water. Our study indicate that spas may be a significant health hazard if hygienic management fails.
authors: Miyazaki Prefectural Institute for Public Health and Environment.
authors: Mika
authors: M
authors: Okada
authors: Kimiko
authors: K
authors: Kawano
authors: Fumiaki
authors: F
authors: Kura
authors: Junko
authors: J
authors: Amemura-Maekawa
authors: Haruo
authors: H
authors: Watanabe
authors: Kenji
authors: K
authors: Yagita
authors: Takuro
authors: T
authors: Endo
authors: Sen
authors: S
authors: Suzuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001494:Baths; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004783:Environmental Microbiology; D004866:Equipment Contamination; D005260:Female; D045482:Hot Springs; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D016952:Legionella pneumophila / Q000145:classification / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012703:Serotyping; D014871:Water Microbiology