title: Nosocomial transmission of Legionella pneumophila to a child from a hospital's cold-water supply.
abstract: Human Legionella infections mainly consist of community-acquired and nosocomial pneumonia and rarely affect children. We describe a nosocomial infection with Legionella pneumophila, serogroup 1, subgroup OLDA, in an immunocompromized 2-y-old girl at a paediatric clinic. L. pneumophila identical to that of the patient was found in the hospital's cold-water but not in the hot-water distribution system. Transmission of Legionella to the girl most probably occurred by Legionella-contaminated cold water mixed and heated by water from the hot-water system. Mixing of hot and cold water probably occurred through thermostatic water mixing valves connected to showers regulated by a handle at the shower head. Nosocomial Legionella infection might thus have occurred, although circulating hot water temperatures never dropped below 53 degrees C and cultures for surveillance of Legionella from central parts of the hot-water system have been consistently negative. Legionellae were successfully eliminated from the hospital's cold-water distribution system by hot water flushing at 73 degrees C for 1h.
authors.affiliation: Hospital Infection Control Unit, Clinical Microbiology and Immunology, Lund, Sweden. hugo.johansson@skane.se
authors.forename: P J Hugo
authors.initials: PJ
authors.lastname: Johansson
authors.forename: Kaj
authors.initials: K
authors.lastname: Andersson
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiebe
authors.forename: Claes
authors.initials: C
authors.lastname: Schalén
authors.forename: Sverker
authors.initials: S
authors.lastname: Bernander
mesh_terms: D002675:Child, Preschool; D003080:Cold Temperature; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control; D005260:Female; D005618:Fresh Water / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D007877:Legionnaires' Disease / Q000209:etiology*; D013548:Sweden; D014881:Water Supply