title: A preliminary assessment of the occupational risk of acquiring Legionnaires' disease for people working in telephone manholes, a new workplace environment for Legionella growth.
abstract: BACKGROUND
  Telephone manholes (TMs) are underground wells, used in Italy by the telecommunication companies to locate telephone networks. Following a fatal case of Legionnaires' disease (LD), acquired during working activity in a TM, we investigated whether Legionella was present in TMs and could be a risk for manhole workers (MWs).
  
  
  METHODS
  Three hundred fifty-three environmental samples were collected from 100 TMs, and serum antibody titer against Legionella pneumophila and Legionella species non-pneumophila was determined from both MWs and control non-manhole workers.
  
  
  RESULTS
  L pneumophila and Legionella species non-pneumophila were detected in 28% of water samples, in 8% of the biofilm, and in 6% of sediment matrices taken in TMs, in a concentration range of 10(2) to 10(4) colony-forming units/L. No Legionella was found in TM air samples. Although there was a statistically significant difference (P = .027) in antibody titer to L pneumophila serogroup 1 (Lp1) between MWs and non-manhole workers, a multivariate logistic regression analysis showed a significant association between antibody against Lp1 and both age group and the practice of aquatic sports.
  
  
  CONCLUSIONS
  Although further investigations will be performed to quantify the risk of acquiring legionellosis, this preliminary study demonstrates for the first time the presence of Legionella, including human pathogenic species, in a working environment such as TM.
authors.affiliation: Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy. marialuisa.ricci@iss.it
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Ricci
authors.forename: Stefano
authors.initials: S
authors.lastname: Fontana
authors.forename: Antonino
authors.initials: A
authors.lastname: Bella
authors.forename: A
authors.initials: A
authors.lastname: Gaggioli
authors.forename: R
authors.initials: R
authors.lastname: Cascella
authors.forename: Antonio
authors.initials: A
authors.lastname: Cassone
authors.forename: Maria
authors.initials: M
authors.lastname: Scaturro
mesh_terms: D000328:Adult; D015169:Colony Count, Microbial; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D007558:Italy; D016952:Legionella pneumophila / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000517:prevention & control; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013689:Telephone