title: Epidemiological investigation of a legionellosis outbreak in a Slovenian nursing home, August 2010.
abstract: BACKGROUND
  August 2010 marked the beginning of the largest outbreak of legionellosis in a Slovenian nursing home. This article presents our experiences with the outbreak investigation.
  
  
  METHODS
  In order to collect the necessary patient epidemiological data, we used individual epidemiological questionnaires. Samples were available from 15 patients and were subject to laboratory investigation. Urine and sputum samples were difficult to obtain due to the underlying diseases of the patients. Serological diagnostics constituted an important part of the epidemiological investigation. Sixty-four environmental samples were taken to identify the sources of infection. By genotyping, we assessed the affinity of the allelic profile of Legionella pneumophila serogroup 1 in environmental samples and in patient samples.
  
  
  RESULTS
  Legionnaires' disease was diagnosed in 10 patients based on a combination of various tests. Legionella pneumophila serogroup 1, Legionella pneumophila serogroups 2-14, and Legionella sp., in concentrations of < 10 to 61,000 CFU/l, were isolated from 51 out of 64 environmental samples. The source of the outbreak was confirmed by genotyping the isolates from patients and the isolates from the water supply system. The 2 isolates had identical allelic profiles corresponding to that of L. pneumophila serogroup 1 allelic profile 2,3,9,10,2,1,6, designated sequence type 23 (according to the European Working Group for Legionella Infections).
  
  
  CONCLUSIONS
  We describe a Legionella pneumophila serogroup 1 outbreak in a Slovenian nursing home. The source of infection was demonstrated using sequence-based typing. Water flow disturbances were determined as the most probable cause of Legionella growth. Overall, the risk of a Legionella outbreak is underestimated in Slovenia.
authors.affiliation: Institute of Public Health Celje, Celje, Slovenia. alenka.skaza@zzv-ce.si
authors.forename: Alenka
authors.initials: A
authors.lastname: Trop Skaza
authors.forename: Lucija
authors.initials: L
authors.lastname: Beskovnik
authors.forename: Alenka
authors.initials: A
authors.lastname: Storman
authors.forename: Darja
authors.initials: D
authors.lastname: Kese
authors.forename: Simona
authors.initials: S
authors.lastname: Ursic
mesh_terms: D000328:Adult; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D060766:Drinking Water / Q000382:microbiology; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000235:genetics / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017524:Slovenia / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D060766:Drinking Water