title: A single Legionella pneumophila genotype in the freshwater system in a ship experiencing three separate outbreaks of legionellosis in 6 years.
abstract: BACKGROUND
  Recurrent legionella outbreaks at one and the same location are common. We have identified a single Legionella pneumophila genotype associated with recurrent Legionella outbreaks over 6 years.
  
  
  METHODS
  Field emergency surveys following Legionella outbreaks were performed on a vessel in 2008, 2009 and 2013. Water samples from both the distribution and technical parts of the potable water system were analyzed with respect to L. pneumophila [Real-Time PCR, cultivation, serotyping and genotyping (PFGE)] and free-living amoebae, (FLA).
  
  
  RESULTS
  Legionella pneumophila serogroup 1 was present in the ship's potable water system during every outbreak. Genotyping of the 2008 survey material showed two separate PFGE genotypes while those in 2009 and 2013 demonstrated the presence of only one of the two genotypes. FLA with intracellular L. pneumophila of the same genotype were also detected. Analyses of the freshwater system on a ship following three separate Legionella outbreaks, for L. pneumophila and FLAs, revealed a single L. pneumophila genotype and FLA (Hartmanella).
  
  
  CONCLUSIONS
  It is reasonable to assume that the L. pneumophila genotype detected in the freshwater system was the causal agent in the outbreaks onboard. Persistence of an apparently low-pathogenic L. pneumophila genotype and FLA in a potable water system represent a potential risk for recurrent outbreaks.
authors: Norwegian Centre for Maritime Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; catrineahlen@gmail.com.
authors: Catrine
authors: C
authors: Ahlen
authors: Department of Environmental Technology, Microbiology, SINTEF, Trondheim, Norway.
authors: Marianne
authors: M
authors: Aas
authors: Department of Microbiology, Parasitology and Waterborne Pathogens, Public Health Agency of Sweden, Stockholm, Sweden.
authors: Jadwiga
authors: J
authors: Krusnell
authors: Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
authors: Ole-Jan
authors: OJ
authors: Iversen
keywords: Free-living amoeba; Genotypes; Legionella pneumophila; Pathogenicity; Prevention and control; Ships; Virulence; infection outbreaks