Tuğba ERAT, Halil ÖZDEMİR, Aysun YAHŞİ, Tuğçe TURAL KARA, Elif ÜNAL İNCE, Kemal OSMAN MEMİKOĞLU, Erdal İNCE, Ergin ÇİFTÇİ

Nosocomial pneumonia caused by water-born Legionella pneumophila in a pediatric hematopoietic stem cell transplantation recipient for thalassemia major

Background. Nosocomial pneumonia caused by Legionella pneumophila serogroup 2-14 occurred in a 7-year-old patient following allogeneic hematopoietic stem cell transplantation for thalassemia major. Case. The patient was diagnosed with nosocomial Legionella pneumophila by polymerase chain reaction (PCR) examination of the bronchoalveolar lavage and culturing Legionella pneumophila serogroup 2-14 from the patient’s room faucet water. Legionella pneumophila was eradicated from our hospital’s water distribution system by superheating and chemical eradication methods (hyper-chlorination and hydrogen peroxide). We did not detect any other case after this event. Conclusion. Early recognition of contamination of the hospital water system with Legionella proves the importance of prevention in new cases.

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1.Hayashi M, Kuraishi H, Masubuchi T, et al. A fatal case of relapsing pneumonia caused by Legionella pneumophila in a patient with rheumatoid arthritis after two injections of adalimumab. Clin Med Insights Case Rep 2013; 6: 101-106.

2.Heine S, Fuchs A, von Müller L, et al. Legionellosis must be kept in mind in case of pneumonia with lung abscesses in children receiving therapeutic steroids. Infection 2011; 39: 481-484.

3.Oren I, Zuckerman T, Avivi I, Finkelstein R, Yigla M, Rowe JM. Nosocomial outbreak of Legionella pneumophila serogroup 3 pneumonia in a new bone marrow transplant unit: evaluation, treatment and control. Bone Marrow Transplant 2002; 30: 175-179.

4.Osawa K, Shigemura K, Abe Y, et al. A case of nosocomial Legionella pneumonia associated with a contaminated hospital cooling tower. J Infect Chemother 2014; 20: 68-70.

5.Cordes LG, Wiesenthal AM, Gorman GW, et al. Isolation of Legionella pneumophila from hospital shower heads. Ann Intern Med 1981; 94:195-197.

6.Wadowsky RM, Yee RB, Mezmar L, Wing EJ, Dowling JN. Hot water systems as sources of Legionella pneumophila in hospital and nonhospital plumbing fixtures. Appl Environ Microbiol 1982; 43: 1104-1110.

7.Hoebe CJ, Kool JL. Control of legionella in drinking-water systems. Lancet 2000; 355: 2093-2094.

8.Musallam N, Bamberger E, Srugo I, et al. Legionella pneumophila and Pneumocystis jirovecii coinfection in an infant treated with adrenocorticotropic hormone for infantile spasm: case report and literature review. J Child Neurol 2014; 29: 240-242.

9.Ampel NM, Wing EJ. Legionella infection in transplant patients. Semin Respir Infect 1990; 5: 30-37.

10.Orsi GB, Vitali M, Marinelli L, et al. Legionella control in the water system of antiquated hospital buildings by shock and continuous hyperchlorination: 5 years experience. BMC Infect Dis 2014; 14: 394.

11.Franzin L, Scolfaro C, Cabodi D, Valera M, Tovo PA. Legionella pneumophila pneumonia in a newborn after water birth: a new mode of transmission. Clin Infect Dis 2001; 33: e103-e104.

12.Bartley PB, Ben Zakour NL, Stanton-Cook M, et al. Hospital-wide eradication of a nosocomial Legionella pneumophila serogroup 1 outbreak. Clin Infect Dis 2016; 62: 273-279.

13.Yiallouros PK, Papadouri T, Karaoli C, et al. First outbreak of nosocomial Legionella infection in term neonates caused by a cold mist ultrasonic humidifier. Clin Infect Dis 2013; 57: 48-56.

14.Lin YE, Stout JE, Yu VL. Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods. Infect Control Hosp Epidemiol 2011; 32: 166-173.

15.Ditommaso S, Giacomuzzi M, Rivera SRA, Raso R, Ferrero P, Zotti CM. Virulence of Legionella pneumophila strains isolated from hospital water system and healthcare-associated Legionnaires disease in Northern Italy between 2004 and 2009. BMC Infect Dis 2014; 14: 483.