LEGIONELLOSIS - AUSTRIA CROATIA

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A ProMED-mail post

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ProMED-mail is a program of the International Society for Infectious Diseases

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Date: 30 Jun 2001 13:00:50 +0200

From: Martin Haditsch, MD, PhD <martin.haditsch@travel-clinic.at> [edited]

I´d like to report one case of legionellosis that is most likely linked to a hotel near Zadar / Croatia [with exposure from] 11 to 16 Jun 2001. On his way home (via bus) the male patient aged about 55 years got the first symptoms and was admitted to a hospital in Linz / Upper Austria the next day (17 Jun 2001) with symptoms of pneumonia and fever up to 39.9 C. He had a positive Legionella antigen in his urine [this test is specific for Legionella pneumophila serogroup 1]. Serum [antibody] results are still missing [pending]. He recovered partially under therapy with quinolones but still feels bad after discharge from hospital last weekend so that I suggested to switch to macrolide therapy when speaking to his pneumologist. Data were collected from a very cooperative tour operator who also told me that the hotel was closed a day after my phone-call reporting the positive result, tourists were shifted to another hotel and examinations have already been performed by the Croatian health authorities (a written report announced to be available within a few weeks). All data were reported to the Austrian legionellosis reference laboratory (Prof. G. Wewalka) in Vienna.

Martin Haditsch, MD, PhD <martin.haditsch@travel-clinic>

[Outbreaks of infection with _Legionella pneumophila_ are well known to occur in hotel guests. In fact, the organism is named for the large outbreak that occurred during a convention of American Legion members at a hotel in Philadelphia, USA that resulted in the organism's initial isolation and characterization. Hotel-associated infections have been demonstrated not merely by the isolation of the organism from the hotel's water system, but by showing that the clinical isolates are indistinguishable from the environmental isolates recovered from the hotel water supply (see reference 4, below and the ProMED-mail postings, above) on the basis of molecular methods.

A few references follow.

1. Band JD, LaVenture M, Davis JP, Mallison GF, Skaliy P, Hayes PS, Schell WL, Weiss H, Greenberg DJ, Fraser DW. Epidemic Legionnaires' disease. Airborne transmission down a chimney. JAMA 1981 Jun 19;245(23):2404-7.

2. Schlech WF 3rd, Gorman GW, Payne MC, Broome CV. Legionnaires' disease in the Caribbean. An outbreak associated with a resort hotel. Arch Intern Med 1985 Nov;145(11):2076-9.

3. Rosmini F, Castellani-Pastoris M, Mazzotti MF, Forastiere F, Gavazzoni A, Greco D, Ruckdeschel G, Tartagni E, Zampieri A, Baine WB. Febrile illness in successive cohorts of tourists at a hotel on the Italian Adriatic coast: evidence for a persistent focus of Legionella infection. Am J Epidemiol 1984 Jan;119(1):124-34.

4. Joseph C, Morgan D, Birtles R, Pelaz C, Martin-Bourgon C, Black M, Garcia-Sanchez I, Griffin M, Bornstein N, Bartlett C. An international investigation of an outbreak of Legionnaires disease among UK and French tourists. Eur J Epidemiol 1996 Jun;12(3):215-9.