Molecular Determination of Infection Source of a Sporadic Legionella Pneumonia Case Associated with a Hot Spring Bath

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  • Miyamoto Hiroshi
    Department of Microbiology, School of Medicine, University of Occupational and Environmental Health
  • Jitsurong Siroj
    Department of Pathology, Faculty of Medicine, Prince of Songkla University
  • Shiota Ryoko
    Department of Clinical Laboratory, Takinomiya General Hospital
  • Maruta Koji
    Department of Microbiology, School of Medicine, University of Occupational and Environmental Health
  • Yoshida Shin-ichi
    Department of Microbiology, School of Medicine, University of Occupational and Environmental Health
  • Yabuuchi Eiko
    Department of Bacteriology, Osaka City University Medical School

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  • Molecular Determination of Infection Source of a Sporadic <i>Legionella</i> Pneumonia Case Associated with a Hot Spring Bath
  • Molecular Determination of Infection So

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To determine the infection source of a sporadic Legionella pneumonia case associated with a hot spring bath, we used five molecular methods, including repetitive element polymerase chain reaction (rep-PCR), arbitrarily primed PCR (AP-PCR), ribotyping, restriction endonuclease analysis (REA), and macrorestriction endonuclease analysis (MREA) by pulsed-field gel electrophoresis. L. pneumophila serogroup (SG) 3 strain EY 3702, isolated from an intratracheal specimen of a 71-year-old Japanese female who developed pneumonia after nearly drowning in a hot spring spa bath, produced rep-PCR and AP-PCR fingerprints identical to those of L. pneumophila SG 3 strains EY 3768 and EY 3769 isolated from the bath water. Four epidemiologically unrelated L. pneumophila SG 3 strains showed different rep-PCR or AP-PCR fingerprints from those of the three EY strains (EY 3702, 3768, and 3769). The three EY strains were also genotypically indistinguishable by ribotyping with EcoRI and PstI, by REA with EcoRI or HindIII, and by MREA with NotI. Based on these results, we identified the bath water of the hot spring spa as the source of infection of this patient, even though the viable number of the organisms in the bath water was low (3CFU/100ml) when determined 27 days after her nearly drowning.

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