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First outbreak of nosocomial Legionella infection in term neonates caused by a cold mist ultrasonic humidifier.
[legionellosis]
To
date
,
all
descriptions
of
legionellosis
in
neonates
have
emerged
from
a
small
number
of
isolated
case
reports
in
newborns
with
unusually
severe
pneumonia
.
In
December
2008
,
a
large
outbreak
of
Legionella
infection
occurred
in
term
neonates
in
Cyprus
,
providing
new
information
on
the
epidemiological
and
clinical
features
of
Legionellosis
in
this
age
group
.
An
environmental
investigation
was
performed
at
a
small
private
hospital
where
the
infected
neonates
were
delivered
.
The
medical
records
of
the
infected
neonates
were
retrospectively
reviewed
to
obtain
clinical
data
on
presentation
,
complications
,
and
course
of
disease
.
Nine
of
the
32
(
28
%
)
newborns
who
were
exposed
to
the
contaminated
source
at
the
private
nursery
were
infected
with
Legionella
.
Six
subjects
had
pulmonary
infiltrates
,
but
in
3
cases
there
were
no
abnormal
radiological
findings
and
clinical
presentation
was
mild
.
In
4
neonates
,
pulmonary
infiltrates
at
presentation
were
bilateral
and
extensive
and
3
died
,
conferring
a
mortality
rate
of
50
%
in
subjects
with
pulmonary
infiltrates
and
an
overall
mortality
of
33
.
3
%
.
Legionella
pneumophila
serogroup
3
was
recovered
in
neonatal
biological
samples
,
although
in
some
patients
there
was
implication
of
a
second
strain
,
serogroup
1
.
It
was
determined
that
the
neonates
were
infected
while
in
the
nursery
at
the
private
hospital
by
aerosol
produced
by
a
recently
installed
cold-mist
humidifier
that
was
filled
with
contaminated
water
.
Use
of
humidifiers
in
nursery
units
must
be
avoided
as
the
risk
of
disseminating
Legionella
in
neonates
is
very
high
.
In
neonates
legionellosis
should
be
suspected
when
signs
of
infection
first
appear
and
take
an
unusual
course
,
even
when
no
pulmonary
infiltrates
appear
.
Diseases
Validation
Diseases presenting
"severe pneumonia"
symptom
allergic bronchopulmonary aspergillosis
legionellosis
scrub typhus
von hippel-lindau disease
wiskott-aldrich syndrome
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