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An unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong.
[legionellosis]
The
environmental
sources
associated
with
community-acquired
or
nosocomial
legionellosis
were
not
always
detectable
in
the
mainland
of
China
and
Hong
Kong
,
China
.
The
objective
of
this
study
was
to
illustrate
the
control
measures
implemented
for
nosocomial
and
community
outbreaks
of
legionellosis
,
and
to
understand
the
environmental
distribution
of
legionella
in
the
water
system
in
Hong
Kong
,
China
.
We
investigated
the
environmental
sources
of
two
cases
of
legionellosis
acquired
in
the
hospital
and
the
community
by
extensive
outbreak
investigation
and
sampling
of
the
potable
water
system
using
culture
and
genetic
testing
at
the
respective
premises
.
The
diagnosis
of
nosocomial
legionellosis
was
suspected
in
a
patient
presenting
with
nosocomial
pneumonia
not
responsive
to
multiple
beta
-lactam
antibiotics
with
subsequent
confirmation
by
Legionella
pneumophila
serogroup
1
antigenuria
.
High
counts
of
Legionella
pneumophila
were
detected
in
the
potable
water
supply
of
the
70
-
year
-old
hospital
building
.
Another
patient
on
continuous
ambulatory
peritoneal
dialysis
presenting
with
acute
community-acquired
pneumonia
and
severe
diarrhoea
was
positive
for
Legionella
pneumophila
serogroup
1
by
polymerase
chain
reaction
(
PCR
)
testing
on
both
sputum
and
nasopharyngeal
aspirate
despite
negative
antigenuria
.
Paradoxically
the
source
of
the
second
case
was
traced
to
the
water
system
of
a
newly
commissioned
office
building
complex
.
No
further
cases
were
detected
after
shock
hyperchlorination
with
or
without
superheating
of
the
water
systems
.
Subsequent
legionella
counts
were
drastically
reduced
.
Point-of-care
infection
control
by
off-boiled
or
sterile
water
for
mouth
care
and
installation
of
water
filter
for
showers
in
the
hospital
wards
for
immunocompromised
patients
was
instituted
.
Territory
wide
investigation
of
the
community
potable
water
supply
showed
that
22
.
1
%
of
the
household
water
supply
was
positive
at
a
mean
legionella
count
of
108
.
56
CFU
/
ml
(
range
0
.
10
to
639
.
30
CFU
/
ml
)
.
Potable
water
systems
are
open
systems
which
are
inevitably
colonized
by
bacterial
biofilms
containing
Legionella
species
.
High
bacterial
counts
related
to
human
cases
may
occur
with
stagnation
of
flow
in
both
old
or
newly
commissioned
buildings
.
Vigilance
against
legionellosis
is
important
in
healthcare
settings
with
dense
population
of
highly
susceptible
hosts
.