Transmission of Legionnaires' Disease Through Toilet Flushing

Jeanne Couturier; Christophe Ginevra; Didier Nesa; Marine Adam; Cyril Gouot; Ghislaine Descours; Christine Campèse; Giorgia Battipaglia; Eolia Brissot; Laetitia Beraud; Anne-Gaëlle Ranc; Sophie Jarraud; Frédéric Barbut


Emerging Infectious Diseases. 2020;26(7):1526-1528. 

In This Article

Abstract and Introduction


We describe 2 cases of healthcare-associated Legionnaires' disease in patients in France hospitalized 5 months apart in the same room. Whole-genome sequencing analyses showed that clinical isolates from the patients and isolates from the room's toilet clustered together. Toilet contamination by Legionella pneumophila could lead to a risk for exposure through flushing.


Legionella pneumophila is a gram-negative bacterium usually found in small amounts in water in both nature and built environments. In larger amounts, it can be responsible for a severe pneumonia known as Legionnaires' disease (LD). Transmission usually occurs when someone inhales contaminated aerosols from showers, cooling towers, faucets, or fountains. Person-to-person transmission is extremely rare.[1] Researchers have shown evidence of a variety of other uncommon sources of contamination, such as windshield washer fluid[2] or dental unit waterlines.[3] LD transmission through flushing toilets has also been suspected[4] but not demonstrated. We report 2 cases of LD in immunocompromised patients in France, potentially caused by L. pneumophila transmission through flushing toilets.