Abstract and Introduction
Abstract
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.
Introduction
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.
Emerging Infectious Diseases. 2020;26(7):1526-1528. © 2020 Centers for Disease Control and Prevention (CDC)
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