Clinical-environmental surveillance of legionellosis: an experience in Southern Italy.

In Italy, although the number of cases of legionellosis notified to the health authorities has significantly increased in recent years, the incidence is still believed to be underestimated. To verify the true frequency and identify the sources of infection, an active clinical-environmental surveillance program was instituted in three hospital facilities in Southern Italy. Between January 2001 and March 2005, a total of 1000 patients admitted to the three hospitals with a diagnosis of pneumonia were enrolled. The urinary antigen and anti-Legionella antibody titre were assayed in each subject, and direct searches for the microorganism were made in biological specimens. Legionellosis was found to be present in 5.9% of the patients. For each of the cases of legionellosis, microbiological surveys were made of the water supply in the public and/or private facilities involved. Overall, 197 water samples of hospital origin and 218 of community origin were analysed: Legionella spp was isolated in 44.2 and 36.7% of the cases, respectively. Comparison of our data with those of the routine surveillance system for the same area (only 7 cases during the period 1997-2000), showed that the frequency of legionellosis is grossly underestimated in Southern Italy. It is therefore necessary to set up more rigorous controls in both hospital and community facilities, so that timely preventive measures can be taken to avoid any further spread of the disease.

Relationship between mineral content of domestic hot water and microbial contamination.

The relationship between Legionella and Pseudomonas spp contamination and mineral content of domestic hot waters was investigated in a cross-sectional Italian survey. Pseudomonas spp contamination was associated with elevated Ca, but lower Fe and free chlorine content in the water. Waters with Cu concentrations > 50 microg/L prevented Legionella spp colonisation (OR = 0.14, 95% CI = 0.02-1.13), whereas the risk of legionellae occurrence increased in waters with Mn levels > 3 microg/L (OR = 2.37, 95% CI = 1.06-5.30). Furthermore, Mn was positively associated with the risk of colonisation by eterotrophic bacteria growing at either 22 and 36 degrees C. Legionella species and serogroups were differently distributed according to Cu and Mn concentrations, suggesting that Legionella strains may have a different sensibility/resistance to trace elements. A specific action of Cu as decontamination factor is suggested and the consideration of Mn as a risk indicator for bacterial colonisation and biofilm presence is proposed.