Journal Article

Legionnaires' Disease on a Cruise Ship Linked to the Water Supply System: Clinical and Public Health Implications

Maddalena Castellani Pastoris, Renato Lo Monaco, Paola Goldoni, Bruno Mentore, Giacomo Balestra and Lorenzo Ciceroni

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 28, issue 1, pages 33-38
Published in print January 1999 | ISSN: 1058-4838
Published online January 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/515083
Legionnaires' Disease on a Cruise Ship Linked to the Water Supply System: Clinical and Public Health Implications

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The occurrence of legionnaires' disease has been described previously in passengers of cruise ships, but determination of the source has been rare. A 67-year-old, male cigarette smoker with heart disease contracted legionnaires' disease during a cruise in September 1995 and died 9 days after disembarking. Legionella pneumophila serogroup 1 was isolated from the patient's sputum and the ship's water supply. Samples from the air-conditioning system were negative. L. pneumophila serogroup 1 isolates from the water supply matched the patient's isolate, by both monoclonal antibody subtyping and genomic fingerprinting. None of 116 crew members had significant antibody titers to L. pneumophila serogroup 1. One clinically suspected case of legionnaires' disease and one confirmed case were subsequently diagnosed among passengers cruising on the same ship in November 1995 and October 1996, respectively. This is the first documented evidence of the involvement of a water supply system in the transmission of legionella infection on ships. These cases were identified because of the presence of a unique international system of surveillance and collaboration between public health authorities.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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