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A small outbreak of Legionnaires' disease in a cargo ship under repair

¹ Servei d'Epidemiologia, Institut Municipal de Salut Pública, ² Servei de Microbiologia IDIBAPS, Hospital Clínic, ³ Laboratori Municipal, Institut Municipal de Salut Pública, ⁴ Servicio de Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain, ⁵ Servei d'Anàlisi i Vigilància Ambiental, Ajuntament de Barcelona and ⁶ Institut Municipal de Salut Pública, Barcelona, Spain

CORRESPONDENCE: J.A. Caylà, Servei d'Epidemiologia, Institut Municipal de Salut Pública, P1. Lesseps, 1, 08023, Barcelona. Fax: 34 932182275

Keywords: legionnaires' disease, outbreak, ship

Received: May 24, 2000
Accepted January 5, 2001

Abstract

It was reported that two mechanics working on a cargo ship under repair in the port of Barcelona had died after having fever.

An investigation was made into the possibility of any additional cases and the presence of Legionella pneumophila in the ship they were repairing and in their hotel. The contaminated water system was treated with sodium hypochlorite.

Both patients died after having been repeatedly diagnosed as having influenza. The two cases occurred among those who had been working with the pump of the ship's water system, while no cases were observed among the other workers (p=0.02). Various serogroups of L. pneumophila were isolated from the ship's water pump and distribution system. However, organism of serogroup 1, subgroup Pontiac (Knoxville) were identified with identical deoxyribonucleic acid (DNA) patterns in the lung tissue of one patient and in the cooling water circuit valve of the ship's water pump. The first postintervention control water samples showed no further growth of legionella, but serogrups 4 and 8 were identified 8 months later.

This legionellosis outbreak, although small, was highly lethal, probably due to the high levels of bacteria to which the patients were exposed and also because of the failure of correct diagnosis. International recommendations on prevention and control of legionellosis, which include ships under repair, are required.