An outbreak of pneumonia in a thermal water spa contaminated with Pseudomonas aeruginosa: An epidemiological and environmental concern

Abstract

This article described an outbreak of bacterial pneumonia/bronchopneumonia in a group of visitors to a mineral water spa contaminated with Pseudomonas aeruginosa in summer 2009. The epidemiologic investigation was activated after the hospitalization for pneumonia of three people who had undergone therapy at the spa. Discharge with a diagnosis of pneumonia/bronchopneumonia in weeks 27 to 39 of 2009 of four hospitals near the spa were data-linked with the list of spa’s visitors. Environmental samples of thermal water were performed and analysed. Investigations discovered a total of 39 cases of pneumonia among the spa visitors. Checks carried out in the hospitals near the spa revealed more hospitalizations for pneumonia in summer 2009 than the average for the previous five summers. There was a significant association between pneumonia and inhalation therapy (RR=7.33; p<0.0001) and aerosol therapy (RR=8.25; p<0.0001). P. aeruginosa was discovered in the water of the inhalation equipment. The spa micro-environment offers a risk of infection from pathogenic and/or opportunistic micro-organisms and therefore in-house testing, surveillance and prevention systems should be put in place for the well-being of clients. Key words: Community acquired pneumonia, Pseudomonas aeruginosa, thermal water.