Abstract
Several Travel-associated Legionnaires’ disease (TALD) cases occur annually in Europe. Except from the most obvious sites (cooling towers and hot water systems), infections can also be associated with recreational, water feature, and garden areas of hotels. This argument is of great interest to better comprehend the colonization and to calculate the risk to human health of these sites. From July 2000–November 2017, the public health authorities of the Island of Crete (Greece) inspected 119 hotels associated with TALD, as reported through the European Legionnaires’ Disease Surveillance Network. Five hundred and eighteen samples were collected from decorative fountain ponds, showers near pools and spas, swimming pools, spa pools, garden sprinklers, drip irrigation systems (reclaimed water) and soil. Of those, 67 (12.93%), originating from 43 (35.83%) hotels, tested positive for Legionella (Legionella pneumophila serogroups 1, 2, 3, 6, 7, 8, 13, 14, 15 and non-pneumophila species (L. anisa, L. erythra, L. taurinensis, L. birminghamensis, L. rubrilucens). A Relative Risk (R.R.) > 1 (p < 0.0001) was calculated for chlorine concentrations of less than 0.2 mg/L (R.R.: 54.78), star classification (<4) (R.R.: 4.75) and absence of Water Safety Plan implementation (R.R.: 3.96). High risk (≥104 CFU/L) was estimated for pool showers (16.42%), garden sprinklers (7.46%) and pool water (5.97%).
Highlights
Legionella bacteria live naturally in fresh water, as well as in artificial water systems such as hot water tanks, hot tubs or spas, cooling towers, plumbing systems, and decorative pools or fountains [1,2].Hotel gardens are, frequently irrigated with sprinklers and these may present an additional risk, if they utilize recycled grey-water or sewage-based water [3]
Legionella species are able to reproduce at 25–43 ◦ C and able to survive at temperatures of up to 55–60 ◦ C, making it possible for them to thrive even in hot water systems [4]
Legionnaires’ disease, a serious form of pneumonia, may be caused by any type of Legionella bacteria, L. pneumophila serogroup 1 is considered the most virulent of all species and serogroups, causing approximately 75% of all Legionella infections [2,6,7]
Summary
Legionella bacteria live naturally in fresh water, as well as in artificial water systems such as hot water tanks, hot tubs or spas, cooling towers, plumbing systems, and decorative pools or fountains [1,2].Hotel gardens are, frequently irrigated with sprinklers and these may present an additional risk, if they utilize recycled grey-water or sewage-based water [3]. Legionella bacteria live naturally in fresh water, as well as in artificial water systems such as hot water tanks, hot tubs or spas, cooling towers, plumbing systems, and decorative pools or fountains [1,2]. Legionella species are able to reproduce at 25–43 ◦ C and able to survive at temperatures of up to 55–60 ◦ C, making it possible for them to thrive even in hot water systems [4]. Two forms of legionellosis are caused by the Legionella pathogens: Legionnaires’ disease (LD), presenting with pneumonia-like symptoms, and Pontiac fever, presenting with influenza-like symptoms [5]. Legionnaires’ disease, a serious form of pneumonia, may be caused by any type of Legionella bacteria, L. pneumophila serogroup 1 is considered the most virulent of all species and serogroups, causing approximately 75% of all Legionella infections [2,6,7].
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