ABSTRACT

Legionnaires’ disease is an atypical pneumonia caused by inhaling small droplets of water containing the bacterium Legionella spp. In newborns, it is a rare event, usually associated with water births and the use of air conditioning systems or air humidifiers. A nosocomial outbreak of Legionnaires’ disease in the maternity ward of a secondary-care hospital in Arandjelovac, Serbia is described.

Two male newborns were found to be infected with Legionnella pneumophila. On Days 7 and 6 of life, respectively, they were transferred to a tertiary-care hospital with signs of severe pneumonia which was radiologically confirmed. L. pneumophila was detected in tracheal secretions from both infants by RT-PCR, and its antigens were also positive in urine samples. The source of infection in the secondary-care hospital was the internal hot water heating system, and the main contributory factor to the emergence of the infection was the low temperature of the hot water which did not kill the bacteria during the available exposure time.

These two cases highlight the importance of being cautious about possible Legionnaires’ disease in maternity wards with outdated or irregularly maintained internal water supply systems. The adoption of official guidelines for the control and regular maintenance of water supply systems, including the multidisciplinary cooperation of all relevant parties, forms the basis for direct monitoring for Legionella and the prevention of new outbreaks.

Abbreviations: BCYE: buffered charcoal yeast extract agar; GVPC: glycine vancomycin polymyxin cycloheximide agar; LD - Legionnaires’ disease; TR-PCR: Reverse transcription polymerase chain reaction

摘要

军团病是由吸入含有军团菌属细菌的小水滴引起的非典型肺炎。在新生儿中，这是一种罕见的事件，通常与水中分娩和使用空调系统或空气加湿器有关。描述了在塞尔维亚 Arandjelovac 的一家二级保健医院的产科病房内爆发的军团病。

两名男新生儿被发现感染了嗜肺军团菌。分别在生命的第 7 天和第 6 天，他们被转移到三级医院，有严重肺炎的迹象，放射学证实。通过RT-PCR在两名婴儿的气管分泌物中检测到嗜肺军团菌，其抗原在尿样中也呈阳性。二级医院的感染源是内部热水加热系统，造成感染的主要原因是热水温度过低，在可用暴露时间内没有杀死细菌。

这两个案例凸显了在内部供水系统过时或维护不定期的产科病房中对可能的退伍军人病保持谨慎的重要性。采用官方指导方针控制和定期维护供水系统，包括所有相关方的多学科合作，为军团菌的直接监测和预防新的爆发奠定了基础。

缩写： BCYE：缓冲炭酵母提取物琼脂；GVPC：甘氨酸万古霉素多粘菌素放线菌酮琼脂；LD - 军团病；TR-PCR：逆转录聚合酶链式反应