A cluster of Legionella sternal-wound infections due to postoperative topical exposure to contaminated water

Article Abstract:

Legionella infections (caused by the bacteria associated with Legionnaire's disease, a type of pneumonia) transmitted in hospital settings rarely cause infections in sites other than the lungs. Three cases of infection of the surgical wound made near the breastbone (sternum) to perform cardiac surgery are identified and described. The cases occurred within a larger group of patients who developed infections due to Legionella over a seven-year period; this investigation revealed the route of transmission. The cardiac patients' conditions necessitated an unusual amount of sternal disruption (due to need for cardiac massage, chest compression, and related treatments), and within about seven days signs of infection began to appear. Two of the three patients died. Three control patients underwent cardiovascular surgery close to the time of the patients' surgeries without subsequent infection; data from their medical records were compared with data from the infected patients (cases) to learn more concerning risk factors for Legionella. Cases were more likely than controls to have two or more previous operations in which the sternum had been cut; they also had more changes of the wound dressings during the first postsurgical week. A survey of nursing personnel (102 people) revealed that 97 percent bathed patients in tap water after surgery, using the water to wash away the colored liquid with which the patients were cleaned prior to surgery. Many of the nurses washed the area near the wound and chest tubes (inserted to drain the chest) with tap water. Tests showed that the edges and undersurface of the dressing became wet after washing. Analysis of water samples from 61 locations in the hospital revealed the presence of the strains Legionella dumoffii and Legionella pneumophila only in water from the intensive care unit where the patients had been housed. On only one occasion was Legionella dumoffii isolated from the hospital tap water, but the organisms are known to persist in plumbing, even though concentrations may fluctuate. The use of tap water for bathing surgical patients should be carefully monitored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surgical wound infections, Nosocomial infections, Cross infection, Legionella pneumophila

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Of cats, humans, and Bartonella

Article Abstract:

The prevention of Bartonella infections may require the cooperation of physicians, veterinarians and social workers. There are two major species of Bartonella (B.): B. henselae and B. quintana. They were first discovered to be the cause of angiomatosis in AIDS patients, which causes a skin lesion similar to Kaposi's sarcoma. The same infection in the liver is called peliosis. B. henselae was also found to be the cause of cat-scratch disease. In one region, 40% of the domestic cats studied were infected with B. henselae. B. quintana appears to be transmitted by lice and is common in homeless and low-income populations.

Health aspects, Editorial, Domestic cats, Cats, Bartonella, Angiomatosis

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Potable water as a cause of sporadic cases of community-acquired Legionnaires' disease

Article Abstract:

Drinking water supplied to homes, businesses and hospitals could harbor the bacterium that causes Legionnaires' disease. Of 20 patients diagnosed with Legionnaires' disease, eight were found to be infected with the same type of Legionella pneumophila as was found in samples of their drinking water. Three patients were living at home prior to their infection, two were in a nursing home, one was in a hospital and one was working in an industrial plant. Two of the patients living at home lived in an apartment complex. Drinking water may be a source of sporadic cases of Legionnaires' disease.

Drinking water, Contamination, Legionnaires' disease

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