Franzin L, Cabodi D, Scolfaro C, Gioannini P
Infectious Diseases Unit, University of Turin, Turin, Italy.
Infez Med. 2004 Mar;12(1):69-75.
A case of Legionella pneumophila 1 pneumonia, confirmed by positive serology and urinary antigen, occurred in a 7-day old neonate after water birth in hospital. As respiratory samples were not available for culture, further microbiological investigations were performed in neonate and environment, in order to recognize the source of infection. The hospital water supply was contaminated by L. pneumophila 1 strains (300-2000 cfu/L) of two monoclonal subtypes of Pontiac subgroup. L. spiritensis (10-225 cfu/L) was isolated from cold tap water of the patient's home. PCR from tap and humidifiers water of the patient's home was positive for Legionella spp, but not for L. pneumophila. Because L. pneumophila 1, responsible of child infection, was only isolated from the hospital pool water for waterbirthing, we conclude that the infant acquired the nosocomial legionellosis by prolonged delivery in contaminated water, perhaps by aspiration. Infection control measures for waterbirthing are highly recommended. A review of neonatal case of legionellosis is also presented. As this rare infection may have a high fatality rate if unrecognized, pediatricians should be aware of the possibility of the legionellosis in newborns.
一名7天大的新生儿在医院水中分娩后发生了嗜肺军团菌1型肺炎，血清学和尿抗原检测呈阳性，确诊为此病。由于没有呼吸道样本用于培养，因此对新生儿和环境进行了进一步的微生物学调查，以确定感染源。医院供水被庞蒂亚克亚群的两种单克隆亚型的嗜肺军团菌1型菌株污染（300 - 2000 cfu/L）。从患者家中的冷水龙头水中分离出了斯皮里滕斯军团菌（10 - 225 cfu/L）。对患者家中水龙头水和加湿器水进行的聚合酶链反应检测显示军团菌属呈阳性，但嗜肺军团菌呈阴性。由于导致儿童感染的嗜肺军团菌1型仅从医院水中分娩池的水中分离出来，我们得出结论，婴儿是在受污染的水中长时间分娩过程中，可能通过误吸感染了医院获得性军团菌病。强烈建议对水中分娩采取感染控制措施。本文还对新生儿军团菌病病例进行了综述。由于这种罕见感染如果未被识别可能具有较高的死亡率，儿科医生应意识到新生儿患军团菌病的可能性。
