Nosocomial transmission of Legionella pneumophila to a child from a hospital's cold-water supply.

Human Legionella infections mainly consist of community-acquired and nosocomial pneumonia and rarely affect children. We describe a nosocomial infection with Legionella pneumophila, serogroup 1, subgroup OLDA, in an immunocompromized 2-y-old girl at a paediatric clinic. L. pneumophila identical to that of the patient was found in the hospital's cold-water but not in the hot-water distribution system. Transmission of Legionella to the girl most probably occurred by Legionella-contaminated cold water mixed and heated by water from the hot-water system. Mixing of hot and cold water probably occurred through thermostatic water mixing valves connected to showers regulated by a handle at the shower head. Nosocomial Legionella infection might thus have occurred, although circulating hot water temperatures never dropped below 53 degrees C and cultures for surveillance of Legionella from central parts of the hot-water system have been consistently negative. Legionellae were successfully eliminated from the hospital's cold-water distribution system by hot water flushing at 73 degrees C for 1h.