A fatal newborn case of Legionella pneumophila pneumonia occurring after water birth in a bathtub with an all day circulating system, June 1999 - Nagoya City
(IASR 2000; 21:190-191)

In Japan 5 neonatal cases of Legionella pneumophila pneumonia have been reported. Nosocomial infections were suspected to these cases. This is the first case report of the pneumonia after water birth.

The case girl was born at the 42nd week with 3.5kg. The mother had had no health problem during her pregnancy, but she had wished water birth at home. The midwife arrived 15 minutes after the girl was born in a bathtub with an all day circulating system. She was normal at that time.

She presented jaundice and fever on 4 days old. She was hospitalized for one day to receive ultraviolet therapy. She developed fever and vomiting on 7 days old. The following morning, fever decreased and she was fine. On 14:30 the mother found that her breathing was arrested. When an ambulance arrived, she was in cardio-pulmonary arrest. Resuscitation was attempted, but the attending physician of the emergency room of the Nagoya Daini Red Cross Hospital confirmed her death.

An autopsy revealed diffuse bean-size nodules in the lungs. Infiltration of neutrophils and cluster of histiocytes in alveolar lesion of the nodule were observed. Numerous rod bacteria were observed in the histiocytes, which were refratory to Gram stain but positive to Gimenez stain. L. pneumophila DNA was positive in the pulmonary lesion by polymerase chain reaction. Indirect fluorescent antibody method visualized the bacteria with the L. pneumophila serogroup (SG) 6 antigens. Thus, the autopsy concluded that she died from pneumonia due to L. pneumophila SG6 infection.

Water samples were collected from the bathtub 2 weeks after the labor. Concentration level of Legionella spp. was 14,640 cfu/dl, but the species could not be identified.

Reported by: Takuhito Nagai, Hisanori Sobajima, and Mitsuji Iwasa, Dept. of Pediatrics, Nagoya Daini Red Cross Hospital; Toyonori Tsuzuki, Dept. of Pathology, Nagoya Daini Red Cross Hospital; Fumiaki Kura, Junko Maekawa, and Haruo Watanabe, Dept. of Bacteriology, NIID.

Correspondence: Takuhito Nagai;
E-mail: nagataku@nagoya2.jrc.or.jp
Fax: +81-52-832-1130

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