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Case Reports in Medicine
Volume 2013 (2013), Article ID 303712, 4 pages
http://dx.doi.org/10.1155/2013/303712
Case Report

A Culture-Proven Case of Community-Acquired Legionella Pneumonia Apparently Classified as Nosocomial: Diagnostic and Public Health Implications

1Department of Clinical, Diagnostic and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy
2Prevention and Protection Service, Health Direction, University Hospital, Via Del Pozzo 71, 41124 Modena, Italy
3Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via Del Pozzo 71, 41124 Modena, Italy
4Public Health Authority, Emilia Romagna Region, Via Aldo Moro 21, 40127 Bologna, Italy

Received 24 October 2012; Accepted 14 January 2013

Academic Editor: A. Chow

Copyright © 2013 Annalisa Bargellini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of Legionella pneumonia in a 78-year-old patient affected by cerebellar haemangioblastoma continuously hospitalised for 24 days prior to the onset of overt symptoms. According to the established case definition, this woman should have been definitely classified as a nosocomial case (patient spending all of the ten days in hospital before onset of symptoms). Water samples from the oncology ward were negative, notably the patient’s room and the oxygen bubbler, and the revision of the case history induced us to verify possible contamination in water samples collected at home. We found that the clinical strain had identical rep-PCR fingerprint of L. pneumophila serogroup 1 isolated at home. The description of this culture-proven case of Legionnaires’ disease has major clinical, legal, and public health consequences as the complexity of hospitalised patients poses limitations to the rule-of-thumb surveillance definition of nosocomial pneumonia based on 2–10-day incubation period.