Background. Only a few cases of nosocomial Legionella sp, infection have be
en reported in children. We report the clinical and epidemiologic data of f
ive nosocomial legionellosis cases that occurred in the Pediatric Nephrolog
y Service between August, 1994, and December, 1998, and the control measure
s adopted,
Methods. The Hospital Materno-Infantil Vall d'Hebron, Barcelona, is a 407-b
ed tertiary care hospital. The pediatric kidney transplant unit has three i
solated beds in the same ward within the Pediatric Nephrology Service. Diag
nostic workup to establish Legionella pneumophila infection included cultur
e, fluorescent antibody and serologic studies. Macrorestriction analysis of
genomic DNA was used as epidemiologic markers of the isolated strains.
Results, In May, 1996, a case of L. pneumophila serogroup 6 pneumonia was i
dentified in a 19-year-old youth who had received a kidney transplant 16 da
ys earlier. Retrospective and prospective analysis of legionellosis cases d
iagnosed at our center up to August, 1994, yielded four additional cases. F
our patients had had a kidney transplant and were receiving immunosuppressi
ve therapy, and the fifth had been diagnosed with systemic lupus erythemato
sus with renal involvement. L, pneumophila serogroup 6 was isolated in bron
chial secretions in four cases; in the fifth patient the diagnosis was made
by serology. L, pneumophila serogroup 6 was isolated from potable water of
the hospital, Molecular epidemiologic methods revealed the identity of the
environmental and clinical isolates. Shower-was implicated as the most fea
sible means of exposure to contaminated water.
Conclusions. Nosocomial legionellosis, albeit rare in children, should be c
onsidered in the differential diagnosis of pneumonias, particularly in immu
nosuppressed children, because the fatality rate may be high without early
diagnosis and treatment.