0
January 25, 1985, Vol 253, No. 4 >
ARTICLE | January 25, 1985

An Outbreak of Pontiac Fever Related to Whirlpool Use, Michigan 1982 FREE

Ellen J. Mangione, MD; Robert S. Remis, MD, MPH; Keith A. Tait, MPH; Harry B. McGee, MPH; George W. Gorman; Berttina B. Wentworth, PhD; Paul A. Baron, PhD; Allen W. Hightower, MS; James M. Barbaree, PhD; claire V. Broome, MD
[+] Author Affiliations

Reprint requests to Centers for Disease Control, Division of Bacterial Diseases, Center for Infectious Diseases, Atlanta, GA 30333 (Dr Mangione).


JAMA. 1985;253(4):535-539. doi:10.1001/jama.1985.03350280091026
Text Size: A A A
Published online
Article
References

Fourteen of 23 female members of a church group experienced an acute self-limited illness characterized by chills, fever, chest pain, cough, and nausea, consistent with the diagnosis of Pontiac fever. All 14 affected women had used a whirlpool located in the women's locker room during a racquetball party. Legionella pneumophila serogroup 6 was isolated from the women's whirlpool. Nine of 14 cases showed a seroconversion to heat-fixed antigen prepared from the L pneumophila serogroup 6 isolate. Aerosol size studies show that the whirlpool aerator produced water droplets small enough to travel deep into the tracheobronchial tree but large enough to transport L pneumophila. This outbreak demonstrated that Pontiac fever may be associated with L pneumophila serogroup 6, that whirlpools can serve as a reservoir for these organisms, and that seroconversion can occur in the absence of illness.

(JAMA 1985;253:535-539)

REFERENCES

1 +
Fraser DW, Tsai TR, Orenstein W, et al:  Legionnaires' disease: Description of an epidemic of pneumonia . N Engl J Med 1977;; 297:1189-1197.
2 +
McDade JE, Shepard CC, Fraser DW, et al:  Legionnaires' disease: Isolation of a bacterium and demonstration of its role in other respiratory disease . N Engl J Med 1977;;29:1197-1203.
3 +
Glick TH, Gregg MB, Berman B, et al:  Pontiac fever: An epidemic of unknown etiology in a health department: I. Clinical and epidemiologic aspects . Am J Epidemiol 1978;;107:149-160.
4 +
Kaufmann AF, McDade JE, Patton CM, et al:  Pontiac fever: Isolation of the etiologic agent (Legionella pneumophila) and demonstration of its mode of transmission . Am J Epidemiol 1981;;114:337-347.
5 +
Fraser DW, Deubner DC, Hill DL, et al:  Nonpneumonic, short-incubation-period legionellosis (Pontiac fever) in men who cleaned a steam turbine condenser . Science 1979;;205:690-691.
6 +
Spitalny K, Vogt R, Witherell L, et al:  Legionnaires' disease and Pontiac fever associated with a whirlpool . Presented at the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami Beach, Fla, November 1982 .
7 +
Gorman GW, Feeley JC:  Procedures for the recovery of Legionella from water , in Laboratory Manual . Atlanta, Centers for Disease Control, 1982;.
8 +
Cherry WB, Pittman B, Harris PP, et al:  Detection of Legionnaires' disease bacteria by direct immunofluorescent staining . J Clin Microbiol 1978;;8:329-338.
9 +
McKinney RM, Thomason BM, Harris PP, et al:  Recognition of a new serogroup of Legionnaires' disease bacterium . J Clin Microbiol 1979;; 9:103-107.
10 +
Wilkinson HW, Fikes BJ, Cruce DD:  Indirect immunofluorescence test for serodiagnosis of Legionnaires' disease: Evidence for serogroup diversity of Legionnaires' disease bacterial antigens and for multiple specificity of human antibodies . J Clin Microbiol 1979;;9:379-383.
11 +
Wilkinson HW, Cruce DD, Broome CV:  Validation of Legionella pneumophila indirect immunofluorescence assay with epidemic sera . J Clin Microbiol 1981;;13:139-146.
12 +
Yonke CA, Stiefel HE, Wilson DL, et al:  Evaluation of an indirect hemagglutination test for Legionella pneumophila serogroups 1 to 4 . J Clin Microbiol 1981;;13:1040-1045.
13 +
Herwaldt LA, Gorman GW, McGrath T, et al:  A new Legionella species, Legionella feeleii species nova, causes Pontiac fever in an automobile plant . Ann Intern Med 1984;;100:333-338.
14 +
 Size definitions for particle sampling: Recommendations of ad hoc working group appointed by Committee TC 146 of the International Standards Organization . Am Ind Hyg Assoc J 1981;;42:A64-A68.
15 +
Wilkinson HW, Farshy CE, Fikes BJ, et al:  Measure of immunoglobulin G-, M-, and A-specific titers against Legionella pneumophila and inhibition of titers against nonspecific, gram-negative bacterial antigens in the indirect immunofluorescence test for legionellosis . J Clin Microbiol 1979;;10:685-689.
16 +
Suggested Health and Safety Guidelines for Public Spas and Hot Tubs , US Dept of Health and Human Services publication 99-960. Atlanta, Centers for Disease Control, 1982;.
17 +
Skaliy P, Thompson TA, Gorman GW, et al:  Laboratory studies of disinfectants against Legionella pneumophila . Appl Environ Microbiol 1980;;40:697-700.
18 +
Dondero TJ, Rendtorff RC, Mallison GF, et al:  An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower . N Engl J Med 1980;;302:365-370.
19 +
Cordes LG, Fraser DW, Skaliy P, et al:  Legionnaires' disease outbreak at an Atlanta, Georgia, country club: Evidence for spread from an evaporative condenser . Am J Epidemiol 1980;; 111:425-431.
20 +
Arnow PM, Chou T, Weil D, et al:  Nosocomial Legionnaires' disease caused by aerosolized tap water from respiratory devices . J Infect Dis 1982;;146:460-467.
21 +
Berendt RF:  Survival of Legionella pneumophila in aerosols: Effect of relative humidity . J Infect Dis 1980;;141:689.
22 +
Zuravleff JJ, Yu VL, Shonnard JW, et al:  Legionella pneumophila contamination of a hospital humidifier: Demonstration of aerosol transmission and subsequent subclinical infection in exposed guinea pigs . Am Rev Respir Dis 1983;;128:657-661.
23 +
Haley CE, Cohen ML, Halter J, et al:  Nosocomial Legionnaires' disease: A continuing common-source epidemic at Wadsworth Medical Center . Ann Intern Med 1979;;90:583-586.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Fraser DW, Tsai TR, Orenstein W, et al:  Legionnaires' disease: Description of an epidemic of pneumonia . N Engl J Med 1977;; 297:1189-1197.
2 +
McDade JE, Shepard CC, Fraser DW, et al:  Legionnaires' disease: Isolation of a bacterium and demonstration of its role in other respiratory disease . N Engl J Med 1977;;29:1197-1203.
3 +
Glick TH, Gregg MB, Berman B, et al:  Pontiac fever: An epidemic of unknown etiology in a health department: I. Clinical and epidemiologic aspects . Am J Epidemiol 1978;;107:149-160.
4 +
Kaufmann AF, McDade JE, Patton CM, et al:  Pontiac fever: Isolation of the etiologic agent (Legionella pneumophila) and demonstration of its mode of transmission . Am J Epidemiol 1981;;114:337-347.
5 +
Fraser DW, Deubner DC, Hill DL, et al:  Nonpneumonic, short-incubation-period legionellosis (Pontiac fever) in men who cleaned a steam turbine condenser . Science 1979;;205:690-691.
6 +
Spitalny K, Vogt R, Witherell L, et al:  Legionnaires' disease and Pontiac fever associated with a whirlpool . Presented at the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami Beach, Fla, November 1982 .
7 +
Gorman GW, Feeley JC:  Procedures for the recovery of Legionella from water , in Laboratory Manual . Atlanta, Centers for Disease Control, 1982;.
8 +
Cherry WB, Pittman B, Harris PP, et al:  Detection of Legionnaires' disease bacteria by direct immunofluorescent staining . J Clin Microbiol 1978;;8:329-338.
9 +
McKinney RM, Thomason BM, Harris PP, et al:  Recognition of a new serogroup of Legionnaires' disease bacterium . J Clin Microbiol 1979;; 9:103-107.
10 +
Wilkinson HW, Fikes BJ, Cruce DD:  Indirect immunofluorescence test for serodiagnosis of Legionnaires' disease: Evidence for serogroup diversity of Legionnaires' disease bacterial antigens and for multiple specificity of human antibodies . J Clin Microbiol 1979;;9:379-383.
11 +
Wilkinson HW, Cruce DD, Broome CV:  Validation of Legionella pneumophila indirect immunofluorescence assay with epidemic sera . J Clin Microbiol 1981;;13:139-146.
12 +
Yonke CA, Stiefel HE, Wilson DL, et al:  Evaluation of an indirect hemagglutination test for Legionella pneumophila serogroups 1 to 4 . J Clin Microbiol 1981;;13:1040-1045.
13 +
Herwaldt LA, Gorman GW, McGrath T, et al:  A new Legionella species, Legionella feeleii species nova, causes Pontiac fever in an automobile plant . Ann Intern Med 1984;;100:333-338.
14 +
 Size definitions for particle sampling: Recommendations of ad hoc working group appointed by Committee TC 146 of the International Standards Organization . Am Ind Hyg Assoc J 1981;;42:A64-A68.
15 +
Wilkinson HW, Farshy CE, Fikes BJ, et al:  Measure of immunoglobulin G-, M-, and A-specific titers against Legionella pneumophila and inhibition of titers against nonspecific, gram-negative bacterial antigens in the indirect immunofluorescence test for legionellosis . J Clin Microbiol 1979;;10:685-689.
16 +
Suggested Health and Safety Guidelines for Public Spas and Hot Tubs , US Dept of Health and Human Services publication 99-960. Atlanta, Centers for Disease Control, 1982;.
17 +
Skaliy P, Thompson TA, Gorman GW, et al:  Laboratory studies of disinfectants against Legionella pneumophila . Appl Environ Microbiol 1980;;40:697-700.
18 +
Dondero TJ, Rendtorff RC, Mallison GF, et al:  An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower . N Engl J Med 1980;;302:365-370.
19 +
Cordes LG, Fraser DW, Skaliy P, et al:  Legionnaires' disease outbreak at an Atlanta, Georgia, country club: Evidence for spread from an evaporative condenser . Am J Epidemiol 1980;; 111:425-431.
20 +
Arnow PM, Chou T, Weil D, et al:  Nosocomial Legionnaires' disease caused by aerosolized tap water from respiratory devices . J Infect Dis 1982;;146:460-467.
21 +
Berendt RF:  Survival of Legionella pneumophila in aerosols: Effect of relative humidity . J Infect Dis 1980;;141:689.
22 +
Zuravleff JJ, Yu VL, Shonnard JW, et al:  Legionella pneumophila contamination of a hospital humidifier: Demonstration of aerosol transmission and subsequent subclinical infection in exposed guinea pigs . Am Rev Respir Dis 1983;;128:657-661.
23 +
Haley CE, Cohen ML, Halter J, et al:  Nosocomial Legionnaires' disease: A continuing common-source epidemic at Wadsworth Medical Center . Ann Intern Med 1979;;90:583-586.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems