Legionella prevalence in hot spring recreation areas of Taiwan

Legionella is a bacterium ubiquitous to aquatic environments. Within the genus a few species are recognized as opportunistic potential human pathogens, especially the species Legionella pneumophila, which causes pneumonia legionellosis. Outbreaks of legionellosis are frequently reported by hotel guests and hospital patients, and are spread through inhaled aerosols of contaminated institutional water systems. Contaminations in hot tubs, spas and public baths are also possible. As a result, in this study, we investigated the distribution of Legionella at seven hot spring recreational areas throughout Taiwan. We gathered data on factors potentially associated with the pathogen's distribution, including environment, facility operation, and physical and microbiological water quality parameters. Spring water was collected from 91 sites and Legionella was detected in 21 (23%). The most frequently detected was L. pneumophila, followed by uncultured Legionella species, Legionella-like amoebal pathogen. Five species, L. bozemanii, L. dumoffi, L. feelei, L. lyticum and L. oakridgenesis, were all detected once. Legionella species were found in water temperatures ranging from 22 to 50 degrees C. Optimal pH appeared to be between 5.0 and 9.0. The prevalence of Legionella also coincided with the prevalence of indicator microorganisms. Legionella detection was not proportional to the frequency of cleaning. Results of this survey confirm the ubiquity of Legionella in Taiwan spring recreation areas. L. pneumophila, the organism responsible for the majority of legionellosis outbreaks, should be considered a potential public health threat in spa areas of Taiwan.