![]() was detected by culture at a concentration of 6.3 × 10 3 CFU/L ( Table). pneumophila by culture or real-time PCR, Legionella spp. Analysis of the sample was performed in the PHAB laboratory according to the stated standards. On the basis of previous case experience, we obtained a sample of the windshield wiper fluid. The patient used the truck daily and denied adding screen wash to the windshield wiper fluid he also reported that the windshield wiper fluid had not been changed for >6 months. No further cases that could be epidemiologically linked to this case were identified during the same period. His driving routes included industrial areas frequently located within Barcelona. He was hospitalized briefly and was successfully treated with antimicrobial drug therapy. The patient was a 58-year-old man who smoked and had a medical history of recently diagnosed chronic obstructive pulmonary disease. A respiratory sample was unavailable because of lack of respiratory secretions. On September 17, 2020, a new case of Legionnaires’ disease was detected by UAT in commercial truck driver. Public health inspectors also recommended adding screen wash fluid to the windshield wiper fluid regularly. Laboratory test results and cleaning procedures to follow for the windshield wiper tank were explained to the driver. Testing showed that the fluid was PCR positive for L. However, the sample was also analyzed by using real-time PCR ( Appendix). Culture results using Legionella selective media, according to the ISO 11731:2017 protocol ( ), were negative. The PHAB laboratory analyzed the sample for L. The 2,000-mL sample of water was collected and stored in a sterile container (Deltalab, ) treated with sodium thiosulfate. Two weeks after the interview, environmental inspectors from PHAB sampled the fluid that remained in the windshield wiper tank of the truck. No other cases of Legionnaires’ disease reported during the same period were related to his residence or driving areas. ![]() He reported that the vehicle had been unused for several months before the purchase and denied using screen wash in the windshield wiper fluid. The truck used for work was self-owned the patient had purchased it secondhand ≈1.5 years before illness. He worked as a commercial truck driver, and his driving route included merchandise pickup at an industrial area once a day. The patient smoked and had a medical history of hypertension and type 2 diabetes. After discharge, he completed the remaining course of antimicrobial drug therapy and proceeded favorably to cure.Īfter the case was reported, public health nurses contacted the patient to complete a structured epidemiologic questionnaire that included demographic data, personal risk factors, activities, and potential exposures during the 14 days before illness onset. The patient was hospitalized briefly, and his clinical course was unremarkable. A respiratory sample was not available because of the lack of productive secretions. On December 13, the patient sought care at a hospital, and a diagnosis of Legionnaires’ disease was made by UAT. Onset of symptoms had begun a week before diagnosis. In December 2019, the Public Health Agency of Barcelona (PHAB) received a case report of Legionnaires’ disease in a 59-year-old man. ![]() We report 2 cases of Legionnaires’ disease cases diagnosed by urine antigen testing (UAT) linked to detection of the bacteria in the windshield wiper fluid. ![]() However, no studies have epidemiologically confirmed the fluid as the source of infection ( 8). can grow in windshield wiper fluid that does not contain screen wash. Using windshield wiper fluid without added screen wash has been identified as a risk factor for Legionnaires’ disease in commercial drivers in a previous case‒control study ( 4). Exposures related to the vehicle are usually considered secondary to outside sources in industrial areas, such as cooling towers, and are seldomly investigated, despite some studies suggesting them as potential sources ( 4). However, in most sporadic cases, the source of infection remains unknown ( 3).Ĭommercial truck drivers are at increased risk for Legionnaires’ disease ( 4– 7). Cooling towers, warm water systems, and whirlpool spas are well-established sources of infection ( 2). Systems with warm water (35☌), stagnation, and lack of disinfection and maintenance can lead to proliferation of Legionella spp. Most Legionella infections are related to contaminated artificial water systems. Legionnaires’ disease is a severe form of acute pneumonia caused by inhalation of aerosols containing Legionella bacteria.
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