An outbreak of pneumonia and meningitis caused by a previously undescribed Gram-negative bacterium in a hot spring spa

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Abstract
SUMMARY An outbreak of infection caused by a previously undescribed Gram-negative bacterium affected people attending a hot (37 °C) spring spa in France in 1987. Thirty-five case of pneumonia and two cases of meningitis occurred. None of these patients died. Attack rates were significantly higher for patients above 70 years old and for male patients. An epidemiological comparison of the 26 hospitalized eases with 52 matched controls suggests that spa treatment early on the first day (OR = 4·8) and attendance at the vapour baths (OR = 10·7) were significant risk factors for acquiring the infection. Person-to-person spread was not thought to have occurred. The same bacterium was isolated from the hot spring water. All strains studied shows a single rRNA gene restriction pattern. Epidemiological data indicated that the thermal water was the source of infection. This outbreak stresses the need for increased surveillance of infections in people attending hot spring spas.

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