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1 3 5 2014 727.. 1 .. 59 .. Legionella pneumophila serogroup 1 .. aerosol .. Legionella pneumonia, Garden hose, Pulsed-field gel electrophoresis PFGE . / panipe- . nem/betamipron PAPM/BP . clindamycin CLDM .. 173 cm 58 kg JCS I-1 . 166/94 mmHg 112 /min . 28 /min SpO2 88 15 L/min . coarse crackles . serogroup 1 SG1 . 1 .. 13,300/ l CRP 40 mg/dl .. X 1 .. 59 . CT 2 .. 30 / 39 1 / Binax NOW. Legionella . 2011 5 WYO . 38 MRC Grade 4 104 cfu/ml . 6 CT 3 .. pazu- oxacin PZFX 1 g/ rifampicin . RFP 450 mg/ . 866-8533 1670.. 6 PaO2/FiO2 100 .. E-mail: . Received 27 Jan 2014/Accepted 24 Jun 2014 11 . 728 3 5 2014. 1 . Hematology Biochemistry Arterial blood gas WBC 13,300/ l TP g/dl O2 reservoir mask 15 L/min.

2 Eo Alb g/dl pH Neu T-Bil mg/dl PaCO2 mmHg Ly ALP 274 IU/L PaO2 mmHg Mo -GTP 101 IU/L HCO3 mmol/L. Ba AST 39 IU/L BE mmol/L. RBC 271 104/ l ALT 19 IU/L. Hb g/dl LDH 338 IU/L. Ht Amy 57 IU/L. Plt 104/ l CK 106 IU/L. BUN mg/dl Serology Cr mg/dl CRP 40 mg/dl Na 138 mEq/L. PCT ng/ml K mEq/L. Cl 106 mEq/L. Ca mg/dl BS 137 mg/dl 2 CT .. 1 X .. SG1 . 4 .. 34 .. 4 . WYO . 2 1 2 . SG1 .. 30 .. 1 729. 3 WBC CRP PZ pazufloxacin RFP rifampicin SBT/ABPC sulbactam/. ampicillin MEPM meropenem TAZ/PIPC tazobactam/piperacillin mPSL methylpredniso- lone . 4 . SG1 .. DNA.. 3 . 730 3 5 2014.. 4 1 Piso RJ, et al. Hose as a source of Legionella pneu- monia.

3 A new risk factor for gardeners? J Hosp In- 5 6 fect 2007; 67: 396-7. 24 9 7 2 Euser SM, et al. Legionnaires disease and Pontiac aerosol 4 fever after using a private outdoor whirlpool spa. Scand J Infect Dis 2010; 42: 910-6. aerosol 3 Jonas D, et al. Comparative evaluation of three dif- ferent genotyping methods for investigation of nos- ocomial outbreaks of Legionnaires disease in hospi- . tals. J Clin Microbiol 2000; 38: 2284-91. 20 42 35 . 4 . 8 . Legionella longbeachae 1 . mg/L 9 . 2007; 45: 698-703. mg/ 5 Steele TW, et al. Distribution of Legionella long- L beachae serogroup 1 and other legionellae in pot- ting soils in Australia.

4 Appl Environ Microbiol 1990;. 56: 2984-8. 10 2011 4 6 Yu Victor L, et al. Distribution of Legionella Species and Serogroups Isolated by Culture in Patients 18 with Sporadic Community-Acquired Legionellosis: 25 An International Collaborative Survey. J Infect Dis 2002; 186: 127-8. 7 Koide M, et al. Distribution of Legionella long- . beachae and other legionellae in Japanese potting . soils. J Infect Chemother 2001; 7: 224-7. 11 . 8 Fields BS, et al. Legionella and Legionnaires dis- . ease: 25 years of investigation. Clin Microbiol Rev 2002; 15: 506-26. 3 4 9 Legionella . BNP pg/ml 1995; 69: 151-7. 10 .. 2008; 36: 749-56. 12 11 Sopena N, et al.

5 Comparative study of the clinical presentation of Legionella pneumonia and other . community-acquired pneumonias. Chest 1998; 113: 13 . 1195-200.. 12 Tan MJ, et al. The radiologic manifestation of Le- . gionnaire s disease. The Ohio Community-Based 52 2012. Pneumonia Incidence Study Group. Chest 2000; 116: 4 398-403. 13 sivelestat sodium .. 1 2007; 45: 413-8. COI con icts of interest .. 1 731. Abstract A case of Legionella pneumonia caused by a garden hose Hirotaka Maruyama a, Shinji Iyama b, Reina Tanaka a, Makoto Andou a, Mikoto Moriguchi c and Kiyotaka Ito a a Department of Respiratory Medicine, Kumamoto Rousai Hospital b Department of Pathology, Tsukuba University Hospital c Department of Clinical Microbiological Laboratory, Kumamoto Rousai Hospital A 59-year-old man with hypertension and hyperlipidemia, who was a smoker and fond of gardening, was ad- mitted to our hospital because of fever and dyspnea.

6 A chest radiograph revealed bilateral pulmonary infiltration and pleural effusions. He was diagnosed with pneumonia because a urine sample was positive for the antigen. He was treated with intravenous pazufloxacin and oral rifampicin, as well as controlled me- chanical ventilation. Despite these treatments, the bilateral infiltration as assessed using chest radiography . worsened. Allowing for heart failure and acute respiratory distress syndrome ARDS ,he was treated with in- travenous furosemide and pulse methylprednisolone. A few days later his respiratory failure recovered, and he was discharged. Serogroup 1 was isolated from his sputum, as well as from his private garden hose and the wa- ter contained within it.

7 Both samples exhibited the same pathogen, as assessed by genetic analysis using pulsed- field gel electrophoresis PFGE . This is the first case of pneumonia caused by a private garden hose and confirmed by genetic analysis. The present study showed that a private garden hose should be consid- ered as a cause of pneumonia.