{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:37:00Z","timestamp":1787683020604,"version":"build-2784847793"},"reference-count":17,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T00:00:00Z","timestamp":1560211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Legionella pneumophila (Lp) is the most common etiologic agent causing Legionnaires\u2019 Disease (LD). Water systems offer the best growth conditions for Lp and support its spread by producing aerosols. From 2015 to 2017, the Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis of Palermo monitored the presence of Lp in nine prisons in Western Sicily. During this investigation, we compared Lp isolates from environmental samples in a prison located in Palermo with isolates from two prisoners in the same prison. Methods: We collected 93 water samples from nine Sicilian prisons and the bronchoalveolar lavages (BALs) of two prisoners considered cases of LD. These samples were processed following the procedures described in the Italian Guidelines for the Prevention and Control of Legionellosis of 2015. Then, genotyping was performed on 19 Lp colonies (17 from water samples and 2 from clinical samples) using the Sequence-Based Typing (SBT) method, according to European Study Group for Legionella Infections (ESGLI) protocols. Results: Lp serogroup (sg) 6 was the most prevalent serogroup isolated from the prisons analyzed (40%), followed by Lp sg 1 (16%). Most of all, in four penitentiary institutions, we detected a high concentration of Lp &gt;104 Colony Forming Unit\/Liter (CFU\/L). The environmental molecular investigation found the following Sequence Types (STs) in Lp sg 6: ST 93, ST 292, ST 461, ST 728, ST 1317 and ST 1362, while most of the isolates in sg 1 belonged to ST 1. We also found a new ST that has since been assigned the number 2451 in the ESGLI-SBT database. From the several Lp sg 1 colonies isolated from the two BALs, we identified ST 2451. Conclusions: In this article, we described the results obtained from environmental and epidemiological investigations of Lp isolated from prisons in Western Sicily. Furthermore, we reported the first cluster of Legionnaires\u2019 in an Italian prison and the molecular typing of Lp sg 1 from one prison\u2019s water system and two BALs, identified the source of the contamination, and discovered a new ST.<\/jats:p>","DOI":"10.3390\/ijerph16112062","type":"journal-article","created":{"date-parts":[[2019,6,11]],"date-time":"2019-06-11T10:55:44Z","timestamp":1560250544000},"page":"2062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Cluster of Legionnaires\u2019 Disease in an Italian Prison"],"prefix":"10.3390","volume":"16","author":[{"given":"Teresa","family":"Fasciana","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Mascarella","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"},{"name":"Unit of Microbiology, Virology and Parasitology, A.O.U.P, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore Antonino","family":"Distefano","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"},{"name":"Unit of Microbiology, Virology and Parasitology, A.O.U.P, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia","family":"Cal\u00e0","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"},{"name":"Unit of Microbiology, Virology and Parasitology, A.O.U.P, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1407-7282","authenticated-orcid":false,"given":"Giuseppina","family":"Capra","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"},{"name":"Unit of Microbiology, Virology and Parasitology, A.O.U.P, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Rampulla","sequence":"additional","affiliation":[{"name":"Laboratory of Public Health, ASP 6, 90141 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4418-5855","authenticated-orcid":false,"given":"Paola","family":"Di Carlo","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Palermo","sequence":"additional","affiliation":[{"name":"Sicilian Health Department, Public Health and Environmental Risks Service, 90127  Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Giammanco","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"},{"name":"Unit of Microbiology, Virology and Parasitology, A.O.U.P, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/QCO.0b013e328336835b","article-title":"An update on Legionella","volume":"23","year":"2010","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1128\/CMR.00029-14","article-title":"Current and emerging legionella diagnostics for laboratory and outbreak investigations","volume":"28","author":"Mercante","year":"2015","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"20497","DOI":"10.2807\/ese.18.23.20497-en","article-title":"Legionnaires\u2019 disease in Italy: Results of the epidemiological surveillance from 2000 to 2011","volume":"18","author":"Rota","year":"2013","journal-title":"Eurosurveillance"},{"key":"ref_4","unstructured":"Ministero della Salute (2019, June 11). Linee guida per la Prevenzione ed il Controllo della Legionellosi, Available online: http:\/\/www.salute.gov.it\/imgs\/C_17_pubblicazioni_2362_allegato."},{"key":"ref_5","unstructured":"Italian National Institute of Health (2016). Rapporto Annuale Sulla Legionellosi in Italia Nel 2015."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1007\/s10096-002-0820-3","article-title":"Pan-European study on culture-proven Legionnaires\u2019 disease: Distribution of Legionella pneumophila serogroups and monoclonal subgroups","volume":"21","author":"Helbig","year":"2002","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_7","unstructured":"European Centre for Disease Control and Prevention (ECDC) (2018, December 15). Legionnaires\u2019 Disease Surveillance in Europe, 2014, Available online: http:\/\/ecdc.europa.eu\/en\/publications-data\/legionnaires-disease-europe-2014."},{"key":"ref_8","unstructured":"(2018, December 09). Annual Reports of Legionellosis, Available online: www.iss.it."},{"key":"ref_9","first-page":"114","article-title":"Occurrence of legionella in beach shower facilities","volume":"48","author":"Delia","year":"2007","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_10","first-page":"489","article-title":"Prevention of legionellosis in hotel establishments: A proposal to introduce a plan of action in accordance with Provision 13 January 2005 (Italy)","volume":"64","author":"Delia","year":"2008","journal-title":"Ig. Sanit\u00e0 Pubbl."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"276","DOI":"10.26444\/aaem\/74717","article-title":"Prevalence and distribution of Legionella pneumophila in cruise ships and ferries","volume":"24","author":"Gambuzza","year":"2017","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1128\/JCM.43.5.2047-2052.2005","article-title":"Consensus sequence-based scheme for epidemiological typing of clinical and environmental isolates of Legionella pneumophila","volume":"43","author":"Gaia","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1128\/JCM.00261-07","article-title":"Addition of neuA, the gene encoding N-acylneuraminate cytidylyl transferase, increases the discriminatory ability of the consensus sequence-based scheme for typing Legionella pneumophila serogroup 1 strains","volume":"45","author":"Ratzow","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4052","DOI":"10.1128\/JCM.00687-11","article-title":"The N-acylneuraminate cytidyltransferase gene, neuA, is heterogenous in Legionella pneumophila strains but can be used as a marker for epidemiological typing in the consensus sequence-based typing scheme","volume":"49","author":"Farhat","year":"2011","journal-title":"J. Clin. Microbiol."},{"key":"ref_15","unstructured":"ESGLI (2017, July 26). The ESGLI SBT Database for the Typing of Legionella Pneumophila. Available online: http:\/\/www.hpa-bioinformatics.org.uk\/legionella\/legionella_sbt\/php\/sbt_homepage.php."},{"key":"ref_16","unstructured":"European Centre for Disease Prevention and Control (2017). Legionnaires\u2019 Disease\u2013Annual Epidemiological Report for 2015."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1111\/ajt.14024","article-title":"Vital signs: Deficiencies in environmental control identified in outbreaks of Legionnaires\u2019 disease-North America, 2000\u20132014","volume":"16","author":"Garrison","year":"2016","journal-title":"Am. J. Transplant."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/11\/2062\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:57:35Z","timestamp":1760187455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/11\/2062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,11]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2019,6]]}},"alternative-id":["ijerph16112062"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16112062","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,11]]}}}