Batam- A team of Indonesian health researchers has confirmed a case of legionellosis, a severe form of pneumonia caused by Legionella pneumophila, alongside widespread contamination of water systems in both a hospital and a patient’s home. The findings were published in 2026 in the East Asian Journal of Multidisciplinary Research by scientists from the National Health Biology Laboratory and the Public Health Laboratory in Batam. The case highlights growing concerns about water safety and infection risks in healthcare and residential environments in Indonesia.
The research was led by Darmawali Handoko, Subangkit, and Kambang Sariadji—the corresponding author—together with colleagues Hana Apsari Pawestri, Rencana, Ardiansyah Nugraha, Fauzul Muna, Yuni Rukminiati, and Eka Pratiwi. Their investigation matters because legionellosis is often underdiagnosed, yet it can be fatal if not properly identified and treated. The study also points to hidden environmental exposure routes that may affect vulnerable patients, especially children, the elderly, and people with weakened immune systems.
Why Legionella Is a Growing Public Health Issue
Legionella pneumophila is a waterborne bacterium that spreads through inhalation of contaminated water aerosols, not through direct human contact. It thrives in warm, stagnant water and can persist inside biofilms and free-living amoebae, making it difficult to eliminate once established. Hospitals are considered high-risk settings due to their complex plumbing systems and frequent use of aerosol-generating medical devices.
Globally, international health agencies such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have warned that poorly managed water systems can become reservoirs for Legionella. In Indonesia, however, routine surveillance remains limited. While past cases were documented in Bali and Tangerang, national data suggest that legionellosis is still widely underrecognized.
This newly published case adds to growing evidence that Legionella exposure may occur simultaneously in healthcare facilities and private homes, especially in tropical regions where warm temperatures support bacterial growth year-round.
How the Investigation Was Conducted
The research team examined a patient treated in a hospital in the Riau Islands Province in mid-2025. Respiratory samples were collected and analyzed using polymerase chain reaction (PCR) testing, a molecular method that detects bacterial DNA with high accuracy.
To trace potential sources of exposure, researchers also collected environmental swab samples from multiple locations:
- Hospital taps, water dispensers, nebulizers, and oxygen humidifier equipment
- Household air conditioners, taps, water dispensers, kettles, thermos containers, and feeding bottles
All environmental samples were tested using PCR to detect both Legionella species (genus-level) and L. pneumophila (species-level).
Key Findings at a Glance
The investigation revealed a clear contrast between clinical and environmental results:
- 7 of 12 patient respiratory samples tested positive for Legionella pneumophila, confirming legionellosis
- 10 of 15 environmental samples tested positive for Legionella species, indicating widespread contamination
- No environmental samples tested positive for L. pneumophila specifically
- Contamination was found in both hospital and household water systems
Positive environmental samples included air conditioning units, taps, water dispensers, kettles, feeding bottles, and oxygen humidifiers—devices known to produce aerosols that can be inhaled.
What the Results Mean
According to the authors, the absence of L. pneumophila in environmental samples does not rule out environmental exposure. Genus-level PCR tests are more sensitive and can detect low concentrations of Legionella DNA, while species-specific tests require higher bacterial loads.
“Environmental samples often contain mixed Legionella species, and L. pneumophila may exist in very low numbers or in a viable-but-non-culturable state,” explained Kambang Sariadji of the National Health Biology Laboratory. “This means exposure can still occur even when species-specific tests are negative.”
The coexistence of a confirmed clinical infection and widespread environmental contamination strongly suggests dual exposure pathways, involving both healthcare-associated and residential sources.
Real-World Implications for Health and Policy
The findings carry important implications for infection prevention, hospital management, and public health policy:
- Hospitals should implement routine Legionella surveillance in water systems, especially at high-risk points such as taps and oxygen humidifiers
- Water management programs must focus on temperature control, disinfection, and biofilm prevention
- Household water systems also require attention, particularly in homes with infants, elderly residents, or immunocompromised individuals
- Genus-level PCR testing should be integrated into national environmental health monitoring programs
The study aligns with Indonesia’s Ministry of Health Regulation No. 2/2023 on environmental health standards and reinforces institutional accountability under Health Law No. 17/2023.
About the Authors
The research was conducted by Darmawali Handoko, Subangkit, Kambang Sariadji, Hana Apsari Pawestri, Ardiansyah Nugraha, Fauzul Muna, Yuni Rukminiati, and Eka Pratiwi from the National Health Biology Laboratory, in collaboration with Rencana from the Public Health Laboratory, Batam. T
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