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Legionnaires' disease (LD), which carries a 10% case fatality rate in adults, is typically spread through inhalation of aerosols contaminated with Legionella pneumophila, a bacterium that can withstand water chlorination and temperatures up to 140ºF. In 2016, two cases of neonatal LD were reported to the Arizona Department of Public Health.
The first infant was delivered at home by a midwife using a birthing tub filled with tap water. The baby developed symptoms of acute severe respiratory distress within 1 day of birth; congenital heart disease was also diagnosed. Radiography revealed cavitary pneumonia, and bronchoscopy specimens were positive for L. pneumophila. Treatment with azithromycin curtailed the pneumonia, but a 4-month hospitaliz…