Abstract
Legionella pneumophila (L. pneumophila), the bacteria causing Legionnaires' disease, a severe pneumonia with high morbidity and mortality globally. The underreporting of this disease is marked particularly in low-income African countries, where data on Legionellosis remains extremely limited. Gauteng, South Africa's most densely populated province, faces challenges such as rapid urbanisation, limited access to sanitary facilities, and ageing infrastructure, which can compromise drinking water quality by increasing the presence of bacteria within the water distribution systems. Although research on Legionella in South Africa has been conducted, no research has compared its prevalence in urban and rural households in the country. This study examines the presence and distribution of L. pneumophila and amoeba-associated strains in water distribution systems in both urban (Hillbrow and Atteridgeville) and rural (Zandspruit and Melusi) areas in Gauteng province in South Africa. In total, 134 water samples were obtained from tap faucets and storage containers, and 260 biofilm samples were obtained from tap faucets, storage containers, and toilet bowls. Water samples were analysed for Escherichia coli (E. coli) using the IDEXX Colilert (R) and for L. pneumophila using the IDEXX LegiolertTM assay. Both water and biofilm samples were analysed for evidence of amoeba-associated Legionella using the amoeba enrichment technique. The Colilert assay detected total coliforms in 13% of the urban samples and 25% of the rural samples. The LegiolertTM assay detected L. pneumophila in 52% of urban and 78% of rural samples. Amoeba-associated L. pneumophila was confirmed in 35% of urban samples and 25% in rural samples. The conventional PCR confirmed L. pneumophila in 81% of both urban and rural samples, while real-time PCR detected L. pneumophila in 97% of urban and 100% of rural samples. In total, 111 water and 19 biofilm samples tested positive for the presence of L. pneumophila across the four areas. These results revealed that L. pneumophila is prevalent in both urban and rural water systems in Gauteng.