Monthly Archives: September 2011

Rhode Island Hospital finds lack of testing for Legionella

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Current recommendations for testing missed 41 percent of cases

PROVIDENCE, R.I. — A new study from Rhode Island Hospital shows that guidelines concerning testing patients for possible community-acquired pneumonia due to Legionella may underestimate the number of cases being seen by clinicians. The study found that if testing was only done in patients felt to be at increased risk of Legionnaires’ disease based on such guidelines, more than 40 percent of Legionella cases could be missed based on this single-center study. The researchers suggest more widespread testing for Legionella in patients admitted to hospitals with pneumonia. The study is published in BMC Infectious Diseases and is now available online in advance of print.

Legionella is the bacteria that causes Legionnaires’ disease, a dangerous and potentially fatal infectious disease. In the Infectious Diseases Society of American (IDSA) and the American Thoracic Society (ATS) community-acquired pneumonia guidelines, testing for the urine antigen of Legionella is recommended for patients with any of the following: severe pneumonia requiring intensive care unit admission, failure of outpatient antibiotics, active alcohol abuse, history of travel within previous two weeks, or pleural effusion.

Leonard Mermel, DO, medical director of the epidemiology and infection control department at Rhode Island Hospital, is the senior author of this retrospective study that identified nearly 4,000 patients with a primary or secondary diagnosis of pneumonia in an 18-month period. Of those patients, 35 percent had a Legionella urine antigen testing or had a Legionella culture performed. In addition, 44 percent of patients who had a bronchoscopy had a specimen sent for Legionella culture and/or had Legionella urine antigen testing. Of the patients with pneumonia due to Legionella, only 22 percent met the IDSA/ATC criteria recommending Legionella testing.

Mermel says, “This single-center study suggests that current recommendations for Legionella testing will result in missed cases. More widespread testing will identify additional cases allowing focused antimicrobial therapy and will alert public health officials of such Legionella cases”.

Co-author Brian Hollenbeck, M.D., adds, “Legionella is a severe cause of community- and hospital-acquired pneumonias. We hope that this study will raise awareness of the need for more comprehensive Legionella testing in patients who are hospitalized with pneumonia.”

Other researchers in the study with Mermel include Brian Hollenbeck, M.D., and Irene Dupont, RN, BSN, both of Rhode Island Hospital. Mermel’s principal affiliation is Rhode Island Hospital, a member hospital of the Lifespan health system in Rhode Island, and direct financial and infrastructure support for this project was received through the Lifespan Office of Research Administration. The researcher also has an academic appointment at The Warren Alpert Medical School of Brown University. Mermel’s lab is fully supported by Rhode Island Hospital and the Lifespan health system. Mermel is also a physician with University Medicine (www.umfmed.org) a non-profit, multi-specialty medical group practice employing many of the full-time faculty of the department of medicine of the Alpert Medical School.

About Rhode Island Hospital

Founded in 1863, Rhode Island Hospital (www.rhodeislandhospital.org) in Providence, R.I., is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. The hospital receives nearly $50 million each year in external research funding and is home to Hasbro Children’s Hospital, the state’s only facility dedicated to pediatric care. It is a founding member of the Lifespan health system.

Original article from EurekaAlert.org

Athens County has two cases of Legionnaire’s disease

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September 20, 2011 – An Athens County health official on Tuesday confirmed that within the last week, two cases of Legionnaire’s disease have been diagnosed at O’Bleness Memorial Hospital in Athens.

One case reportedly involves a graduate student at Ohio University; the other, an out-of-county resident who apparently just came to O’Bleness as the nearest available hospital.

“We’re looking at this very closely,” said Chuck Hammer, administrator of the Athens City-County Health Department. “We’ve been aware of this since late last week.”

OU spokeswoman Jennifer Krisch confirmed Tuesday morning that “Yes, we have a graduate student with a confirmed case of Legionnaire’s disease.” She referred questions about the case to the Health Department.

In an internal OU e-mail obtained by The Athens NEWS, Steven Ross, director of the university’s School of Film, advised people in his department Sunday that a graduate student in that department had been taken ill the previous week and diagnosed with Legionnaire’s Disease at O’Bleness.

According to the email message, the graduate student, who is from New York, was transferred to a Columbus hospital.

Calls to the Columbus hospital seeking information on the student’s condition were not returned by the time this story was posted Tuesday.

Legionnaire’s disease is an acute respiratory infection caused by the Legionella bacteria.

According to Hammer of the Health Department, it is typically spread not from person to person, but though an infected shared water supply such as a hot tub, sprinkler system or air conditioner.

Hammer stressed that the disease poses a threat mainly to vulnerable populations such as the elderly or people with compromised immune systems.

“Generally speaking, Legionnaire’s disease can be quite mild,” he said.

Hammer said that state health officials have been informed of the two recent Athens County cases, and that investigators are working to try to find out if the two people diagnosed with the disease have any overlapping recent history, to suggest where they might have picked up the bacterium.

“There’s a little detective work that goes on,” he explained. Just because the two cases were both diagnosed in Athens County, he said, does not necessarily mean the source of the infection is here.

“There are a couple of cases of Legionella (locally), but we don’t know where they originated,” he said.

Hammer said he has heard from state health officials that there has been a “small uptick” in reports of Legionnaire’s disease across Ohio recently.

Ohio Department of Health spokesperson Tessie Pollock confirmed that a number of cases of Legionnaire’s disease are currently under investigation statewide, but added that these do not appear to be connected.

“So far, there is no indication of there being an outbreak,” Pollock said.

Original article from Athens News

Second Pa. care home hit by Legionnaires’ disease

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TURTLE CREEK, Pa. (AP) — Health officials now say at least 10 cases of Legionnaires’ disease have been discovered at a pair of care facilities in western Pennsylvania.

The Allegheny County Health Department said Wednesday at least two people have been sickened at the Hamilton Hills Personal Care Facility in Turtle Creek. That’s in addition to eight cases at the nearby LGAR Health & Rehabilitation Center.

No fatalities have been reported related to the outbreak but three people had to be hospitalized with pneumonia-like symptoms. Health officials say they’re treating the water supplies at both facilities, although the cause of the outbreak remains unknown.

The health department said previously the bacteria can sometimes occur when facilities install systems that prevent hot water from scalding people.

Original article at: FortWayne.com

Memorial Sloan-Kettering Cancer Center Warns Against Its Tap Water After Patient Contracts Legionnaire’s Disease

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Patients and staff at Memorial Sloan-Kettering Cancer Center are being told to avoid the tap water after one patient tested positive for Legionnaire’s disease.

Hospital representatives said the test results were preliminary and that no other patients have tested positive.

Legionnaire’s is a type of pneumonia contracted when people breathe in water vapor or mist that’s been contaminated with the disease.

Patients have been told not to shower or use the sinks or water fountains.

Until the situation is resolved, the hospital is providing bottled water for drinking and pre-moistened towelettes for bathing.

“An administrative gentleman came around and put notes on bathroom doors and just ensuring that we remember not to use the sink,” said a patient.

“I love this hospital, but I’m very concerned about my mother. My mother has one kidney, and the one kidney she has left has cancer on it,” said one woman.

Hospital representatives said tests conducted on other patients and the water supply came back negative for Legionnaires.

Original article at: NY1 News

Eight in Turtle Creek get Legionnaires’ disease

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UPDATE on Turtle Creek Legionnaires’ Disease Outbreak.

Eight people living at the LGAR Health & Rehabilitation Center in Turtle Creek contracted Legionnaires’ disease, an Allegheny County Health Department official said Tuesday.

Legionnaires’ disease, caused by a bacteria called Legionella, mimics pneumonia and can cause a high fever, chills, a cough, muscle aches and headaches, according to the Centers for Disease Control and Prevention.

Bruce Dixon, director of the Allegheny County Health Department, said no one has died and the center is taking extra precautions to prevent it from spreading.

Dr. Dixon said the center has switched to using bottled water and is using a heavy metal iron system hospitals employ to prevent the spread of the bacteria.

He said Legionella often spreads when facilities install systems to prevent water from scalding people, causing it to lower in temperature and sometimes become tepid. He said he did not know what caused the Legionella to appear in the LGAR facility.

Representatives for LGAR could not be reached for comment Tuesday evening.

Original article at: post-gazette.com