Contaminated Dental Surgery Equipment Source of Legionnaire’s Disease Death

This week’s issue of The Lancet describes a case report of an 82-year-old woman in Italy who died of Legionnaires disease after becoming infected with L pneumophila at her dentist. This case has prompted the authors – led by Dr Maria Luisa Ricci at the Istituto Superiore di Sanità, Rome, Italy, to call for various control measures at dental surgeries to prevent similar incidents.

Suffering with fever and respiratory distress, the woman who was conscious and responsive and had no underlying disease, was admitted in February, 2011, to the intensive care unit of the “G.B. Morgagni-Pierantoni” Hospital, Department of emergency Anaesthesia and Intensive Care Unit, Forlì, Italy.

Results from a chest radiography showed multiple areas of lung consolidation. A Legionella pneumophila urinary antigen test quickly diagnosed the woman with Legionnaires’ disease and she was immediately given oral antibiotics (ciprofloxacin) every 12 hours. However, she sadly died two days later after developing rapid and irreversible septic shock, prompting an investigation to find the source of L pneumophila.

The patient had been at home for the majority of the time during the 2 to 10 day incubation period, leaving only twice to attend dentist appointments.

The investigators took water samples from the dental practice’s tap, the tap and the high-speed turbine of the dental unit waterlines, as well as from the woman’s home (shower and taps) in order to investigate possible L pneumophila contamination. They found that samples from her home tested negative for L pneumophila, but samples from the dental practice tested positive. After laboratory experiments were conducted, results showed genomic matching between L pneumphila in the dental unit waterline and in the women’s respiratory secretion.

L pneumophila is a Gram-negative bacterium found in man-made water systems and is ubiquitous in natural water environments. The bacteria can infect individuals by inhalation or microaspiration of aerosolized water causing Pontiac fever (a flu-like disease) or Legionnaires’ disease (severe pneumonia), mostly affecting immune-compromised patients and the elderly.

Spas, fountains, air-conditioning systems, and hot-water systems, have been demonstrated to be leading sources of infection.

It has been widely documented that dental waterlines are substantially contaminated with Legionella and studies have also demonstrated that the blood of dentists and dental practice staff has a higher prevalence of antibodies to L pneumophila, which indicates that people working in a dental practice environment are potentially at risk. However, prior to this case, the researchers knew no other cases in which Legionnaires’ disease had been linked to this source of infection.

The authors explain:

“The case here shows that the disease can be acquired from a dental unit waterline during routine dental treatment. Aerosolized water from high-speed turbine instruments was most likely the source of the infection. Legionella contamination in dental unit waterlines must be minimized to prevent exposure of patients and staff to the bacterium.

We suggest several control measures: use of anti-stagnation and continuous-circulation water systems; use of sterile water instead of the main water supply in the dental unit waterline; application of discontinuous or continuous disinfecting treatment; daily flushing of all outlets and before each dental treatment; use of filters upstream of the instruments; and annual monitoring of the waterline. Further useful procedures to prevent legionellosis within dental surgeries can be obtained from [already available] dedicated guidelines.”

Original article at: medicalnewstoday.com

Family Blames Hospital for Man’s Death from Legionnaires’ Disease

DAYTON — Miami Valley Hospital is responsible for the death of a 94-year-old Kettering man from Legionnaires’ disease, his family claims in a lawsuit filed Tuesday in Montgomery County Common Pleas Court.

The lawsuit, which includes three other deaths, is the first filed concerning an outbreak of Legionella at the hospital in February 2011, when Charles O. Preston was a patient. Preston’s death certificate states he died March 23 from Legionella pneumonia.

Hospital officials said in March that 11 patients were infected.

It was the largest outbreak in Ohio since 2004, when 13 confirmed or probable cases were reported at a Cuyahoga County worksite. Miami Valley Hospital did report six cases in 2008, 2009 and 2010.

The lawsuit was filed by attorney Dwight Brannon. The families of deceased patients Robert Austin of Springfield and Doris Day of Kettering are also represented. Though their death certificates don’t mention Legionella, medical records and an oral admission by a hospital attorney confirm that they had the infection, according to the complaint.

Additionally, Brannon is seeking information on a patient who died Feb. 21, who also had Legionnaires’ disease, according to the complaint.

A surviving patient, Janis Lowery, is also represented. She “has suffered a significant loss of lung function, other health hazards and emotional distress as a results of contracting Legionnaires’ disease,” the complaint states.

The Dayton Daily News has extensively covered the outbreak and subsequent developments since last March.

The lawsuit names multiple officials with the hospital and Premier Health Partners as defendants, as well as a number of firms involved in the construction of the hospital’s new wing, which opened in December 2010.

Hospital officials said they could not comment on pending litigation and referred calls to attorney Neil Freund, who said on Wednesday that he could not comment.

Preston was hospitalized from Feb. 9 through Feb. 15, 2011, for treatment of severe back pain. He returned to the hospital Feb. 25 with complaints of fever, malaise, fatigue and headache. That same day, he tested positive for the infection.

Preston transferred to Trinity Nursing Home on March 1, then back to the hospital March 15, then returned to the nursing home under the care of Hospice of Dayton, according to the complaint.

Brannon also lists “approximately 127 patients” as unknown plaintiffs, people who were admitted to, treated at or present in the new wing during its first three months of operation, as well as all “visitors, frequenters, invitees, licensees and workmen.”

The complaint claims that the construction was done by a “pre-fabricated method,” in which corridor modules, bathroom pods and patient room headwalls were assembled in leased warehouses two miles away from the hospital.

The defendants performed water pressure tests on those units, then let them sit in the warehouses for months, allowing the Legionella bacteria to develop, the complaint states.

At the time of the outbreak, hospital officials suspected the Legionella bacteria colonized during construction of the $135 million tower. It shut down the patient tower’s water system Feb. 22-25 for sterilization.

Original article at: Dayton Daily News

Lack of Legionnaire’s Alert Upsets Guests; Woman Files Suit Against Another Hotel

Man says group wasn’t told of risk; suit filed against different hotel

ALBANY — Guests to one area hotel claim they weren’t warned about the presence of a potentially dangerous bacterial contamination on a visit this week, while a woman who fell ill last year after attending a conference at a different establishment is filing a lawsuit seeking damages.

Ken Cooper, a state canteen operator from Buffalo, checked in to Best Western Sovereign on Tuesday, one day after state tests confirmed the hotel’s water system was contaminated with legionnella bacteria.

Nobody at the front desk told him, Cooper said.

Cooper, who is legally blind, said he went to his room and noticed a white paper taped to the bathroom mirror. He couldn’t read it because of his vision impairment and almost ignored it, but Cooper said he decided to ask a hotel worker to read it to him.

The worker informed him about the bacteria risk at the hotel and told him the water temperature had been raised to help eliminate the bacteria, he said.

“We were pretty appalled that nobody was forthcoming with the information at the front desk,” Cooper said. “I felt I was done wrong.”

Cooper, who runs the canteen at Roswell Park Cancer Institute, was attending a meeting at the hotel for State Committee of Blind Vendors, whose members operate the numerous convenience stores located in state buildings throughout New York. The group talked over the situation but decided to remain at the hotel for the two-day meeting, he said.

Mansoor Mustafa, general manager of Best Western Sovereign, 1228 Western Ave., said in a statement: “My understanding is that someone in the group who was not sight impaired informed members of the group about the issue at the property.”

He would not comment on whether the group was told before they checked in.

Six cases of Legionnaires’ disease between September and December have been linked to the Western Avenue hotel. All of the people have recovered and hotel is taking steps to eliminate the bacteria from its aging water system. The hotel will flush out its water system on Sunday, according to the Albany County Health Department.

Legionnaires’ is a severe form of pneumonia. The disease is transmitted on water droplets that can come from shower mist, steam from a hot tub and air conditioners. Legionnella, a naturally occurring bacteria that is present in many bodies of water, is harmless at lower levels.

County health officials said the hotel is under orders to inform hotel guests about the elevated bacteria at the hotel.

On Friday, an Albany lawyer announced that he is filing a lawsuit on behalf of a woman who nearly died after allegedly contracting Legionnaires’ disease at another area hotel.

Lori Clark, 48, of Nassau, an associate project manager for the New York State Energy Research and Development Authority, attended a three-day training session at the Comfort Inn in East Greenbush in early January 2011. Clark did not stay overnight, but ate several meals and used the hotel’s restrooms.

Clark’s lawyer, Michael Conway, of the Albany law firm Harris, Conway & Donovan, said the hotel never informed Clark that there were elevated levels of legionnella despite tests done a month earlier that showed abnormal results. Days after her visit to the hotel, Clark said she and several coworkers developed flu-like symptoms. Clark, who suffers from rheumatoid arthritis and lupus, became critically ill. She went into septic shock and organ failure. Clark eventually recovered and has returned to work, though she mostly works from home and only has 50 percent lung function.

“They were negligent in cleaning up their mess and they had a lack of concern for the public,” Clark said about the hotel.

Nicole Nykorchuk, general manager at the Comfort Inn, said the hotel has no comment.

Conway said the hotel shut down their hot tub for a couple days and cleaned it.

“They appeared to have done nothing to clean the air system,” he said. “And they said nothing to folks staying there or visiting for conferences.”

Original article at: timesunion.com

Guest Who Stayed at Luxor Dies of Legionnaires’ Disease

Three guests at the Luxor have contracted Legionnaires’ disease since last spring, including one who recently died as a result, the Southern Nevada Health District announced today.

The other two cases were not fatal, health district officials said. The Centers for Disease Control and Prevention contacted the health district about each case of the disease, which causes respiratory illness.

The first two cases occurred in spring 2011, prompting the health district to collect bulk water samples from the Luxor for an environmental assessment, officials said.

The water samples did not detect Legionella bacteria, indicating the resort’s water did not pose an increased risk to guests for contracting the disease, officials said. Both patients fully recovered.

The CDC reported the third case, which was fatal, to the health district Jan. 6, officials said. The patient stayed at the Luxor in December and contracted the disease later that month, said Brian Labus, a senior epidemiologist at the health district.

The CDC has not released the patient’s name or when he or she died, Labus said.

The health district began another environmental investigation after the death, that found Luxor water samples positive for Legionella bacteria, officials said.

Gordon Absher, vice president of public affairs for MGM Resorts International, said authorities immediately began remediation — super-heating and super-chlorinating water to kill the bacteria — when health district officials notified the resort last week.

Luxor completed remediation for a 400-room water loop, where the deceased guest had stayed, within a day, Absher said. A voluntary remediation for the rest of the hotel will be completed within 10 days, he said.

“We take this very seriously,” Absher said. “Health of our guests and our employees is of paramount importance to MGM Resorts.”

The Luxor also formed a monitoring plan to prevent another cluster from occurring, Labus said, calling the resort very cooperative in the process.

Chlorine and other water treatments typically kill Legionella bacteria, a common form found in water, but large buildings are at risk for the bacteria becoming established in the pipe system and growing, Labus said.

No other cases have been reported so far, authorities said.

Legionnaires’ disease, a form of pneumonia, can cause high fever, chills, cough and occasional muscle aches and headaches, officials said. Symptoms typically occur two to 14 days after being exposed to the bacteria.

Health officials said most people exposed to the bacteria do not get sick, but people who are elderly, have chronic illnesses, a compromised immune system or respiratory disease are at higher risk.

Luxor guests possibly experiencing symptoms should contact their doctors, health officials said. MGM officials also created a website (luxorfacts.com) for more information.

Last year, health officials linked six cases of Legionnaires’ disease to Aria, where all the patients had stayed as guests. All six people fully recovered.

Aria officials alerted guests who stayed there from June 21 to July 4 of their possible exposure to the bacteria. Water tests had detected elevated levels of the bacteria in several guest rooms.

“Legionnaires’ is something we have to live with,” Absher said. “It’s in everyone’s homes. It’s here…We feel we are industry leaders in the way we go after this issue.”

MGM Resorts has started installing secondary water treatment systems in all its hotels, Absher said. The first one is installed and operating at Aria, he said.

“It’s yet another investment in how we protect guest safety,” Absher said.

Original article at: lasvegassun.com

Outbreak of Legionnaires’ Disease Traced to Hospital Fountain

WEDNESDAY, Jan. 11 (HealthDay News) — A decorative fountain in a hospital lobby was the cause of a 2010 Legionnaires’ disease outbreak in Wisconsin, a new study says.

Legionnaires’ disease is a severe and potentially deadly form of pneumonia caused by the bacteria Legionella, which can be inhaled from contaminated water sources.

State and local health officials launched an investigation after eight people in southeast Wisconsin developed Legionnaires’ disease. After interviewing the patients, investigators identified one hospital as the origin of the outbreak.

Environmental testing within the hospital found notable amounts of Legionella in samples collected from the “water wall” decorative fountain in the hospital’s main lobby. All eight patients had spent time in the lobby, the study said.

The fountain was shut down when it was first suspected as a source of the outbreak and hospital officials alerted staff and about 4,000 potentially exposed patients and visitors. All eight patients recovered and no further cases of Legionnaires’ disease occurred after the fountain was shut down.

Before the outbreak, the fountain had undergone routine cleaning and maintenance, the researchers said.

“Since our investigation, the Wisconsin Division of Public Health has developed interim guidelines advising health-care facilities with decorative fountains to establish strict maintenance procedures and conduct periodic bacteriologic monitoring for Legionella,” study lead author Thomas Haupt, an epidemiologist with the Wisconsin Division of Public Health, said in a journal news release.

“The guidelines stress that until additional data are available that demonstrate effective maintenance procedures for eliminating the risk of Legionella transmission from indoor decorative water fountains in health-care settings, water fountains of any type should be considered at risk of becoming contaminated with Legionella bacteria,” he added.

The study appears in the February issue of the journal Infection Control and Hospital Epidemiology.

More information
The U.S. Centers for Disease Control and Prevention has more about Legionnaires’ disease.

Original article at: Yahoo! News

Health Department Investigating Case of Legionnaires’ Disease at Westernport Apartment Complex

WESTERNPORT — The Allegany County Health Department is investigating one confirmed case of Legionnaires’ disease in a resident of Grandview Apartments, a senior apartment community in Westernport.

Personal details about the case, including the individual’s name, age and gender, will not be released.

Legionnaires’ disease is caused by a type of bacteria called Legionella, which can be found in many different water sources — manmade and natural. People most at risk of getting the disease are the elderly, smokers and those with lung or kidney disease, diabetes, cancer or weakened immune systems because of diseases or medications.

Legionellosis is acquired by inhaling aerosols of water containing the Legionella bacteria. The disease is not passed from person to person. Legionellosis can be treated by commonly used antibiotics.

Signs of the disease are similar to pneumonia and can include a high fever, chills, chest pain and cough. Some people may also suffer from muscle aches and headaches. Symptoms appear two to 14 days after coming in contact with the bacteria.

Since Jan. 1, 139 cases of Legionnaires’ disease have been reported in Maryland; three of these were in Allegany County. A case also was confirmed a year ago at Moran Manor in Westernport. Each year, between 8,000 and 18,000 people are hospitalized with Legionnaires’ disease in the United States.

The Allegany County Housing Authority and the health department are working together to assess the risk associated with the building. In the meantime, recommendations to apartment residents include:

  • Reducing contact with water sprays/mists.
  • Taking tub baths rather than showers.
  • Using bottled water or water that has been boiled for five minutes at a rolling boil for drinking, cooking and other oral consumption, including tooth-brushing.

It is very important to always use sterile or distilled water in respiratory equipment such as oxygen dispensers and nebulizers.

Residents or recent visitors to the apartment building who are currently ill with fever, cough and/or shortness of breath should seek attention by a health-care provider. Possible cases should be reported to the health department at 301-759-5093.

Individuals who aren’t ill do not need testing for Legionella infection.

For more information, go to the Maryland Department of Health and Mental Hygiene website at http://ideha.dhmh. maryland.gov or the U.S. Centers for Disease Control and Prevention at http://www.cdc. gov/legionella.

Original article at: times-news.com

Hotel with Legionnaires’ Cases Plans Tests Prior to Reopening

OCEAN CITY — The hotel where several people contracted Legionnaires’ Disease will have consulted with a water systems expert and will have regular water testing done by the health department when it reopens in the spring.

The Plim Plaza Hotel, which closed for the season a few days early this fall after some of its guests developed Legionnaires’ Disease, has been required by the Worcester County Health Department to consult with a water expert to develop a plan for treating its water before it reopens in April 2012.

“We’ll be monitoring the effectiveness of the plan,” said Debra Stevens, nursing program manager at the Worcester County Health Department. “This is an ongoing investigation.”

When it opens in the spring, the oceanfront hotel will also have its water tested regularly for about six months by the health department.

Plim Plaza spokesperson Betsy FauntLeRoy said the hotel had been working closely with the health department since the bacteria was discovered in its water pipes and had hired a water expert immediately.

“We had remediation done,” she said. “All the bacteria has been cleared from the building, everything is good to go.”

She said an exact source of the bacteria had not been determined. “The source is unclear, but we did everything in our power to clean out every pipe and drain,” she said.

The Plim Plaza Hotel closed after three former guests developed Legionnaires’ Disease after staying there in September. Once it closed, four more guests contracted the disease, which can show up anywhere between two and 14 days after exposure to the Legionella bacteria. One of the seven sickened, an elderly out-of-state hotel guest, died.

Legionnaires’ Disease, a form of pneumonia, has symptoms similar to the flu including a high fever, cough and shortness of breath. People develop the illness after exposure to the Legionella bacteria, which is common in the environment, according to the Maryland Department of Health and Mental Hygiene.

Original article at: delmarvanow.com

CHP Investigates a Legionnaires’ Disease Case

The Centre for Health Protection (CHP) of the Department of Health is today (December 21) investigating a case of Legionnaires’ Disease involving a 67-year-old man.

The patient, with underlying illnesses, presented with fever, cough, shortness of breath and malaise since December 16. He was admitted to Queen Mary Hospital on December 18 and was transferred to Intensive Care Unit the next day. He is in stable condition now.

Test on his nasopharyngeal aspirate specimen revealed that the patient was infected with Legionella bacteria.

He had travelled to the Mainland between December 10 and 11. His close contacts were asymptomatic. Investigation is in progress.

Information on Legionnaires’ Disease and advice on prevention can be found at the CHP’s website, www.chp.gov.hk.

Original article at: flutrackers.com

Ocean City Hotel Works to Reopen after Legionnaires’ Disease Cases

OCEAN CITY — The hotel where health officials say several people contracted Legionnaires’ disease will consult with a water systems expert and have regular water testing done by the Worcester Health Department when it reopens in the spring.

The Plim Plaza Hotel, which closed for the season a few days early this fall after some of its guests developed Legionnaires’ disease, has been required by the health department to consult with a water expert to develop a plan for treating its water before it reopens in April 2012.

“We’ll be monitoring the effectiveness of the plan,” said Debra Stevens, nursing program manager at the Worcester County Health Department. “This is an ongoing investigation.”

When it opens in the spring, the oceanfront hotel will have its water tested regularly for about six months.

Plim Plaza spokeswoman Betsy FauntLeRoy said the hotel has worked closely with the health department since the bacteria was discovered in its water pipes and hired a water expert.

“We had remediation done,” she said. “All the bacteria has been cleared from the building; everything is good to go.”

She said an exact source of the bacteria had not been determined.

“The source is unclear, but we did everything in our power to clean out every pipe and drain,” she said.

The Plim Plaza Hotel closed after three guests developed Legionnaires’ disease in September. Once it closed, four more guests contracted the disease, which can show up between two and 14 days after exposure to the Legionella bacteria. One of the seven sickened, an elderly out-of-state hotel guest, died.

Legionnaires’ disease, a form of pneumonia, has symptoms similar to the flu including a high fever, cough and shortness of breath. People develop the illness after exposure to the Legionella bacteria, which is common in the environment, according to the Maryland Department of Health and Mental Hygiene. It is spread by the release of small droplets of contaminated water into the air from sources including air conditioning cooling towers, showers and humidifiers. People get sick when they inhale infected droplets; the disease is not spread by person-to-person contact.

Original article at: delmarvanow.com

Cases of Legionnaires’ Disease In Maine, Massachusetts, and Connecticut Nearly Double

The total number of Legionnaires’ cases in Maine, Massachusetts, and Connecticut has nearly doubled from last year, reports Reuters. Many states in New England had dramatic increases as well, but surprisingly states in other parts of the country did not. For example, California confirmed only slightly more cases than last year.

New York and Pennsylvania also saw large jumps in Legionnaires’ cases.

Legionnaires’ disease is a very serious form of pneumonia that results in long term health effects or a flu-like illness called Pontiac Fever. Most individuals become infected by inhaling Legionella bacteria in the air; it is not spread from person to person. The bacteria spread through mist or vapor from contaminated water in hot tubs, cooling towers, faucets, showerheads, and other water systems. A current or previous smoking habit, chronic lung disease, age (usually 50 years or older), and the use of certain rheumatoid arthritis and chemotherapy drugs can increase the risk of contracting Legionnaires’ disease.

Epidemiologists have not yet given a reason for the increase, but they are considering various explanations, including increased awareness of Legionnaires’ causing more testing, climate changes, more air conditioner use, and a larger number of seniors who are more vulnerable than younger people.

Original article at: webwire.com