Legionnaires’ Disease Outbreak in Quebec City

MONTREAL — The regional director of the public health department was categoric in her condemnation in the wake of last summer’s explosion of Legionnaires’ disease in Quebec City.

“There were insufficient practices in place,” said François Desbiens, of the epidemic that saw 181 people fall sick and 13 die of the bacteria found in the cooling towers of buildings in the provincial capital.

The provincial health department got involved in examining the cause of the deadly respiratory disease that comes from bacteria that thrive in aquatic environments.

A report of their findings was made public on Thursday.

Cooling towers, containing water used in building air-conditioning systems, were found to be the source of the bacteria in Quebec City.

The bacteria was found in 24 per cent of the buildings visited by health inspectors after the outbreak was first declared.

In the report, Desbiens calls for more stringent maintenance protocols and cleaning and disinfecting procedures, as well as better official surveillance of these practices.

Original article at: montrealgazette.com

Third Vet’s Death Tied to Legionnaires’

His wife blames water from VA hospital in Oakland

The wife of a Vietnam War Army veteran who died Oct. 23 in Erie believes her husband may have died after contracting Legionnaires’ disease from the water system at the VA hospital in Oakland.

If John McChesney, 63, did die after contracting the pneumonia-like disease at the University Drive facility, that potentially makes him the third patient in the past two years to die after getting Legionnaires’ disease there.

It also makes Mr. McChesney part of an expanding investigation into the Legionnaires’ outbreak at the hospital that has caught national attention in part because the hospital used to be home to researcher Victor Yu, who in 1982 first confirmed the connection between the spread of the disease and water systems.

Part of that expanding inquiry is looking into whether Legionnnaires’ cases also originated at the VA’s H.J. Heinz campus near Aspinwall, a site that contains a nursing home for veterans.

VA spokesman David Cowgill on Monday confirmed the VA has detected Legionella, the bacterium that causes the disease, in the water system at Heinz, and that facility still has water restrictions in effect while the water system is being treated with chlorine. Water restrictions were finally lifted at University Drive on Friday after two weeks of cleaning.

Mr. Cowgill said in an email that one of the five cases of Legionnaires’ disease that originated at the VA may have originated at Heinz, though there is a “high probability” that it began at University Drive for that patient.

Mr. Cowgill said he could not comment on Mr. McChesney’s case, though Mr. McChesney’s wife, Evelyn, said she has been contacted three times in the past five days by officials from the VA about her husband’s death and requests to test the water in her Columbus, Warren County, home to see if that was the source of the Legionnaires’ disease he contracted.

“I think he got it at the VA,” she said Monday. “I don’t believe there’s anything wrong with my water.”

Mr. McChesney had suffered from kidney and heart trouble that resulted from contact with the chemical defoliant Agent Orange during his 18-month stint in the infantry in Vietnam.

He died after his wife of 18 years took him to St. Vincent Health Center in Erie on Oct. 1 because he was coughing and wheezing badly. She said an emergency room doctor there said Mr. McChesney tested positive for Legionnaires’ disease.

That was less than 14 days after he had spent six days over two visits to the University Drive facility in late September, where he was being seen for heart problems. Legionnaires’ disease typically has up to a 14-day incubation period.

Mrs. McChesney, who has been following the stories about the outbreak over the past two weeks, was incensed by what she has read.

“Whoever was responsible for this, they should be held accountable,” she said. “I mean, the suffering my husband went through for 3 1/2 weeks [before he died] was needless and it was because they just neglected things.”

“I feel my husband and other soldiers served their country and they deserve the best care possible,” she added.

The outbreak was first revealed by the VA Pittsburgh Healthcare System on Nov. 16, when it said that it had confirmed just four cases of the disease linked to the University Drive hospital, and it said all four patients had recovered.

It later said on Nov. 22 that a fifth person had contracted the disease from the hospital, though it omitted from the news release that the fifth patient had died. It wasn’t until Friday that the VA told the Allegheny County Health Department that that person — whom the VA refuses to identify — had died after contracting the disease.

In addition, the children of a second veteran, John Ciarolla, 83, told the Pittsburgh Post-Gazette that he died last year after contracting the disease following stays at both University Drive and the VA’s H.J. Heinz nursing home.

The U.S. Centers for Disease Control and Prevention is investigating how the outbreak occurred, and U.S. Sen. Bob Casey, D-Pa., has asked Veterans Affairs Secretary Eric Shinseki for a report on why the outbreak occurred.

Dr. Yu and his research colleague, Janet Stout, who both left the VA after a dispute with management in 2006 and 2007, respectively, believe that the outbreak is due to the VA’s failure to properly manage and maintain the water treatment system they first installed at the hospital in 1993. The VA believes the treatment system is what failed.

U.S. Rep. Brad Miller, D-N.C., was chairman of the House Investigations and Oversight Subcommittee in 2008 when it held a hearing into the way that Dr. Yu and Dr. Stout were pushed out of the hospital, and how the VA destroyed 30 years worth of frozen isolates of Legionnaires’ disease that the researchers had collected.

Mr. Miller believed then that the VA seriously erred in forcing Dr. Yu and Dr. Stout out and destroying their isolate collection. Now the actions look even worse, he said, since it was Dr. Stout who oversaw the water treatment system at the hospital.

“At the very least, [losing Dr. Yu and Dr. Stout] compromised that hospital’s ability to deal” with the outbreak, Mr. Miller said Monday. “And they may have lost the people who were best at handling [the water treatment] system.”

Another part of the story that has bothered Mrs. McChesney and others is that the VA knew as early as June that it had a problem with the water treatment system — known as a copper-silver ionization system. The VA called in a consultant then, who recommended in July a series of steps to make it work properly.

But the VA did not do anything in response to the recommendations until sometime in October, when it called the consultant back in and asked the consultant to adjust the copper-silver system to work properly.

“I mean, for them to be that negligent,” Mrs. McChesney said. “They never even warned their patients.”

Because the Legionella bacterium must get into a patient’s lungs, one of the most common ways it infects a person is while taking a shower, when the moist mist from a shower is inhaled. Mrs. McChesney believes her husband took at least two showers during a four-day stay at the hospital from Sept. 18 to Sept. 21. He returned for a two-day visit at the VA Sept. 26 and 27 and then went home after a procedure.

About 8,000 to 10,000 people each year are hospitalized with the disease. But the Centers for Disease Control and other experts believe many more cases occur each year that go undiagnosed as simple pneumonia or other afflictions. Legionnaires’ disease can be fatal in 5 percent to 30 percent of cases, depending on who it strikes and where it is acquired.

After Mr. McChesney was admitted to St. Vincent on Oct. 1, his condition got worse, and it was the heart and kidney conditions he had suffered from for much of his life that were the official causes of death on Oct. 23. But his wife said his doctors acknowledged to her that it was the Legionnaires’ disease that exacerbated them, leading to his death.

Mrs. McChesney said VA officials told her in late October that they would send bottles to her to collect samples of her home water to test.

But she never got the bottles and no one followed up until the past five days, after the outbreak had been publicly revealed.

On Thursday, a VA official called and asked if she could send Mrs. McChesney a kit to test her home’s water. Then, on Friday, Robert Muder, director of the infectious disease section at University Drive, called her and left a message that he wanted to talk to her. And finally, on Monday, another VA official called and asked if the VA could send a social worker to her home to test her water.

“I’m not sure I want them to come, or if I want to talk to them,” Mrs. McChesney said.

Now, she said, she’s focused on getting to the bottom of what caused her husband’s death, to honor his memory.

“I do know that he would not want me to just let this go,” she said.

Original article at: post-gazette.com

Italian Woman Dies from Legionnaires Disease at Dental Practice

A recent death of an Italian woman from Legionnaires Disease is a timely reminder that dental surgeries should be constantly checked for cleanliness and bacterial infection.

It has been found that the 82-year-old woman died from bacteria found in the water line used by her dentist, which shows the need to ensure that patients are not at risk.

Legionnaires Disease causes severe pneumonia, which even healthy people can succumb to. The lady although in her early 80s was apparently very healthy and visited her dentist on 2 occasions. As such, when the cause of death was realised, the only place where they could find the bacterium was at the practice.

Samples were taken from water supplies in the lady’s home but the L pneumophila was not found there. However, samples taken from water supplies at the dental practice showed high levels of the bacterium with the highest levels found in the output from the high-speed turbine.

Legionnaires Disease comes in 2 forms – Legion Fever and Pontiac Fever. The former is more severe and causes pneumonia. The latter is a milder illness that is less likely to be fatal.

Speaking with reporters, Peter Bacon, technical director at a company that supplies a product that helps reduce contamination in dental surgeries said: “We have long understood the risks associated with infections caused by the presence of biofilm in dental unit water lines and have worked to provide an easy to use solution for dentists.”

He added: “This case underpins the duty of care dentists need to demonstrate to patients as well as to the regulatory bodies, to ensure they are minimising risk. This is exactly the reason we offer free, reliable dental unit water assessments to dentists.”

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

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

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

More Legionnaires’ Cases Diagnosed

NEW PORT RICHEY – Pasco County public health authorities are trying to determine what may have caused three cases of Legionnaires’ disease.

Two cases were diagnosed on the same street in Port Richey.

“We just heard of a third case that’s in a different location four miles away,” said Dr. David Johnson, director of the Pasco County Health Department.

The three cases follow last week’s outbreak of Legionnaire’s disease in Plant City. Three people were diagnosed to the bacterial infection in the Meadows Countrywood neighborhood last week.

One of the patients died. Initially the Hillsborough County Health Department suspected a community hot tub may have been the source of the illness. That has since been ruled out.

No known cause has been identified.

“Sometimes the cause jumps right out at you,” Pasco’s Dr. Johnson said. “But often the cause is never found,” he added.

There is no common connection between Pasco County’s three cases, except from location. Two of the patients live on the same street. The third lives nearby.

The cause could be as simple as a dirty shower head. People who live near one of the Port Richey patients say he was rushed to a hospital in an ambulance.

Johnson suggests not waiting that long for anyone who feels ill.

“If you have symptoms, if you’re developing a fever and cough you need to get in and see your doctor,” he said.

Legionnaires’ Disease comes from bacteria usually found in water. The bacteria that causes it thrives in warm and wet environments, and people contract the disease by breathing in contaminated water vapor.

“It is not contracted person to person,” explained FOX 13’s Dr. Joette Giovinco. “However, if several people were exposed to the same source, then many of those people may get sick, depending on their health.”

More information from the U.S. Centers for Disease Control:

Original Article on My Fox Tampa Bay

Legionnaires Disease at Boardwalk Hotel; One Fatality

OCEAN CITY- Three more cases of Legionnaire’s Disease connected to a historic Boardwalk hotel were confirmed this week, including an elderly out-of-state victim who has died from the disease, while state and local health officials this week confirmed the presence of the bacteria in the water at the facility.

Last week, the Maryland Department of Health and Mental Hygiene and the Worcester County Health Department reported three individuals who were guests at the Plim Plaza Hotel on the Boardwalk had developed legionellosis, more commonly known as Legionnaire’s Disease, roughly one week after staying at the hotel. All three individuals were hospitalized, although none had died.
This week, however, three additional cases of Legionnaire’s Disease were confirmed in people who had stayed at the hotel. One of the victims, an elderly out-of-state guest at the hotel, succumbed to symptoms of the disease, according to state health department officials.

“Our sincere condolences go out to the family of the elderly victim that passed away,” said Plim Plaza spokesperson Betsy FauntLeroy, who did not provide any more information about the victim. “We really want to respect their privacy.”

This week, Maryland Department of Health and Mental Hygiene Laboratories Administration testing confirmed the presence of legionella bacteria in water collected at the Plim Plaza last week. Legionella pneumophia, the bacteria that causes Legionnaire’s Disease, was detected in water collected from various locations at the hotel.

The Worcester County Health Department and the state DHMH continue to work on the investigation, along with the Plim Plaza Hotel management, which has been proactive and cooperative from the start, according to state and local health officials.

“We’re following all of the strict guidelines with our health department and our own independent company to make sure anything and everything is undertaken to ensure nobody else is put at risk,” said FauntLeroy this week.

Almost immediately after the Plim Plaza and Harrison Group staff learned of a possible connection between the hotel and the three reported cases, guests staying at the hotel were relocated to the group’s other properties in Ocean City. The 181-room facility was about 50-percent occupied at the time the possible connection to legionellosis was reported.

For the Plim Plaza, even a remote connection between the reported cases and the hotel where the original three individuals had stayed was reason enough to relocate the guests and shut down the facility three days prior to its scheduled season-ending closure. In addition to closing the hotel early and relocating its guest, the Plim Plaza staff has reached out to all guests who stayed at the facility over the last month or so.

Legionellosisi is a form of pneumonia caused by inhaling aerosolized water, or water mist, containing the legionella bacteria. Roughly two to 14 days after exposure to the bacteria, a small number of individuals exposed the bacteria may develop legionellosis, which can be treated with commonly available antibiotics.

Symptoms mimic the flu, including high fever, cough and shortness of breath. Other symptoms include abdominal pain, diarrhea, or severe body aches. Persons at higher risk include smokers, the elderly, those with chronic lung disease or those with compromised immune systems. However, the illness is not spread from person to person.

Although the hotel is currently closed for the season, state and local health officials, along with the hotel staff, continue to urge anyone who was a guest at the Plim Plaza during the month of September and is experiencing pneumonia-like symptoms to contact his or her health care provider.

Original article from: The Dispatch

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

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