Carolina legionellosis outbreak: 4 dead, 142 sickened, 95 hospitalized

North Carolina health officials announced several developments in the state’s recent legionellosis outbreak linked to last month’s Mountain State Fair:

• A fourth victim has died from Legionnaires’ disease. The North Carolina Department of Health and Human Services (NCDHHS) did not provide any additional information.
• A case of Legionnaires’ disease unrelated to the fair was confirmed two weeks after it ended Sept. 15. The victim is a person who attended the Asheville Quilt Show in the Davis Event Center – the same building that has been identified as the outbreak source.
• The Davis Event Center in the WNC Ag Center has been closed until the air conditioning system can be checked by an “industrial hygienist,” according to WLOS.com.

Carolina legionellosis outbreak:
134 Legionnaires’ disease cases

In addition to the four victims who have died, other case characteristics compiled by the NCDHHS as of today (Oct. 21) are:

• A total of 142 people have been sickened, 134 with Legionnaires’ disease and eight with Pontiac fever, a milder form of legionellosis that does not affect the lungs.
• Eighty-two victims (58 percent) are male, and 59 are female.
• The victims’ ages are between 24 and 91, with a median age of 61. (Note: People over the age of 50 are particularly susceptible to Legionella bacteria.)
• Ninety-five people (69 percent) have been hospitalized.
• Four victims have died.
• There are 10 out-of-state cases.

Carolina legionellosis outbreak:
Illnesses linked to hot tubs

The outbreak was traced to hot tubs on display in the Davis Event Center, specifically during the final five days of the 10-day fair. No new cases were linked to the outbreak until the announcement that a person who attended the Asheville Quilt Show (Sept. 27-29) was diagnosed with Legionnaires’ disease.

“We don’t know how or where this person might have been exposed to the Legionella bacteria,” state epidemiologist Zack Moore told WLOS.com. “It is possible that they were exposed at the WNC Ag Center, but Legionella bacteria are very common in the environment. So, we can’t rule out exposure in another location.”

WNC Ag Center general manager Matt Buchanan said the Davis Event Center would be closed until it has been given a clean bill of health. “They have looked at it before – the CDC did – and saw nothing wrong with it,” Buchanan said. “But we’re going to actually run some really hard tests on it to make sure there is no evidence at all there.”

The highly publicized Carolina legionellosis outbreak has killed 4 people, sickened 142 (134 with Legionnaires’ disease), and put 95 victims in hospitals. The outbreak has been traced to contaminated hot tubs on display during last month’s Mountain State Fair in Fletcher.

Carolina legionellosis outbreak:
Illness symptoms are numerous

Legionnaires’ disease is a severe type of pneumonia that, according to the CDC, sickens about 25,000 people in the United States annually. Because of the disease’s nonspecific symptoms, however, only 5,000 cases are reported.

The onset of symptoms usually involves:

• severe headaches
• muscle aches
• fever, which can be 104 degrees Fahrenheit or higher, and chills.

By Day 2 or Day 3, symptoms often worsen and include:

• coughing, which can produce mucus or blood
• shortness of breath (or dyspnea)
• chest pains (or pleuritic chest pains, pleurisy, pleuritis)
• gastrointestinal symptoms, such as nausea, vomiting, and diarrhea
• confusion and other mental changes.

Although Legionnaires’ disease primarily affects the lungs, it occasionally can infect other parts of the body, including the heart.

Carolina legionellosis outbreak:
Legionnaires a difficult diagnosis

Legionnaires’ disease, which is also known as Legionella pneumonia, is contracted by inhaling microscopic aerosolized water droplets (vapor or mist) contaminated with Legionella bacteria (scientific term: Legionella pneumophila).

People 50 and older – especially those who smoke or suffer from a chronic lung condition, such as COPD (chronic obstructive pulmonary disorder, most commonly bronchitis and emphysema) – are more susceptible to developing Legionnaires’ disease.

Other high-risk people include:

• anyone with a weakened immune system
• organ-transplant recipients
• anyone on a specific drug protocol (for example, corticosteroids)
• alcoholics.