University Hospital outbreak claims 3 lives

The University Hospital outbreak of Legionnaires’ disease in Madison, Wisconsin, continues to worsen as UW Health officials announced that three patients have now died. In addition, officials said the case count has increased to 14.

The three patients who have passed away all had “serious, life-limiting health conditions,” UW Health’s statement said. One patient is still hospitalized with serious health conditions; the other 10 patients have been discharged.

Test results from three patients confirmed that the strain of Legionella bacteria, which causes Legionnaires’ disease, was identical to the strain found in the hospital’s water system. The other 11 patients were unable to provide samples for testing.

University Hospital outbreak: chlorine

Hospital officials said the water system has been flushed with high levels of chlorine to eliminate Legionella, and the procedure has been successful.

“Testing completed so far continues to show the expected reduction in the bacteria,” the hospital statement said. “UW Health will continue intensive monitoring of its water system to ensure patient safety.”

The University Hospital outbreak of Legionnaires’ disease in Madison, Wisconsin, has resulted in the deaths of three patients. The case count has grown from four to 14.

University Hospital outbreak: growing steadily

The University Hospital outbreak first made headlines Nov. 28, when it was announced that there were four cases. At that time, the outbreak was attributed to a change in the hospital’s hot-water system, which had been adjusted to save water.

“The flow was altered in the system,” said Nasia Safdar, medical director of infection control at UW Hospital and Clinics. “So, instead of being at a consistent high flow, it was altered to be more flexible to be on demand.”

On Nov. 29, a fifth case and a fatality were announced, and the case count was subsequently increased to 11 in early December.

University Hospital outbreak: CDC called

Hospital officials said they have been working with the Centers for Disease Control and Prevention (CDC) on their response to the outbreak, and a review and analysis from the CDC is expected in approximately three months.

University Hospital outbreak: disease info

Legionnaires’ disease is also known as legionellosis and Legionella pneumonia, and it is a severe type of lung infection. The CDC estimates about 25,000 cases of pneumonia due to Legionella bacteria (Legionella pneumophila) yearly in the United States, but only 5,000 cases are reported because of the disease’s nonspecific signs and symptoms.

The disease is treatable with antibiotics if diagnosed early, but if that does not occur, severe complications can develop, and the disease can become deadly, as evidenced by this outbreak.

University Hospital outbreak: symptoms

Legionnaires’ disease develops anywhere from two to 10 days after exposure to Legionella, and symptoms frequently begin with the following:

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

By the second or third day, symptoms can worsen to include:

• pleuritic chest pain (pleurisy), which occurs when the lining of the lungs becomes inflamed
• shortness of breath (dyspnea)
• cough, which can bring up mucus or blood
• gastrointestinal symptoms: nausea, vomiting, diarrhea
• mental agitation and confusion.

Although Legionnaires’ disease primarily affects the lungs, it occasionally can cause infections elsewhere in the body, including the heart.

University Hospital outbreak: numerous sources

Legionella bacteria are contracted by inhaling microscopic water droplets (vapor or mist). The bacteria grow best in warm water, and they are found most commonly in built environments, such as:

• water systems: hospitals, nursing homes, hotels
• large plumbing systems
• physical-therapy equipment
• hot-water tanks and heaters
• bathroom showers and faucets
• swimming pools, whirlpools, hot tubs
• mist machines: produce sections of grocery stores
• hand-held sprayers
• decorative fountains
• cooling towers of air conditioning systems.

University Hospital outbreak: higher risk

Although anyone can become ill from Legionella, those most susceptible to infection include:

• people with weakened immune systems
• people with chronic lung disease or COPD (most commonly emphysema or bronchitis)
• smokers, current or former
• people 50 or older
• organ-transplant recipients
• people on specific drug protocols (corticosteroids, to name one)
• alcoholics.