HEALTH Legionella identified as source of Argentina's deadly pneumonia cluster

[China Connection]

Legionella identified as source of Argentina's deadly pneumonia cluster​

Filed Under:
Legionella
;
Pneumonia
Lisa Schnirring | News Editor | CIDRAP News
|
Sep 06, 2022

legionella_bacteria-cdc.jpg​

CDC / Francis Chandler
Over the weekend, Argentinian health officials announced that Legionella was isolated from samples from four people infected in an unexplained cluster of bilateral pneumonia at a hospital that triggered fears of a possible outbreak of a new pathogen.
In the outbreak centered at a private facility in Tucuman province, in separate reports over the past few days, officials reported 9 more cases and 3 more deaths, raising the outbreak total to 19 cases, 6 of them fatal.

Tests indicate Legionalla pneumophilia​

In a Sep 3 statement, provincial health officials said the three of the samples that tested positive were respiratory samples from sick patients, and the other was a puncture biopsy from one of the patients who died. They said the Legionella bacteria were still being subtyped, but they suspect it is Legionella pneumophilia.
Legionella can be transmitted through inhalation through water or air conditioning. Officials said it is safe to transfer patients to another facility so that investigators can examine the water and air conditioning systems in the affected hospital.
The World Health Organization (WHO) said in a statement that tests at Argentina's national lab had were negative for several respiratory viruses and bacteria and that tests were negative for the urinary antigen for Legionella. More detailed DNA testing on two bronchoalveolar lavage samples were consistent with Legionella species, with further testing suggesting that the results were compatible with Legionella pneumophilia.
"This laboratory result supports evidence compatible with Legionnaires' disease. Blood culture and seroconversion tests continue to be conducted to complement the diagnosis of Legionella infection," the WHO said. Though uncommon, Legionnaires' disease is a known cause of community- and hospital-acquired pneumonia.

Three healthcare workers died​

All of the patients with confirmed infections have connections to the hospital. Of the 11 cases and 4 deaths covered in the WHO statement, 8 involved healthcare workers and 3 involved patients.
And of the four deaths, three occurred in healthcare workers. So far, no secondary infections have been identified. Symptoms included bilateral pneumonia, fever, muscle pain, abdominal pain, and breathing difficulty.
The WHO said environmental samples are being collected to identify the source of the contamination.
In a statement today, Tucuman health officials expanded the case inclusion criteria to include patients, caregivers, or health workers who had been at the hospital in August and developed any kind of pneumonia, not just bilateral (involving both lungs).
As a result, they added 8 more cases, which include 1 patient, 5 caregivers who were hospitalized, and 2 health workers. One is a stroke patient who is listed in serious condition.
Officials also announced two more deaths, one in an 81-year-old person and the other in a 64-year-old patient. Nine people are being treated at home for mild or moderate infections.

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[China Connection]

Legionellosis - Argentina​

5 September 2022


Outbreak at a glance
As of 3 September 2022, a cluster of 11 cases of severe pneumonia, including four deaths, have been reported in San Miguel de Tucumán city, Tucuman Province, Argentina. Legionella spp. was isolated in the samples from four cases. Legionellosis is a pneumonia-like illness that varies in severity from mild febrile illness to a serious and sometimes fatal form of pneumonia. Cases were initially reported as being pneumonia of unknown cause. Legionella bacteria was identified as the causative organism on 3 September.
All cases presented with bilateral pneumonia, fever, myalgia, abdominal pain, and dyspnea between 18 and 25 August 2022 and are epidemiologically linked to one health facility. Of the 11 cases, eight are health workers of the facility; three are patients of the health facility. Three of the four deaths were among health workers.
Health authorities are coordinating cluster investigation activities, active case finding to identify additional cases, contact tracing and public health activities to limit further spread.
Outbreak overview
On 29 August 2022, WHO was notified by the Ministry of Health of Argentina of a report from the Ministry of Public Health of Tucumán Province, of a cluster of six cases of bilateral pneumonia without an etiological cause identified in San Miguel de Tucumán city, Tucuman Province, Argentina 1. All six cases were linked to one private health facility in the city of San Miguel de Tucumán, with the onset of symptoms between 18 and 22 August 2022. The six cases included five health workers and one patient who was admitted to the clinic for an unrelated condition and then subsequently to the intensive care unit after developing pneumonia. In addition to bilateral pneumonia, all cases presented with fever, myalgia, abdominal pain, and dyspnea.
On 1 September, three additional cases were identified through active case finding - all health workers from the same private health facility, aged 30 to 44 years - with similar signs and symptoms to the initial six cases identified 2. The onset of symptoms for these cases was between 20 and 25 August 2022.

Between 2 and 3 September, two additional cases were identified, an 81-year-old male and a 64-year-old male, both with comorbidities, who were hospitalized and presented similar clinical presentation as the previous cases 3.
As of 3 September 2022, 11 cases have been identified, four of whom have died (three health workers). Eight of the 11 reported cases are health workers of the same health facility. The median age of the cases is 45 years; seven are male. Ten cases had underlying conditions and/or risk factors for severe disease, including the four reported deaths. Four cases are still hospitalized as of 3 September. Contacts of the cases are under follow-up and, to date, none have developed symptoms.
Laboratory results
Blood, respiratory and tissues samples were obtained from the 11 cases. Preliminary tests conducted at the local Public Health Laboratory were negative for respiratory viruses, and other viral, bacterial, and fungal agents. On 31 August, samples from the initial six cases were sent to the National Reference Laboratory - the Administration of National Laboratories and Health Institutes (Administración Nacional de Laboratorios e Institutos de Salud - ANLIS per its acronym in Spanish) - for additional testing 4 . As of 3 September 2022, negative results have been obtained for COVID-19 (RT-PCR), Influenza, detection of antibodies for Coxiella, urinary antigen for Legionella spp., panel of 12 respiratory viruses, hantavirus (Elisa IgM), histoplasma (RT-PCR), Yersinia pestis (PCR) and micro agglutination for leptospirosis.
Further analyses of two bronchoalveolar lavage samples by highly sensitive total DNA sequencing (metagenomics) found readings compatible with Legionella spp. On 3 September 2022, ANLIS reported that amplification products of the 16S ribosomal gene for Legionella spp. from the two samples of bronchoalveolar lavage sequenced by metagenomics and analyzed by four different bioinformatic methods, produced results compatible with Legionella pneumophila. Confirmation of these results is expected upon completion of the sequencing processes. This laboratory result supports evidence compatible with Legionnaires’ disease. Blood culture and seroconversion tests continue to be conducted to complement the diagnosis of Legionella infection.
Epidemiology of Legionellosis
Legionellosis is a generic term describing the pneumonic and non-pneumonic forms of infection with the Legionella species of bacteria. Legionellosis varies in severity from mild to serious and can sometimes be fatal.
Legionnaires’ disease, the pneumonic form, has an incubation period of 2 to 10 days (but up to 16 days have been recorded in some outbreaks). It is an important cause of community- and hospital-acquired pneumonia; and although uncommon, Legionnaires may cause outbreaks of public health significance. Initially, symptoms are fever, mild cough, loss of appetite, headache, malaise and lethargy, with some patients also experiencing muscle pain, diarrhoea and confusion. The severity of Legionnaires’ disease ranges from a mild cough to rapidly fatal pneumonia. Untreated Legionnaires’ disease usually worsens during the first week.
Mortality from Legionnaires’ disease depends on the severity of the disease, the use of antibiotic treatment, the setting where Legionella was acquired, and whether the patient has underlying conditions, including immunosuppression. The death rate may be as high as 40–80% in untreated immunosuppressed patients and can be reduced to 5–30% through appropriate case management, depending on the severity of the clinical signs and symptoms. Overall, the death rate is usually between 5–10%.

Public health response​

In response to the detection of the cluster of bilateral pneumonia, health authorities in Tucuman Province coordinated cluster investigation activities including the follow-up of cases, search for the source(s) of infection, active case finding to identify additional cases, and contact tracing. Preliminary investigations indicated no secondary cases were identified.
As Legionella spp. has been identified as the etiology of this outbreak, the following public health measures were implemented:

• Risk assessment and suspension of healthcare activities in the health facility.
• Enhanced surveillance including active and passive case finding.
• Biological and environmental sampling, and laboratory testing, including bacteria isolation, and metagenomics.
• Case isolation and clinical care of patients.
• Contact identification, support and monitoring.
• Risk communication

With the support of national health authorities, environmental samples are being collected to define the source of contamination and urgently implement prevention and control measures. The health authorities are also implementing internal and external communication strategies for health professionals and the community.
The Pan American Health Organization (PAHO)/WHO is providing technical support for the outbreak investigation, including advice on sampling, environmental assessment, clinical management, and Infection and Prevention Control (IPC) measures.

WHO risk assessment​

Legionellosis varies in severity from a mild febrile illness to a serious and sometimes fatal form of pneumonia and is caused by exposure to Legionella species found in contaminated water and potting mixes. The most common form of transmission of Legionellosis is inhalation of contaminated aerosols from contaminated water sources. Sources that have been linked to both the transmission of Legionella via aerosols and outbreaks of Legionellosis include air conditioning cooling towers or evaporative condensers associated with air conditioning and industrial cooling, hot and cold water systems, humidifiers, and whirlpool spas. Infection can also occur by aspiration of contaminated water or ice, particularly in susceptible hospital patients. To date, there is no reported direct human-to-human transmission.
Sporadic outbreaks of legionellosis pneumonia have been reported in Argentina before. There are robust surveillance activities being implemented in the affected health facility. Nonetheless, in the absence of an identified source of Legionella bacteria, the risk of developing Legionellosis for people working or hospitalized at the same health facility is currently moderate.
Countries with cases of Legionellosis reported after travel to Argentina should notify their regional IHR focal point.

WHO advice​

WHO recommends the continuation of laboratory analyses, case identification and clinical care, contact tracing, outbreak investigation to identify the source(s), implementation of measures to prevent further infections and enhancement of Infection Prevention and Control (IPC) measures. IPC measures in health facilities have been enhanced during the COVID-19 pandemic and should be reinforced to prevent healthcare-associated transmission. Precautions that are recommended for COVID-19 should continue to be followed.
WHO does not recommend any specific different measures for travelers. In case of symptoms suggestive of respiratory illness either during or after travel, travelers are encouraged to seek medical attention and share their travel history with their healthcare provider.
WHO advises against the application of any travel or trade restrictions on Argentina based on the current information available on this event.

Further information​

• Pan American Health Organization / World Health Organization. Informative Note: Update cases of pneumonia due to Legionella – Tucumán, Argentina. 3 September 2022, Washington, D.C.: PAHO/WHO; 2022. Available at: https://bit.ly/3AN00e9
• Infection prevention and control of epidemic-and pandemic prone acute respiratory infections in health care, WHO guidelines: https://bit.ly/3AMk14G
• Ministry of Public Health of the Government of Tucumán Official Communication. Available at: https://bit.ly/3TJaHac
• Ministry of Public Health of the Government of Tucumán Official Communication. Available at: https://bit.ly/3cOjKWT
• Argentina Ministry of Health press release, “ANLIS-MALBRÁN analyzes samples from cases of pneumonia of unknown cause in Tucumán”. Available at: https://bit.ly/3cLPqw0
• Ministry of Public Health of the Government of Tucumán Official Communication. The Minister of Public Health led a virtual meeting with Carla Vizzotti to analyze the situation of pneumonia of unknown origin. Available at: https://bit.ly/3RC3XZS
• Ministry of Public Health of the Government of Tucumán Official Communication, “Vizzotti confirmed that the outbreak of pneumonia in Tucumán was due to Legionella”. Available at: https://bit.ly/3cJhxvV
• World Health Organization. Legionellosis fact sheet. Available at: https://bit.ly/3KMmZL9
• World Health Organization. Legionellosis Outbreak Toolbox. Available at: https://bit.ly/3KMIdZd

[1] Ministry of Public Health of the Government of Tucumán Official Communication. Available at: Comunicado Oficial
[2] Ministry of Public Health of the Government of Tucumán Official Communication. Available at: El ministerio de Salud Pública informó sobre la situación sanitaria del brote de neumonía bilateral
[3] Ministry of Public Health of the Government of Tucumán Official Communication. Available at: COMUNICADO OFICIAL
[4] Argentina Ministry of Health press release, “ANLIS-MALBRÁN analyzes samples from cases of pneumonia of unknown cause in Tucumán”. Available at: https://www.argentina.gob.ar/noticias/anlis-malbran-analiza-las-muestras-de-los-casos-de-neumonia-de-causa-desconocida-en-tucuman
Citable reference: World Health Organization (5 September 2022). Disease Outbreak News;Legionellosis in Argentina . Available at: Legionellosis - Argentina

Legionellosis - Argentina

www.who.int

 

[China Connection]

Legionella suspected of causing illness that killed 4 and sickened 7 in Argentina, health officials say​

The cases appear to be centered around a medical facility in San Miguel de Tucumán, health officials said. Symptoms include pneumonia, fever and abdominal pain.

Police officers stand outside Luz Medica hospital, where nine people infected with bilateral pneumonia of unknown origin have been treated, in Tucuman, Argentina, on Sept. 1, 2022.Diego Araoz / AFP - Getty Images


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Sept. 4, 2022, 5:10 AM AEST / Updated Sept. 4, 2022, 9:51 AM AEST
By Dennis Romero and Isabela Espadas Barros Leal
An illness that has stricken 11 people in Argentina, killing four, may have been the result of Legionella, the bacteria that causes Legionnaires’ disease, health officials said Saturday.
Officials have been trying to determine what was causing the malady that had sickened 11 people linked to a private clinic in the city of San Miguel de Tucumán, roughly 670 miles north of Buenos Aires.

On Saturday, health officials said Legionella bacteria was identified in tests of four samples — three respiratory and a biopsy from one of the people who died.
“The suspicion is that it is an outbreak of legionella pneumophila,” Dr. Carla Vizzotti, the country’s health minister, said in a statement.
Data is still preliminary and pending final diagnosis, Vizzotti added.
The Legionella bacteria can be transmitted when people breathe in small droplets of water or accidentally swallow water containing the bacteria into the lungs, according to the U.S. Centers for Disease Control and Prevention. It can cause Legionnaires’ disease, a serious type of pneumonia.
The 11 patients linked to the Luz Médica clinic include three people who were under observation and receiving treatment; a 64-year-old man with preexisting conditions, or comorbidities, who was hospitalized in serious condition; and an 81-year-old man who was also hospitalized in serious condition, the health ministry for Tucumán Province said in news releases.
Three employees at the clinic also contracted the illness: a 40-year-old pharmacy assistant who was hospitalized, a 44-year-old nurse being monitored at home, and a 30-year-old nurse, said Luis Medina Ruiz, the provincial health minister, at a news conference this week.
The Tucumán province ministry of health said Saturday that a fourth death has been tied to the cluster. The deceased was described as a 48-year-old man with comorbidities who had been in serious condition at a hospital, the ministry said in a statement.

Legionella suspected of causing illness that killed 4 and sickened 7 in Argentina, health officials say

The cases appear to be centered around a medical facility in San Miguel de Tucumán, health officials said. Symptoms include pneumonia, fever and abdominal pain.

www.nbcnews.com

 

[China Connection]

New mysterious lung disease in Argentina: Next pandemic or no cause for concern?​

Saturday, 3 September 2022
By Belle de Jong

Credit: Belga / Benoit Doppagne
An unexplained outbreak of pneumonia at a private clinic in Argentina leaves experts and authorities confused as the mysterious disease has take the lives of three people, while four patients are in hospital on a ventilator.
The outbreak is reminiscent of the start of the Covid crisis at the end of 2019, but experts say it is also also conceivable that the outbreak will end with a sizzle, as often happens.







According to the Argentine health organization PAHO, ten people are currently infected with the mysterious disease, three of whom have passed away.



The patients experience symptoms similar to Covid: pneumonia, with fever, muscle aches, abdominal pain and shortness of breath. “It’s big news here,” said Enrique Borym, an Argentine clinical pathologist who covered the case on social media.
The cause is still unknown. The patients did not test positive for the most obvious possibilities, being flu, Covid, RS virus and a number of other respiratory viruses. They also tested negative for the tropical disease hantaan.

Unusual infectious disease​

Of the ten patients, eight are health workers at the hospital where the outbreak was detected. This may indicate that it is a disease that is already circulating in the population, Professor of Virology Marion Koopmans told De Morgen.


“It is difficult to spot an unusual infectious disease in the population. There are several examples where a newly emerging infection was the first to be noticed because there was an outbreak in a hospital. Then you will notice.”

Related News​

• Belgium to scale up monkeypox vaccination next week
• Monkeypox: WHO notes 'early signs' of a slowdown in Europe

The main suspect as ‘patient zero’ would then be a 70-year-old woman, who was admitted for an operation a few weeks ago. The fact that eight employees subsequently became ill could indicate a fairly contagious disease. How the newly discovered patient is related to the other patients is still unclear.

On a brighter note​

New mysterious lung disease in Argentina: Next pandemic or no cause for concern?

According to the Argentine health organization PAHO, ten people are currently infected with the mysterious disease, three of whom have passed away.

www.brusselstimes.com

On the bright side, no new infections seem to have arisen among the contacts of the patients in the past few days. That could indicate that the outbreak will die out as it arose: spontaneously, as an unsolved mystery, as often happens. The deceased were all elderly and ill, indicating that the disease seems especially harmful to vulnerable people.
Disease outbreaks that aren’t immediately understood are common, and don’t always indicate the need for excessive concern. However, since the Covid pandemic, mysterious disease outbreaks have come under more scrutiny, especially when pneumonia is involved.

New mysterious lung disease in Argentina: Next pandemic or no cause for concern?

According to the Argentine health organization PAHO, ten people are currently infected with the mysterious disease, three of whom have passed away.

www.brusselstimes.com

 

[Heliobas Disciple]

This is a dupe, there is a long thread with a lot of discussion already in progress.

See:

HEALTH - Mysterious pneumonia kills 3, infects 9 in Argentina: ‘Similar to COVID’

https://nypost.com/2022/09/01/mysterious-pneumonia-kills-three-people-in-argentina/ (fair use applies) Mysterious pneumonia kills 3, infects 9 in Argentina: ‘Similar to COVID’ By Adriana Diaz September 1, 2022 2:53pm Updated Fears of a new deadly viral outbreak have begun to spread after...

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