Monday, August 5, 2013

Legionaire's disease outbreak in the VA hospital of Pittsburgh

I ran across this on the right wing Freeper's website (*while checking  the GGG forum pings such as an article on the Moche (Peru) treasures. I also get pinged when medical stuff is posted)

It seems that there was a bad outbreak of Legionaire's disease in the Pittsburgh VA hospital, but a local newslady is mad because it's been ignored by the press.

another Trib article here.
It's not just Pittsburgh.
Department of Veterans Affairs hospitals across the country failed to follow policies designed to stop the spread of Legionnaires' disease, according to a VA Office of Inspector General's report released on Thursday.
More than one-third of VA hospitals and clinical care facilities did not conduct proper planning and risk assessment required by a 2008 national VA directive to control the Legionella bacteria. If inhaled in water mist, the bacteria can become a potentially deadly form of pneumonia known as Legionnaires' disease.
“The report shows a clear lack of understanding at VA facilities across the country about proper protocol when testing for Legionella,” Sen. Bob Casey Jr., D-Scranton, wrote in an email to the Tribune-Review.

Usually Legionaire's disease is spread when water droplets carrying the germ get sprayed into the air, for example from contaminated water (example, in a shower) or in a humidifier or air conditioning sytem.

It began at a hotel holding an American Legion convention, ergo the name. A lot of men died, many of whom were smokers and died of pneumonias etc. that didn't respond to ordinary antibiotics. They found that erythromycin works, but we don't usually use that for severe pneumonia. I've never treated a case.  It is a weird organism, sort of a "naked bacteria". This caused problems in finding the cause of the illness, since usually we identify bacteria by staining their walls. Also, it means antibiotics in the Penicillin family, which work by making it impossible for them to kill this germ. The antibiotics that kill it work elsewhere: inside the cell where it manufactures it's protein.

Preferred antibiotics include doxycycline, tigecycline, and azithromycin because of their activity and pharmacokinetic properties (eg, better bioavailability, better penetration into macrophages, longer half-life).

the problem is that people with good immune systems usually are healthy enough not to get sick (in contrast, often with food poisoning, everyone who eats the food is sick) so it took awhile to figure out what was causing the American legionaires to get sick. Finally they found it was a bacteria and not a virus (important since bacteria are easier to kill with antibiotics than viruses).by using a silver stain that coated the germ. They now use antibody tests, which are easier and more specific.

CDC article on the VA problems here...when they checked who had been reported sick, they came up with 16 or maybe 21 cases...

and yes, the water systems were contaminated.

Factoid of the day: they have a lot of Legionaire's disease in Pittsburgh, so the public health dept didn't recognize it was an outbreak (Pittsburgh has lot of ex coal miners and steel workers who have lung damage from their occupation or from heavy smoking).

Factoid number two:
a sample from the sand filter of the decorative fountain at the entrance showed growth of the outbreak strain; therefore the fountain cannot be ruled out as a potential source of exposure for some cases.
Translation: they even found Legionaire bacteria in the decorative fountain in the entrance of the hospital.
Well, there goes all your pretty fountains.

factoid number three: The superheating and the silver/copper ions used to keep the water clear for ordinary legionella bacteria didn't work...ditto for Chlorine....a resistant strain had popped up.

Factoid number four: The outbreak started at the time they were doing upgrading/construction. The Legionella bacteria lives in soil, so this might be the source of the germ: it floated from the dust, settled into the water sytems, and voila, a slow spread of germs.

The CDC upgraded the water cleansing system and so far things look clear.

So kudos to the CDC folks, who don't get no respect for protecting our Veterans.

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