Walmart in Johnsburg, Warren Barr Nursing Home in Chicago Identified by IDPH As Possible Sources of Legionnaires’ Disease

The Illinois Department of Public Health (IDPH) has identified two separate clusters of Legionnaires’ disease cases — one involving residents in McHenry and Lake Counties, and another involving residents at Warren Barr South Loop nursing home in Chicago.

“The two recently identified clusters of Legionnaires’ disease are not connected. IDPH is continuing to investigate possible sources, identify other individuals who may have been exposed, and recommend remediation and prevention measures.”

— IDPH Director Nirav D. Shah, M.D.

In McHenry County, the Walmart in Johnsburg has been identified as a potential location where residents that contracted Legionnaires’ disease were exposed to Legionella bacteria, according to the Illinois Department of Public Health. The IDPH identified a cluster of cases in McHenry and Lake counties in September 2018, identifying the Walmart, 3801 Running Brook Farm Boulevard, as a potential exposure source.

Johnsburg Walmart store has taken action, including turning off the produce water sprayers, according to an IDPH news release dated October 26, 2018. Health officials said they will continue to investigate other potential exposure sources and identify other cases of Legionnaires’ disease (legionellosis), which is more frequently identified in hot weather when Legionella bacteria are transmitted through mist or small droplets of water from freshwater environments such as creeks, ponds, lakes and streams. Legionella bacteria have also been found historically in water taps (primarily hot water taps), hot water tanks, cooling towers and evaporative condensers, whirlpool spas, and decorative fountains. The disease can occur at any time of the year, but is more common in the summer and early autumn.

There are many different types of Legionella bacteria, but only a few are common. In the United States, as many as 80% of legionella infections in adults are caused by Legionella pneumophila, serogroup 1 (a subtype of the species). Other serogroups of L. pneumophila, including 4 and 6, cause a number of cases. Other species of Legionella, such as Legionella micdadei, Legionella bozemanii, Legionella dumoffii, and Legionella longbeachae, may cause infections in children and/or are more prevalent in other parts of the world.

— LabCorp (Legionella Testing)

Legionnaires’ disease is a serious lung infection (pneumonia) that people can get by breathing in small droplets of water containing Legionella bacteria (Legionella pneumophila). Most people contract Legionnaires’ disease by inhaling mist or vapor from a water source contaminated with the bacteria. In some cases, the disease may be transmitted by other ways, such as aspirating contaminated water. The disease is not contracted by drinking contaminated water, and person-to-person spread of legionellosis does not occur. Outbreaks are most commonly associated with buildings or structures that have complex water systems, such as hotels, hospitals, long-term care facilities, and cruise ships. The Legionella bacteria can become a health concern when it grows and spreads in human-made water systems, like hot tubs and whirlpool spas, cooling towers, hot water tanks, large plumbing systems, drinking water and bathing water lines, public fountains, decorative fountains, humidifiers, and ice machines.

Most healthy people do not get Legionnaires’ disease after being exposed to Legionella bacteria. People at increased risk of Legionnaires’ disease include people 50 years of age or older, or people identified with certain risk factors, such as being a current or former smoker, having a chronic lung disease (emphysema or COPD), or having a weakened immune system (such as patients who receive corticosteroids or have had an organ transplant). People with underlying illnesses, such as cancer, kidney disease, liver disease, diabetes, or AIDS are also at higher risk.

Symptoms typically begin two to 10 days, but can begin up to 12 days after exposure. Symptoms include coughing, muscle aches, high fever (102 degrees F – 105 degrees F), chills, muscle pain, shortness of breath, chest pain, headaches. Gastrointestinal symptoms, diarrhea and mental confusion also are common. Laboratory testing is required to confirm a legionellosis diagnosis. A chest exam and/or x-ray is usually performed to confirm a diagnosis of pneumonia. The most common laboratory test is the urinary antigen test (Legionella Antigen, urine), which detects the presence of Legionella antigen in the urine. The urine antigen test provides rapid results within 15 minutes.

A diagnosis of legionellosis can be confirmed by successful culture (isolation and growth) of the bacteria from sputum specimens taken from an ill patient (Legionella Culture; Legionella by PCR). Deep coughing is generally required for the culture tests, and the patient should be informed that it is phlegm/mucus from the lungs, not saliva, that is required for the culture. A positive culture may be determined in about 48 to 72 hours. Negative cultures are held for at least 7 days before a final result is reported, according to LabCorp. PCR test results require 1-2 days, according to ARUP laboratories in New York.

Another less common test is Direct Fluorescent Antibody (DFA) Staining. DFA staining can detect legionella bacteria in respiratory secretions and tissue samples. DFA staining has the advantage of providing a result within 2–4 h, but it is technically demanding and should be performed by experienced laboratory personnel.

Legionella bacteria can also cause Pontiac fever, a milder and self-limiting illness with flu-like symptoms.

The McHenry County Department of Health announced 12 people from McHenry County were diagnosed with Legionnaires’ disease in June 2018, compared to four cases of the disease during the entire year of 2017, nine in 2016 and three in 2015. An estimated 8,000 to 18,000 people are hospitalized with legionellosis in the United States each year. An additional unknown number are infected with Legionella bacteria but have mild symptoms or no illness at all.

See also …

LabCorp ” Legionella Testing

ltd.aruplab.com/Tests/Pub/2010125

OXFORD ACADEMIC | Diagnosis of Legionella Infection

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