LEGIONELLA um grande problema e números cada vez maiores

Legionnaires' disease in LTC facilities: A hidden threat

In the summer of 2013, the Wesley Ridge Retirement Community inReynoldsburg, Ohio, experienced the largest and deadliest Legionnaires' disease outbreak in state history. Six people died at the assistedand independent-living facility, and another 33 become seriously ill. The victims ranged in age from 63 to 99 years and included residents, visitors and one employee.

For most people, Legionnaires' disease is something from the history books, a vague memory of Philadelphia conventioneers falling ill in the 1970s. In fact, outbreaks of this often-fatal form of pneumonia, including in long-term-care (LTC) facilities, have been increasing for several years in the United States. In just the past three years, nursing home and senior living outbreaks have occurred in Baltimore; Pittsburgh; Cleveland; Clearwater, Fla.; Jacksonville, Fla.; and Florence, Ala. The worst outbreak in an LTC facility in North Americaoccurred in 2005 at the Seven Oaks Home for the Aged in Toronto, Ontario, where 23 residents died and 112 other people fell ill.

A LITTLE BACKGROUND

Legionnaires' disease-clinically known as legionellosis-is a form of pneumonia caused by waterborne bacteria of the genus Legionella. It carries a mortality rate of 40 percent when acquired in hospitals.

More than 50 species and subspecies of Legionella exist, several of which can infect people. By far the most common is Legionella pneumophila serogroup 1. The bacteria are ubiquitous and usually harmless in the environment, but they easily can grow in warm, stagnant water. In certain circumstances, especially in institutions housing the elderly or in those with chronic illness, Legionella can multiply and cause pneumonia when people aspirate tiny particles while drinking water or showering.

Since 2001, Centers for Disease Control and Prevention (CDC) surveillance reports have stated that Legionella is the single most commonly reported pathogen associated with drinking water outbreaks in the United States. Voluntarily reported cases of Legionnaires' disease tripled from 2000 to 2009, to 3,522 annually. This amount, however, is now known to be a vast underestimate, and some estimates of incidence exceed 10,000 cases per year. As many as 70 percent of all water systems in buildings taller than three stories are contaminated with Legionella. Because it takes specialized laboratory testing to diagnose it, the disease is severely underdiagnosed in long-term care.