Published Date: 2010-11-15 11:00:07
Subject: PRO/EDR> Legionellosis - Spain (05): Madrid
Archive Number: 20101115.4142
LEGIONELLOSIS - SPAIN (05): MADRID
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sat 13 Nov 2010
Source: Antena 3, Agencia EFE report [in Spanish, trans. Sr.Tech.Ed.MJ,edited]
According to reports from the Madrid Health Council, last 1 Nov 2010,
a person died in Madrid as a result of legionellosis, bringing the
number of deaths to 5 since the onset of this outbreak, which has
affected so far a total of 46 [other] people.
The 5th victim was an 87-year-old man whose symptoms began on 26 Oct
2010. He was admitted on 1 Nov 2010 in the emergency department at the
Fundacion Jimenez Diaz and died the same day.
The epidemiological confirmation of this case was made on 8 Nov 2010,
added the Health Council, which has sealed another 8 cooling towers
due to high _Legionella_ contamination, bringing to 12 the number of
sealed towers. The 8 newly sealed cooling towers are located in Gran
Via 29, Preciados 18, Jordan 11, Paseo de los Melancolicos 1, Arenal
4, Arenal 7; Puerta del Sol 11, and Peciados 32.
Of the 46 cases of legionellosis in the outbreak, 30 have been
discharged, 7 remain hospitalized (including 4 in the medical ward and
3 in the ICU), and 4 have not required hospitalization. This is in
addition to the 5 deaths recorded.
Of the 46 [surviving] cases, 2 have been recorded this week [week of 8
Nov 2010], one of them with symptoms since 8 Nov 2010, and the other
since 26 Oct 2010.
From the moment when the outbreak was reported, the Madrid Health
Council, according to the General Subdivision of Environmental Health
intervention protocol for legionellosis, ordered the cleaning of all
the towers that were inspected, and samples were taken from 179 of
them. The council is awaiting more test results of the cultures taken
during inspections and continues its inspection and control
activities. To date, 736 inspections have been carried out. Of the
culture results available, 122 have tested negative and 31 positive
for _Legionella pneumophila_ serogroup 1.
In addition, the protocol for control and monitoring of legionellosis
in the community of Madrid remains active in order to further
investigate the possible link between cases and the potential exposure
to a common source of infection.
HealthMap Alerts via ProMED-mail
[Legionellosis is an infectious disease caused by a Gram-negative
bacillus of the genus _Legionella_, most commonly _Legionella
pneumophila_. Legionnaires' disease is the acute pneumonic form of the
disease. Pontiac fever is a non-pneumonic form of legionellosis that
is less severe than Legionnaires' disease and develops from hours to 2
days after initial infection, with fever, malaise and muscle aches.
Legionnaires' disease, and presumably Pontiac fever, is acquired by
inhalation of an infectious dose of aerosolized _Legionella_. Water
temperatures of 25-40 C (77-104 F) support the highest concentrations
of the organism in water storage tanks of plumbing systems.
Aerosolization of the contaminated warm water can occur in showers,
spa pools, sprays in groceries, fountains, and cooling towers. Why
some persons exposed to contaminated aerosols develop Legionnaires'
disease and others develop Pontiac fever is unknown.
Genotyping _L. pneumophila_ of patient and environmental isolates
should be done to confirm epidemiologic linkages. Identical genotypes
among patient isolates in an outbreak would suggest that there is a
common source. However, in a recent legionellosis outbreak in Wales,
UK, each clinical isolate was genetically distinct, which suggested
that multiple sources were responsible (see ProMED post Legionellosis,
fatal - UK (03): (Wales) 20101014.3725). Because _Legionella_ species
are commonly found in the environment even in the absence of illness,
matching the genotypes of clinical isolates with those of possible
environmental sources helps identify the environmental sources that
have given rise to the cases.
Madrid is the capital and largest city of Spain. The population of the
city is about 3.3 million (2009) and that of the metropolitan area
(urban area and suburbs) is nearly 6.5 million. It is the 3rd most
populous municipality in the European Union after London and Berlin
The HealthMap/ProMED-mail interactive map of Spain can be accessed at
<http://healthmap.org/r/01Dt>. - Mod.ML]