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Published Date: 2012-07-06 17:30:01
Subject: PRO/EDR> Legionellosis - Spain (05): (MD) restaurant
Archive Number: 20120706.1192385

LEGIONELLOSIS - SPAIN (05): (MADRID) RESTAURANT
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[1]
Date: Wed 4 Jul 2012
Source: Spero News [edited]
http://www.speroforum.com/a/LKVYAJVMEF36/72944-Outbreak-in-Spain-Deadly-legionnaires-disease

According to reports from Spain, at least 12 people have been infected with a strain of legionella, which causes legionellosis, which in its more severe form is known as legionnaires' disease, so called because of a deadly outbreak of the bacteria at a 1976 American Legion convention in Philadelphia, Pennsylvania. As confirmed by Madrid's office of sanitation, a restaurant in Mostoles (a town near Madrid) is the proximate source of the contagion. Another 13 cases are currently being studied, having begun to show symptoms. Epidemiological studies have shown that those people now affected had visited a restaurant in an industrial area of Mostoles.

Of the 12 confirmed and 13 possible cases of legionellosis, there are 18 men and 7 women who range in age from 35 to 87. They are being treated in various hospitals, including the Prince of Asturias Hospital, Mostoles Hospital, and the King Juan Carlos Hospital.

The patients mainly show symptoms of pneumonia, which vary according to the risk factors present in each patient.

Symptoms were noted in late June 2012, and by 27 Jun 2012, local health authorities took samples from the refrigeration and water sources at Marisqueria Moreno II in Mostoles. Inspectors have fanned out from the restaurant to the surrounding neighborhood in search for sources of contagion. Health authorities fear that more cases of the deadly disease may soon arise.

Legionellosis is a potentially fatal and infectious disease caused by the legionella bacterium. It can cause the well-known legionnaires' disease (also known as legion fever) or a milder malady known as Pontiac fever. Legionnaires' disease is characterized by high fever and pneumonia, while Pontiac fever is a milder respiratory infection without pneumonia that resembles a severe flu.

Spanish authorities are taking the latest outbreak seriously, since in 2010 one of Spain's worst outbreaks of legionellosis took place in Madrid. In that case, 6 people died. The 2010 outbreak was 3 times more deadly than all those that took place from 1999 to 2009.

The restaurant in Mostoles, Marisqueria Moreno II, is open for business despite the scare. The proprietor told local media that its business as usual at his establishment. The owner confirmed that there are no refrigeration towers at his restaurant but would not say what is the focus of the health inspectors' attention. The restaurant has not yet been closed by the local sanitation authorities.

[byline: Martin Barillas]

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[2]
Date: Thu 5 Jul 2012
Source: Madrid2noticias.com [in Spanish, trans., edited]
http://www.madrid2noticias.com/n-10440-2-Posible_brote_legionela_ciudad_Mostoles

The Ministry of Health has activated a control protocol for legionnaires' disease after detection of 25 possible cases in hospitals in the Madrid region. The common feature for the 25 patients was having eaten at a restaurant of Mostoles.

[Regional minister for health of the Community of Madrid, Javier Fernandez Lasquetty's] department has said that [the diagnosis of legionnaires' disease] has been confirmed in 12 of the 25 cases by analyzing the urine [legionella urinary antigen test, which detects _Legionella pneumophila_ serogroup 1 antigen in human urine]. The rest have symptoms of the disease. Madrid has already informed the Ministry of Health of the possible outbreak of legionnaires' disease so that precautions can be taken.

As explained by the Ministry, the 25 patients attended the same restaurant in a Mostoles industrial park. There are 18 men and 7 women, whose ages range between 35 and 87. 7 of them were hospitalized in Madrid before 22 Jun 2012, after an incubation period of 8 to 10 days. 13 patients were admitted to the Mostoles Hospital.

The Ministry has begun inspecting the restaurant and the industrial park, taking samples from 19 sites to detect the source of the infection. Results are awaited.

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[3]
Date: Fri 6 Jul 2012
Source: MedicinaTV.com [in Spanish, trans. Sr.Tech.Ed.MJ, edited]
http://www.medicinatv.com/noticias/la-comunidad-de-madrid-confirma-un-caso-mas-de-legionella-y-aumenta-a-29-los-posibles-afectados-235493

The Ministry of Health of the Community of Madrid has confirmed another case of legionellosis in the region (already 14) and the number of people possibly affected by this outbreak has increased to 29. As indicated by the regional government in a statement, the [regional ministry for health of the Community of Madrid led by Javier Fernandez Lasquetty] has kept in place the protocol for control and surveillance of legionellosis to investigate the possible cases, of which 14 have been confirmed by urine analysis and the rest are suspected cases based on their symptoms.

Of the 29 possible cases of legionellosis that have been reported, 15 have been released and the other 14 remain hospitalized; of these, 13 -- 12 in a ward and one in an ICU -- are progressing favorably and one is in critical condition.

The common feature for all patients is that they went to a restaurant in an industrial park in the municipality of Mostoles [a city near Madrid] on dates consistent with the incubation period of the disease. The possibly affected are 21 men and 8 women aged between 44 and 87 years. The onset of symptoms for the 1st case was 12 Jun 2012 and for the last, 3 Jul 2012. Of the 29 possible cases, 14 are in hospital; of these, 2 are in the Prince of Asturias Hospital, 7 in the Mostoles Hospital, 2 in the Rey Juan Carlos Hospital, 1 in Alcorcon Hospital Foundation, 1 in the Southeast Hospital, and 1 in the Getafe Hospital.

The predominant clinical picture is one of pneumonia whose evolution is variable depending on the patients pre-existing risk factors.

The health department continues to conduct inspections. So far, there have been 29 inspections in the area where the restaurant is and areas that surround the industrial park. 19 samples have been taken and referred to the Public Health Laboratory. 25 professionals are involved in the investigation. To avoid new infections, on 27 Jun 2012 the health department sealed elements that posed a risk identified in the restaurant: an evaporative cooling system and 2 fountains, and took the appropriate samples.

On 27 Jun 2012 the Health Promotion and Prevention Subdivision received notification of the existence of 7 possible cases of legionellosis, admitted to different hospitals of the Community of Madrid starting on 20 Jun 2012. The incubation period is 8-10 days. The protocol for control and surveillance of legionellosis includes an epidemiological survey to determine the possible relationship between patients (such as their place of residence or areas frequented) and inspection of the identified risk facilities to verify their sanitary condition, specifically cooling towers or evaporative refrigeration systems, which can be the source of legionnaires' disease.

The investigation is being coordinated by the 2 directorates of the Ministry of Health -- the General Directorate of Primary Care and the Department of Management and Inspection -- which report to the Ministry of Health, Social Services and Equality. Legionnaires' disease is a notifiable disease, which usually presents as a pulmonary infection. A less severe form is known as Pontiac fever. The disease is treatable and the evolution is usually favorable, although in some cases it can progress to severe illness.

[Legionnaires' disease] is caused by the bacterium _Legionella pneumophila_, an intracellular microorganism. It is not spread from person to person. The bacteria colonize cooling towers or other devices containing water at warm temperatures, which encourages the multiplication of bacteria. If these bacteria are spread in aerosols they can be inhaled and lead to the onset of disease.

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[For a discussion of legionellosis, see ProMED-mail post: Legionellosis - Spain (05): Madrid 20101115.4142. Dr Steve Berger has noted that rates of legionellosis have been increasing in Spain (http://www.gideononline.com/2010/06/12/legionellosis-in-spain/). It is not known whether this is due to increased reporting or an actual increase in acquisition of this infection.

Mostoles is the 2nd-largest city in population belonging to the Autonomous Community of Madrid. It is located 18 km/11 mi south west from central Madrid (http://en.wikipedia.org/wiki/Mostoles).

The HealthMap/ProMED-mail interactive map of Spain can be accessed at http://healthmap.org/r/2Ike. - Mod.ML]

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