Legionella Bacteria in Hot Tub

An outbreak of Legionnaire’s disease in Staffordshire likely originated from a hot tub according to government health officials.

Investigators from the Health Protection Agency (HPA) took samples from a hot tub at the Stoke-on-Trent JTF Mega Discount Warehouse and found bacteria that match the strain responsible for 18 recent cases. One patient died in the Staffordshire outbreak.

JTF Warehouse released a statement saying that it was “extremely concerned” over the incident and that it had withdrawn the product from all of its stores, which consist of 11 branches spread across the Midlands and northern England. The store also said that it was cooperating with the ongoing investigation.

Seven remain in hospital

Seven people are still at the Stoke-on-Trent hospital with one other person in stable condition at a Leicester hospital, health officials reported on Monday. No details are available on the patient who died on Saturday.

The health agencies said that JFT Warehouse decommissioned the hot tub on Tuesday when investigations began to identify the possible source of the Legionnaire’s disease outbreak. Among the sites tested were air conditioning systems and cooling towers, which are common mechanisms for the spread of the bacteria.

Unusual strain of disease

Samples from the JFT Warehouse hot tub tested at a Colindale specialist laboratory on Monday revealed an “unusual strain” of the legionella microbe, according to Sue Ibbotson, the HPA’s regional director. The hot tub strain’s DNA fingerprint matched the samples taken from the patients. All those infected ranged in age from their late 40s to their mid 70s.

Health and Safety Executive teams and the Stoke-on-Trent council continue to take samples from locations across the city as a precautionary measure.

Ibbotson said the agency also looked at “detailed histories” of the confirmed cases and found that 17 of 18 known cases visited the JFT Warehouse within two weeks prior to becoming ill. Additionally, spa pools are a common source of Legionnaire’s disease, which infects the lungs.

She cautioned that we may still see further cases of the disease related to this outbreak as JTF Warehouse withdrew the hot tub on 24 July. Typically, it can take up to two weeks for people to become ill after exposure to the legionella bacteria.

Zafar Iqbal, the Stoke NHS director of public health, expressed optimism now that health authorities have identified the probable source of the outbreak and have implemented proper measures. He said that if any one is displaying Legionnaire’s disease symptoms, including fever, aching muscles, fatigue, headaches and dry cough, they should see their doctor and call NHS Direct on 0845 46 47.

Legionnaire’s disease attacks lungs

The bacterial disease infects the lungs and can cause pneumonia. The symptoms resemble those of the flu and include high fever that is often 39.5°C or above.

If pneumonia develops, there may be shortness of breath, chest pain, sore belly, vomiting, hallucinations and diarrhoea. On average, there are more than 500 cases of the disease in the UK each year. About 160 cases involve infections that occur while travelling abroad. About one out of every 10 cases results in fatality.

How the disease spreads

Legionnaire’s disease spreads primarily through exposure to bacteria-contaminated water that ranges in temperature from 20°C-45°C. Among the systems that provide ideal conditions for legionella bacteria growth are spa pools, cooling towers and hot water systems. Other common sources of the disease are fountains, ponds and communal showers. The risk for infection increases when the system creates water mists and aerosol that people can easily inhale.

Normally, the body’s defences can adequately prevent infection due to breathing in tiny droplets of contaminated water by forcing the fluid into the stomach where the bacteria breaks down in the digestive system. The action that prevents fluid from entering the breathing system is the gag reflex. Tiny hair-like cilia located on the mucous membranes further block water droplets from passing into the respiratory system.

However, for people suffering from lung disease or weakened immune systems, and smokers, these defence mechanisms may not work properly. The middle-aged, and particularly middle-aged men, are most susceptible to the disease.

Treatment

Legionnaire’s disease requires prompt treatment with antibiotics that are capable of accessing cells in the respiratory system where the bacteria hide. Prevention of the disease involves regular cleaning and maintenance of source mechanisms including cooling towers and spa pools.

Hospitals report that remaining patients from the Staffordshire outbreak are in “stable and improving” condition.

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Author: +Duncan Hollis