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Thursday, June 7, 2012

Legionnaires' disease: an airborne killer

The number of suspected cases of Legionnaires' disease in a deadly outbreak has increased to 37, the Scottish Health Secretary has said.

The number of confirmed cases in the south-west of Edinburgh remains at 24 but suspected cases have risen by 10 to 37 from an earlier update.

Of the 24 confirmed cases, 12 people are being treated in intensive care while five have been discharged from hospital.

One man has died, named locally as 56-year-old Robert Air from the Seafield area of the city.

Nicola Sturgeon also said two patients are being treated outside of the NHS Lothian area: in the Highlands and in the north of England.

"I want to stress that although these patients are being treated elsewhere, they are considered part of the south-west Edinburgh outbreak. They have had association with the affected area," the Health Secretary said.

Ms Sturgeon updated the figures at a press conference in St Andrew's House, the Scottish Government ministerial headquarters in Edinburgh.

Those going for medical treatment now are generally not as ill as at the start of the outbreak, she said.

Although the source has not been identified, a fresh round of chemical treatment is under way at cooling towers in the industrial area of the capital where the outbreak is centred.

Barrow council was fined £125,000 and ordered to pay £90,000 costs for failures under the Health and Safety at Work Act.

In the Barrow outbreak, however, the mortality rate was relatively low. In another case, at Stafford hospital in 1985, there were 22 deaths out of 68 confirmed cases.

The disease takes its name from an outbreak at a convention of the American Legion veterans' organisation at the Bellevue-Stratford hotel in Philadelphia in 1976. In all, 221 people were affected and 34 died. Doctors now look for it and diagnosis can be made in a variety of ways, including taking cultures from patients' sputum, collecting cells from airways or lung tissue and blood or urine tests.

Legionnaires' is caught by breathing in small droplets of contaminated water. It is not contagious and is not known to spread directly from person to person, nor can it be contracted through drinking water. Symptoms usually begin with a mild headache and muscle pain but these might only emerge between two and 14 days after exposure to the bacteria. The symptoms then worsen and might include high fever, with a temperature of 40C (104F) or more, and increasing muscle pain and chills.

Once the bacteria infect the lungs, carriers may also experience a persistent cough, later including mucus or blood, shortness of breath and chest pains. A third of people with the disease will experience nausea, vomiting, diarrhoea or loss of appetite. About half may also experience changes to their mental state. The disease is particularly dangerous for older people or those with underlying health conditions. The earlier those who develop it are treated with antibiotics the better. An estimated 10-15% of otherwise healthy people who develop the full-blown disease are expected to die. It is three times more common in men than women (although most of those who died in Barrow were women) and mostly affects the over-50s. Smokers and heavy drinkers are more prone to developing it.

It is difficult to tell how common it is. In its milder form, symptoms are similar to those of flu. Many cases would therefore not be reported. In 2009 there were 43 deaths from legionnaires' in England and Wales. There were 345 reported cases in the two countries that year and just under half of those were thought to have developed while patients were travelling either in the UK or abroad.

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