Is Legionnaires' Disease a Fallout of Hurricane?

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Is Legionnaires' Disease a Fallout of Hurricane?

Some doctors say soggy refuse is spreading the illness in New

Orleans. Officials see no threat.

by Gold, Times Staff Writer

February 22, 2006

METAIRIE, La. — The question quietly circulating here is whether

Legionnaires' disease is being spread by the battered refuse left by

Hurricane Katrina.

Some New Orleans-area doctors say they think the bacterium that

causes the disease, a severe form of pneumonia, may be growing in

the soggy remains of buildings flooded after the hurricane. But some

experts question whether the bacterium can grow in that environment,

and state officials insist there is no public health threat.

The doctors said in interviews this week that preliminary tests had

confirmed at least seven cases of Legionnaires' in recent months.

Most patients were homeowners or contractors who had been gutting

flooded houses, the doctors said, leading them to suspect that

building materials were a source of the bacteria. The doctors think

that ripping apart flooded homes creates an " aerosol " effect that

can lead to infection.

The doctors said they feared that many other patients were infected

but were not receiving treatment. Others, they said, are probably

being treated with antibiotics that will be ineffective because

their condition has been misdiagnosed — partly because the disease

is difficult to detect and partly because health officials have not

warned hospitals or the public to be on the lookout for the disease.

" It's probably not being diagnosed, " said Dr. S. LaCorte, an

internist and geriatric specialist who sees patients at nursing

homes and two hospitals in the area. LaCorte said he had treated two

patients with Legionnaires' disease. " This is a very serious, life-

threatening problem, " he said.

State health officials disputed the doctors' claims Tuesday. Dr.

Raoult Ratard, Louisiana's epidemiologist, said that he had taken

the doctors' concerns seriously and that it appeared at least four

patients had contracted Legionnaires' since Katrina.

He said there was no evidence that the New Orleans area was seeing

an unusual number of cases.

" This is very, very few cases, " he said. " It's the same as before. "

Ratard questioned whether the bacterium, which thrives in water and

wet climates, could have taken root in flooded building materials.

" That's a crazy story, " he said. " People are so adamant about

blaming things on Katrina. "

Daigle, a spokesman for the federal Centers for Disease

Control and Prevention in Atlanta, said the agency had not received

reports from the state about suspected cases of Legionnaires'.

Dr. Victor L. Yu, a professor of medicine at the University of

Pittsburgh and a Legionnaires' disease expert, said he agreed with

health officials that building materials were an unlikely culprit.

But he said it was possible, even likely, that the New Orleans area

could see more cases of Legionnaires' because the flood could have

introduced the bacterium into water systems.

" If you're ever going to have an outbreak of Legionnaires' disease,

you're going to have it after a major flood event, " he said.

Each year, between 8,000 and 18,000 people in the United States are

hospitalized with the disease, the CDC says. Symptoms include high

fever, chills, cough, muscle aches and headaches.

The bacterium cannot be spread from person to person.

The disease got its name after more than 200 people attending a 1976

American Legion convention in Philadelphia became ill; 34 of them

died. Researchers eventually linked the illness to a bacterium,

which they named Legionella.

Most healthy people do not become ill after coming in contact with

the bacteria. Those who do become ill can usually be treated

successfully with antibiotics.

But the disease can be fatal, particularly for smokers, the elderly,

people with chronic lung disease and those with weakened immune

systems.

One New Orleans-area patient diagnosed with Legionnaires' disease

died last month, said Dr. Penico, an infectious-disease

specialist at East Jefferson General Hospital in Metairie.

That patient also had chronic leukemia, and it is unclear what led

to the patient's death, Penico said.

The dispute over the severity of the problem — or whether there is a

problem — stems from a lack of extensive testing.

Preliminary tests have confirmed the presence of antibodies that

amass in patients' blood after exposure to the bacteria, said

doctors who think the disease is spreading.

But traces of those antibodies in blood are fairly common, said

Ratard, adding that the bacterium is found in many water sources and

that people who are exposed to it carry antibodies in their blood

forever, typically without experiencing ill effects. Therefore,

results of preliminary tests " do not meet the case definition " of

Legionnaires' disease, Ratard said.

Before declaring a public outbreak, most health officials would seek

to confirm the presence of additional antibodies in a second round

of tests, as well as related antigens — molecules that help produce

immune responses — in patients' urine.

The New Orleans area is still a disaster zone, Penico said, and

persuading patients who have been treated successfully with

antibiotics to return for secondary testing is difficult.

Many do not have time; others are in transition from one home to

another.

The doctors would like health officials to issue a public warning. A

warning would probably not keep people from becoming infected, but a

warning could prompt people with symptoms to seek medical attention

sooner.

" The message here is that if you are remodeling a house and you are

very short of breath, get your[self] to the ER, " LaCorte said. " And

think: Legionnaires' disease. "