Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

http://www.clarin.com/sociedad/Murio-Carmen-Areco-internada-Gripe_0_871113045.html

He died the other nurse Carmen de Areco who was hospitalized with symptoms of influenza A
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Etiquetassalud23/02/13

The hospital nurse Carmen de Areco who remained hospitalized in intensive care for 20 days for a box of Influenza A, Rossi died in hospital of La Plata, which now are two fatalities in the same case. In 49 years, she worked as a nurse in the hospital Virgen del Carmen and was the only one of the 11 patients who remained hospitalized affected, the Ministry of Health of Buenos Aires. The remaining nine patients were discharged and, according to the government, so far no complications.

Thus, there are two nurses died after infection with influenza A, which affected nine Areco hospital workers and two patients.

The cause of death, like that of his companion, still under analysis at the Institute Malbr?n where handled various research bacteriological beyond have found in some samples of the virus of influenza A. The woman, who was admitted to hospital on January 27, died yesterday evening following a multiple organ functional failure, respiratory symptoms due to their base.

The first fatality of the case was Andrea Gordillo, 39, who died Jan. 8 at a hospital in La Plata, where he was hospitalized since Feb. 28. Gordillo was identified by the Health Minister Alexander Collie, as possible "epidemiological link" as it would have contracted the disease during a trip to Orlando, in the United States.

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

More recent than anything in this thread, but still a week old.

http://www.saladeprensa.net/inf/inv...meras-no-murieron-de-gripe-a-de-que-murieron/

RESEARCH SALADEPRENSA.NET: Carmen de Areco "Nurses not died from influenza A" THAT DIED?
By redaccion_SDP-February 23, 2013
Posted on: 3, General Information, Police
Dr. Ceriani felt the need to tell the facts to the community to know what really happened so far. Ceriani explained that when everything exploded recently began working with an epidemiological protocol, forcing the medical profession to work without breaks, with the advice of an infectious disease and the province. When the pictures were duplicated and moved, despite the hard work, the doctor said that was perceived from the outside much hostility towards the medical staff and managers. "It is not easy for a physician to work down." Dr. Ceriani clarified that it did everything possible to change the medication which was trying to hit. Once done sometimes successful outcomes. Moreover, the professional nurse Gordillo said yes were vaccinated against the flu, something on the record. Ceriani said he is going to know what is the disease that has brought so much misfortune, but nobody knows when. "The hospital is criticized, as all public hospitals," Ceriani said however that intensive therapy is the best attended of the entire hospital. Ceriani said he was very distressed by the compulsory resignation of Dr. Arias and Dr. Gianolio, resignations carried out by the pressures of the staff do not start work if they did not leave medical office.

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

Almost 2 months later, the hospital is still partially closed:

http://www.amprovincia.com.ar/noticias/13362-evaluan-la-reapertura-del-hospital-de-carmen-de-areco/

To normalize the healthcare

Evaluate the reopening Carmen Hospital of ArecoPara this end, met the mayor Marcelo Skansi with the Minister of Health of the province of Buenos Aires, Alejandro Collia.Mi?rcoles March 6, 2013


The leaders assessed the standardization process that is taking place for the commissioning of all services of the Hospital Nuestra Se?ora del Carmen.

The Mayor highlighted the joint work between the Municipality and the Province to regulate health care to everyone in the district.

For his part, Minister Alejandro Collia confirmed the visit to Carmen de Areco on the occasion of the opening of the medical center.

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - 4 people with influenza A - conflicting reports of subtype

http://www.arecosemanal.com.ar/noticias/82847/Fin-del-misterio-del-Hospital-de-Carmen-de-Areco

End of mystery Hospital Carmen de Areco

Neither 19/03/2013 flu or Hantavirus is Legionella.

Neither influenza nor Hantavirus is Legionella.
Finally, after two long months of uncertainty and mystery, the Ministry of Health of the Province of Buenos Aires released the results of studies conducted in different laboratories on hospital illness that kept the lives of two of the 11 people infected. The response was predictable by professionals who already pressing forward, it is the bacteria called Legionella.

LEGIONELLA: CHARACTERISTICS OF BACTERIA.

Legionella or Legionella, is a Gram negative bacillus shaped. They live in stagnant water with a wide temperature range. Its growth is favored by the presence of organic matter. Requires oxygen to breathe and has a flagellum to move.
Regarding taxonomy, there are 48 species in the genus Legionella, and a total of about 78 serotypes of which the most important, for its medical implications, is the species Legionella pneumophila Legionella pneumophila The species causes Legionnaires' disease, or Legionellosis. Legionella infection may present as typical pneumonia or febrile illness without pulmonary targeting called Pontiac fever. The bacteria need to multiply within amoebae found. SOURCE: news syncope.

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

I am having serious computer problems and have been trying to post that article for the past two days. I am moving this thread at this point to the "Other Respiratory Diseases" forum because it appears influenza had little, if anything, to do with these fatalities.

It remains unclear why 4 cases, including both fatal cases, tested positive for influenza A originally. Co-infections? Laboratory contamination of samples? Or a false report released to prevent panic (after all one reporter tweeted about NCoV on February 2)?

 

[Vibrant62]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

What is puzzling is that for the symptoms presented, Legionella should have been high on the list for the intitial differential diagnosis based on the symptoms presented i.e it should have been tested for and excluded very early on in the outbreak. However, this is now apparently the official cause.

 

[sharon sanders]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

What is puzzling is that for the symptoms presented, Legionella should have been high on the list for the intitial differential diagnosis based on the symptoms presented i.e it should have been tested for and excluded very early on in the outbreak. However, this is now apparently the official cause.

Agreed.

 

[tetano]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Legionella doesn' t exclude influenza, see this article.

Clin Infect Dis. (2010) 51 (1): 115. doi: 10.1086/653444

Pandemic Influenza and Pneumonia Due to Legionella pneumophila: A Frequently Underestimated Coinfection
Caterina Rizzo, Maria Grazia Caporali, and Maria Cristina Rota

From July 2009 through February 2010 in Italy, 2500 confirmed cases of pandemic influenza and 4.5 million cases of influenza-like illnesses were reported to the sentinel surveillance system. Of the confirmed cases of pandemic influenza, 1278 (∼50%) were hospitalized. Of the patients hospitalized, 271 (21%) presented with pneumonia, which was attributed to bacterial coinfection in 33 cases.

Of the 33 cases with pneumonia due to bacterial coinfection, 6 (18%) were caused by Legionella pneumophila serogroup 1, and both the national legionellosis and the Italian mandatory 2009 A(H1N1) virus surveillance systems [3] were notified. The 2009 A(H1N1) virus reporting system is Web-based and was established in July 2009, whereas the national legionellosis surveillance system was established in 1983. Both systems include information about symptoms and risk factors, such as chronic illness, previous hospitalization, and travel.


http://cid.oxfordjournals.org/content/51/1/115.1.full

 

[tetano]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

It was not of flu A the sprout in Carmen de Areco

It would not have been the virus of the flu A the infectious agent that caused the death of two nurses of the hospital of Carmen de Areco, in whose service of intensive therapy produced to itself in last January a sprout of a respiratory infection that affected, in whole, eleven persons.


For Continental, the doctor Luis Crovetto, the director of Preventive from Buenos Aires Medicine, explained that, actually, ? the cases owed to an infection intrahospitalaria closed, with a bacterium gram denial call legionella ?.


The report of the Malbr?n contradicts the preliminary widely used report on February 2, in which it was said that it had been detected ? the presence of viral genoma of flu A [...] in samples of four of the patients affected by the sprout of sharp pneumonia in the hospital Our Lady of Carmen, of the city of Carmen de Areco ?.


In this respect, Crovetto explained in Magdalena Tempran?simo that, ? in three of the patients, the infection for legionella studied with a coinfection with flu A H1N1. But the patients who died did not have this coinfection ?, it specified.


? The legionella is a bacterium of the moisture, which can vaporizar and then the person can inhale it. For some mechanism that we still do not realize well, it contaminated the air conditioning of the hospital ?, it completed Crovetto.

http://www.continental.com.ar/notic...en-carmen-de-areco/20130322/nota/1863572.aspx

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

OK. So they are saying four non-fatal cases tested positive for flu A (and that the flu was H1N1, not H3N2), but that the fatal cases tested positive for only Legionella. The translation is not quite clear, but a reading of the original Spanish tends to support this interpretation, IMO.

I believe that the total number of Legionella confirmed cases in the above report might be 5; the three co-infected cases that survived, and the two fatal cases that had only Legionella. If that is correct, the fourth H1N1 confirmed case would not have tested positive for Legionella.

It appears likely that the additional fatalities in November and December 2012 might also have acquired Legionella in that ICU; I hope environmental samples are being tested to find and eliminate the source of the outbreak.

 

[tetano]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Gordillo ' suffered a flaw hemodin?mica serious, which precipitated the decease '. The organism had expressed across a medical report that ' there were, in some samples of blood, traces of the virus of the flu A '.


Why they state only the survivors had flu H1N1 ?

 

[Ronan Kelly]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

and then there's this....

machine translated;

In the end, it was influenza A
The latest report reveals that the Institute Malbr?n pneumonia outbreak that killed two people originated from the combination of influenza A with the Legionella bacteria.







By Eduardo Videla
The Ministry of Health confirmed yesterday that health workers and hospital patients who suffered Carmen de Areco pneumonia, which proved fatal in two cases, suffered a combination of influenza A virus and the bacterium Legionella, a variety "uncommon which in Argentina were not isolated cases but outbreaks. "

The national health portfolio went well to deny information disclosed from La Plata and picked up by some media, according to which the deceased were not affected by influenza A.

"It detected the viral genome of influenza A (H3N2) in five and by extension it is concluded that the other had the same symptoms that had the same virus," said Jaime Pagina/12 Lazovki, in charge of the management of the Institute Malbr?n where bacteriological studies were made of the case. "As for the bacteria, not found directly or by culture but, weeks later, by the antibodies produced in the body the presence of Legionella pneumophila, in six patients," he added.

In early February, an outbreak of a rare form of pneumonia. Seven affected health workers, two patients and a family member, all within the hospital. On February 8, a nurse died and 23 of that month saw the second fatal outcome.

According to the latest report, dated March 20, which agreed P?gina/12-whose facsimile illustrates this note-also found the bacteria in the water tank and hospital central air conditioning of Health.

Lazovki clarified that, however, two patients died of influenza A or Legionella, or by a combination of both, but in intensive care complications where interned were suffering from respiratory disorders. "The other patients also had the same virus and the same bacteria and recovered," he said.
...
http://www.pagina12.com.ar/diario/sociedad/3-216427-2013-03-23.html

 

[Ronan Kelly]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - outbreak now diagnosed as Legionella

machine translated; (and edited - "Gripe A" is being erroneously translated as "swine flu")

Manzur: "In Areco there was a Influenza A coinfection and Legionella"
Friday, March 22, 2013 13:50


The combination of the virus and the bacteria would be the cause of pneumonia in the hospital staff and patients of Carmen de Areco, according to the latest results obtained from research conducted by the National Administration of Laboratories and Health Institutes (ANLIS) "Dr. Carlos G. Malbr?n "

The Minister of Health of the Nation, Juan Manzur , said today in Santiago del Estero "Influenza A is confirmed by laboratory analysis. thing is that it continued to investigate the situation and what was found is a co aggregate" , he said in relation to cases of pneumonia in the hospital staff and patients of Carmen de Areco, adding: "It is a virus that is detected and which we released, and epidemiology presented by these cases turned order to further research and that was done. "

According to a report released today by the National Administration of Laboratories and Health Institutes (ANLIS) "Dr. Carlos G. Malbr?n", based on numerous studies of pneumonia cases that occurred in workers and hospital patients Carmen Areco last January, and having confirmed the presence of the virus of influenza A (H3N2) by culture and isolation in samples of five of the victims, also found evidence of co-infection with Legionella pneumophila, a bacterium that causes atypical pneumonia.


During the investigation, conducted by the laboratories of the agency, were discarded other germs such as adenovirus, respiratory syncytial virus, dengue, hantavirus, chlamydia, mycoplasma and histoplasma.


Meanwhile, studies last week in follow-up samples of patients showed an increase in antibodies against Legionella in six cases, but so far only observed duplicate and triplicate values ​​with respect to the initial. Note that the diagnosis is confirmed when antibody levels and quadrupled that in this type of infections, the elevation of the same can take several months or even not occur.


However, recent results infer that it would be a co-infection of both organisms: Influenza A and Legionella.


Dr. Jaime Lazovski , Malbr?n ANLIS holder, recalled that in February was detected influenza A viral genome in some patients and that placed the virus as the primary cause of the outbreak although studies would continue, as The statement issued at that time (see: http://bit.ly/YfWDaE). The virus was later confirmed by viral culture and isolation, which was allowed defining Influenza A (H3N2), the same virus that circulated in the northern hemisphere during the last winter season.
http://www.msal.gov.ar/prensa/index...ubo-una-coinfeccion-por-gripe-a-y-legionella-

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - seasonal flu H3N2 and Legionella both confirmed

Nice find, Ro. Post #92 indicates that both A/H3N2 flu and Legionella bacteria have been confirmed in multiple cases. I believe that five cases are confirmed as H3N2, and six cases are confirmed as Legionella. It is unclear whether this represents all 11 official patients, or whether some patients have been confirmed with both pathogens. It also indicates that NCoV was actually tested for and ruled out (as coronavirus is listed under the excluded diagnoses list).

The image posted in that post also indicates that Legionella bacteria have been found in a water tank and in the air conditioning unit of the hospital, in addition to the confirmed cases.

I am renaming and re-moving this thread accordingly.

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - seasonal flu H3N2 and Legionella both confirmed

A bit behind, and it's not H1N1....

http://www.promedmail.org/es

Published Date: 23/03/2013 00:23:22
Subject: PRO / ESP> Legionella, nosocomial - Argentina (BA): deaths, no influenza A H1N1
Archive Number: 20130323.310631

Legionella NOSOCOMIAL - ARGENTINA (BA): DEATH, NO INFLUENZA A H1N1
************************************************** ****

A ProMED-mail
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: March 22, 2013
Source: Continental, Argentina

[Edited by Jaime Torres]


Luis Crovetto, director of Preventive Medicine of Buenos Aires, explained that
it was "closed hospital infection with a bacterium
_Legionella_ call. In three patients, extended with a
coinfection of H1N1 influenza A, but no patients died
coinfection had that, "he added.

There have been the influenza virus causing infectious agent
the deaths of two hospital nurses Carmen de Areco, in which
intensive care unit last January came an outbreak of
a respiratory infection that affected a total of eleven people.

For Continental, Dr. Luis Crovetto, director of Medicine
Preventive Aires, explained that, in fact, "cases
due to a closed hospital infection with a bacterium
_Legionella_ Called Gram negative. "

The report contradicts Malbr?n preliminary report released on 2
February, in which he said he had found "the presence of
influenza viral genome [...] in samples of four patients
affected by the outbreak of severe pneumonia in hospital Our Lady
del Carmen, in the town of Carmen de Areco ".

In this regard, in Magdalena unearthly Crovetto explained that, "in
Three patients, the infection with an extended _Legionella_
coinfection with influenza A H1N1. But patients who died were not
coinfection had that, "he said.

"The _Legionella_ by some mechanism still not clear,
contaminated hospital air conditioning "Crovetto completed.


Reported by: Jaime R. Torres <torresjaime@cantv.net>



See also

Enf. viral nosocomial, hospital closure: Influenza A - Argentina
(BA) 20130203.301146

- ProMED-ESP

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - seasonal flu H3N2 and Legionella both confirmed

Published Date: 24/03/2013 22:21:42
Subject: PRO / ESP> Legionella, nosocomial - Argentina (BA): Epidemiological first record
Archive Number: 20130325.310916

Legionella NOSOCOMIAL - ARGENTINA (BA): Epidemiological Record FIRST************************************************** ***

A ProMED-mail
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: March 16, 2013
Source: The Liberal, Argentina
http://www.elliberal.com.ar/ampliada.php?ID=83578http://www.elliberal.com.ar/ampliada.php?ID=83578
[Edited by Jaime Torres]


On Friday it emerged that nurses who died in the
Carmen de Areco hospital in January, had suffered a coinfection
_Legionella_ flu with a bacteria that no records
epidemiological Argentina.

A report issued by the Institute based on studies Malbr?n
made to workers and patients with pneumonia in the hospital
bonaerense south _Legionella revealed the presence of pneumophila_ that
cause atypical pneumonia and could be the cause of death
women. The dangerous bacteria was found also in the
air conditioning equipment of the institution.

"Faced with this reality, we will have specialists who review
addressing many aspects of people with severe pneumonia. The
news was a surprise to the scientific medical community
and forces us to reconsider many things, "he admitted yesterday Joaquin Bermejo,
infectious diseases physician, head of the Hospital of Infectious Diseases
Spanish in Rosario, Santa Fe

The specialist spoke with LaCapital to arrive an hour
meeting that took place in Tierra del Fuego, which brought together
infectologists prestigious in the country.

The appearance of the hospital _Legionella_ was one bonaerense
exclusive themes, acknowledged. "There should be no doctors in Argentina
they see patients with pneumonia _Legionella_, why not
suspected as a possible cause of a severe respiratory infection.
This will change the story, "he said.

The fact that the bacterium has been found in equipment
Air conditioning is a fact that worries people. "It
highly unlikely to be in the air household in
Generally it is detected in air centralized and that
there in hotels, sanatoriums and hospitals, "he explained.


Reported by: Jaime R. Torres <torresjaime@cantv.net>

 

[Giuseppe]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - seasonal flu H3N2 and Legionella both confirmed

[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]


COMMUNICABLE DISEASE THREATS REPORT

Week 12, 17-23 March 2013

(?)


Acute Respiratory Syndrome ?Argentina

Opening date: 2 February 2013 Latest update: 27 February 2013


Epidemiological summary

A cluster of acute severe respiratory disease was reported in January in Carmen de Areco, Buenos Aires province, in a local hospital.

Of the 11 affected patients ten were health care workers.

Besides respiratory symptoms, patients complained of headache, myalgia, fever and gastrointestinal symptoms, such as nausea, vomiting and diarrhoea.

Two of the patients died, the others were discharged.

In four of ten samples analysed influenza A virus was detected by PCR.

On 18 March, local health authorities in Buenos Aires province announced in a press conference that Legionnaires' disease caused the outbreak.

The source of the outbreak was not identified.


ECDC assessment

The diagnosis of Legionnaires' disease as reported by the health authorities in Buenos Aires province is consistent with the disease presentation.

(?)


-
-------

 

[alert]

Re: Argentina - Two nurses die of flu-like illness, several others hospitalized, unconfirmed reports of additional linked fatalities - hospital closed in Carmen de Areco - seasonal flu H3N2 and Legionella both confirmed

Published Date: 2013-03-26 16:50:38
Subject: PRO/EDR> Legionellosis - Argentina: (BA) nosocomial, fatal, RFI
Archive Number: 20130326.1604475

LEGIONELLOSIS - ARGENTINA: (BUENOS AIRES) NOSOCOMIAL, FATAL, REQUEST FOR INFORMATION
************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1]Date: Sat 2 Feb 2013
Source: m24digital.com [edited]
http://m24digital.com/en/2013/02/02...tected-a-case-of-influenza-a-in-the-hospital/


Juan Manzur, Minister of Health of the Nation, confirmed that "there is no viral circulation of the disease in Argentina" but did say that the 1st case came from a patient who "entered the country with the virus from the United States."

10 days ago, the Carmen de Areco hospital closed its doors due to a rare virus that affected 10 employees and patients. After the fact, the Ministry of Health released the results of studies done to those affected.

They said that they had "detected the presence of influenza A viral genome in 4 samples of patients affected by the outbreak of severe pneumonia in the hospital."

"This clearly reveals the importance of being vaccinated against the flu because influenza is a potentially serious illness for people within the risk groups, as in the case of health care workers" said Manzur.

He added "the 1st case of those that occurred in the Carmen de Areco [hospital] correspond to a patient who entered the country with the virus from the United States and spread to people that he had contact with in the intensive care unit of the hospital. "

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: Fri 22 Feb 2013
Source: Buenos Aires Herald [edited]
http://www.buenosairesherald.com/article/124763/second-nurse-infected-with-swine-flu-dies


A 2nd nurse infected with swine flu has died. A nurse who had become infected with swine flu in a Carmen de Areco hospital died in La Plata after being hospitalized for 20 days.

The woman worked as a nursing auxiliary at the Nuestra Senora del Carmen hospital, in Carmen de Areco, where the virus had affected another 11 people.

This is the 2nd fatal case registered in the region. On 8 Feb 2013 the head nurse in the hospital's ICU department, 39-year-old [woman], also died after becoming infected with swine flu. She was also being treated in La Plata.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3]
Date: Sat 23 Mar 2013
Source: colonbuenosaires.com.ar [In Spanish, transl. Mod.JG, edited]
http://www.colonbuenosaires.com.ar/semanariocolondoce/cgi-bin/hoy/archivo/2013/00000077.html


The Ministry of Health in Buenos Aires confirmed that the 2 nurses in Carmen de Areco Hospital did not die because of influenza A as it was initially stated by the National Government. They died because of an infection caused by a microorganism detected in water tanks and pipes in the hospital, and it was announced that the investigation will continue because "it is the 1st outbreak reported in this country with such characteristics."

Meanwhile, a sister of one of the victims complained that the information was deliberately hidden, while the union of health care workers in Buenos Aires (CICOP, according to its Spanish initials) declared that the hospital is functioning in "non-sanitary" conditions.

Dr. Luis Crovetto, Director of Primary Care and Preventive Medicine in the Ministry of Health, pointed out that "the conclusions of epidemiological analyses -- including the autopsies carried out on the fatal victims -- revealed that they died because of a nosocomial infection outbreak produced by _Legionella_, a microorganism that may have been living in the water supply." The officer also warned that "this is the 1st outbreak occurring in this country with such characteristics'; and for this reason, they will continue investigating this situation in order to learn more about the microorganism that ultimately killed [the 2 nurses]. This outbreak also was responsible for 9 persons who became sick and had to be hospitalized.

Knowing these recent facts, Dr. Crovetto declared that "we will replace the pipes and tanks in the hospital in order to guarantee biological safety for our personnel and our patients," after the presence of _Legionella_ in the water pipes of the health care facility was revealed. The information was communicated last Monday to the victims' relatives, but this was made public yesterday after a formal complaint from CICOP, in which they mentioned "the disastrous management" and "deep neglect" in provincial hospitals.

Meanwhile, Carmen de Areco local authority, Mr. Marcelo Skansi, declared that "we wanted to get to the truth and even if it took some time because of the use of scientific techniques (sic), now we know what really happened. Now we need to know how this microorganism got here and we are expecting the arrival of Dr. Collia (Ministry of health) in order to reopen our beloved hospital."

The local authority praised the performance of the former hospital authorities, who have been removed (because of this occurrence), pointing out that "they were fully dedicated to this issue. As soon as an infection was declared, they acted in the right way, since even if the diagnosis took a long time, they prescribed proper medications and this is a proof that they did well."

On the other hand, the sister of one of the deceased nurses, declared that now that there are so many different versions about the possible causes of the aforementioned infection "we do not know what to believe and what to disbelieve in;" and she also said that "nobody apologized after they blamed (at the beginning of this ordeal) my sister for bringing influenza A from the United States."

On the other hand, Mr. Guillermo Pacagnini, from CICOP, declared that "the Ministry of Health lied about the presence of influenza A in Carmen de Areco Hospital." He said in an interview to QM News Channel "the conditions of this hospital are non-sanitary," and this is something occurring "throughout this province. They wanted to do a cover-up with this influenza A issue so that there would be no more complaints about the poor sanitary conditions of this hospital," he added.

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Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

[The 3 news reports above concern an outbreak of an acute respiratory infection that occurred at a hospital in Carmen de Areco, Argentina, which was closed in late January 2013 because of this outbreak. The number of outbreak cases varies from 10 in the initial report on 2 Feb 2013, to 12 in the 2nd report on 22 Feb 2013, and to 11 in the 3rd report on 23 Mar 2013. 2 hospital employees were involved; both were nurses, one of whom worked in the ICU. Both nurses died and their autopsies confirmed they both died of Legionnaires' disease, which the latest report says was also responsible for illness in 9 other patients. However, the 1st report says that "the presence of influenza A viral genome" was detected "in 4 samples of patients" involved in the outbreak; we are not told specifically the number of patients these samples represent or if any of these samples were from the 2 nurses. We are also told that _Legionella_ has been detected in the hospital plumbing system, but are not told if the species of _Legionella_ detected in the plumbing system or its genotype matches that found in any of the patients.

Legionellosis is an infectious disease caused usually by inhalation of aerosols containing _Legionella_ species. Legionnaires' disease is the acute pneumonic form of legionellosis; more than 70 percent of cases of Legionnaires' disease are due to _L. pneumophila_ serogroup 1, except in Australia and New Zealand, where _L. pneumophila_ serogroup one has accounted for only 45.7 percent of cases of community-acquired legionellosis, and _Legionella longbeachae_ has accounted for 30.4 percent of cases (Yu VL, et al: Distribution of _Legionella_ species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: An international collaborative survey. J Infect Dis. 2002; 186(1): 127-8. Available at: http://www.legionella.org/lp_distribution.pdf). Legionnaires' disease due to _L. longbeachae_ has been associated with the use of potting soil and gardening.

Legionnaires' disease attacks more frequently and is more severe in individuals who are elderly, smokers, alcoholics, or who have an underlying illness such as chronic obstructive pulmonary disease (COPD), or who have a weakened immune system as a result of, for example, organ transplant or taking immunosuppressive drugs (such as, corticosteroid therapy) for other reasons. However, it is important to emphasize that relatively healthy individuals can also be at risk of contracting this disease.

A diagnosis of even a single case of Legionnaires' disease implies the presence of an environmental source to which other susceptible individuals are likely to have been exposed. It is, therefore, a public health imperative to find that source to prevent further cases.

Genotyping of patient and environmental isolates has become a helpful tool to establish transmission pathways. The predominance of one genotype of _Legionella_ isolated from patient specimens would suggest transmission from a common source. Because _Legionella_ may be found in environmental samples without linkage to any cases of legionellosis, the actual causative infectious reservoir can be confirmed by matching the genotype of clinical and environmental isolates (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/ and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/).

However, this is difficult in legionellosis outbreaks, because, frequently, the diagnosis of Legionnaires' disease is made only on the basis of urinary _L. pneumophila_ serogroup 1 antigen testing or serology rather than isolation of the organism from cultures of respiratory tract specimens. Consequently, clinical isolates are often not available for genotyping.

For a description of an extensive investigation of a nosocomial outbreak, please see the CDC report of on the outbreak of Legionnaires' disease at the Pittsburgh, Pennsylvania Veterans Hospital posted by ProMED-mail recently (Legionellosis - USA: (PA) nosocomial, CDC investigation 20130226.1560035).

Carmen de Areco, with a population of about 14 000 inhabitants (http://en.wikipedia.org/wiki/Carmen_de_Areco_Partido), is a city and partido (an administrative division) in Buenos Aires Province, and is located 140 km (87 mi) west of the city of Buenos Aires (http://maps.google.com/maps?hl=en&b...e3:0xc46a0fb6b3ef82b1,Carmen+de+Areco+Partido). La Plata is the capital city of the Buenos Aires Province and is located southeast of the city of Buenos Aires (http://en.wikipedia.org/wiki/Buenos_Aires_Province). The city of Buenos Aires, a federalized autonomous district, is the capital of Argentina and is located within the province of Buenos Aires, but is not administratively part of Buenos Aires Province.