Italy: 878 pneumonia cases in Brescia province, legionella bacterium in the cooling towers

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Pneumonia in Brescia, findings on two deaths


Investigations were made on the deaths of an 85 year-old from Carpenedolo and a 69-year-old from Mezzane di Calvisano, in Brescia, to assess whether the deaths are related to the cases of pneumonia they are affecting the southern eastern Brescia province.

Only accesses to the emergency room of the hospitals in the area were 121, but the cases of pneumonia exceed 150. One hundred and twenty-one patients all concentrated in the Lower Brescia and in some countries bordering the high Mantovano, scattered between the towns of Calvisano, Carpenedolo , Montichiari, Acquafredda, Desenzano and Gavardo. General practitioners, family paediatricians and continuity nursing physicians (ex-doctor) are paying particular attention to cases of patients presenting with respiratory symptoms.

Ats of Brescia is carrying out the analysis of the aqueducts because it is hypothesized that the epidemic is due to a bacterium present in the water. Doctors and technicians are trying to understand if there is a correlation between all these cases. If there is a single source of contagion. And if, given the non-traditional symptomatology, it is in the presence of community pneumonia, ie taken within the home and caused by the legionella bacteria. If you are dealing with legionella pneumonia you can not yet say, what is certain is that this bacterium has infected two of the patients, since yesterday hospitalized in intensive care hospital in Brescia, their conditions have worsened and the doctors have ordered the transfer from the infectious ward to the intensive care unit.


https://www.corriere.it/cronache/18_...7915528b.shtml

 

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Brescia, 138 cases of pneumonia: hypothesis of a bacterium in the water.

The numbers are those of an epidemic. The number of cases of pneumonia in the lower part of eastern Brescia has exceeded 130, in particular in the municipalities of Carpenedolo, Montichiari, Calvisano, Visano, Acquafredda and Remedello. One hundred twenty-one accesses registered in the emergency room, in 107 were admitted. Most of these are over 60s, from already problematic health conditions. The hospital of Montichiari was particularly assaulted, with the percentage of consultations for pneumonia passed from 1 to 80 percent. And investigations were made on the deaths of an 85 year-old from Carpenedolo and a 69-year-old from Mezzane di Calvisano, to assess whether the cause was in any way linked to the epidemic. Autopsies that, according to the Councilor for Health Giulio Gallera, gave a negative result: "The two deaths of Brescia would not seem to be related to pneumonia cases," he said. To then add: "We work at 360 degrees to identify the cause of this phenomenon. To date, there are 138 cases, of which only two are legionella ".
The situation, in fact, immediately brought to mind the legionella emergency that broke out in July in Bresso, a municipality in the Milan hinterland, with 52 confirmed cases and 4 deaths. As in that case, it is hypothesized that the cause of the epidemic is a bacterium present in the water. Yesterday afternoon, in Brescia, a summit was held between Ats, the Lombard health protection agency, and the aqueduct managers in the lower Brescia area. The supervisory staff of the Department of Hygiene and Health Prevention and of the Public Health Laboratory of Ats Brescia is engaged in the verification of the water network of the municipalities concerned. "Hygiene technicians are carrying out sampling of drinking water, while the laboratory has ongoing specific analyzes whose outcomes will be available in the coming days," said the regional councilor Gallera.

https://www.ilfattoquotidiano.it/201...attia/4613617/

 

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[h=1]Pneumonia in Bresciano, dying of ducks in the Fossa Magna canal[/h] Montichiari, 10 September 2018 - Slaughter of ducks in a few days in the Fossa Magna of Carpenedolo, country epicenter of numerous cases of pneumonia that also led to the death of two people, a man of 84 years of Carpenedolo and a woman of 68 Calvisano. Altogether there are 138 accesses to the emergency rooms of the hospitals of Montichiari, Manerbio, Desenzano Del Garda, Gavardo, Asola and Castiglione delle Stiviere and Mantova. It is premature to hypothesize a link between the death of anatids and the anomalous wave of respiratory infections. But of course, in a context of very high health alert, the Ats wants to shed light. Yesterday morning, around 10.30, the staff of the veterinary department took the carcasses of the 25 birds that will now be subjected to an autopsy examination at the Zooprofilattico institute.

Poisoning or more likely avian influenza causes ended under the lens of health authorities. If, however, there were no findings to these hypotheses, the investigations will be investigated to verify precisely if there are links between the deaths of the ducks and the epidemic of pneumonia. The node to be dissolved is not so much the contagion practically impossible, given the bacterial nature of the infection, but how much to understand if the animals have contracted a form of pathology from the water considered a potential carrier of the germ.

https://www.ilgiorno.it/brescia/cronaca/polmonite-strage-anatre-1.4161747

 

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Cases of pneumonia, virologist: the legionella bacterium is the main suspect

cases of pneumonia recorded in Bresciano, with 138 accesses in the emergency room, "have a number one suspect and is the bacterium of the legionella, although it will take some more time to have certain elements. It's like doing a police investigation by fitting all the pieces of a mosaic of clues: analysis of the water samples, controls and interviews on the sick subjects and checking what they have in common. It is possible that other episodes of the past can also be traced back to Legionella, but the link has never been found ": Fabrizio Pregliasco, a virologist at the University of Milan, explained this to Adnkronos Salute.



Per approfondire http://www.meteoweb.eu/2018/09/polmonite-batterio-legionella/1148005/#BRMDGx5euM4AGCMw.99

 

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[h=1]Pneumonia in Brescia: the Prosecution opens an investigation. The cases go up to 148[/h] The Brescia Public Prosecutor's Office has opened an investigation into the cases of pneumonia that have been occurring for days in the Lower Bresciana Orientale. It is the Carabinieri del Nas who collects data on infections and is in contact with the top management of Ats. The number of cases of people who showed up in the emergency room in the last few hours has increased by reaching 148.

https://www.gazzettadiparma.it/news...a-apre-un-inchiesta-i-casi-salgono-a-148.html

 

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[h=1]Pneumonia in Brescia, air investigations are evaluated[/h]
On the cases of pneumonia recorded in Brescia, "we are doing everything that can be done, either by investigating the sampling made to understand if the vector is water, or by interrogating patients to see if there is an element that unite and identify the source, but we also work in other directions. "We do not want to leave anything to chance". This was stated by the Regional Councilor for Welfare, Giulio Gallera, on the sidelines of the presentation of the project for the new San Raffaele building. To those who asked him if they are also considering checks in the air, the commissioner replied: "Yes, even on the air we are starting to think about doing something". "We are working in all directions in harmony with the most experts and with the Istituto Superiore di Sanit? - added Gallera - We want to give a message of reassurance to the population.
We count in a short time to be able to give definitive messages. "At the moment the hypothesis that the legionella is the cause of the contagion" can not be said to be excluded, or that this bacterium is certainly the triggering factor ". the number of infected persons confirmed the Councilor that they are still in 138 cases of access to the Emergency Department, of which 124 are hospitalized.

http://www.ansa.it/lombardia/notizi...ano_606fc12c-3eca-4d64-9dd0-a4a2f2c39d73.html

 

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?Pneumonia epidemic: cases rise to 250, boy nearing death

?Up to 250 cases of pneumonia recorded from 2 to 9 September in about twenty Brescia municipalities. The pathogen has not yet been identified, but, according to regional councilor Giulio Gallera, it is certainly bacterial pneumonia "because there are increasing cases of legionella, at least 12 confirmed ones". Meanwhile, a 29-year-old from Ro? Volciano suffering from pneumonia was admitted to the hospital in San Gerardo di Monza. It is located in the intensive care unit, attached to the machine for extracorporeal circulation, but for the Ats it would not be a case related to the epidemic in the Lower "as resident in a different area", although the spread seems now having passed the municipalities of the "red zone".


?On the other hand, at the Civile di Brescia two people aged 57 and 58 were admitted to the Intensive Care Unit, transferred from the Montichiari hospital after their condition worsened.?
Potrebbe interessarti: http://www.bresciatoday.it/cronaca/p...e-notizie.html

 

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[h=1]Epidemic in Lower Brescia, the spectrum of Legionella[/h] Brescia, 11 September 2018 - Three cases of legionella ascertained in Bresciano rise since the pneumonia case broke out on 2 September. A 55 year old from Carpenedolo, already hospitalized in Montichiari, was transferred to the Policlinico di Milano. However, the pathogen that caused the cases of pneumonia registered in the hospitals of the Lower Brescia and Mantovano areas in little more than a week has yet to be ascertained.

Cases in continuous increase: yesterday it has reached quota 200. The regional councilor to the health, Giulio Gallera, is unbalanced declaring: ?We are sure that it is bacterial pneumonia?. "Legionella cases are on the rise and this makes us think that the bacterium in question is just that".

https://www.ilgiorno.it/brescia/cronaca/polmonite-legionella-1.4165155

 

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[h=1]Legionella pneumonia, a very serious 29-year-old from Brescia who was hospitalized in Monza[/h]
?On Monday 10 September, up to 8 pm, there were 235 accesses to the emergency room, 196 are currently hospitalized, 12 people who have refused admission or who have been discharged, two deaths, one with an established diagnosis of legionella ?. This was stated by the Lombardy Welfare Councilor Giulio Gallera, reporting to the Regional Council on the pneumonia epidemic affecting Bresciano, Mantovano and Cremonese. "In 12 cases, on the total number, it has been ascertained that it is legionella," he added.

We can say that there is a falling epidemic curve. There are no data that lead us to believe that there are new cases, "Gallera continues. "There is no reason to close schools or not to drink tap water", clarified the commissioner. "The subjects involved are 70% male, predominantly elderly or with diseases that involve immunosuppression. Children, young people and people without health problems have not been affected. I say this because they open schools and need clear messages on the overall picture of how the disease developed ", Mantova and Cremona
The wave of pneumonia crossed the borders passing from the Brescia plain to Mantua and reaching as far as Cremona. Thirty-seven patients, including two Cremonese, are hospitalized in Mantua hospitals. Another Cremonese is in a Brescia hospital. Also in this part of the Bassa, as in Montichiari and in the other surrounding countries, the bacterium under accusation as a possible cause of an infection so widespread is legionella. Precisely for this reason we are doing more in-depth analysis on those affected.



[h=5]Il caso di Asola[/h] The case of Asola in the Mantuan area is striking: at the moment there are 22 people at the hospital. Another 6, Monday, they went to the emergency room, where their conditions are being evaluated. Nine of the 22 are residents of Asola. The mayor, Raffaele Favalli, knows them almost one by one. "Among them there are a farmer, a worker, a surveyor and so on. Some work in Montichiari and in other Brescian centers that are only a few kilometers away. And it is precisely with the territorial proximity that I explain the phenomenon ?. In Asola we are recording what the mayor calls "two anomalies: the presence not only of elderly people (the youngest is 43 years old), who are responding very well to the therapies, and the overwhelming percentage of men compared to women".


https://milano.corriere.it/notizie/...le-a6f945a2-b5a0-11e8-827a-b1abf87e7dca.shtml

 

[tetano]

Pneumonia, the peak has passed The legionella cases rose to 17


The numbers are slowing down, said the Regional Councilor for Health Giulio Gallera, who began his day by reporting the regional council on the case and closed the Committee for the order and security of the Prefecture meeting with the mayors of the "crater" epidemic with ATC's top management and experts. It is the sign that the epidemic curve developed from 2 to 7 September is dwindling, given that the last numbers growing slightly are the result of some late reporting: 237 access to the emergency room, a hundred people assisted at home by the forty doctors of base of the area, 17 confirmed cases of legionella, a number that could further grow with the completion of the latest analysis on patients, deaths (two, one per legionella) remain stable, while the most serious (all patients with other serious diseases) are being improved. Stationary also the 29 year old Ro? Volciano hospitalized at San Gerardo in Monza for legionella and on which there is no certainty that it can have a relationship with the heart of the epidemic developed in the Bassa.

For some days now we have been working on the Churches as a place of culture of the bacterium and on countless methods of diffusion (from irrigation to rain, widespread in these areas, to the cooling towers of the companies that may have created large water vapor aerosols capable of migrating from one country to another). The next will be weeks for health intelligence experts, for 007 of epidemiology. After all, an epidemic is unprecedented in Italy and here in Brescia it is studied on cases in Norway, Germany and Portugal.

https://brescia.corriere.it/notizie/...aceaa02b.shtml

 

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[h=1]Dead ducks in the canal, pneumonia has nothing to do with it[/h] No connection between the ducks found without life in the Fossa Magna in Carpenedolo and the 34 cases of pneumonia registered in the country. The analyzes carried out on the carcasses of the animals would in fact have brought out different results compared to those that had been hypothesised in advance. The ducks would die because of a botulinum toxin that develops in the water at high temperatures. In this case the botulinum toxin, which is lethal for some species of birds, would have spread in the semi-dry canal and in the surrounding land. The analyzes conducted by the Istituto Zooprofilattico di Brescia thus allow to exclude not only a link with the numerous cases of pneumonia but also with an epidemic of bird flu, which less than a year ago had forced so many farmers to bring down a million and a half of specimens and send almost two million eggs to the waste.

http://www.bsnews.it/2018/09/12/anatre-morte-canale-polmonite/?refresh_ce

 

[tetano]

[h=1]Pneumonia in the Brescia area. In point of Gallera: "12 access to the Ps in the last two days, 26 patients discharged"[/h]
[h=2]To date, the cases of positivity to Legionella are 23. It is confirmed "a trend in decrease compared to the peak of recent days and constant in recent days". Meanwhile, the sampling of drinking water continues, both in private and environmental homes (204 those already carried out, of which 78 three on 11 and 12 September). Gallera reassures: "There is no risk of using food water".[/h] The Brescia ATS continues with the sampling of drinking water, both in private and environmental homes. To date, there are 204 samples (of which 78 are made on 11 and 12 September). "The supervision activity at the cooling towers, carried out by the ATS Prevention Technicians - explains the Region in a known note - has become even more significant thanks also to the collaboration guaranteed by the NBCR Group (Nuclear - Biological - Chemical - Radiological) of the Provincial Fire Brigade Command of Brescia. A further important contribution to the mapping of the territory is provided by the Orio al Serio Carousel Helicopters Unit, which are carrying out overflights in the area most affected by the phenomenon, using high-definition cameras to identify further possible new points of investigation ".

"It has been completed - he added - the epidemiological and environmental survey on the cases of people with pneumonia through questionnaires realized in person to the patients and on the phone in case of people discharged. The questions refer to the habits of life of the two weeks prior to the manifestation of the symptoms of the disease. The case investigation has been completed and we are awaiting the results ".

http://www.quotidianosanita.it/regioni-e-asl/articolo.php?articolo_id=65538

 

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[h=1]Pneumonia, it is not water that transmits the infection[/h]
Brescia, 14 September 2018 - The Istituto Superiore di Sanit? excludes the possibility that the water network has been transmitting pneumonia between the various municipalities of the Lower Brescia region concerned. ?After checking the drinking water distribution network, the possibility of possible connections between the various municipalities involved was excluded?, wrote the experts on the Epicentro portal by ISS, underlining that ?however, sampling has been carried out to the water network (more than 50 points sampled) and at the homes of those diagnosed with legionellosis ?.
At 10 September last, the Institute recalls, there were 235 cases of pneumonia registered in the emergency room, the highest number recorded on 6 and 7 September, 196 people hospitalized, 2 deaths. The death toll does not take into account the suspected case, which led to the death of a 68-year-old yesterday at the Gavardo hospital in Brescia. So far there have been 12 cases of legionellosis confirmed and 9 municipalities most affected, with at least 5 cases each. The subjects involved are mainly males (about 70%)

https://www.ilgiorno.it/brescia/cronaca/polmonite-legionella-acqua-istituto-sanità-1.4178174

 

[tetano]

The epidemic of pneumonia kills another victim: 68 year old dies in hospital


?The epidemic of pneumonia that has hit our province is reaping another victim. At the hospital in Gavardo a 68-year-old brescian died: he was hospitalized there since September 10 for bacterial pneumonia, following the transfer after the first treatment given to the Poliambulanza. From the first information leaked, it seems that the 68 year old was at home in Ro? Volciano. The first findings seem to exclude Legionella from the causes of death and, if the diagnosis was confirmed, it would thus result in the second death from bacterial pneumonia after that of a 84-year-old Carpenedolese. The Brescia prosecutor has however ordered an autopsy. Recall that, at the moment, the only confirmed death for legionella is that of Guglielmina Castelletti, 69 year old Calvisano expired during the transport by ambulance from the hospital of Montichiari to the Civil of Brescia, the night of 7 September.

?http://www.bresciatoday.it/cronaca/b...e-vittime.html

 

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[h=1]Pneumonia, 52 still in intensive care[/h]
As reported in recent days, it is increasingly reducing the number of accesses for respiratory problems to the emergency rooms of the Municipalities of Bresciano and of the high Mantua. Today the accesses were 10 of which only for 4 the hospitalization was requested ". This was stated by Lombardy Region Welfare Councilor Giulio Gallera on pneumonia cases in the municipalities of Bresciano and the upper Mantua. CLINICAL PATIENT CONDITIONS. "Regarding the clinical conditions of the patients currently hospitalized in the public structures of ASST Spedali Civili of Brescia, ASST Franciacorta and ASST Del Garda, for respiratory problems plausibly attributable to pneumonia, to date 104 are in stable condition and 52 are in remission phase and may be discharged in the next few days, while 5 cases remain that are still currently in intensive care ". LEGIONELLA CASES. As of September 2nd, the cases established as positive for Legionella are 36 (of which 32 in ATS Brescia and 4 in ATS Valpadana).

http://www.quibrescia.it/cms/2018/09/14/polmonite-ancora-52-in-terapia-intensiva/

 

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?Pneumonia, the epidemic continues to scare. "The number of new accesses is stable", explains Regional Health Councilor Giulio Gallera, commenting on the update of the situation in the municipalities of Brescia and Mantua where there have been numerous cases of pneumonia since 2 September.?



?But the numbers seem to say more: Sunday there are 33 people who came to the emergency room with the symptoms of pneumonia. One third more on Saturday, when there were 22, and even three times more than on Friday, when around ten. "Once the peak phase is over - Gallera commented - we are entering a phase in which the number of accesses to the emergency room is now constant".

?Of the 33 accesses in the emergency room, there are a total of 21 hospitalizations, of which 12 in Ats Brescia and 9 in Ats Valpadana. Among these, the most serious is a 30-year-old boy from Calcinato, hospitalized in Montichiari for a suspected legionella. There are 40 people today who are positive to the legionella, with a new confirmed case.


?In addition to deaths, many patients are hospitalized in serious conditions. Two are from Remedello: a 43-year-old hospitalized at the San Gerardo hospital in Monza and a 56-year-old hospitalized in Pavia. Also in Monza also the 29 year old Ro? Volciano but originally from Lake Garda. In Milan instead the 57 year old Carpenedolo who was among the first to contract the legionella.


?To date, there are 191 people in the hospital. There are eight Brescian municipalities in which the epidemic would have been concentrated: Acquafredda, Calvisano, Carpenedolo, Ghedi, Isorella, Montichiari, Remedello and Visano. For all the other municipalities, the Council of Representatives of the mayors of Ats had written, "no extraordinary precautions are required to be observed, and it is not necessary to take precautions for attendance in schools and other centers of aggregation".?


http://www.bresciatoday.it/cronaca/p...ornamenti.html

 

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[h=2]Epidemic of pneumonia in Lombardy: the current situation and ongoing investigations[/h] Maria Cristina Rota[SUP]1[/SUP], Maria Luisa Ricci[SUP]1[/SUP], Maria Scaturro[SUP]1[/SUP], Maria Gramegna[SUP]2[/SUP], Antonio Piro[SUP]3[/SUP], Danilo Cereda[SUP]4[/SUP], Giovanni Rezza[SUP]1[/SUP]
[SUP]1[/SUP]Dipartimento Malattie infettive, Istituto superiore di sanit?
[SUP]2[/SUP]DG Welfare ? UO Prevenzione, Regione Lombardia
[SUP]3[/SUP]Ats Brescia
[SUP]4[/SUP]Ats Valpadana


September 13, 2018 - In relation to the pneumonia cases recorded in numerous municipalities of the Provinces of Brescia and Mantua starting from the beginning of September 2018, the Higher Institute of Health (ISS) emphasizes that the epidemiological and microbiological investigation of all cases is still ongoing and is aimed at finding an eventual common exposure such as: frequentation of environments, whether working or leisure or commercial activities, participation in public events or other. Specific actions are also under way to identify the source and methods of transmission of the bacterium. The data available at September 10 show: 235 accesses to the emergency room (the largest number registered on 6 and 7 September) 196 currently hospitalized people 12 people who refused hospitalization 2 deaths (including 1 with a confirmed diagnosis of legionellosis) 12 cases of legionellosis confirmed 9 cases hospitalized in intensive care units 9 Municipalities most affected, with at least 5 cases each.

The subjects involved are mainly males (about 70%), mainly elderly or people with immunosuppression conditions and / or with risk factors (such as smoking habits). Since the diagnosis of legionellosis was confirmed mainly on the day of 10 September (until the morning the confirmed cases were only 2), the epidemiological survey is now oriented towards a cluster of legionellosis. At the moment, clinical research continues on individual cases to confirm the etiologic agent of pneumonia in hospitalized patients. All cases of pneumonia will be tested for Legionella with more than one diagnostic method, since initially all cases were negative to the urinary antigen. Both the First Aid and General Practitioners (Mmg) and Care Continuity were alerted.

Environmental investigation After checking the drinking water distribution network, the possibility of possible connections between the various municipalities involved was excluded. However, sampling was carried out on the water network (more than 50 points sampled) and at the homes of those diagnosed with legionellosis. Sampling for the research of the Legionella pneumophila bacterium is now focusing on the cooling towers of the industrial settlements in the area. All the interested Municipalities are located near the river Chiese.
Regarding the communication aspects towards the population, the involved Auditors (immediately called by the local health authority of Brescia) received support and guidelines for communicating the risk to the population, underlining that currently there are no reasons to limit the use of the 'water. The Ats (Health Protection Agencies) concerned informed the population also through their institutional sites. The Ats and the Asst (Local Healthcare Organizations) concerned are still actively engaged in the investigations, in close connection with the DG Welfare - Prevention OU, the Higher Institute of Health and the Ministry of Health.

http://www.epicentro.iss.it/temi/infettive/EpidemiaPolmoniti2018.asp

 

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Pneumonia, Gallera: "42 cases of legionella pneumonia"


Alarm pneumonia. the regional councilor Giulio Gallera in a press conference in Brescia. Cases established "To date, 400 cases of pneumonia were detected, of which 42 were positive for the legionella bacteria. In total, the number of inmates is still at 200, including new admissions and resignations ". And the river Chiese? According to Gallera, among the large excluded, there is the river Chiese, which today would not seem to be the transmission vector, but in the
evaporative cooling tower there are the cooling towers of many industrial activities that rise right near the waterway.

https://bresciasettegiorni.it/cronac...da-legionella/

 

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[h=1]Legionella is in cooling towers[/h]
MILAN, 17 SEP - "The results of the sampling carried out by ATS Brescia allow us to definitively establish that the cause is not found in the water of the aqueducts, but in the cooling towers of the companies. I calm down all citizens that they can continue to drink and use the water in the water supply in all tranquility ", said the Lombardy Region Welfare Councilor, Giulio Gallera after nine cooling towers in the Brescia area, nine they were positive for the legionella bacteria.

http://www.ansa.it/sito/notizie/top...nto_2c19df3b-70a8-4928-bd63-d7c0a28d3e2d.html

 

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[h=1]Gallera: legionella in cooling towers, immediate sanification[/h] The results of the sampling carried out by ATS Brescia have definitively established that the cause is not found in the water of the aqueducts, but in the cooling towers of the companies. This is a summary of what was declared by Giulio Gallera, Welfare Councilor of the Lombardy Region on the cases of pneumonia and the samplings carried out by ATS Brescia on the territories of the lower Brescia region and in the upper Mantua area. "I calm down all the citizens that they can continue to drink and use water from the water supply in complete tranquility". "To date - Gallera explained - the analysis of data allows us to concentrate all the efforts made by ATS in the cooling towers of companies. The results of the sampling carried out in the most affected municipalities are positive for Legionella. Of the 10 samples analyzed to date on the cooling towers of 3 companies in the Municipalities of Montichiari, Carpenedolo and Calvisano, 9 were positive for Legionella ".

Following the first results, the ATS Brescia convened the mayors of the three municipalities to provide the first appropriate information. Then they were sent a formal note requesting the issuance of contingency and urgent order to have the sanitation of some companies in their territory. It will also be assessed whether they have carried out biological risk assessments and self-checks. "We will extend the sampling work - the councilor pointed out - to a larger area and we will involve the mayors of the territory concerned so that all the companies can sanitize their cooling towers. By the end of the year, we would approve in the Regional Council a measure to record all the cooling towers in Lombardy, specific rules for their periodic sanification and checks and sanctions by ATS in case of failure to comply ". "Even in the river Chiese - has concluded Gallera - have been found of the positivity, but the reduced number makes us believe that it is not the river water the cause of the cases of pneumonia found in the last two weeks. It is hypothesized that legionella was present in stagnant pools, but we believe that there are no conditions because from there it spread in the environment, we remember that legionella spreads only through nebulized water ".

https://www.milanopost.info/2018/09...ri-di-raffreddamento-immediata-sanificazione/