The World Health Organization (WHO) published a Disease Outbreak News release on the situation in Tucuman Province, Argentina today:
As of 3 September 2022, a cluster of 11 cases of severe pneumonia, including four deaths, have been reported in San Miguel de Tucumán city, Tucuman Province, Argentina. Legionella spp. was isolated in the samples from four cases. Legionellosis is a pneumonia-like illness that varies in severity from mild febrile illness to a serious and sometimes fatal form of pneumonia. Cases were initially reported as being pneumonia of unknown cause. Legionella bacteria was identified as the causative organism on 3 September.
All cases presented with bilateral pneumonia, fever, myalgia, abdominal pain, and dyspnea between 18 and 25 August 2022 and are epidemiologically linked to one health facility. Of the 11 cases, eight are health workers of the facility; three are patients of the health facility. Three of the four deaths were among health workers.
Health authorities are coordinating cluster investigation activities, active case finding to identify additional cases, contact tracing and public health activities to limit further spread.
Read more at WHO
In addition, officials in Argentina announced new inclusion criteria (computer translated):
Within the framework of a new press conference, the person in charge of the Sanitary portfolio, Dr. Luis Medina Ruiz, explained that the change in criteria includes patients, health personnel, and caregivers who have been in the sanatorium in August private, or has received a surgical intervention and has some compatible symptom such as fever or respiratory symptoms.
“We want to inform you that, having a known etiology of this outbreak linked to the private sanatorium, we have considered together with the Minister of the Nation, Dr. Carla Vizzotti, a change in the inclusion criteria within this outbreak. Initially, when we detected two patients with bilateral pneumonia that coincided with the common workplace and that we also could not find its etiology, that was what we had as inclusion criteria. Today, knowing that it is a bacterium that does not always cause bilateral pneumonia, we are including any health personnel, patient or family caregiver who has been in the month of August or has received a surgical intervention in the selection criteria for patients. in this private sanatorium and who has some compatible symptom such as fever or respiratory symptoms, not necessarily bilateral pneumonia, “he reported.
|“That is why today we are including at least 8 new patients, of which 1 is a patient, 2 are health personnel and 5 are caregivers of patients who were hospitalized, post-surgical or with neurological problems. Of these 8 patients, there is one who has severe comorbidity, due to a cerebrovascular accident and is also suffering from pneumonia, he is the only one who is serious. We are very sorry for the death of the two patients yesterday, who were on mechanical respiratory assistance for their bilateral pneumonia, and very seriously ill with severe comorbidities. One of them was 81 years old and the other 64, in summary today we have 6 deceased, 9 patients who are at home with outpatient medical follow-up, since the clinic they present is of moderate or mild severity,
Likewise, the official stressed that it is a bacterium that is not transmitted from person to person and the fact of having found the cause gives them a lot of certainty about the measures to be taken. “Initially we had taken the measure of isolating the sanatorium without removing the patients, since not knowing the etiology it could have been a virus or a battery that could have spread in the community. Knowing today that it is a bacterium, has allowed us to take other measures regarding this outbreak.”
Regarding the private sanatorium, the Minister stressed: “First of all we have to analyze responsibility, today we are with the sanatorium closed, patients cannot enter, neither outpatients nor inpatients, and as of today or tomorrow a team of experts will come since Legionella is not an easy-to-find bacterium, a special technique is needed”.
|At the same time, Medina Ruiz clarified that the Ministry carries out tests on the condition of the water, if it is drinkable, if it has residual chlorine, if it has germs and that has not been found; since the conditions were within the adequate. “The public sector has a permanent epidemiological surveillance, in case of seriously ill patients, the cause is sought, that does not happen everywhere. Here we saw patients who came from the private sector, we took action on the matter and we have thoroughly investigated what the cause is. And not finding it is when all this is triggered. I think the next steps will depend on the findings in the coming weeks.”
At the same time he added: “There are no patients who are not related to the private sanatorium in the month of August, and that is the situation where the limits are. Today we have a little more certainty. This disease has the characteristic that it is self-limited; it is very different from COVID that one does not know when it ends. With this bacterium no, most people can have an asymptomatic or mild symptomatic picture, and it is self-limited. That means that when the disease begins, the body itself limits it and cures it. He will not have relapses because he has no new contact with the germ, ”he detailed.
In the same way, he remarked: “Anyone who begins with symptoms such as fever, symptoms compatible with the flu: body aches, headache, cough, cold, dyspnea. In some patients diarrheal pictures. We are going to control them for at least two weeks, from the closure of the sanatorium and that there is no other person working inside, until we are certain that there are no more patients.
Medina Ruiz, remarked that the patients who are hospitalized are receiving a specific treatment. Pneumonia is a very frequent cause of death in older people and with comorbidities, the cause is not always known and that is every year and winter. Pneumonia is usually fatal, due to the Influenza virus.
|“Today all the patients who are compromised are under strict surveillance, in therapy with professionals with a lot of experience and of course we are going to have a very fluid communication with the family. It will be opportune, we are going to have a press conference once a day, and then with official communications when some relevant information appears, ”she warned.
Finally, the official explained: “The way this disease is spread is through water vapor, air conditioning, the shower when it disperses the water, when it is breathed. The bacteria do not enter through the mouth when one touches the water, it has a special way of contagion and entry into the body. In a certain way, it generates outbreaks and this way of contagion does not give rise to interhuman contagion, that is, for the person next to me to become infected, they need a cloud of particles that enter the lung.”
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