In a follow-up on the Legionnaires’ disease outbreak at the São Francisco Xavier Hospital in Lisbon,  the General Directorate of Health (DGS) is now reporting the number of people affected by the Legionella outbreak is up to 41 people as of Thursday.

Two fatalities have been reported to date and five people are still being treated in intensive care. Seven out of 10 people affected by the outbreak (29) are over the age of 70.

Legionella bacteria Image/CDC
Legionella bacteria
Image/CDC

Portuguese Health Minister, Adalberto Campos Fernandes said the source of the infection is the Lisbon hospital itself.

Portugal has seen the third largest outbreak of Legionnaires’ disease back in November 2014 in the town of Vila Franca de Xira, about 35 kilometers north of Lisbon, which infected 403 and killed 14. A 2001 outbreak in Spain, which affected 450 is considered the largest.

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Legionnaires’ disease is a respiratory infection caused by Legionella bacteria. These bacteria can also cause a milder illness called Pontiac fever. The signs and symptoms of Legionnaires’ disease include fever, cough, shortness of breath, muscle aches, pneumonia, and sometimes diarrhea and abdominal pain. Pontiac fever has similar symptoms but does not progress to pneumonia. Antibiotics are highly effective against Legionella bacteria.

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Legionella bacteria are commonly found in the environment (rivers, lakes, streams). It is a waterborne disease, usually spread by man-made water supplies that aerosolize water, such as showers, hot water tanks, cooling towers, whirlpool spas, and decorative fountains. People can get Legionnaires’ disease when they breathe in a mist containing the bacteria. People may also be exposed to Legionella bacteria from water that “goes down the wrong pipe” (aspiration). In general, the bacteria are not spread from one person to another.

People who are at most risk of developing Legionnaires’ disease are those who are older, smokers/former smokers, have a weakened immune system, and those who have other underlying or chronic health conditions.