The South Bronx Legionnaires’ disease outbreak saw an increase of one case, bringing the case tally to 101. The death toll from the outbreak remains at 10, according to New York City health officials.

The New York Daily News reports of the first legal action over the outbreak. The news agency reports that one of the 101 patients, 36-year-old Marvin Montgomery  would be the first to file a notice of claim against the city — the first step in a lawsuit. The paperwork will be filed Friday, said his attorney Adam Slater.

Gov. Andrew Cuomo/photo donkeyhotey
Gov. Andrew Cuomo/photo donkeyhotey

The Legionnaires’ disease outbreak has also got political as a mini-battle between the New York Governor Andrew Cuomo and NYC Mayor Bill de Blasio has commenced. The Wall Street Journal reports:

Mr. Cuomo’s office, after largely staying silent in the initial days of the outbreak, grew increasingly aggressive in its response to the situation. After announcing the state’s plan of action and sending people to the Bronx, the governor’s office called a news conference Friday.

Aides to the mayor, after seething over the governor’s actions, didn’t hide their dissatisfaction with the way the news conference unfolded. “We were not pleased that our health commissioner had to interrupt the state health commissioner in order to speak,” said Karen Hinton, the mayor’s chief spokeswoman.

Politics aside, health officials offered information to health care practitioners this week concerning diagnosis and treatment of Legionnaires’ patients:

Physicians should maintain a high index of suspicion for Legionella infection among people who live in, work in, or visit the South Bronx and have respiratory illness or sepsis. Patients are at highest risk for infection and severe disease if they have an immune-compromising condition, chronic lung disease, or diabetes, if they are past or current smokers, and if they are elderly.

Legionella infection is best diagnosed by urine antigen test or culture of a respiratory tract specimen (sputum, tracheal aspirate, or bronchoalveolar lavage). Respiratory tract specimens should ideally be obtained before initiation of antibiotics, although antibiotics should not be delayed to obtain a specimen. When ordering cultures, physicians must specify that the culture is for Legionella, because the laboratory must use special culture media. We do not recommend serology as a method of diagnosis. Legionnaires’ Disease cannot be distinguished from other causes of pneumonia on clinical or radiologic grounds.

Empiric treatment of community-acquired pneumonia should include adequate coverage for Legionella with either a macrolide (e.g., azithromycin) or a fluoroquinolone (e.g., levofloxacin).

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