4 Deaths, 141 Legionnaires' Infections Linked to Hot Tubs

The families of four dead from Legionnaires' disease and 141 infected people can blame a hot tub display at the Mountain State Fair in North Carolina, according to state health officials.

Legionella pneumophilia, the bacteria that lives in pooled water and infects those who inhale water droplets containing the bacteria, causes flu-like symptoms that progress into pneumonia.

Early information gathered by local health departments and a Henderson County, N.C. doctor indicated that most of those infected reported attending the State Fair, which ran from Sept. 6-15 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, NC, according to a statement from the North Carolina Department of Health and Human Services.

Almost 70% of the people infected had to go to the hospital -- a total of 94 people, according to the NC Health Department.

Health department officials tested a broad range of water sources from the WNC Ag Center and found multiple positives for Legionella from different water sources around the building. The center is undergoing an industrial cleaning designed to disinfect any remaining reservoirs of Legionella, the health department states.

What Is Legionnaires' Disease?

Legionnaires' disease and Pontiac fever, a milder form of the illness caused by the same bacteria, cause fever, chills, and cough. At its worst, Legionnaires' disease can cause severe pneumonia and respiratory failure, according to , a MedicineNet author.

"Legionella organisms can be found in many types of water systems," Dr. Schiffman said. "However, the bacteria reproduce to high numbers in warm, stagnant water (95 F-115 F), such as that which is found in certain plumbing systems and hot-water tanks, cooling towers, and evaporative condensers of large air-conditioning systems, and hot tubs. Cases of legionellosis have been identified throughout the United States and in several other countries. The disease likely occurs worldwide."

What Are the Symptoms of Legionnaires' Disease?

Patients with Legionnaires' disease usually develop a fever, chills, and a cough. The cough may either be dry or produce sputum. Some patients with Legionnaires' disease also have muscle aches, headache, tiredness, loss of appetite, and occasionally diarrhea. Legionnaires' disease can cause a severe pneumonia, seriously affect breathing, even lead to respiratory failure and adult respiratory distress syndrome (ARDS), Dr. Schiffman said.

In some cases, the heart rate is slower than expected for the degree of fever. There are no specific symptoms that directly identify Legionnaires' pneumonia. Legionnaires' pneumonia presents in a manner similar to chlamydia pneumonia and mycoplasma pneumonia, so-called atypical pneumonias (previously referred to as "walking pneumonia"). These are referred to as atypical because the associated symptoms and signs are unlike typical pneumonia (as characterized by Streptococcus pneumonia), which involves spiking high fevers, sudden onset, cough, and purulent sputum and often chest pain and a localized infiltrate on chest X-ray, Dr. Schiffman said.

People with Pontiac fever experience a self-limiting influenza-like illness with fever, chills, headache, and muscle aches but, by definition, do not have pneumonia. Sickened individuals generally recover in two to five days without treatment, according to Dr. Schiffman.

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