Legionnaires' outbreak confirmed at Poly-Seal Health authorities search Holabird plant for source of bacteria

4 in family are stricken

October 08, 1998|By Scott Shane and Joe Mathews | Scott Shane and Joe Mathews,SUN STAFF

As medical detectives searched a Southeast Baltimore plastics factory yesterday for a microscopic killer, Maryland health officials confirmed three cases of Legionnaires' disease among the plant's workers, including a 51-year-old jazz singer who died last week.

Six more workers at the Poly-Seal Corp. suffered respiratory illness, including three who had pneumonia, but tests to confirm that they were infected with the Legionella pneumophila bacteria are not complete, said Dr. Diane Dwyer, chief epidemiologist for the Maryland Department of Health and Mental Hygiene.

In addition to Joenell Fisher, who died Thursday, three workers were hospitalized, but all have been released and are in satisfactory condition, she said.

Several more employees have reported cough, fever and other symptoms consistent with Legionella infection, Dwyer said.

But because the symptoms so resemble ordinary cases of colds and flu, only tests can link the illness to the Legionnaires' outbreak, she said.

"We are asking any employees with symptoms to call and report their illness to Poly-Seal," Dwyer said. Health department investigators will interview the patients, she said.

Among the ailing employees are four members of a single family.

Catherine Combs; her two daughters, Theresa Stern and Donna Monicle; and Combs' sister, Rosemary Smith, said yesterday that they all worked near Fisher at the plant and contracted illnesses they believe to be part of the outbreak.

All but Monicle said their doctors were treating them with Legionnaires' in mind, although none has required hospitalization.

Legionnaires' disease is not common, but 23 cases, including one death, were reported in Maryland this year before the current outbreak, health officials said. Last year, 23 cases, seven of them fatal, were reported in the state.

Health officials believe 10 times as many cases may go unreported, because antibiotics often cure the illness before doctors order tests. Blood tests can take several weeks to produce definitive results; a urine test can identify many Legionella infections within 12 hours.

What makes the Poly-Seal illnesses unusual is the cluster of cases at one workplace, which suggests the bacteria came from one source of tainted water.

Dwyer said the last such cluster in Maryland occurred at a health care facility in 1990.

Some 15 investigators from the state and city health departments, the Maryland Occupational Safety and Health program and the Johns Hopkins University worked yesterday to interview patients and inspect Poly-Seal's closed east building, where the all the ailing employees worked.

They took swabs from cooling towers, air conditioners and other water sources, which will be cultured in laboratories and examined for the presence of Legionella. Eventually, investigators will try to match the molecular fingerprint of Legionella bacteria infecting the patients with the samples from the plant, officials said.

The investigators are searching for a rod-shaped bacterium that is common in water supplies but proliferates and becomes dangerous under particular conditions.

Dormant in cool water and killed by very hot water, Legionella bacteria thrive in stagnant water at 95 to 115 degrees Fahrenheit; they can be found in natural hot springs.

To infect a person, the contaminated water must be aerosolized and the tiny droplets inhaled deep into the lungs, said Dr. Victor L. Yu, an infectious disease specialist at the University of Pittsburgh and expert on Legionnaires'.

Past outbreaks have been linked to showers, hospital humidifiers, produce-spraying machines at grocery stores, even a crack in a plastic-molding machine that sprayed cooling water. Drinking water can cause Legionnaires', but only if a person chokes and aspirates the water.

The fatality rate of Legionnaires' is 5 percent to 15 percent; smokers, the elderly and people with compromised immune systems are most at risk.

Tracking the source of Legionnaires' in hospitals, where many cases occur, can be relatively easy, Yu said. Elsewhere, tracking the source is far more difficult.

"In the community, you build the jigsaw puzzle much more slowly," he said. "There are many outbreaks where the source is never found." The incubation period between exposure and illness, two to 10 days, complicates the tracing process, Yu said.

The Legionella organism grows in the "biofilm" that forms on water-using equipment, a slimy layer of moisture and mineral deposits where amoeba often live, said Sharon G. Berk, a microbiologist at Tennessee Technological University. "Amoeba will feed on Legionella and become infected, and then the Legionella grows inside the amoeba," she said.

At the Poly-Seal plant on Portal Street, suspicion naturally falls on the industrial cooling system used in the manufacture of plastic caps and seals, as well as the building's air-conditioning system.

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