Monday, September 10, 2018

PRO/EDR> Pneumonia - Italy: (LM) fatal, waterborne, susp., RFI

PNEUMONIA - ITALY: (LOMBARDY) FATAL, WATERBORNE, SUSPECTED, REQUEST
FOR INFORMATION
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Date: Sun 9 Sep 2018
Source: ANSA Lombardy [in Italian, machine trans.,edited]
<http://www.ansa.it/lombardia/notizie/2018/09/08/piu-di-150-casi-polmonite-nel-bresciano_606fc12c-3eca-4d64-9dd0-a4a2f2c39d73.html>


[Figure shows a map of what appears to be the Lombardy Region of Italy
(<https://en.wikipedia.org/wiki/Lombardy#/media/File:Lombardie70.gif>)
with 2 pie charts:]
1. In the July [2018] legionellosis outbreak in Bresso: 52 cases, 4
deaths
[Bresso is a city with a population of 26 255 residents (2001) in the
Province of Milan in the Italian region of Lombardy, located about 8
km (5 miles) north of Milan; (<https://en.wikipedia.org/wiki/Bresso>).
ProMED-mail previously reported this outbreak. See Legionellosis -
Italy: (LM) fatal http://promedmail.org/post/20180727.5931959. -
Mod.ML.]

2. In the September [2018] pneumonia outbreak in eastern Bassa
Bresciana (towns of Carpenedolo, Montichiari, Calvisano, Visano,
Acquafredda, and Remedello): over 150 cases; 121 were seen in an
emergency room
[Bassa Bresciana, with a population of about 169 000 residents in
2014, is a zone in the southeastern part of the Province of Brescia of
the Lombardy Region, near Lake Garda
(<https://en.wikipedia.org/wiki/Province_of_Brescia#/media/File:Brescia_Province_Map.svg>
and <https://it.wikipedia.org/wiki/Bassa_Bresciana_orientale>). -
Mod.ML]

The numbers are those of an epidemic. And they have increased in the
last hours. Cases of pneumonia in lower Brescia [Bassa Bresciana]
region have exceeded 150. Six municipalities are particularly
[involved] -- Carpenedolo, Montichiari, Calvisano, Visano,
Acquafredda, and Remedello -- and 121 people [sought hospital care].

Investigations were made on the deaths of 2, an 85-year-old from
Carpenedolo and a 69-year-old from Mezzane di Calvisano from Brescia,
to assess whether the deaths are related to the cases of pneumonia in
the Lower Bresciana Orientale. "According to ATS [L'Agenzia di Tutela
della Salute (ATS) or The Health Protection Agency], both deaths in
the affected district of pneumonia cases are not due to
[legionellosis]," ANSA was told by mayor Stefano Tramonti of
Carpenedolo, a town in Brescia.

[However,] the hypothesis of a bacterium present in water is not
excluded. The cases bring to mind the [legionellosis] emergency that
broke out in July [2018] in Bresso, a municipality in Milan's
hinterland. "Of the 121 cases who sought 1st aid for pneumonia, 109
are resident or domiciled in the territory of ATS Brescia, and 12 are
resident or domiciled in ATS Valpadana. A total of 107 are
hospitalized," says the Lombardy Region commissioner Giulio Gallera.
The Istituto Superiore di Sanita is also involved in the assessment of
the situation.

Yesterday afternoon [Sat 8 Sep 2018] in Brescia, a summit was held
between ATS, the health protection agency, and those responsible for
the aqueducts of the Lower Brescia region to assess the possible
connection between cases of pneumonia and the presence of a bacterium
in the water. "The supervisory staff of the Department of Hygiene and
Health Prevention and of the Public Health Laboratory of ATS Brescia,"
Gallera explained, "is engaged in the verification of the water
network of the municipalities concerned; in particular, the hygiene
technicians are carrying out sampling of drinking water while the
laboratory has ongoing specific analyses whose outcomes will be
available in the coming days."

Meanwhile, ATS has sent a note to the mayors of the municipalities of
Brescia with some rules to be followed at this stage, even if it was
assured that "there is no risk of using food and [potable?] water and
there is no restriction to the normal development of the activity in
the various communities, between schools and workplaces" underlying
the Lombardy Region. Among the requests made to the population, there
are those to replace the filters of the taps or to wash them with
anti-limescale, to let the hot water flow and then the cold before
using it, and to move away from the emission point after opening the
taps and opening the windows. It is also suggested to bring the hot
water temperature to 70-80 deg C [158-176 deg F] for 3 consecutive
days, ensuring its outflow from all dispensing points for at least 30
minutes a day. In July [2018] in the Milan hinterland, the
[legionellosis] emergency broke out: 52 cases confirmed, 4 dead.

--
Communicated by:
Remigio Russo
<russoremigio@yahoo.it>

[ProMED-mail thanks Remigio Russo for submitting this news report of a
pneumonia outbreak in Bassa Bresciana, in the Province of Brescia in
the Lombardy Region of Italy. ProMED-mail recently reported on a
legionellosis outbreak in nearby Bresso, a city in the Province of
Milan, also in the Lombardy region.

Legionnaires' disease, a form of pneumonia caused by _Legionella_, a
water-borne bacterium, occurs most commonly in people with advanced
age and underlying medical conditions. The underlying medical
conditions are often found to be the cause of death at autopsy,
although legionellosis is likely a contributing factor. Such may be
the case for the 2 deaths in the current pneumonia outbreak in Bassa
Bresciana. More information would be appreciated from knowledgeable
sources on the microbial diagnoses on the more than 150 cases of
pneumonia in Bassa Bresciana. The suspected source for this outbreak
is said to be a water-borne bacterium, which suggests it may be
_Legionella_; but how many patients had a positive urinary antigen
test or sputum culture for this organism? Genotyping the _Legionella_
strains isolated sputum will help establish whether this is a common
source outbreak, if the genotypes match. However, if the diagnosis of
legionnaires' disease is based only on a positive urinary antigen
test, there will be no isolates for genotyping. - Mod.ML

HealthMap/ProMED-mail map:
Lombardy, Italy: <http://healthmap.org/promed/p/9585>]

[See Also:
Legionellosis - Italy (02): (LM) fatal, background Legionellosis -
Italy: (LM) fatal http://promedmail.org/post/20180727.5931959
Legionellosis - France: RFI
http://promedmail.org/post/20180622.5870859
Legionellosis - Portugal: (Lisbon) nosocomial, RFI
http://promedmail.org/post/20180201.5599692
2016
----
Legionellosis - Italy (02): (PR) fatal, more cases
http://promedmail.org/post/20161017.4565806
Legionellosis - Italy: (PR) fatal, RFI
http://promedmail.org/post/20161005.4538287
2012
----
Legionellosis - Italy: (Rome) dental exposure
http://promedmail.org/post/20120218.1045716
2011
----
Legionellosis - Italy (04): (VR) travelers, Eurosurveillance report
http://promedmail.org/post/20111008.3020
Legionellosis - Italy (02): (VR) travelers
http://promedmail.org/post/20110915.2817
Legionellosis - Italy: (VR) travelers
http://promedmail.org/post/20110914.2802
2006
----
Legionellosis - Italy (Venice): alert
http://promedmail.org/post/20060912.2588]
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