Notes from the Field: Two Cases of Legionnaires’ Disease in Newborns After Water Births — Arizona, 2016

نویسندگان

  • Geoffrey Granseth
  • Rachana Bhattarai
  • Tammy Sylvester
  • Siru Prasai
  • Eugene Livar
چکیده

Legionnaires’ disease is a severe, sometimes fatal disease characterized by fever, myalgia, cough, and clinical or radiographic pneumonia, caused by inhaling or aspirating small droplets of water containing Legionella bacteria.* In 2015, approximately 6,000 cases of Legionnaires’ disease were reported in the United States (1). Nearly 10% of cases are fatal (2). The number of reported cases of Legionnaires’ disease in Arizona has increased in recent years. Surveillance data from Arizona’s Medical Electronic Disease Surveillance Intelligence System (MEDSIS) identified 46 reported cases in 2011 and 93 in 2015 (3), representing more than a 100% increase. During 2011–2015, only one case was reported in an infant aged <1 month; however, during the first 4 months of 2016, two cases were reported in infants, both of whom were delivered at home in a birthing tub (water births). The first case was reported to the Maricopa County Department of Public Health (MCDPH) during January 2016. The infant was delivered at home by a midwife on January 6, 2016 in a tub filled with tap water. The 1and 5-minute Apgar scores were 5/10 and 9/10, respectively. The following day the infant was taken to a local emergency department with severe respiratory distress, tachypnea, and hypoxemia, where a diagnosis of congenital heart disease was made; the infant was transferred to children’s hospital A. An initial chest radiograph showed a confluent opacity in the lower left lobe, which was initially thought to represent atelectasis, although pneumonia could not be excluded. During the hospital stay, serial chest radiograph revealed persisting bilateral pulmonary infiltrates with possible cavitary lesions. The infant was later transferred to children’s hospital B where a bronchoscopy was performed, and a bronchoalveolar lavage culture tested positive for Legionella pneumophila, later identified at CDC as serogroup 1. The patient was treated with a 10-day course of azithromycin, but remained hospitalized for more than 2 months, primarily because of the congenital heart disease. MCDPH conducted an epidemiologic investigation to identify the etiology of Legionnaires’ disease and provide recommendations based on potentially remediable transmission routes. The investigation revealed that a newly purchased

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عنوان ژورنال:

دوره 66  شماره 

صفحات  -

تاریخ انتشار 2017