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Michigan health officials are investigating a nursing care facility in Three Rivers that tested positive for Legionella bacteria.

Yvonne Atwood, the personal health and disease prevention director at Branch-Hillsdale-St. Joseph Community Health Agency (BHSJCHA), said 14 of the 22 environmental samples collected at the facility tested positive for Legionella, the bacterial pathogen that causes Legionnaires’ disease.

The BHSJCHA has asked for assistance with its investigation from the Michigan Department of Health and Human Services (MDHHS).

“Based on guidance from the U.S. Centers for Disease Control and Prevention (CDC), this level of contamination indicates potential risk to patients and visitors at the nursing care facility in St. Joseph County,” a notice released by the BHSJCHA read. “An environmental assessment has been conducted, and remediation has been initiated to eliminate the source of contamination.”

Testing was ordered after an Allegan County man staying at the facility was diagnosed with Legionnaires’ disease, a severe pneumonia-like illness. Tri-County health officials are not naming the southwestern Michigan facility unless they can definitively identify it as the origin of the disease.

Atwood verified that testing was underway to determine if water at the facility is the source of the Legionella.

Possible sources

Legionella are contracted by inhaling microscopic water droplets in the form of mist or vapor. The bacteria, which thrive in warm water, are found primarily in human-made environments, such as:

  • water systems of large buildings (hospitals, nursing homes, hotels, etc.)
  • large plumbing systems
  • air-conditioning system cooling towers
  • hot-water heaters and tanks
  • bathroom showers and faucets
  • physical therapy equipment
  • whirlpools and hot tubs
  • swimming pools
  • mist machines and hand-held sprayers
  • decorative fountains.
Numerous steps taken

The Allegan County Communicable Disease team said it determined that the onset of the patient’s illness occurred during the two weeks he was being treated at the Three Rivers facility, although he was diagnosed with Legionnaires’ disease after his stay. Information regarding his condition was not released.

According to the BHSJCHA notice, the facility has been directed to assess the status of its water-management program, comply with the ongoing public health investigation, and conduct public notifications describing the possible risk of infection. The facility also has been requested to:

  • Coordinate with public health officials in support of on-site evaluation of water systems.
  • Notify clinicians of the possible facility-associated cases and remind them of appropriate patient-testing requirements.
  • Conduct appropriate notification to those at possible risk of infection. This includes risk messaging, and education to patients at discharge from inpatient stays, including why they may be at risk for Legionnaires’ disease, what the symptoms are, and what to do if they have these symptoms for up to 14 days after discharge. Similar communication should be sent to all patients discharged from the agency since Feb. 1.
  • Inform the BHSJCHA immediately if they learn of other Legionnaires’ disease diagnoses among patients, visitors, or staff.
Water restrictions

“The facility has been put on water restriction,” said Rebecca Burns, BHSJCHA health officer. “No showers, for example.”

The facility’s water is supplied by a municipal system that does not chlorinate its water. Outside water is being used for client care.

High-risk groups

Anyone can become ill from Legionella, but those most susceptible include:

  • people 50 years of age or older
  • smokers, both current and former
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one)
  • heavy drinkers of alcoholic beverages.

Additionally, recent travel and overnight stays in hospitals or other health-care facilities can increase the risk for Legionnaires’ disease. Patients with pneumonia should be tested for the disease if they have any of the following histories:

  • failed outpatient antibiotic treatment for community-acquired pneumonia
  • immunocompromised
  • admitted to an ICU
  • traveled within 10 days before onset of symptoms
  • hospitalized within 10 days of being diagnosed
  • developed pneumonia after 48 hours of hospital admission.
Legionnaires symptoms

Legionnaires’ disease usually develops two to 10 days after exposure to Legionella bacteria. It frequently begins with the following symptoms:

  • headache
  • muscle pain
  • chills
  • fever, which can be 104 degrees Fahrenheit or higher.

By the second or third day, other symptoms develop, including:

  • cough, which can bring up mucus and sometimes blood
  • shortness of breath
  • chest pain
  • gastrointestinal symptoms, such as nausea, vomiting, and diarrhea
  • confusion and other mental changes.

Although Legionnaires’ disease primarily affects the lungs, it occasionally can cause infections in wounds and other parts of the body, including the heart.