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Legionnaires outbreak a mystery, may be tied to summer’s late start

Disease has seriously sickened 31 people in Milwaukee area since June 1

By Karen Herzog of the Journal Sentinel

July 21, 2013
A mysterious, potentially fatal form of pneumonia that cropped up in the Milwaukee area last month may be linked to, of all things, summer’s late start.

Public health officials have not determined the environmental source of the Legionnaires’ disease that has seriously sickened 31 people in southeastern Wisconsin since June 1. It’s possible they never will find the source, if the legionella bacteria that caused the disease already dissipated.

One theory points to cooling towers on top of large buildings, prepped and waiting for hot weather that arrived unusually late, in mid-June.

Photo courtesy of Gilman family. Greg Gilman, 49, (with daughter Mariah Gilman and granddaughter Jazelyn) wonders what building he happened to be near when he contracted a potentially fatal form of pneumonia called Legionnaires’ disease.

The outbreak has the families of victims such as 49-year-old Greg Gilman grasping for answers.

Gilman and at least four others might have been within a few-mile radius at about the same time in June, family members said they were told. Public health officials haven’t disclosed the geographic location because it’s an active investigation.

Gilman, who lives in Waukesha but works in St. Francis, is a smoker with newly diagnosed emphysema. He’s one of four people in Waukesha County diagnosed with Legionnaires’ since June 1.

Gilman drove himself to Waukesha Memorial Hospital July 5 because he couldn’t breathe. He spent nearly two weeks in a medically induced coma and on a ventilator while being treated with antibiotics. His kidneys failed, requiring daily dialysis.

Now in critical but stable condition, he is breathing with the help of a tracheotomy, according to family members.

Towers that use water to cool buildings are suspect because they have a seasonal maintenance schedule that assumes hot weather before mid-June, said Paul Biedrzycki, director of disease control and environmental health for the Milwaukee Health Department.

The towers are filled with water in late April or early May, so they’re ready to cool buildings as soon as it gets hot outside, Biedrzycki said.

Because the water sat in rooftop cooling towers from early spring until sometime in June, it could have stagnated and become dirty, allowing legionella bacteria to colonize, Biedrzycki said. When air-conditioning units finally were flipped on, the cooling towers could have spewed the bacteria into the air. The bacteria could travel a few miles beyond the buildings on water droplets.

Chlorine that’s automatically fed through cooling towers once air conditioning is turned on for the first time may not have reached appropriate levels yet to kill the legionella, Biedrzycki said.

Someone randomly passing within a few miles of contaminated cooling towers could have inhaled the airborne bacteria. Those with heart or lung conditions would be most vulnerable.

Biedrzycki said there isn’t a single source common to all 14 city of Milwaukee cases, or even to a cluster of a half-dozen cases that appear to be related.

“In absence of a smoking gun after a week of looking, I wonder whether there was a seasonality factor,” he said, referring to the cooling towers and timing of hot weather.

Four of the 14 Milwaukee people sickened by the bacteria remain hospitalized but are expected to recover, Biedrzycki said. Some of the 17 cases in surrounding counties may be linked to exposure in Milwaukee, too.

The last report of Legionnaires’ in the city was last Monday. It can take up to 14 days from exposure to the bacteria until symptoms begin, though the Milwaukee cases have had incubation of four to five days on average, Biedrzycki said.

Three years ago, a Legionnaires’ outbreak that sickened eight people was linked to a decorative waterfall inside a Cudahy hospital. The waterfall was contaminated with high levels of the heat-loving legionella bacteria.

The first recognized cases of Legionnaires’ disease occurred in 1976, when 4,000 World War II veterans and their families and friends attended an American Legion convention at the Bellevue-Stratford Hotel in Philadelphia. A total of 221 Legionnaires were infected, and 34 died. Officials identified what’s now known as legionella bacteria, but they never found its source.

Water samples negative

Those sickened in the current Milwaukee-area outbreak weren’t in a common building, Biedrzycki said.

Water samples have been taken from outdoor decorative fountains and pools with water-spraying devices — anything other than building cooling towers that could aerosolize legionella bacteria. Tests of those samples, and of swabs taken from surfaces of devices that spray warm water, so far have come back negative for legionella, Biedrzycki said.

A total of 37 cases of Legionnaires’ disease have been confirmed statewide since June 1, including 31 cases in contiguous counties in southeastern Wisconsin: 20 in Milwaukee County, four in Waukesha County, three in Racine County, three in Walworth County and one in Kenosha County, according to epidemiologist Tom Haupt of the state Department of Health Services.

“At least four or five cases had onset of symptoms on the Fourth of July, with an incubation period up to 14 days prior,” Haupt said.

Officials have been investigating whether those individuals shared a common travel history in or around Milwaukee in the same time frame.

“We may never know which cases are related,” Haupt said. “When you can’t pinpoint it to one location, it makes it extremely difficult.”

Legionnaires’ cases are confirmed every year in Wisconsin. Last year, there were 93 cases statewide. In 2011, there were 69 cases, and in 2010, 63 cases, according to Haupt. So far this year, the state has seen 53 cases, including the 37 since June 1.

The recent cases in Milwaukee make up one of the larger clusters detected in the state in a while, Haupt said.

Patient put in ICU

Gilman works for a chemical company in St. Francis, but no one else at his workplace has reported symptoms of Legionnaires’, said his ex-wife, Jacqueline Mijokovich.

“They said two days before he went into the hospital, he looked like death warmed over,” she said. “His friends were telling him to see a doctor because he was struggling to breathe and running a fever.”

When he drove himself to the hospital, Mijokovich said, Gilman thought the doctor would give him an antibiotic and send him home. Instead, he was admitted to the hospital. Two days later, he was moved into an intensive care unit and “was scared to death,” Mijokovich said.

Gilman is fighting for his life.

He opened his eyes for the first time on Thursday and his 4-year-old granddaughter, Jazelyn Uhrmann, showed him colorful get-well pictures that she had painted for him.

“One eye had a tear in it,” recalled Mariah Gilman, the girl’s mom and Gilman’s daughter. “The simple things in life you take for granted — just to see his eyes open,” Gilman said. “I started bawling.”