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Legionnaires’ disease diagnosed in Fresno nursing home patient

A resident at Horizon Health & Subacute Center in northeast Fresno was diagnosed with Legionnaires’ disease in late December 2016. Cases of Legionnaires’ disease have been increasing in the county and nationwide.
A resident at Horizon Health & Subacute Center in northeast Fresno was diagnosed with Legionnaires’ disease in late December 2016. Cases of Legionnaires’ disease have been increasing in the county and nationwide. banderson@fresnobee.com

Fresno County’s health officer alerted hospitals and nursing homes three months ago that cases of Legionnaires’ disease have been increasing in the county and nationwide – and three weeks ago a resident of a northeast Fresno nursing home was diagnosed with the respiratory disease.

Fresno County health officials confirmed Thursday that Legionnaires’ disease had been diagnosed in a resident at Horizon Health & Subacute Center.

The resident’s health status and name were not released because of patient confidentiality laws.

The county was notified Dec. 27 of the diagnosis, said Dr. Ken Bird, Fresno County’s health officer. Horizon and the acute-care hospital where the resident had been admitted contacted the county, he said.

Legionnaires’ disease is caused when water that is contaminated with the Legionella bacteria is converted into a fine spray and is inhaled, or less often, is aspirated. The bacteria causes pneumonia that is not contagious from person to person. Water restrictions, such as not using showers, drinking only bottled water and not using ice from machines, are ways to control the spread of the infection.

The 180-bed nursing home on East Herndon Avenue has been on water restrictions pending correction with either super-heat treatment or hyper-chlorination of the water system, Bird said Friday. The restrictions that remain: only bottled water for drinking; point-of-use filters on all showers; no use of ice made at the nursing home; only sterile water for respiratory devices and procedures. The hospital can cook with the water.

New residents can be admitted as long as the restrictions are in place, Bird said.

On Friday, Horizon Administrator Stepan Sarmazian said he thanked the county and state health departments for working with the nursing home: “All of our residents are safe; they’re well. We’ve had no new documented cases. None of our family members or employees are ill. Everyone is safe.”

Bird said results of Legionella testing on other residents with clinical pneumonia had not been shared with him as of Friday morning. But it’s not uncommon, especially this time of year, for residents in long-term care institutions to have pneumonia that is not Legionnaires’ disease, he said.

The Horizon case is only the most recent in Fresno County. In the past 24 months there have been two confirmed and four possible health care-associated cases. There have been other cases that could not be connected to health care institutions. In the past year, Bird said there were nine confirmed or suspected cases of Legionnaires’ disease that included two deaths.

In October, Bird sent an advisory to health care institutions to be on the lookout for Legionnaires’ disease.

And in a follow-up letter in November, Bird recommended that “patients admitted to a hospital with pneumonia and underlying risk factors should be tested for Legionella  this includes testing patients with acute pneumonia admitted to a hospital from a skilled nursing facility or long-term care facility, and patients who develop pneumonia during an inpatient hospitalization.” A simple urine test is used to determine Legionnaires’ disease.

Bird also recommended hospitals and long-term care institutions follow water management guidelines from the federal Centers for Disease Control and Prevention to prevent and control the growth of the bacteria in their water systems.

The pneumonia caused by the Legionella bacteria can look identical to a community-acquired pneumonia, he said. People most at risk are those with chronic health conditions, such as diabetes and immune disorders. But smokers and people older than age 50 also are at higher risk of infection. About 10 percent of people infected die of the disease.

Barbara Anderson: 559-441-6310, @beehealthwriter

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