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A bacteria that can cause the deadly lung disease – commonly known as Legionnaires' – has been found in two Pennsylvania lung transplant patients.
The transplants were given by a single donor in Philadelphia in May 2022, according to a CDC release on Friday, Sept. 15.
The Pennsylvania Department of Health was notified in July 2022 and the patients learned they had the disease in June.
The donor was a 30 to 39-year-old man who had fallen into a river and was submerged for five minutes or more. Despite resuscitation efforts, he sustained anoxic brain injury – also known as brain death. His organs were recovered for donation within seven days of his drowning.
"At the time, exposure to Legionella was not suspected, and no testing for Legionella was performed on any donor specimens before or after organ recovery," the CDC said.
After the patients' infections were detected in June, the CDC led an investigation team into how both patients contracted the bacteria. The first patient is a woman between 70 and 79, she received her donation the same day as a 60 to 69-year-old man. Both had their infections detected by CT scans – the woman's performed at 9 days post-op and the man's at 24 days.
The woman was treated with doxycycline treatment and has fully recovered.
The man suffered post-operative complications, including the need for an extracorporeal membrane oxygenation and renal replacement therapy machine, which pumps blood outside the body to remove carbon dioxide and allows the heart and lungs to rest – in addition to renal failure care.
He was given a doxycycline treatment during that process, but before his Legionnaires' diagnosis, and showed signs of recovery. Pneumophila by culture at a commercial laboratory. "After a prolonged hospital stay, he died approximately 6 months after the transplant surgery due to respiratory failure secondary to a mucous plug," the CDC explained.
The other transplant recipients from the same donor – heart, liver, and right kidney – all tested negative for the bacteria.
No other cases were reported at the hospital in the six months prior to this incident or since the CDC reports.
"Although laboratory testing did not confirm the source of recipient infections, available data suggest that the most likely source was the donor lungs," the CDC stated. "This cluster highlights the need for increased clinical awareness of possible infection with Legionella in recipients of lungs from donors who drowned in freshwater before organ recovery. "
Legionnaires’ disease is a pneumonia type of lung infection caused by bacteria called Legionella. Symptoms, which can take up to two weeks to develop, can include fever, chills, cough, shortness of breath, chest pain, muscle aches, and headache. If Legionnaires’ disease is suspected, only tests ordered by a doctor can confirm the diagnosis. Legionnaires’ disease is treatable with antibiotics.
People over the age of 50, especially those who smoke, or those with certain medical conditions, including weakened immune systems, chronic lung disease, or other chronic health conditions, are at increased risk for Legionnaires’ disease if exposed.
Legionnaires’ disease is typically transmitted by breathing in small droplets of water containing Legionella bacteria. Aerosolized water can come from cooling towers, hot tubs, cooling water misters, decorative fountains, and plumbing systems. Home air conditioning units do not use water to cool and are not a risk for Legionella growth. These organ donations are the first ever report of the disease being transmitted in this fashion.
Legionella outbreaks are on the rise worldwide with more than 10,000 new cases reported in the USA each year since 2018 – a peak of 2.71 cases per 100,000 persons, according to the Centers for Disease Control and Prevention.
There was also an investigation into a Legionnaires outbreak in the Lancaster County Prison over the summer, but in that case, the contamination did come from the facility and was found in seven places.
There are also active investigations into Legionnaires outbreaks at a hotel in Las Vegas, the City and Town of Ithaca, two counties in New Jersey, and a US military base in Poland.
You can read more about the disease on the CDC website by clicking here.
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