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Dr Richard W Gilpin’s Blog

Legionellosis - New York Assisted Living Facility, Persistent Legionella

A ProMED-mail post. http://www.promedmail.org.

ProMED-mail is a program of the International Society for Infectious Diseases. http://www.isid.org.

Date: Thu 28 Mar 2019.

Source: The Altamont Enterprise [edited].

https://altamontenterprise.com/03282019/legionnaires-outbreaks-2019-and-2012-same-bacteria.

The Legionella bacteria that caused an outbreak in February [2019], sickening 2 residents of the Promenade at University Place Assisted Living facility [see ProMED-mail post Legionellosis - USA (02): (NY) fatal, assisted living facility http://promedmail.org/post/20190223.6332765], killing one of them, has been found to match samples from a 2012 outbreak when the building, on Route 20 in Guilderland, was a Best Western Hotel. [See ProMED-mail post Legionellosis - USA: (NY) hotel http://promedmail.org/post/20120205.1033536. 6 cases of Legionnaire's disease were linked to the water system at Best Western Sovereign Hotel in Albany, New York, in 2012; the water system was subsequently remediated at that time.]

The announcement was made on Wednesday [27 Mar 2019] in a joint release from the state and county health departments. "Using specialized testing called whole genome sequencing, the state's Wadsworth Laboratories has determined that the Legionella bacteria from clinical samples from the facility match the Legionella bacteria cultured from water samples found in the existing internal plumbing system," the release said.

Wadsworth also compared the recent samples with samples from the 2012 outbreak and found they were a "molecular match," the release said. No cases of Legionnaires' disease have been identified since the investigation.

[Another news report added that state officials say the testing for Legionella before the Promenade opened in October 2018 was negative and said, "The Promenade has both short- and long-term water testing programs they've been working to develop ever since, including installing new shower and sink filters and providing bottled water." (https://wnyt.com/health/legionella-promenade-at-university-place-assisted-living-facility-guilderland/5294705/).

Legionella are gram-negative bacilli that are found in both natural freshwater environments, like lakes and streams, and in manufactured plumbing systems, such as showerheads and sink faucets, cooling towers, decorative fountains, and hot tubs/spas and hot water tanks and heaters. Eradication of these bacteria from plumbing systems is often difficult. Long-term persistence within these water systems is favored by the intracellular location of Legionella within several species of protozoa, where Legionella replicate and which provide protection from environmental stressors, like biocides and heat treatment; the formation of biofilms allows adherence of Legionella to the inner surfaces of the plumbing systems.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835138/). Legionella pneumophila have been shown to persist for long periods after exposure to a biocide or heat treatment in biofilms in a viable but nonculturable (VBNC) state. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515819/). Monitoring L. pneumophila in water systems usually done by culture would miss VBNC Legionella, which can be revived by the subsequent addition of ameba (https://www.ncbi.nlm.nih.gov/pubmed/18839249). The persistence of Legionella over many years in the water system at the Promenade at University Place Assisted Living facility, despite negative cultures, could perhaps be due to VBNC organisms.

The Promenade at University Place. (https://blog.timesunion.com/ishoplocal/promenade-at-university-place-the-capital-regions-new-senior-living-community/143/). occupies a former Best Western Sovereign Hotel located at 1228 Western Ave., Albany, NY that had been converted into 170 residential units each with a private bathroom, cooking facility and sleeping area for seniors, that offers 3 meals per day and assistance with activities of daily living and personal care. (https://www.townofguilderland.org/sites/guilderlandny/files/uploads/master_application_-_guilderland_ida_albany_place_development_final.pdf).

A map showing the location of this assisted living facility can be found at. https://www.google.com/maps/place/1228+Western+Ave,+Albany,+NY+12203.

- Mod.ML.