Epidemic of Legionella Pneumophila Pneumonia South of Brescia (Italy)

Sergio Perini

doi:10.11648/j.ijidt.20210602.13

Abstract

In September 2018, a serious epidemic of Legionella Pneumophila serotypes 1-2-14, diagnosed by the Istituto Superiore Sanita (ISS), occurred in the low plain south of Brescia. This resulted in a considerable number of hospitalizations in the hospitals of the ATS of Brescia and Valpadana (Mantua) with high mortality rate. It was an anomalous situation both for the spread and for the Legionella serotypes which alarmed the Istituto Superiore Sanita and the local health structures. This epidemic is an expressions of the malaise of the geographical area in question caused by the impact of various environmental degradations. Some environmental criticalities: 1-the low water flow of the Chiese river in the summer of 2018 due to the exploitation of water by intensive agriculture and the presence of 22 hydroelectric power plants along its course. 2-the presence of numerous industrial cooling towers with a lack of mapping of the same towers by the political bodies (Region and Municipalities). 3-the abnormal disposal of sludge on the countryside surrounding the agricultural area adjacent to the river bed of the Chiese river as a consequence of the enormous production of livestock waste by pig, cattle and chicken farms in the same area. 4-In the lower Brescia plain there are numerous disposal companies that receive sewage sludge from 15 regions of Italy and also from abroad. 5-different and numerous types of landfills in the municipalities of Montichiari, Rezzato, Ghedi, Calcinato and Bedizzole filled with 12 million cubic meters of toxic-harmful waste. 6- the Lombardy region allows an excessive number of CERs (Catalog European Waste). It concludes by emphasizing how everyone, citizens and institutions, have a great responsibility in the management of the territory and a change of direction is hoped for an economy that has reached limits that it can no longer tolerate. This calls the various responsibilities of Politics, Public Health, the industrial and agricultural world in the management of a territory that continues to send signs of suffering and which is reflected on the health of men, animals and the plant world.

Highlights

I work in Carpenedolo, one of the 7 municipalities of the lower Brescia area involved in this pandemic of pneumonia which took place in September 2018
I dealt with this health emergency by carefully following both the health events of my patients (15 cases of pneumonia on 1600 patients) and the various phases of the health emergency in the whole area managed by the ATS Health Protection Agengy of Brescia
Thanks to molecular biology tests with PCR (Polymerase Chain Reaction) performed by the ISS on 90% of both autopsy and environmental samples, we saw the presence of serotypes 1 and of the rarer serotypes 2 and 14 of Legionella pneumophila

Summary

Introduction

At the beginning of September 2018, a serious epidemic of Legionella pneumophia occurred in the lower Po valley, south of Brescia, involving in particular 7 municipalities (Montichiari, Carpenedolo, Visano, Remedello, Acquafredda, Isorella, Calvisano) comprising nearly 60,000 inhabitants.Legionella pneumophila is a bacteria that colonizes natural and artificial aquatic environments, in particular the peripheral systems of hot water distributions between 25°C and 45°C in hospitals, spas and tourist accommodation facilities.In September, in the area of competence of ATS Brescia and Valpadana, 878 cases of community acquired pneumonia were reported, of which 64 were identified as legionellosis serotype 1 with research of urinary antigens and blood antibodies (IgM and IgG).A community epidemic caused by Legionella pneumophila serogroups other than type 1 has so far never been described in the analysis of the scientific literature [1,2,3].In Italy, clusters of legionellosis have occurred in the hospital setting caued by serogroup 6 and others have been described in the literature caused by other serogroups but always in a nosocomial setting. [1]. At the beginning of September 2018, a serious epidemic of Legionella pneumophia occurred in the lower Po valley, south of Brescia, involving in particular 7 municipalities (Montichiari, Carpenedolo, Visano, Remedello, Acquafredda, Isorella, Calvisano) comprising nearly 60,000 inhabitants. Legionella pneumophila is a bacteria that colonizes natural and artificial aquatic environments, in particular the peripheral systems of hot water distributions between 25°C and 45°C in hospitals, spas and tourist accommodation facilities. A community epidemic caused by Legionella pneumophila serogroups other than type 1 has so far never been described in the analysis of the scientific literature [1,2,3]. In Italy, clusters of legionellosis have occurred in the hospital setting caued by serogroup 6 and others have been described in the literature caused by other serogroups but always in a nosocomial setting.

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