SCOTLAND: LEGIONELLOSIS

PRO/EDR> Legionellosis, hotel - UK: (Scotland)
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LEGIONELLOSIS, HOTEL - UK: (SCOTLAND)
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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: Sat 26 Mar 2011
Source: The Press & Journal [edited]
<http://www.pressandjournal.co.uk/Article.aspx/2197354?UserKey=3D>

A man is in hospital with the potentially fatal Legionnaires' disease
after using the leisure centre at a 4-star hotel in Dundee. Some 66
staff and visitors at the Landmark Dundee have also experienced
flu-like sickness, NHS [National Health Service] Tayside confirmed
last night [25 Mar 2011].
The man who was confirmed positive for the disease is being treated
in Ninewells Hospital.
The health authority and Dundee City Council environmental health
officers said last night [25 Mar 2011] they had carried out
investigations at the hotel after staff and guests reported feeling
unwell. NHS Tayside said that before the single confirmed case, there
was no evidence of _Legionella_ infection in any samples taken.
Consultant in public health medicine for the health authority Dr
Christopher McGuigan said: "To date, 66 people who work in or have
visited Landmark Dundee are known to have experienced flu-like
illness, which has, for the majority, been short-lived and managed
symptomatically at home. We are not recommending that people should
stay away from the hotel as the investigations are focusing on the
leisure club, which has been closed since the evening of Thursday, 17
Mar 2011. We have been working closely with the hotel since the
investigation started late last week, and we are systematically
carrying out all appropriate health and environmental tests."
NHS Tayside has asked anyone who has visited the hotel over the last
2 weeks, and who has been unwell with a flu-like illness -- for
example, high temperature, chills, cough, headache or shortness of
breath -- to seek advice.
Legionnaires' disease, a potentially fatal form of pneumonia, is
caused by types of bacteria commonly found in the environment. People
can become infected when they breathe in air that contains
_Legionella_ bacteria which have been dispersed into the air in very
fine droplets of water.
Most people exposed to these common bacteria do not become ill, and
the disease cannot be spread from person to person. Contaminated water
is usually the source of infection.
[Byline: Rebecca Buchan]
--
Communicated by:
Denis Green <legion@q-net.net.au>
[For a discussion of Legionnaires' disease (LD) and Pontiac fever
(PF), please see the prior ProMED-mail post Legionellosis - USA (02):
(CA) conference, susp 20110304.0713.
Outbreaks of legionellosis are usually either LD or PF; combined
outbreaks of both LD and PF are unusual [1-4]. Why some people
apparently exposed to the same source develop Legionnaires' disease
and others develop Pontiac fever has not been explained.
1. Thomas DL, Mundy LM, Tucker PC. Hot tub legionellosis:
Legionnaires' disease and Pontiac fever after a point-source exposure
to Legionella pneumophila. Arch Intern Med 1993;153:2597-9.
2. Goldberg DJ, Fallon RJ, Green ST, Wrench JG. Pontiac fever in
children. Pediatr Infect Dis J 1992; 11:240-1.
3. Girod JC, Reichman RC, Winn WC, Klaucke DN, Vogt RL, Dolin R.
Pneumonic and nonpneumonic forms of legionellosis. The result of a
common-source exposure to Legionella pneumophila. Arch Intern Med.
1982;142(3):545-7.
4. Benin AL, Benson RF, Arnold KE, Fiore AE, Cook PG, Williams LK,
Fields B, Besser RE. An outbreak of travel-associated Legionnaires
disease and Pontiac fever: the need for enhanced surveillance of
travel-associated legionellosis in the United States. J Infect Dis.
2002; 185(2):237-43.
A excellent review of the topic can be found at: Edelstein PH. Urine
Antigen Tests Positive for Pontiac Fever: Implications for Diagnosis
and Pathogenesis. Clin Infect Dis 2007; 44 (2):229-231. Available at:
<http://cid.oxfordjournals.org/content/44/2/229.full>.
The Landmark Hotel, located on the outskirts of Dundee, Scotland, has
3 bedrooms situated in the old mansion house with the remaining 100
bedrooms located in an extension. The hotel has a "leisure club" with
an indoor heated pool, spa, sauna, solarium, and a 10-station
gymnasium (<http://www.gbstay.com/hotel/AAB104398.htm>).
Dundee, a city in the Tayside region of Scotland, lies within the
eastern central Lowlands on the north bank of the Firth of Tay
(<http://en.wikipedia.org/wiki/Dundee>). Ninewells Hospital, a
teaching hospital on the western edge of Dundee, is administered by
NHS Tayside (<http://en.wikipedia.org/wiki/Ninewells_Hospital>).

THAILAND: UNDIAGNOSED DEATHS

)

UNDIAGNOSED DEATHS - THAILAND (02): (CHIANG MAI)
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org/>

Date: 14 Mar 2011
Source: Phuketwan Tourism News [edited]
<http://phuketwan.com/tourism/young-french-tourists-death-chiang-mai-link-13817/>

Young French Tourist's Death No. 6 in Chiang Mai
------------------------------------------------
The revelation of a 6th death and the results of an investigation by
Thailand's Department of Disease Control has shed new light on the
series of mysterious fatalities in Chiang Mai.

The 6th death involved a Frenchwoman -- one of 2 who fell sick, a
media release from the department says. It highlighted the exceptional
nature of a complaint that appears to have struck down 6 young women
aged 23-33 between 9 Jan 2011 and 4 Feb 2011, killing 3 of them.

These 3 deaths -- the unnamed Frenchwoman, a New Zealand woman also
23, and an American, aged 33 -- have been linked by the media to 3
other deaths, 2 British pensioners, a man and a woman and a
47-year-old Thai guide.

The joint investigation by the department with the Chiang Mai
Provincial Health Office found 4 clinically-confirmed cases of
myocarditis (inflammation of the heart muscle) and another 2 patients
with mild symptoms.

"These 6 patients were among 3 separate groups of tourists visiting
Chiang Mai, Thailand, between 9 Jan 2011 and 4 Feb 2011. All were
young women aged 23-33 years and were from the United States (1),
Canada (1), France (2) and New Zealand (3)." 5 of the 6 women "became
ill while visiting Chiang Mai and one developed symptoms 3 days before
arriving there." However, an extensive epidemiological investigation
"has not revealed any common exposures across the 3 groups."

The media release says autopsies on 2 of the dead patients (American
and French) were done by forensic medical experts from Chiang Mai
University. The joint investigation team found 4 clinically-confirmed
cases of myocarditis (inflammation of the heart muscle) and another 2
patients with mild symptoms. "The autopsies found nothing abnormal
except for inflammation of the heart muscle," it says.

"The Department of Disease Control has shared this information with
the World Health Organisation and US CDC offices in Bangkok, as well
as the New Zealand Embassy and the International Health Regulation
focal points of France and the European Community." The report
carefully distinguishes between the cases involving the 6 young women
and the other cases.

"In a separate episode, since 3 Feb 2011, there were 3 other deaths
in the same hotel where the 3 New Zealanders stayed," it says. "This
included an elderly British couple and a 47-year-old Thai woman. As
these 3 deaths occurred outside the hospital, the police took charge
of the investigation. The autopsies of the 2 elderly Britons found a
high degree of coronary occlusion while the examination of the Thai
woman found no inflammation of the heart muscle or any other clear
evidence to explain the cause of her death."

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SWEDEN: IMPORTED LASSA FEVER

LASSA FEVER, IMPORTED - SWEDEN: (LINKOPING) ex WEST AFRICA
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<http://www.promedmail.org/>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org/>
Date: Tue 8 Mar 2011
Source: The Local (Swedish News in English) [edited]
<http://www.thelocal.se/32470/20110308/>

A Swedish woman is being treated at the intensive care unit of
Linkoping University Hospital in eastern Sweden after being diagnosed
with the deadly disease Lassa fever. The woman was infected in West
Africa, where she had been working for a humanitarian aid
organization. She is the 1st patient ever to be treated for Lassa
fever in Sweden.
The woman's condition is stable, but she will remain isolated for
another few weeks, according to infectious disease specialist Britt
Akerlind. The woman, who is in her 30s, was flown home on a medical
transport flight and arrived in Sweden on Monday [7 Mar 2011] morning.
"She tested positive for the disease in Africa. We have since
conducted some tests here, but the results are not in yet. We are
treating this as a serious illness," Akerlind told news agency TT.
The symptoms of Lassa fever, which infects between 300 000 and 500
000 people annually, include a high temperature and internal
haemorrhaging, but the majority of those that contract the disease
make a full recovery. "Only about one per cent of those infected
become seriously ill, and it is impossible to know in advance who will
be affected worse than others," Akerlind told TT.
Rodents are often carriers of Lassa fever, and the disease is spread
through contact with their faeces. Between humans, the disease is
passed through the exchange of bodily fluids. How the Swedish woman
caught the disease is unknown.
According to Akerlind there is no risk that Lassa fever, which claims
around 5000 lives annually, will spread in Sweden.

SPAIN: FATAL TRICHINELLOSIS

PRO/AH/EDR> Trichinellosis, fatal - Spain: (AR) wild boar meat
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TRICHINELLOSIS, FATAL - SPAIN: (ARAGON), WILD BOAR MEAT
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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: Wed 2 Mar 2011
Source: Diario ABC, Agencia EFE report [in Spanish, trans. & summ.
Sr.Tech.Ed.MJ, edited]
<http://www.abc.es/agencias/noticia.asp?noticia=710697>

An outbreak of trichinellosis was detected in Huesca [Autonomous
Community of Aragon], affecting 5 men and one woman, all residents of
Huesca and aged between 52 and 58 years, who ate sausages from the
meat of a wild boar that one of them had hunted and which was not
subjected to the required veterinary control.
The 6 people began feeling ill on 5 Feb 2011. They consulted the San
Jorge de Huesca hospital and were not admitted at first, but their
condition deteriorated, and they were readmitted days later. One of
them, a 54-year-old man, died yesterday [1 Mar 2011].
According to Aragon public health officials, the brother of the
deceased remains in serious but stable condition in the intensive care
unit; the 3 other men are in stable condition, and the woman has been
released.
Public health officials have indicated that the source of the
outbreak was the wild boar meat. The rest of the meat was identified
and taken for testing and to prevent further cases of the disease.
The main reservoirs of the trichinellosis parasite are domestic
animals such as pigs or wild animals such as wild boars or foxes.
Transmission of the disease occurs through consumption of raw or
insufficiently cooked meat or meat products infected with the larvae
of the _Trichinella_ worm.
--
Communicated by:
ProMED-mail <promed@promedmail.org>
[This outbreak underlines that trichinellae are found in wild animals
also in western Europe. As is the case here, acute trichinellosis may
be life-threatening.
Sausage is a particularly common source of human infection because
the meat is often not heated to a high enough temperature to kill the
parasite when smoked. - Mod.EP]

MALE HYPOGONADISM

• The Guardian, Tuesday 28 September 2010
• Article history

Opera singer Ian Storey at home in Herefordshire. Photograph: Steve Woods (stf)/Steve Woods / newsteam.co.uk

It would be grossly unfair to suggest that opera singers spend their free time lounging on chaises longues being spoonfed foie gras. When there are no witnesses, many of them probably run marathons or something. Still, Ian Storey must be more active than most; as a young man, he played badminton and squash at county level and above. Now aged 52, he relaxes by laying bricks or swinging a sledgehammer. Having built a home for his family in the Herefordshire countryside, he's planning to bulldoze it and start over. "I normally have a building project on the go," he says.

Yet a couple of years ago, he found this energy draining away. He'd taken on one of opera's most demanding roles – the lovestruck hero of Wagner's Tristan und Isolde – and breezed through the 10-hour rehearsals and the first shows in Milan. But in early 2008, he recalls, "I just started to feel tired. I thought, 'Oh, well, maybe it's just everything catching up with me.' So I plodded on. But I wasn't my usual self."

Fatigue turned to exhaustion, joined by headaches and hot flushes. Away from the stage, Storey could barely bring himself to pick up a drill. By the summer of 2009, he says, "I was getting to the end of a performance and I'd just want to curl up under the table and go to sleep. The next day I felt like I'd been run over by a tram. Performing takes it out of you, but not to that extent." In the end his wife insisted he take himself to the doctor.

It took six months of blood tests and MRIs, but Storey finally got a diagnosis. The good news? He didn't have heart disease, diabetes or a brain tumour. On the other hand, he did have extremely low levels of the sex hormone testosterone. He was going through the andropause.