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Cases of Legionnaires’ Disease Are Occurring Across the U.S. What Is It, and Are You at Risk?
You've probably been seeing an increase in Legionnaires' disease coverage in the news lately. Legionnaires' was blamed for the illnesses of four L.A. Fitness gym members in Florida late last month, and a New York City police officer is currently in the hospital recovering from Legionnaires' as well. (Fellow cops were warned not to shower at a precinct in East Harlem, where traces of the bacteria that causes the disease were found.)
Last week, the Centers for Disease Control and Prevention issued a warning about risks associated with home water births, which have been linked to two 2016 cases of the disease. And yesterday, Michigan's top health official was charged with involuntary manslaughter for failing to alert the public about an outbreak, which some experts have linked to the contaminated-water crisis in the city of Flint. Twelve people died from the outbreak in 2014 and 2015.
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But wait, wait, wait. What is Legionnaires' in the first place? Back in 2015, after an outbreak in the South Bronx killed 12 people and sickened dozens more, Health broke down the basics and spoke with experts. Here's what you should know.
It's a serious form of pneumonia
From 8,000 to 18,000 people are hospitalized each year in the US with Legionnaires' disease, according to the Centers for Disease Control and Prevention. It's an infectious disease, but unlike other things like influenza and the common cold, it doesn’t spread from person to person; people catch it by inhaling mist from water systems harboring Legionella bacteria. The first known outbreak occurred in 1976, at an American Legion convention in Philadelphia, which is where the name comes from.
Symptoms can show up two days to two weeks after someone is exposed, and can include fever, cough, chills, muscle aches, headache, fatigue, confusion, loss of appetite, and diarrhea.
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“It is a true bacterial pneumonia. That’s why it is severe, but at the same time it doesn’t make everyone ill, and it doesn’t kill everybody,” Hassan Bencheqroun, MD, an interventional pulmonologist and critical care specialist at Pacific Pulmonary Medical Group and an assistant clinical professor at the University of California, Riverside, explained to Health. “Those that develop the pneumonia and those that die from it are those that have risk factors.”
These risk factors include being 50 or older, having a chronic lung condition (such as asthma or emphysema), smoking cigarettes, taking medication that suppresses the immune system, and having an immune-suppressing illness.
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The bacteria can grow in water tanks, spas, and air-conditioning systems
Legionella pneumophila is the strain responsible for 90% of cases of Legionnaires' disease. The bug lives in the condensers of large air conditioning systems, hot water tanks, whirlpool spas, cooling towers, even ornamental fountains. While low levels of the bacteria won’t lead to an outbreak, “it’s when it multiplies to the level that it would cause disease that we worry,” Dr. Bencheqroun said.
“Legionella is usually a rarer cause of pneumonia,” Belinda Ostrowsky, MD, director of epidemiology, stewardship, and infection prevention at Montefiore Health System in the Bronx, added in an interview with Health. “In the Bronx we can see clusters (increased number of cases) in the summer months. Clusters can also be seen at times due to specific environmental sources.”
In the 2015 outbreak, investigators determined that a cooling tower on top of a hotel was the source of the illnesses in the Bronx. To confirm that certain structures are the source of a particular outbreak, medical sleuths must match the DNA signature of the bacteria found at the source to the bacteria that’s making people sick.
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Antibiotics can treat the disease
Death rates from Legionnaires' disease range from 5% to 30%. Some patients will get better with just a few days of intravenous antibiotics, while others may need to spend 10 days to two weeks in the intensive care unit, according to Dr. Bencheqroun. “Most of these people have an incredible amount of inflammation in the lining of their lungs, so their oxygen level is very low,” he says. Some people may simply need some extra oxygen, while others may need to be on a ventilator.
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The good news, Dr. Bencheqroun said, is that inexpensive, very effective drugs for treating Legionnaires' disease are available. “We have excellent antibiotics that treat this pneumonia, and these antibiotics are not complex, third tier, only-accessible-to-the-rich kinds of antibiotics,” he said. “Most of the cases of Legionella pneumonia that we diagnose, we send home, and they restart their life with just a story to be told.”
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Health24.com | 7 common myths and misconceptions about anaemia
Anaemia is a disorder that occurs when there are problems with the production of haemoglobin (the red protein in your blood responsible for transferring oxygen) in the body. According to pathologist and haematologist Dr Alicia Els, iron-deficiency anaemia is the most common form of anaemia, with anaemia of chronic disease (ACD) the most common anaemia in hospitalised patients.
Anaemia is usually caused by blood loss, but can also be caused by a lack of iron in the diet. While this widely known, there are other common misconceptions about anaemia and iron deficiency:
1. If you are iron deficient, you are anaemic and vice versa
Anaemia can certainly be caused by iron deficiency. In fact, iron deficiency is the most common cause of anaemia. This, however, doesn’t mean that iron deficiency and anaemia can always be linked. There are other causes of anaemia, such as ACD and sickle-cell anaemia. These types of anaemia are not caused by nutritional deficiency.
2. If you are vegan or vegetarian, you will suffer from iron deficiency anaemia
While red meat is a common source of iron, plant foods such as leafy greens are also sources of iron. Giving up meat and dairy may increase your chances of iron-deficiency anaemia, but this doesn’t necessarily have to be the case.
Another cause of anaemia is the lack of vitamin B12 in your diet, as this vitamin plays an important role in producing red blood cells. Vitamin B12 is found in red meat, poultry and dairy products, and is generally absent in plant foods. It is therefore believed that those on vegetarian and vegan diets have a higher risk of lack of vitamin B12 and subsequent anaemia. But if you monitor your diet, talk to your doctor or nutritionist, and take a supplement, there is no reason to develop a B12 deficiency.
3. Anaemia is largely genetic
In some cases, fanconi anaemia (FA), a rare inherited blood disorder, can lead to bone-marrow failure. This is a type of aplastic anaemia that prevents bone marrow from producing enough new blood cells for your body to function normally.
Other forms of anaemia, such as sickle-cell anaemia and thalassemia, are forms of hereditary anaemias. Even though these are linked to genetics, most cases of anaemia are acquired, either through iron shortage, or illness.
4. Children are more likely to suffer from anaemia
Iron-deficiency anaemia is common among infants and children, but it’s not limited to this age group.
Women of child-bearing age are also more susceptible to iron-deficiency anaemia, but anaemia can occur any stage of life.
5. Anaemia is mostly a sign of a poor diet
While malnutrition among children is the most common cause of anaemia, types of anaemia such as sickle cell and thalassemia are not liked to diet and iron intake.
In adults, anaemia is often caused by inflammation, kidney disease, infection, cancer or bleeding gastritis.
6. You can’t breastfeed if you have iron-deficiency anaemia
You can safely breastfeed even if you suffer from iron-deficiency anaemia. Discuss your diet and the use of an iron supplement with your medical practitioner.
7. You can’t exercise or play sport if you have anaemia
There is no reason why children or adults with anaemia shouldn’t partake in sport. While it can be challenging to do physical exercise due to the lack of oxygen caused by a lack of red blood cells, you can still exercise if you wish to do so. It is important to start slowly and listen to your body. Consult your doctor if you are unsure.
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Solving a 100-year mystery in blood pressure research
The baroreceptor reflex is a fascinating medical phenomenon. The reflex is controlled by specialized neurons that react in just a fraction of a second to keep blood pressure fairly consistent.
For example, when you stand up, your blood pressure normally drops — rapidly. Yet you don’t faint thanks to baroreceptors, which tell your heart rate to increase and push more blood to your brain.
A new Scripps Research study pinpoints the two proteins that sense blood pressure and help control the baroreceptor reflex, according to research published recently in Science. The research is the first to reveal exactly how “mechnotransduction,” or the sensing of changes in pressure, works in these cells.
“Tight regulation of blood pressure is essential for health,” says Wei-Zheng Zeng, PhD, a postdoctoral associate at Scripps Research and first author of the study. “Blood pressure is acutely sensed by baroreceptor neurons, but the mechanism of how baroreceptors sense blood pressure remained a mystery for more than 100 years.”
The two proteins — PIEZO1 and PIEZO2 — were originally discovered in the lab of study senior author Ardem Patapoutian, PhD, a Scripps Research professor and Howard Hughes Medical Institute investigator. In just the past few years, it’s become clear PIEZOs do a lot of work. The Patapoutian lab has shown PIEZOs are responsible for sensing pressure in the lungs, different kinds of pain and soft touch. PIEZO1 even helps red blood cells keep their shape.
The scientists focused on PIEZOs as possible players in the baroreceptor reflex because the genes for PIEZO1 and 2 are expressed in sensory neurons responsible for the reflex. Indeed, in the recent experiments with a mouse model, the scientists found that both PIEZOs are necessary for maintaining blood pressure through the reflex.
“Our motivation for this study was rooted in basic science, yet these findings could have major translational implications by improving our understanding of human health,” says Patapoutian.
While it is still basic research at this point, scientists think PIEZO1 and 2 in baroreceptors may work as possible therapeutic targets to help people with “drug-resistant hypertension,” a common clinical disorder defined as uncontrolled high blood pressure by drugs, says Zeng.
“Knowing the identity of the sensors for blood pressure control gives us an idea of how to develop better therapies to treat patients who suffer from drug-resistant hypertension, or any other problems with blood pressure control,” says Kara Marshall, PhD, postdoctoral associate at Scripps Research and co-author of the study.
The scientists recommend further studies of how PIEZO1 and PIEZO2 work together and how they may function in different populations of neurons. “We are also interested in understanding how human genetic changes in the function of these proteins might affect blood pressure regulation,” says Marshall.
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Making a transparent flexible material of silk and nanotubes
The silk fibers produced by Bombyx mori, the domestic silkworm, has been prized for millennia as a strong yet lightweight and luxurious material. Although synthetic polymers like nylon and polyester are less costly, they do not compare to silk’s natural qualities and mechanical properties. And according to research from the University of Pittsburgh’s Swanson School of Engineering, silk combined with carbon nanotubes may lead to a new generation of biomedical devices and so-called transient, biodegradable electronics.
The study, “Promoting Helix-Rich Structure in Silk Fibroin Films through Molecular Interactions with Carbon Nanotubes and Selective Heating for Transparent Biodegradable Devices,” was featured on the Oct. 26 cover of the American Chemistry Society journal Applied Nano Materials.
“Silk is a very interesting material. It is made of natural fibers that humans have been using for thousands of years to make high quality textiles, but we as engineers have recently started to appreciate silk’s potential for many emerging applications such as flexible bioelectronics due to its unique biocompatibility, biodegradability and mechanical flexibility,” noted Mostafa Bedewy, assistant professor of industrial engineering at the Swanson School and lead author of the paper. “The issue is that if we want to use silk for such applications, we don’t want it to be in the form of fibers. Rather, we want to regenerate silk proteins, called fibroins, in the form of films that exhibit desired optical, mechanical and chemical properties.”
As explained by the authors in the video below, these regenerated silk fibroins (RSFs) however typically are chemically unstable in water and suffer from inferior mechanical properties, owing to the difficulty in precisely controlling the molecular structure of the fibroin proteins in RSF films. Bedewy and his NanoProduct Lab group, which also work extensively on carbon nanotubes (CNTs), thought that perhaps the molecular interactions between nanotubes and fibroins could enable “tuning” the structure of RSF proteins.
“One of the interesting aspects of CNTs is that, when they are dispersed in a polymer matrix and exposed to microwave radiation, they locally heat up,” Dr. Bedewy explained. “So we wondered whether we could leverage this unique phenomenon to create desired transformations in the fibroin structure around the CNTs in an “RSF-CNT” composite.”
According to Dr. Bedewy, the microwave irradiation, coupled with a solvent vapor treatment, provided a unique control mechanism for the protein structure and resulted in a flexible and transparent film comparable to synthetic polymers but one that could be both more sustainable and degradable. These RSF-CNT films have potential for use in flexible electronics, biomedical devices and transient electronics such as sensors that would be used for a desired period inside the body ranging from hours to weeks, and then naturally dissolve.
“We are excited about advancing this work further in the future, as we are looking forward to developing the science and technology aspects of these unique functional materials,” Dr. Bedewy said. ” From a scientific perspective, there is still a lot more to understand about the molecular interactions between the functionalization on nanotube surfaces and protein molecules. From an engineering perspective, we want to develop scalable manufacturing processes for taking cocoons of natural silk and transforming them into functional thin films for next generation wearable and implantable electronic devices.”
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Study reconstructs Neanderthal ribcage, offers new clues to ancient human anatomy
An international team of scientists has completed the first 3D virtual reconstruction of the ribcage of the most complete Neanderthal skeleton unearthed to date, potentially shedding new light on how this ancient human moved and breathed.
The team, which included researchers from universities in Spain, Israel, and the United States, including the University of Washington, focused on the thorax — the area of the body containing the rib cage and upper spine, which forms a cavity to house the heart and lungs. Using CT scans of fossils from an approximately 60,000-year-old male skeleton known as Kebara 2, researchers were able to create a 3D model of the chest — one that is different from the longstanding image of the barrel-chested, hunched-over “caveman.” The conclusions point to what may have been an upright individual with greater lung capacity and a straighter spine than today’s modern human.
The study is published Oct. 30 in Nature Communications.
“The shape of the thorax is key to understanding how Neanderthals moved in their environment because it informs us about their breathing and balance,” said Asier Gomez-Olivencia, an Ikerbasque Fellow at the University of the Basque Country and the study’s lead author.
And how Neanderthals moved would have had a direct impact on their ability to survive on the resources available to them, said Patricia Kramer, professor in the UW Department of Anthropology and corresponding author on the paper.
“Neanderthals are closely related to us with complex cultural adaptations much like those of modern humans, but their physical form is different from us in important ways,” she said. “Understanding their adaptations allows us to understand our own evolutionary path better.”
Neanderthals are a type of human that emerged about 400,000 years ago, living mostly from what is today Western Europe to Central Asia. They were hunter-gatherers who, in some areas, lived in caves and who weathered several glacial periods before going extinct about 40,000 years ago. Studies in recent years have suggested that Neanderthals and early Homo sapiens interbred, because evidence of Neanderthal DNA has turned up in many populations.
Over the past 150 years, Neanderthal remains have been found at many sites in Europe, Asia and the Middle East. This team worked with a skeleton labeled Kebara 2, also known as “Moshe,” which was found in Kebara Cave in Northern Israel’s Carmel mountain range in 1983. Though the cranium is missing, the remains of the young adult male are considered one of the most complete Neanderthal skeleton ever found. Two different forms of dating of the surrounding soil, thermoluminescence and electron spin resonance, put the age at somewhere between 59,000 and 64,000 years.
Discoveries and studies of other Neanderthal remains in the 19th and early 20th centuries gave rise to theories and images of a stereotypical, hunched-over caveman. Over time, further research clarified scientific understanding of many Neanderthal traits, but some debate has lingered over the structure of the thorax, the capacity of the lungs and what conditions Neanderthals might have been able to adapt to, or not.
Over the past decade, virtual reconstruction has become more commonplace in biological anthropology, Kramer explained. The approach is useful with fossils such as the thorax, where fragile bones make physical reconstruction difficult and risky.
Nearly two years ago, the same research team created a virtual reconstruction of the Kebara 2 spine, the first step in updating theories of Neanderthal biomechanics. The team’s paper, published in the book “Human Paleontology and Prehistory,” reaffirmed the likelihood of upright posture but pointed to a straighter spine than that of modern humans.
For this model of the thorax, researchers used both direct observations of the Kebara 2 skeleton, currently housed at Tel Aviv University, and medical CT scans of vertebrae, ribs and pelvic bones, along with 3D software designed for scientific use. “This was meticulous work,” said Alon Barash, a lecturer at Bar Ilan University in Israel. “We had to CT scan each vertebra and all of the ribs fragments individually and then reassemble them in 3D.”
They then used a technique called morphometric analysis to compare the images of Neanderthal bones with medical scans of bones from present-day adult men. “In the reconstruction process, it was necessary to virtually ‘cut’ and realign some of the parts that showed deformation, and mirror-image some of those that were not so well-preserved in order to get a complete thorax,” said Gomez-Olivencia.
The reconstruction of the thorax, coupled with the team’s earlier finding, shows ribs that connect to the spine in an inward direction, forcing the chest cavity outward and allowing the spine to tilt slightly back, with little of the lumbar curve that is part of the modern human skeletal structure. “The differences between a Neanderthal and modern human thorax are striking,” said Markus Bastir, senior research scientist at the Laboratory of Virtual Anthropology at the National Museum of Natural History in Spain.
“The Neanderthal spine is located more inside the thorax, which provides more stability,” said Gomez-Olivencia. “Also, the thorax is wider in its lower part.” This shape of the rib cage suggests a larger diaphragm and thus, greater lung capacity.
“The wide lower thorax of Neanderthals and the horizontal orientation of the ribs suggest that Neanderthals relied more on their diaphragm for breathing,” said senior author Ella Been of Ono Academic College. “Modern humans, on the other hand, rely both on the diaphragm and on the expansion of the rib cage for breathing. Here we see how new technologies in the study of fossil remains is providing new information to understand extinct species.”
What that means for how Kebara 2 lived is ripe for further research, Kramer said. How did Neanderthals breathe, and for what physical demands might they have needed powerful lungs? What does that tell us about how they moved, and the environment in which they lived? Did any of these physical traits make them more or less adaptive to climate change?
Reconstructing the thorax was an exercise in starting from scratch, deliberately trying to avoid being influenced by past theories of how Neanderthals looked or lived, Kramer said.
“Thinking through all the permutations of the different fragments, it was like a jigsaw without all the pieces. What do the pieces tell us?” she said. “People have told you it should be a certain way, but you want to make sure you’re not over-reconstructing, or reconstructing it the way you think it should be. You’re trying to maintain a neutral approach.”
Other authors of the study were Daniel Garcia-Martinez of the National Museum of Natural History and Mikel Arlegi, of the University of the Basque Country.
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Health24.com | ‘Yo-Yo’ cardio readings may signal heart risks
If your weight, blood pressure, cholesterol or blood sugar levels fluctuate, you may have a higher risk of heart attack, stroke and premature death than people with more steady readings, new research suggests.
According to the study, during nearly six years of follow-up, men and women whose readings changed the most were 127% more likely to die, 43% more likely to have a heart attack and 41% more likely to have a stroke, compared with those whose readings remained stable.
“Variability in metabolic parameters may have a role in predicting mortality and cardiovascular outcomes,” said lead study author Dr Seung-Hwan Lee, a professor of endocrinology at the College of Medicine at Catholic University of Korea.
Because the study looked at data from the past, however, it can only show an association between variability in these readings and risk. It can’t prove that variability is the cause of the heightened risk of heart attack, stroke or death, the study authors cautioned.
Fluctuations
The researchers also didn’t look at the reasons why the metabolic readings might fluctuate over time.
Treatment strategies to reduce fluctuations in these parameters, however, should be a goal to prevent bad health outcomes, Lee said.
These strategies might include keeping blood pressure, cholesterol and blood sugar within normal ranges – not too high or too low – and maintaining a normal weight – not too fat or too thin.
“This opens up a new avenue for accounting for variation in risk factors over time in estimating risk for cardiovascular disease,” said Dr Gregg Fonarow, a professor of cardiology at the University of California. “Better identification of those at higher and lower risk may translate to better use of prevention strategies and therapies.”
Treatment strategies
But further studies are needed to determine if treatment strategies that specifically reduce fluctuations in these parameters will reduce the risk of cardiovascular events and improve health, Fonarow said.
For the study, Lee and colleagues used the Korean National Health Insurance system to collect data on more than 6.7 million people who had not had heart attacks, diabetes, high blood pressure or high cholesterol.
Between 2005 and 2012, all participants had at least three exams that documented weight, blood sugar, blood pressure and cholesterol.
Risk of death
The researchers specifically looked at the effect of changes in participants whose readings went up or down more than 5%. Whether people’s readings got better or worse didn’t matter – high variability by itself was linked to an increased risk of death during the study period, the findings showed.
Women and older adults were more likely to have highly variable parameters, the researchers said.
Lee said because the study was done in Korea, it’s not certain that these findings would apply to the United States. Other studies in different populations, however, indicate that the link between fluctuating readings and the risk of dying are common.
One specialist offered a note of caution to people who are obese or overweight not to misinterpret these findings.
“This is provocative research that raises questions about binge dieting,” said Dr Byron Lee, director of electrophysiology laboratories and clinics at the University of California.
But it is far from definitive, he added. “Hopefully, obese patients don’t use this as an excuse to stop trying to lose weight,” Lee said.
The report was published online in the journal Circulation.
Image credit: iStock
Health24.com | Milk directly from the breast is best for baby’s weight
Breast milk from the bottle may not have as many benefits for a baby‘s weight as feeding straight from the breast, a new study suggests.
The researchers found what many others have before: Overall, breastfed babies tended to have a healthier weight than those who were formula-fed.
However, babies given pumped breast milk did not benefit as much as those who fed directly from the breast.
Researchers stressed that breast milk, in any form, is better than formula. But they said the findings support the notion that the method of feeding matters, too.
Pumping vs. formula
Many women, particularly in the United States, have to pump breast milk when they return to work, noted lead researcher Meghan Azad, an assistant professor of paediatrics and child health at the University of Manitoba in Canada.
“The message here is not that pumping is ‘bad’ or ‘wrong’, ” she said. “It’s better than formula-feeding.”
However, Azad explained, there are reasons why feeding at the breast might promote the healthiest rate of weight gain.
For one, she said, breast milk contains a range of “interesting enzymes and hormones”. And it’s possible that their activity is depleted when pumped milk is refrigerated.
In addition, Azad said, it’s thought that babies learn to “self-regulate” food intake when they nurse at mom’s breast. In contrast, when parents bottle-feed, they often take charge – encouraging their baby to finish the bottle.
Six months of exclusive breastfeeding
Dr Joan Meek is chair of the American Academy of Pediatrics section on breastfeeding. She said the AAP recommends exclusive breastfeeding for about six months. Once the baby starts on solid foods, Meek said, breastfeeding can continue “for as long mother and child desire”.
She agreed that there are reasons direct breastfeeding is ideal – and the new findings support that. But practically speaking, Meek added, many women have to pump.
“The lack of paid maternity leave policies in the US can be a barrier for mothers who work outside the home,” Meek said. “Certainly for those mothers, their [pumped] breast milk is still the next best thing to direct breastfeeding.”
The findings, published online in the journal Pediatrics, are based on more than 2 500 mother-infant pairs.
Healthy weight gain
On average, the study found, babies who were still exclusively breastfed at six months had the healthiest weight by the age of 12 months. By comparison, babies who were no longer exclusively breastfed at six months had a threefold greater risk of being overweight by their first birthday.
However, when the researchers looked at moms’ feeding methods, they found that babies given pumped breast milk tended to weigh a little more than those who fed from the breast.
It all suggests that direct breastfeeding is better for a “healthy weight trajectory”, said Dr Alison Holmes, a paediatrician at Dartmouth-Hitchcock Medical Center in Hanover, New Hampshire.
Like Meek, Holmes acknowledged the practical barriers. So she recommended that any time working moms are with their baby, they opt for the direct route rather than the bottle.
The study also looked at the effects of solid food introduction on babies’ weight. In general, it found, when babies started on solids before the age of five months, their weight gain was on the rapid side.
But there was no sign that introducing solids at five months, rather than six months, spurred especially quick weight gain.
Starting solids
“So introducing solids at that age may be OK, if that’s what your baby wants,” Azad said.
When it comes to starting solids, Holmes said, there seems to be a window that’s best for babies’ overall health.
“Introducing solid foods sometime after the five-month mark, but before the seven-month mark is healthiest in terms of balancing the benefits of healthy weight gain, allergy prevention and infectious disease prevention,” she said.
To Azad, the findings have implications not just for parents, but for policies on paid maternity leave.
“This is saying, you can’t just give moms a breast pump and think you’ve solved the problem,” Azad said.
Image credit: iStock
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