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Legionnaires’ Disease – Significant Risk or Shiny Object?

This past summer, there was a cluster of Legionnaires’ disease (Legionellosis) cases in the Bronx. As most readers know, legionellosis is a disease that creates pneumonia-like symptoms caused by bacteria that belong to the species Legionella pneumophila. The species disease names both commemorate the sentinel outbreak that struck 221 attendees at the 1976 American Legion Convention in Philadelphia. Everything we know about Legionella today stems from the initial response to the 1976 outbreak.
Fast forward to the summer of 2015. In response to the cluster of cases in the Bronx, New York City issued emergency regulations and New York State is now drafting similar regulations.
Without diminishing the seriousness of the disease, it’s important to create a context. The Centers for Disease Control (CDC) reports incidence (morbidity) and death (mortality) statistics as incidence per 100,000 person-years (py) exposure (# of cases or # of deaths/100,000 people/year). The morbidity rate for Legionnaires’ disease 0.4 cases/100,000 py (all of the statistics in this post are approximations – epidemiology is an imprecise science). The mortality rate is 10 to 15% of the morbidity rate. By comparison, the morbidity rate for asthma 8,000 cases/100,000 py (mortality 8 deaths/100,000 py). Both diseases tend to occur in clusters and peak seasonally. Both are caused by inhalation. However, Legionnaires’ disease is an infectious disease (the symptoms are caused by a combination of direct and indirect effects of a microbe proliferating within the body) and asthma is typically allergenic (the body’s immune system reacts to inhaled substances). Now consider non-tuberculosis Mycobacteria (NTM). NTM are members of the genus Mycobacteria other than M. tuberculosis. Several NTM species are associated with pulmonary diseases (for example: hypersensitivity pneumonitis – extrinsic allergic aveolitis). The morbidity rate for NTM 2/100,000 py for the general population but can be as high as 20% among farm workers, pigeon breeders and other sectors of the population exposed to NTM sources.
All of these statistics can make your head spin. Morbidity and mortality rates mask the occurrence of disease clusters. Thus although L. pneumophila is ubiquitous, legionellosis typically occurs in clusters. The story for asthma and NTM infections is similar. So what is the shiny object? When a disease outbreak occurs, there is tremendous value in focusing on the immediate cause, but there’s also a need for maintaining a more global perspective. In her paper, presented at last month’s AWT Annual Convention, Diane Miskowski (EMSL Analytical, Inc.; www.EMSL.com) reported – almost parenthetically – that increased numbers of NTM had been recovered from cooling towers which had been treated to kill off L. pneumophila. Are our efforts to control Legionella spp. in order to decrease our legionellosis risk may be increasing our risk of contracting other respiratory diseases? More on this in another post. I’d be interested in reading your thoughts.

Legionella pneumophila in Metalworking Fluids

I’m sharing an email exchange that I had with a colleague who had asked about the risk of L. pneumophila (the microbe that causes Legionnaire’s disease) in MWF.
Thank you for posting your query to BCA’s website.

You wrote:
“I wondered if you could help me answer a customer’s question. One of my customer’s machine tool operators is in the hospital being treated for Legionnaires’ disease. My customer asked me if the Kathon 886 MW or Kathon CC kills this strain of bacteria. I really appreciate your help and advice. I attend the annual STLE meeting every year and hear you speak on maintaining and monitoring metal working fluids, so I thought you would be the best source to ask. The Legionnaires’ disease was most likely contracted in Tennessee while this gentleman was on vacation. Other machine operators are now afraid they might contract the disease through the metal working fluids in the plant.
Thank you for your time and thoughts.”

The short answer is yes.

Not long after Legionella pneumophila was identified as the disease agent that caused Legionnaire’s disease, Rohm & Haas tested Kathon WT1.5 efficacy against the bacterium. WT1.5 is just Dow’s (formerly R & H) water treatment market label for the 1.5% active product we use as Kathon 886MW and 886MW 1.5 in the MW industry.

Keep in mind that L. pneumophila is ubiquitous. If you recall the incident at Ford’s Le Brea, OH plant some years ago, four machinists came down with Legionnaire’s disease. Attempts to detect L. pneumophila from MWF systems all failed. An immunological survey of all of the plant’s employees revealed that the majority has antibodies to L. pneumophila. Other immunological surveys (populations outside our industry) have demonstrated that the majority of the population has been exposed to the microbe (i.e.: has the antibodies). Most of the time, folks who contract the disease have other health problems that render them more susceptible than the general population. Back to Le Brea. That incident and a cluster of Pontiac Fever cases at a Pontiac Plant in Windsor Ontario in 1981 are the only two clusters of Legionnaire’s disease that have been reported in the MW industry. The 1981 outbreak was caused by L. feeleii growing in the facility’s cooling towers. The source of L. pneumophila at Le Brea was never confirmed.

From what we know, workers are much more likely to be at risk from improperly controlled heat exchange systems/cooling towers than from MWF.

IBB paper on differential ATP test method now available as video

A 5 min, condensed version of my 2014 paper: “A Differential Adenosine Triphosphate Test Method for Differentiating between Bacterial and Fungal Contamination in Water-Miscible Metalworking Fluids” is now available at http://audioslides.elsevier.com/getvideo.aspx?doi=10.1016/j.ibiod.2015.01.006.
The paper describes how the method was developed and validated. This is the first published report of an ATP test method that can quantify microbial biomass and then distinguish between bacterial and fungal biomass.

Metalworking Fluids Biocide Situation – Part A

STLE held our annual meeting in Dallas two weeks ago. During the meeting I had the pleasure of chairing the MWF 210 – Metalworking Fluids Hot Topics course. Too many hot topics to cover in a blog post, so I’ll focus on my course module: Microbicide Regulatory Roulette Wheel.
The metalworking industry is facing a regulatory tsunami. The EU’s Biocidal Products Regulation (BPR; replaced the Biocidal Products Directive in 2012 and became effective in September 2013). Two items of particular note about the BPR. First, as with all chemicals under REACH, products are evaluated based on their assessed hazard instead of the risks they pose (risk is a function of inherent hazard AND exposure; for example: molten lava is extremely hazardous, but only if you are exposed – get close enough – to it). Second, the definition of “biocidal” is astonishingly broad; “Any substance or mixture, in the form in which it is supplied to the user, consisting of, containing or generating one or more active substances, with the intention of destroying, deterring, rendering harmless, preventing the action of, or otherwise exerting a controlling effect on, any harmful organism by any means other than mere physical or mechanical action.” AND “Any substance or mixture, generated from substances or mixtures which do not themselves fall under the first indent, to be used with the intention of destroying, deterring, rendering harmless, preventing the action of, or otherwise exerting a controlling effect on, any harmful organism by any means other than mere physical or mechanical action.” I’m left wondering what might be left in terms of MWF additives. I’ll write more about what is happening in the US in my next post.

MICROBIAL CONTAMINATION CONTROL LIMITS IN FUELS

Last week, I received an email query from Kevin H:
Hi, do you know the RLU limit for diesel i see the IATA say

Here’s my response:
Kevin:

Thank you for your query about the existence of an RLU criterion for ATP-bioburdens in non-aviation distillate fuel.

When I suggested the HY-LiTE test low, medium and high levels, I basically translated from the culture test criteria I had developed from the decision matrix I had been using for BCA’s Biodeterioration Risk Assessments. (high risk: CFU bacteria/L fuel >100). That 100 CFU/L equals approximately 1,000 RLU/L.

At the time I was collaborating with Merck to help them have the HY-LiTE method become the basis for an ASTM standard test method. The HY-LiTE works quite nicely in Jet A, where additive usage and water content vary little among samples.

Regarding the relationship between microbial loads and damage risk:
1. I’ve been doing fuel microbiology for about 40 years.
2. I’ve seen systems that have had high levels of contamination, but no evidence of damage, and systems with low levels of detectible microbial contamination and substantial evidence of microbially-caused damage (filter plugging, system corrosion, degraded fuel, etc.). We still don’t have a reliable model for figuring out when a non-damaging population is going to start causing problems (very similar to humans: there are 10x as many microbes as human cells in and on our bodies. Normally they keep us healthy, but sometimes the same microbes cause disease). Key here is that there is no clear link between microbial load and damage risk. Moreover, microbes found in the fuel are generally not the ones to worry about. It’s the microbes growing on the fuel system surfaces. We work with fuel samples, because they are easier to collect. For this reason, both the EI Petroleum Microbiology Committee and ASTM Fuel Microbiology Working Group advise against setting criteria levels for microbial contamination in fuels or fuel-associated waters. The microbiologists on the IATA microbiology task force also resisted resisted putting criteria into the IATA document until the non-microbiologists wore them down.
3. BCA’s Biodeterioration Risk Assessment looks at climate, system design, operations, maintenance practice, fuel chemistry, bottoms-water chemistry, fuel microbiology, bottoms-water microbiology and system component condition. ATP is only one of 10 different microbiological tests that I use to assess biodeterioration risk.
4. All that said, given the patchiness of microbe distribution in fuel systems, I and most of the other fuel microbiologist that I know tend to be conservative. We agree that detecting microbial contamination tells us much more than not-detecting it. Any positive test result indicates a need for further testing. 1000RLU/L equals approximately 100 CFU/mL = 0.1 CFU/mL. In the UK, drinking water is permitted to have 10^6 CFU bacteria/mL (as long as they are not potential pathogens). IATA set a very conservative control level because filter pulling at 50,000 ft can cause an aircraft to fall out of the sky. Filter plugging on the ground can also stalling, but the net impact is not nearly as dramatic.

Long answer to a simple question. Based on their risk tolerance, different companies (particularly marine, rail and trucking fleets) have set in-house criteria. I recommend using ATP as a canary in the cave test. If you get numbers above background, you should run additional tests. I do not recommend relying on any single test when deciding whether you need to take corrective action.

What’s New – 10 May 2015

BCA’s updated site launched on 07 May. This is the first overhaul since Wendy Dalia (then working on her PhD in marine biology) created the original site in the late 1990’s. Although I’ve kept much of the site’s original content, it has been reorganized to make it easier to find useful information. Let me know what you think.

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