Its Still A Deadly Contest
May 14th 1978
An update on the quest for a cure of "legionnaires disease”
Sitting in a darkened room Dr Sheila Moriber Katz focused the electron microscope until something like a pebble popped eerily into the green luminescent viewing field
"There That's it a voice that betrayed awe, After spending so much time looking for it, it's thrilling to see it there like that, almost held prisoner, so to speak,'"
"She moved the viewing field and smiled" as more pebbles, and other strange forms in the green glow caught her attention. She had become oblivious to the People standing round her in the darkness she was lost in a microscopic world, entered by what she liked to think of as tronomy in reverse.
The pebbles that enraptured the shy quiet-spoken pathologist at Hahemann Medical College and Hospital where the bacteria that most scientists now believe cause Legionnaires’ disease.
They know a lot more now about the disease that mysteriously swept through the Pennsylvania State American Legion Convention in Philadelphia in late July 1976, killing 29 persons and making another 153 sick.
They know that the disease is not rare. it may be the cause of 1 to 2 percent of all undiagnosed pneumonia cases; That would come to about 50,000 serious illness a year.
Doctors are now beginning to think of Legionnaires’ disease when they encounter
mysterious forms of pneumonia in patients. Because of the sharpened awareness, 258 isolated cases of the disease have been found in 37 states and the district of Columbia since the Philadelphia epidemic.
Other epidemics have been found too, Scientists believe that the bug has caused 10, of them since 1965, killing 84 persons and making 494 ill.
Dr. Katz and the electron microscope with which she
photographs the suspected Legion Bug right/
greatly magnified
The disease has also turned out to be disturbingly lethal killing 15 to 20 percent of its victims since the Philadelphia outbreak.
Doctors now know how to treat it with a very effective antibiotic --erythromycin once they are able to make the diagnosis. But the scientists have not found a way to make a quick diagnosis
Though isolated cases of Legionnaires’ disease seem to occur at any time of the year,
The epidemics seem to come primarily during summer months.
Many scientists at the Center Control (CDC) in Atlanta the federal government's epidemic surveillance agency--- expect increase in numbers of epidemics to be reported this year, not because the disease is becoming more widespread, but because the doctors are on the lookout for it now. Epidemics that would have gone unrecognized two years ago should now be picked up.
Last year alone, epidemics of Legionnaires disease were discovered in five widely scattered. locations Burlington, Vt. Los Angeles; Columbus Ohio, Nottingham, England, Kingsport, Tenn. They were not Large epidemics. The most severe, in Burlington, killed 17 persons and made 25 sick. But they were epidemics.
Ever since the Philadelphia outbreak was discovered in early August 1976, shortly after the Legion convention ended, the bacterium involved and the mystery surrounding it have dominated the professional life of Dr. Katz.
"I remember the date well," she told a visitor to her lab, clasping her hands tightly in her lap. "That's' when I first saw it. It transformed my professional life. Before Aug. 4; I was investigating renal disease. Ever since Aug. 4, I have been working on this."
Two months after Dr. Katz, then 33 Started studying what she believed to be the bug that caused the Legion epidemic she came down with an illness that appeared to resemble Legionnaires’ disease.
The thought struck her then that she might have caught the disease from the bugs she had been examining in-the laboratory. It was a rare opportunity for a pathologist, a chance to study the progress of a disease as it swept through her body.
Despite a splitting headache chills that shook her body and a temperature that reached 104 degrees, Dr. Katz started collecting vials of her body and samples of her sputum for laboratory analysis when she could get out of bed.
She had been working with the samples and those from other patients, ever since.
A few months after Dr. Katz got sick, Dr. Joseph McDade, a scientist at CDC, Discovered the suspected bacterium, or bug” and developed a test to detect it.
Dr. Katz quickly submitted her blood for testing, but the results came back negative. She remained convinced that she had contracted the disease and spent 10 or more hours a week, sometimes three hours at a time, peering at her specimens through the microscope looking for the elusive bacterium
She found suspicious organisms but could not prove that they had caused the epidemic. Still sometimes blood tests miss things. So recently, after the CDC developed a test to detect Legion bugs in the sputum Dr. Katz started checking her sputum
So far she and CDC having been unable to come up with anything proved to be Legionnaires' disease. But analysis of environmental samples from all other epidemics proved negative.
Scientists do not know why the bug seems to prefer men who are 2.5, times more likely to be infected than women. They checked for a relationship to smoking and drinking with the thought that men indulged more, but nothing came of it
They also do not know where the bug hides when it is not infecting people. They think it might live in the form of spores in the soil, breaking out every now and then when conditions are right. Many of the epidemics have taken place near, construction sites or other places where there is much movement of earth.
Most vexing of all, the scientists still have no test to detect the bacterium when it first strikes, and thus they cannot provide early treatment.
Dr. McDade's blood test, which detects antibodies produced by the body to fight off the bacteria, can not identify the disease until three weeks after the first symptoms. By then the patient is well on his way to recovery - or dead.
But none of them is so driven as Dr. Katz.
It has become a cause for her. She is drawing up plans and experimental protocol to investigate particularly intriguing aspects of the mystery, such as finding the bug's ecologic niche.
She collaborates with some of the people at the Pennsylvania Health Department's bureau of laboratories, such as Dr. Philip. Nash, who heads the diagnostic virology lab, and D Bruce Kleger, director of the division of virology and immunology.
Drs. Nash and Kleger have done a lot of work in isolating the Legion bug from the lung tissue of deceased victims - an essential prerequisite for studies - in running tests on old and new blood samples from undiagnosed respiratory illnesses. (Five percent of these undiagnosed cases, it has turned out, were caused by the Legion bug.)
Dr. Katz is independent of the state officials, though frequently working on her own time after doing her regular job as an associate professor in the pathology department at Hahnemann Medical College and Hospital:,
The mystery has captivated other scientists, including Dr. Gary L. Lattimer; an infections-disease specialist in Allentown, who successfully treated six of the Legionnaires stricken in the Philadelphia epidemic.
Dr. Lattimer, 37, is so fascinated by the case that until recently, he had been spending 15 to. 20 hours a week doing research in addition to his normal practice:...
He travelled throughout the states to Legion conventions, drawing blood from more than 150 Legionnaires, Now he is trying to organize the eight pathologists in Pennsylvania who saw the original Legionnaires' disease cases so they might pool specimens to look farther for the cause. rather than those caused by the bug CDC isolated.
Though a few scientists outside CDC have kept after the mystery, others have abandoned it. Dr. Jay Satz who used to be Dr. Nash's superior in the state's bureau of laboratories has resigned to promote a food preparation he developed for weight reduction.
And Drs. William Sunderman Sr. and Jr. have given up. The father and son, who are experts in nickel poisoning had proposed a convincing-sounding theory that the epidemic was caused by nickel carbonyl. Subsequent lab tests, however, were unconvincing.
Dr. Sunderman Sr. who, is also at Hahnemann, is still convinced that nickel-carbonyl poisoning was the cause of the Philadelphia epidemic and that the bacteria found by the CDC were merely secondary invaders of lung tissue already weakened by toxins.
Legionnaires' disease is still an important project at the CDC, which has dozens of people in the laboratories and in the field working on it in expectation that the next epidemic will strike by the end of this summer.
The CDC is also keeping close surveillance on the Wadsworth Veterans Administration Hospital in Los Angeles which seems to be the site of a continuing epidemic that started in May 1977. The most recent case was last month. Twenty-eight persons have become ill, and five have died.
Solving the mystery may be of particular interest to Philadelphians wondering what caused the epidemic that struck the city and closed one of its finest hotels, the Bellevue Stratford Hotel
But, from a public-health viewpoint the value of the Legionnaires' disease research lies in preventing further epidemics and in being able to treat people the moment they fall ill.
Email.......Denis....................legion@q-net.net.au