Return of the Philly Killer

Legionnaires' disease strikes in a Vermont hospital

At first the patients seemed to be suffering from simple pneumonia. But when doctors at the Medical Center Hospital of Vermont in Burlington investigated further last August, they realized that they were probably dealing with something more puzzling and dangerous. As Dr. Harry Beaty, the hospital's chief of medicine, recalls, the symptoms--dry cough, abdominal pain, general malaise --"were defying all our usual concepts of pneumonia." So he promptly sent off blood samples to Atlanta's Center for Disease Control (CDC). A few weeks later the center's sleuths confirmed Beaty's worst fears. His "pneumonia" patients were, in fact, victims of the dread ailment known as Legionnaires' disease.

The CDC reported that at least twelve deaths at the Burlington hospital could be attributed to Legionnaires' disease. Officials suspected that the total number of people stricken by the baffling illness in Vermont over the past two months was at least 54--and most likely dozens more. That would make the outbreak the worst since the discovery of the disease at an American Legion convention in Philadelphia in the summer of 1976, when 181 people were hospitalized and 29 died. Only the prompt decision of the Vermont doctors--made before they had the results from Atlanta--to administer erythromycin kept the toll from climbing higher; the antibiotic is the only one known so far to be effective against Legionnaires' disease.

Almost all the victims, including ten of those who died, had been seriously ill with other ailments even before they were stricken by the mysterious fever. Three had received kidney transplants and were hospitalized on the same surgical floor. Another was a longtime alcoholic. Several had cancer. Still others had chronic lung disease. Their ages ranged from 16 to the late 60s, but they all apparently shared one characteristic: either because of illness or medication, their immune systems were so weakened that they were especially vulnerable to infections.

Doctors worried at first that the hospital itself might be the source of the infection. But this fear was allayed when a CDC team from Atlanta found--from the advanced state of their disease--that at least four patients had been infected before they came to the hospital. Then where did the disease originate? No one knows yet. But as they continued looking for telltale signs of Legionnaires' disease --characteristic antibodies--in the blood of other Vermonters who recently had "pneumonia," investigators expected to find still more cases. Said Dr. Charles Phillips, head of the hospital's infectious diseases unit: "The honest-to-goodness truth is that the disease is all over."

He may be right. The CDC has now confirmed that 24 people have died of Legionnaires' disease in 19 states since the Philadelphia epidemic. It also suspects there may be as many as 2,000 undetected cases a year. Though scientists believe that the culprit is a slow-growing, rod-shaped (as yet unnamed) bacterium, they do not know where it lives in nature, how it spreads or why it is so lethal. Only one thing seems sure. The bug was almost certainly around, even if misdiagnosed, long before the Legionnaires gathered for their ill-fated convention in Philadelphia.

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