As medical detectives searched a Southeast Baltimore plastics factory yesterday for a microscopic killer, Maryland health officials confirmed three cases of Legionnaires' disease among the plant's workers, including a 51-year-old jazz singer who died last week.
Six more workers at the Poly-Seal Corp. suffered respiratory illness, including three who had pneumonia, but tests to confirm that they were infected with the Legionella pneumophila bacteria are not complete, said Dr. Diane Dwyer, chief epidemiologist for the Maryland Department of Health and Mental Hygiene.
In addition to Joenell Fisher, who died Thursday, three workers were hospitalized, but all have been released and are in satisfactory condition, she said.
Several more employees have reported cough, fever and other symptoms consistent with Legionella infection, Dwyer said.
But because the symptoms so resemble ordinary cases of colds and flu, only tests can link the illness to the Legionnaires' outbreak, she said.
"We are asking any employees with symptoms to call and report their illness to Poly-Seal," Dwyer said. Health department investigators will interview the patients, she said.
Among the ailing employees are four members of a single family.
Catherine Combs; her two daughters, Theresa Stern and Donna Monicle; and Combs' sister, Rosemary Smith, said yesterday that they all worked near Fisher at the plant and contracted illnesses they believe to be part of the outbreak.
All but Monicle said their doctors were treating them with Legionnaires' in mind, although none has required hospitalization.
Legionnaires' disease is not common, but 23 cases, including one death, were reported in Maryland this year before the current outbreak, health officials said. Last year, 23 cases, seven of them fatal, were reported in the state.
Health officials believe 10 times as many cases may go unreported, because antibiotics often cure the illness before doctors order tests. Blood tests can take several weeks to produce definitive results; a urine test can identify many Legionella infections within 12 hours.
What makes the Poly-Seal illnesses unusual is the cluster of cases at one workplace, which suggests the bacteria came from one source of tainted water.
Dwyer said the last such cluster in Maryland occurred at a health care facility in 1990.
Some 15 investigators from the state and city health departments, the Maryland Occupational Safety and Health program and the Johns Hopkins University worked yesterday to interview patients and inspect Poly-Seal's closed east building, where the all the ailing employees worked.
They took swabs from cooling towers, air conditioners and other water sources, which will be cultured in laboratories and examined for the presence of Legionella. Eventually, investigators will try to match the molecular fingerprint of Legionella bacteria infecting the patients with the samples from the plant, officials said.
The investigators are searching for a rod-shaped bacterium that is common in water supplies but proliferates and becomes dangerous under particular conditions.
Dormant in cool water and killed by very hot water, Legionella bacteria thrive in stagnant water at 95 to 115 degrees Fahrenheit; they can be found in natural hot springs.
To infect a person, the contaminated water must be aerosolized and the tiny droplets inhaled deep into the lungs, said Dr. Victor L. Yu, an infectious disease specialist at the University of Pittsburgh and expert on Legionnaires'.
Past outbreaks have been linked to showers, hospital humidifiers, produce-spraying machines at grocery stores, even a crack in a plastic-molding machine that sprayed cooling water. Drinking water can cause Legionnaires', but only if a person chokes and aspirates the water.
The fatality rate of Legionnaires' is 5 percent to 15 percent; smokers, the elderly and people with compromised immune systems are most at risk.
Tracking the source of Legionnaires' in hospitals, where many cases occur, can be relatively easy, Yu said. Elsewhere, tracking the source is far more difficult.
"In the community, you build the jigsaw puzzle much more slowly," he said. "There are many outbreaks where the source is never found." The incubation period between exposure and illness, two to 10 days, complicates the tracing process, Yu said.
The Legionella organism grows in the "biofilm" that forms on water-using equipment, a slimy layer of moisture and mineral deposits where amoeba often live, said Sharon G. Berk, a microbiologist at Tennessee Technological University. "Amoeba will feed on Legionella and become infected, and then the Legionella grows inside the amoeba," she said.
At the Poly-Seal plant on Portal Street, suspicion naturally falls on the industrial cooling system used in the manufacture of plastic caps and seals, as well as the building's air-conditioning system.
Robert Weilminster, Poly-Seal's vice president of finance and administration, said the plant uses cooling towers, which reduce high water temperatures by spraying water through the air and have been implicated in other Legionnaires' outbreaks.
Poly-Seal officials recognized they had a problem only early Friday morning, when they got word of Fisher's death. Weilminster said company personnel officers told him several other employees were sick, including some with near-perfect attendance records.
Poly-Seal called its occupational health consultant, Dr. Edward Barnacki of the Johns Hopkins School of Medicine, and notified the Baltimore Health Department, which called in state health investigators.
Early Tuesday, when plant officials learned of a possible cluster of Legionnaires' disease linked to the east building, they closed it and laid off 250 workers.
The illnesses appeared gradually between Sept. 13 and Sept. 27, said Paul Phillips, vice president of Steelworkers Local 6967.
Among those stricken was Fisher, a $12.50-per-hour quality-control inspector and jazz singer in her off hours.
Her son, Anthony Harrison, said she developed flu-like symptoms Sept. 26, took over-the-counter remedies and made a doctor's appointment for Monday. She never returned from the appointment; doctors admitted her to Union Memorial Hospital, where she died Thursday night.
The four possible victims from one family who work at the plant -- two on the day shift and two on the night shift -- said yesterday that they still felt lingering effects of something like severe flu.
Stern has worked at Poly-Seal 10 years; Smith for nine, and Monicle and Combs for two years each. They live in separate homes in Dundalk, and they said there had been no family gatherings in recent weeks.
"The odds have to be astronomical," said Combs, 54. "It feels like luck turned against the family."
The clan's only luck this week, she said, was taking home a $300 lottery pool at work Monday.
Stern, 37, a quality-assurance worker on the 8-4 shift, said she felt tired and sick Sept. 29 and asked a supervisor for permission to go to her doctor.
The doctor treated her with antibiotics and cleared her to return to work Monday. She showed up, but did not feel better, and was laid off Tuesday morning, she said. Her doctor, she says, has told her the same antibiotics will handle Legionnaires'.
"I feel better, but not so good," Stern said. "Everything aches. It's like the worst flu you ever had."
Monicle, 28, said she first felt symptoms Sept. 14. But her doctor is not sure about the diagnosis, she said, because of other medical conditions.
"For me, it feels like it never goes away," she said. "You have a headache and take Tylenol, but it doesn't work."
Smith, 51, said she first felt symptoms Sept. 30 and saw a doctor, who told her the illness "might be environmental" and asked for the name of her boss.
Combs, 54, said she grew ill early last week and told her foreman Friday. She is taking two doses of erythromycin daily to counter Legionnaires'.
"I told my husband this week, 'If I die, I want an autopsy. I don't understand what's happening to me,' " she said.
Employees also identified James Myers, a 54-year-old foreman on the east side of the plant, as one the victims.
Reached at home, Myers would say only: "I was sick, but I'm fine now. I thought I would be going back to work this week, but the doctors wouldn't release me.
"I think I'll be back next Monday."
In the aftermath of a death from Legionnaires', said Yu, the Pittsburgh doctor, "there's an element of panic" that can complicate the tracking of a disease whose symptoms resemble common respiratory illness.
"You shrug something off as sniffles one day. Then the guy who works next to you dies of Legionnaires' and you call your doctor. Your doctor's a little worried, so he hospitalizes you," Yu said.
"But in the end, it may still turn out that you only had the sniffles."
Pub Date: 10/08/98