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An outbreak of Legionnaires' disease has killed four people and sickened 65 in the Bronx section of New York City since July 10, according to New York City health officials. This Legionnaires' outbreak is now more than five times the number of cases recorded in the last outbreak, in which 12 people in the Bronx fell ill in December 2014.
Legionella is a bacteria that can be found in certain plumbing systems, including hot tubs, humidifiers, cooling towers and hot water tanks. It is spread by breathing in mist from water, and cannot be spread from person to person. It is most common in the summer and early fall, according to the Centers for Disease Control and Prevention.
In 2011 the FDA added Legionella to the boxed warnings on all TNF inhibitors based on their review of 80 reports of Legionella pneumonia in patients receiving TNF inhibitors (TNFI); 14 patients died. The median age of patients was 56 years (range 25-85 years). The most frequent indication for TNFi use was RA (65%) and the mean duration of use 10.4 months (range < 1-73 months). Many patients were also on methotrexate, steroids, or both. Legionnaires' disease is a systemic infectious disease primarily involving the lungs. Patients often present with fever, cough, headaches and muscle aches, and extrapulmonary manifestations (e.g., FUO, serositis, endocarditis, myocarditis, pyelonephritis, abscesses) are not uncommon.