Close call leads to prudent advice about potting soil

Sara Taylor's garden is her solace, her refuge and her therapy in times of stress.

This summer, it was nearly the death of her.

Taylor, a 46-year-old Boeing employee who lives and gardens in Renton, is one of two people in the United States believed to have contracted a rare form of Legionnaire's disease this year linked to potting soil.

"I am so lucky to be alive," said Taylor, who was unconscious for two weeks in June while doctors tried one antibiotic after another.

Potting soil is a common gardener's tool, used to start bedding plants and enrich poor native soils. Usually a mixture of humus, peat moss and compost, it's sold in bags at thousands of nurseries and other stores.

"The soil at my house is mostly clay, so I always have to put a lot of compost and potting soil on my flower beds," Taylor said. "But I lost my grip on the bag and it sort of went `poof!' right in my face."

A few days later, she started to feel ill. In less than a week, she was unconscious, in critical care and near death.

"The doctors told my family they were doing the best they could, but it didn't look good," she said.

Lab tests finally showed that Taylor was suffering from Legionnaire's disease, a rare form of pneumonia. The disease takes its name from an outbreak that killed 34 people during a 1976 American Legion convention in Philadelphia.

Legionnaire's disease is carried by bacteria that live in warm water. It's usually spread in the aerated mist from shower heads or - as in the Philadelphia outbreak - air-conditioning cooling towers.

But Taylor was infected by an extremely rare strain, called Legionella longbeachae, which thrives in moist, organic soils.

"It's a form of Legionella that is well-recognized in Australia and has been reported in Japan as well, but this is only the second case we've seen in the United States where we have the association with potting soil," said Dr. Mike Martin of the Centers for Disease Control and Prevention in Atlanta.

Taylor was fortunate, local health officials said. Legionnaire's disease is very hard to diagnose and even harder to test for, since the bacteria do not grow well in the lab.

"She had very good doctors who did the right tests, and they had a very good lab that was able to culture the bacteria," said Dr. Jeff Duchin, chief of communicable diseases for Public Health - Seattle & King County.

Doctors at Virginia Mason Medical Center administered massive doses of antibiotics, and Taylor survived.

The other U.S. case of Legionella longbeachae associated with potting soil was in a 77-year-old Oregon woman who recovered from her bout with the disease in May. She had been gardening with potting soil before becoming ill.

A third case, in which a California man died, is more ambiguous. It is not clear whether the man had any contact with potting soil.

Health officials say the potting soil connection is still circumstantial, and that potting soil is no more dangerous than any other source of Legionella, which is common in nature.

Still, Duchin said, it's only common sense to take some precautions.

"By its nature, potting soil is alive with all kinds of bacteria," he said. "So it is just good sense to avoid getting a whiff in the face. Use gloves when you work with the stuff and always wash thoroughly afterwards. Some of my colleagues in Australia have suggested wetting down the potting soil before you use it, so you don't get a lot of dust."

Further precautions, such as wearing a face mask, are probably not necessary, he said, and wouldn't do a lot of good anyway.

Legionella is so common in nature that many people get it without ever knowing it, say medical experts. The bacteria lurk in the sediment at the bottom of hot water tanks, in kitchen sink drain traps, even in lakes and streams. Only about 5 percent of reported cases are fatal. In a strong, healthy person, a bout of Legionella may seem just like a passing flu bug.

Health officials are still awaiting test results that will show whether the specific strain of Legionella that infected Taylor is the same as that found in her potting soil.

"There are still a lot of questions about the connection to potting soil," Duchin said. "Is it just potting soil that has sat for a long time? Potting soil that has gotten warm and humid? We have not discovered which component of the potting soil contains the organism, or where it comes from."

He said the Oregon and Washington cases were not linked by any particular store or brand.

"We don't think this is something added in the manufacturing process," Duchin said. "It probably occurs naturally in whatever environment the ingredients are drawn from."

Martin of the CDC said it was difficult to draw inferences from only two cases. Spurred by the Seattle incident, the CDC recently sent out a query to doctors and public health officials seeking other occurrences.

"There's still much to learn about Legionnaire's disease," Martin said. "To be honest, we'd like to get a little more information that the infection was due to potting soil. If we do find more cases with potting soil as a common factor, we can begin a real epidemiological investigation."

Makers of potting soil say it may be difficult to isolate the ingredients in all the varieties sold.

"There're so many ways of making potting soils, and almost everybody has a different way of doing it," said Mike Carpinito, owner of Carpinito Brothers Farm in Kent, which among other things mixes potting soil.

Typically, he said, bagged potting soil contains Canadian sphagnum peat moss, ground volcanic pumice, compost - rotted leaves or grass - and forest humus, which can include evergreen needles, bark, ferns and sawdust. Some, but not all, potting soils include manure, and a few are fortified with fertilizers, which can contain nitrogen, potash and trace amounts of heavy metals.

Most manufacturers gather their ingredients locally, Carbonado said, and it's unlikely any would have an Asian source.

Carbonado said he heard about the Legionnaire's disease connection informally, when a state health official called seeking information.

"Basically they were asking the same kind of questions - what's in potting soil," he said. "Other than that, though, there's been no alert or anything put out in the industry."

Taylor is back home, limping a little from a pinched nerve that was the result of her long stay in bed. She credits her recovery to Virginia Mason, her doctors and the efficacy of prayer.

"There were so many people praying for me, I really think that it empowered the doctors and nurses and lab people," she said.

"I remember when I realized how seriously ill I was . . . I grabbed a nurse and said, `Please don't let me die!' And she took my hand and said, `We won't.' And she was as good as her word."

Now, she said, she appreciates life more than ever.

"I'm just so excited to be alive," she said. "I go out in the morning and I think, `God, that sun is beautiful!"

And yes, she's back in the garden.

"There are so many things that need to be cleaned up and cleared out," she said. "Besides, it's good therapy."

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Gardener has brush with death

A little background about Legionnaire's disease

-- Legionnaire's disease is spread by a bacillus called Legionella pneumophila, which lives in lukewarm water and is commonly spread by the aerosol mist from shower heads or air-conditioning cooling towers. A strain called Legionella longbeachae lives in moist organic matter.

-- History: The disease gets its name from an outbreak at the 1976 American Legion convention in Philadelphia. More than 200 people were stricken and 34 died. The bacillus was traced to a hotel air-conditioning system.

-- Symptoms: Flulike symptoms, including fever and muscle aches, nausea and headache, followed by cough and chest pain.

-- Occurrence: Legionella is common in the environment. The bacillus will lie dormant in near-freezing water and survives in water heated to almost boiling. Chlorine will not kill it. It is found in lakes, streams and hot water tanks

-- Contagion: Legionella is infectious only when breathed into the lungs. It is not spread from person to person.

-- Mortality: Between 5 and 15 percent of the 8,000 to 18,000 yearly cases in the United States are fatal. Most fatalities occur in hospitals, among people already weakened by other diseases.

-- At risk: The elderly, people with lung or liver diseases, diabetics and heavy smokers.

-- Treatment: Antibiotics, among them erythromycin, doxycycline and ciprofloxacin.

Sources: Associated Press, New Zealand Health Service, Centers for Disease Control and Prevention, Mosby's Medical Encyclopedia.