(EDITOR’S NOTE: This story was updated late Thursday evening shortly after the state released new information.)

State and county officials have confirmed an outbreak of Legionnaires’ disease in Marshall County.

Iowa Department of Health and Human Services (HHS) Director of Communications Alex Murphy and Marshall County Public Health Director Sydney Grewell confirmed 21 cases on Thursday while sending out similar email responses.

“The Marshall County Public Health Department is working in coordination with Iowa HHS and federal partners to monitor and support the ongoing investigation,” Grewell wrote.

Murphy wrote the same but stated “Iowa HHS is working with local and federal partners.”

There were no comments on possible locations of the outbreak or when it started.

Last night after confirmation of the outbreak, the HHS issued a release stating the people who have been diagnosed all live in north central Marshalltown. It was also confirmed a death of an adult who had Legionnaires’ and underlying health conditions. The release stated the risk to other residents is “low,” but anyone with pneumonia-like symptoms should visit with a physician.

HHS requests Marshalltown businesses and property owners – especially those with cooling towers, hot tubs or fountains – review water management practices. Disinfection of water systems should be done to prevent bacteria growth, along with regular water system maintenance and legionella testing through a laboratory.

Legionnaires’ disease, according to the Mayo Clinic website, primarily impacts the lungs and is caused by the legionella bacteria which grows in human-made water systems, such as whirlpools and air conditioners. Typically, it is not contracted at home, as those air conditioners do not use water for cooling.

People become infected by breathing in the bacteria on water droplets, such as from a shower or hot tub.

The Mayo Clinic website stated outbreaks have been linked to swimming pools, drinking water systems, fountains, hot water heaters and cooling towers.

There have been cases of people coming into contact with the bacteria outdoors from contaminated soil and water, but those typically do not cause infection.

Symptoms of Legionnaires’ disease usually begin within two to 10 days after exposure. They include:

Headache;

Sore muscles;

Fever of 104 degrees or higher;

Coughing which might contain blood;

Chest pain;

Shortness of breath;

Nausea and vomiting;

Diarrhea;

Mental changes, such as confusion.

Legionnaires’ can cause a person to go into septic shock, or lungs or kidneys to fail. If not treated, it can be fatal.