DES MOINES — The state has reported a second death associated with a Legionnaires’ disease outbreak in Marshalltown.

The Iowa Department of Health and Human Services on Monday reported the second death was an elderly adult with multiple underlying health conditions. The unnamed individual died Sept. 18, according to the state.

Since late August, the state has confirmed 54 cases of Legionnaires’ disease. Previously, health officials said all the cases were in residents of the north-central part of the city. It is unclear whether that still holds true.

Legionnaires’ disease is caused by Legionella bacteria, which thrive in warm water and typically spread when a person inhales aerosolized water droplets.

According to the state, all available evidence indicates cooling towers are the most

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