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Legionnaires’ Disease

Legionnaires’ disease is becoming an increasing problem in the United States. In fact, a recent as 2015, the disease claimed the lives of 12 people in New York and sickened another 120 people.

It is not uncommon for someone to have never heard of Legionnaires’ disease. In fact, its discovery is relatively new in comparison to older diseases, like Salmonella. But in the wake of the Flint, Michigan water crisis, Legionnaire’s disease has become more widely known. This severe form of pneumonia is considered rare, but is on the rise in the United States – likely due to an increase in testing.

The CDC reports that the majority of those afflicted with Legionnaires’ disease will require hospitalization. And 1 out of 10 people who get Legionnaires’ disease will die, a staggering statistic from a lesser known disease. Even more concerning, there is no vaccine for Legionnaires’ Disease.

What is Legionnaires’ Disease?

Legionnaires’ disease is a severe form of atypical pneumonia. It is spread by a bacterium called Legionella pneumophila, which is found in water sources. These Legionella bacteria typically live and breed in soil and water, but water systems can cause these bacteria to multiply.

What are the Symptoms of Legionnaires’ Disease?

The onset of symptoms of Legionnaires’ disease begin about 2-10 days after exposure to contaminated water droplets or vapor. These symptoms can include:

  • Cough
  • shortness of breath
  • diarrhea
  • vomiting
  • fever and chills
  • muscle pains
  • headache

In some instances, the fever can reach up to 107° Fahrenheit.

It is not uncommon for people who are infected with Legionnaires’ disease to require hospitalization and undergo intensive treatments. In fact, most of the patients may have some long-term effects from the disease. A recent study of survivors of a Legionella outbreak showed persistence of fatigue (75%), neurologic symptoms (66%) and neuromuscular symptoms (63%) were long-term effects in patients.

Who is at the Highest Risk for Contracting Legionnaires’ Disease?

Anyone can become sick from a Legionella bacteria. However, as with most diseases, there is a high-risk group of people who are more prone to more severe illness from exposure to these bacteria. The group who is at the highest risk include:

  • the elderly
  • those who have history of smoking
  • anyone suffering from chronic lung disease (including asthma, COPD, lung cancer, etc.)
  • people who have poor immune systems

It is highly recommended that people who have pneumonia, especially those who have pneumonia and just returned from travelling, should be tested for the disease.

How is Legionnaires’ Disease Diagnosed?

A patient presenting symptoms of both pneumonia and gastrointestinal issues, such as diarrhea and/or nausea, should be tested for Legionella. Testing is highly recommended, particularly if the ill patient also has mental changes, such as confusion.

There are several ways healthcare providers can diagnose Legionnaires’ disease. Many physicians may use chest x-rays or other radiology to compare the lungs and look for infection. Some physicians may also test sputum or mucus of an infected patient via live culture to find the presence of these bacteria in a patient’s lungs.

Some types of testing used to diagnose Legionnaires’ disease include:

  • antigen testing
  • live culture testing
  • antibody testing
  • genetic testing.

A urine or respiratory sample is required to complete these tests.  The CDC suggests antigen and culture testing to diagnose Legionnaires’ disease.  Additional testes such as sputum culture, gram staining, complete blood count, and chemistry panels may also be ordered to help give a bigger picture of the patients’ overall health and any other ailment the body may be fighting.  An additional blood sample may be required for these tests.

How is Legionnaires’ Disease Treated?

As Legionella bacteria multiply within human cells, strong antibiotics are used to quell the infection. Supportive care, like rest and plenty of fluids, is also recommended. Oftentimes, those with severe forms of the illness may require hospitalization or breathing treatments. It may take much longer to recover if the appropriate medication is not provided to kill this particular bacterium.

How is Legionnaires’ Disease Spread?

Legionnaires’ disease is not contagious by direct contact from person to person. The disease can be spread only through water and nothing else. Diagnosis of Legionnaires’ disease needs specialized laboratory tests which might not be available in all the hospitals. One of tests involves placing a culture media with furnish nutrients of the bacterium. Once the bacteria grow on the medium, it can be identified. Treatment of the infections includes antibiotics such as azithromycin, quinolones, etc.

Is Legionnaires’ Disease on the Rise?

Yes. The discovery of Legionnaires’ disease shows the prevalence of the illness is on the rise, likely due to increased medical testing methods.  Many cases of Legionnaires’ disease go undiagnosed due to lack of testing. Oftentimes, the disease is misdiagnosed as pneumonia.

Outbreaks of Legionnaires’ disease can also be very hard to identify. Health investigators rely heavily on the interviews and patient histories of patients to try to connect the dots to find the common source when an outbreak occurs.

Since 2000, the Center for Disease Control and Prevention’s surveillance of the bacterium shows infections are on the rise. In 2015 alone, there were 6,000 reported cases. But, as the disease is underreported, the number of infections is believed to be much higher – closer to 25,000 cases. The Occupational Safety & Health Administration estimates the disease claims up to 4,000 lives per year.

How Does Someone Get Sick with Legionnaires’ Disease?

Legionella bacteria, the bacteria responsible for Legionnaires’ disease, become infectious when it is inhaled in tiny droplets, making its way into the lungs.

Found in both potable and non-potable water systems, the Legionella bacterium grows well in sources that lack proper maintenance and sanitization. Drinking water systems are the primary source of Legionella bacteria, as are air conditioning units, cooling towers, hot tubs, pools, and even fountains. Further, other places can incubate and spread these bacteria, like humidifiers, whirlpool spas, hot springs, sprinklers, showers, and mist machines.

Legionella bacteria are usually found in larger buildings, including hotels, hospitals, schools, theme parks, care facilities, and even mega resorts.

Legionella bacteria also live in lakes, streams, and ponds, but the levels of bacteria are so low that people are unlikely to get infected from these sources.

How Does Someone Get Sick with Legionnaires’ Disease from a Cooling Tower?

As in the most recent outbreak of Legionnaires’ disease linked to Disneyland, cooling towers and water heaters can form an ideal condition for Legionella to grow. The temperature of the water in most of the water systems that Legionella bacteria love to live in usually range from 68-122° Fahrenheit. As the cooling tower rotates the contaminated, watery air through its recirculated water systems, it emits a considerable amount of water vapor into the atmosphere. As these vapors are exposed to the air, they fall down onto the world below, where they can be inhaled into the lungs of people in the area. It is through this inhalation that someone can become ill.

Studies have found Legionella bacteria present in 60-80% of cooling towers.

How Can Legionnaires’ Disease Be Prevented?

When these bacteria become overgrown they create the potential for infection.  The risk for infection can be reduced by proper maintenance of the water features. The risk of Legionnaires’ disease being spread by large-scale water systems cannot be completely eliminated, but steps and procedures can be taken to greatly reduce the risk of illness. Hot tubs should especially be maintained with the proper chlorine levels, as Legionella grow best in warm water. Further, the likelihood of illness linked to a cooling tower can be significantly reduced proper construction of the cooling tower and proper sanitization of the water in the system. All the cooling tower cleaning and maintenance should be done under careful supervision.

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