Health Care and Legionnaires Disease

Several years ago a strange illness was diagnosed after many attendees of a conference in 1976 became very sick. American Legionnaires returning from a state convention in Philadelphia began to fall ill with mysterious symptoms including pneumonia and fevers up to 107 degrees. Several of the conference attendees died, and no laboratory tests could determine the cause of their illness, which quickly became known as Legionnaires’ disease. Over 30 people died. Many more were hospitalized for several weeks.

It took researchers six months to determine that the illness had been caused by a bacterium, Legionella pneumophilia. Doctors now know this illness usually succumbs to the timely prescription of proper antibiotics, according to the New York Times. The bacterium, which in this case was apparently spread from the hotel’s air-conditioning system, is a cause of pneumonia and other illnesses worldwide. A more detailed background story of this illness is available at this site: http://www.nytimes.com/2006/08/01/health/01docs.html?pagewanted=all&_r=0.

CDC researchers named the species of bacteria Legionella pneumophila because the second word means "lung-loving" in Latin. This bacteria is actually very common in the natural world and only causes trouble when it gets into people's respiratory systems. It finds your lungs to be an especially comfortable place because they have conditions the bacteria prefer—they are warm and moist, according to ScienceClarified.com.

Legionella are found to exist naturally in stagnant water, and in the Philadelphia case, the CDC traced the outbreak source to the hotel's air conditioning system whose condenser was vented very close to its air intake system. This meant that the large air conditioning system, which had not been cleaned for some time, had the common Legionella germ growing in it, which people then inhaled after the organism had gotten into the air intake pipes. Read more at this site: http://www.scienceclarified.com/Io-Ma/Legionnaires-Disease.html

However, while the disease can be treated with antibiotics, many times it is misdiagnosed and it is estimated that only 5-10% of cases are ultimately reported. The fatality rate of Legionnaires’ disease has ranged from 5% to 30% during various outbreaks and can approach 50% when treatment with antibiotics is delayed. More information about the history of Legionnaires’ Disease is available at this website: http://www.thelegionnaireslawyer.com/history-legionnaires-disease/.

According to the Centers for Disease Control (CDC), Illness caused by Legionella continues to be detected, now more than ever. Each year, it is estimated that between 8,000 and 18,000 people in the United States need care in a hospital due to Legionnaires' disease. More illness is usually found in the summer and early fall, but it can happen any time of year.

Legionella is a type of bacterium found naturally in fresh water. When people are exposed to the bacterium, it can cause illness (Legionnaires’ disease and Pontiac fever). This bacterium grows best in warm water, like the kind found in:

·         Hot tubs

·         Cooling towers (air-conditioning units for large buildings)

·         Hot water tanks

·         Large plumbing systems

·         Decorative fountains

Cooling towers use water to remove heat from a process or building. They are often part of the air conditioning systems of large buildings. In contrast, home and car air conditioning units do not use water to cool, so they do not aerosolize water (spread small droplets of water in the air) and are not a risk for Legionella growth. More info is located online at this site: http://www.cdc.gov/legionella/about/history.html.

Patients with Legionnaires' disease have pneumonia and in addition may have clinical findings suggestive of a systemic disease, according to this website: Open-Access-Biology.com .The symptoms and signs of the disease are often quite variable. The majority of patients have fever, which is usually one of the earliest signs of the illness. Accompanying the fever may be anorexia, myalgia, rigors, and headache.

Clinical diagnosis also may indicate chest pain, shortness of breath and cough may or may not be prominent findings. The cough may or may not be productive, and when it is productive the sputum can be bloody, purulent, or scant and mucoid. In some patients the absence of purulent sputum production, chest pain and cough may fool clinicians into discarding pneumonia as a possibility. When chest pain and haemoptysis are prominent the patient may be suspected of having a pulmonary infarction.

Abdominal pain, diarrhea, nausea and vomiting may occur as well, symptoms that have led to consideration of intra-abdominal infections and inflammatory conditions such as appendicitis, peritonitis, abscesses, inflammatory bowel disease and diverticulitis.

Elderly and immune-compromised patients may not have fever or findings that localize to the lung. Confusion and memory loss are common presenting findings. Much less common are frank encephalopathy, focal neurological findings, seizures and meningitis. A deep dive into the clinical analysis of all aspects of Legionnaires’ Disease can be found at that same site: http://www.open-access-biology.com/legionella/edelstein.html.

According to OSHA, some people have lower resistance to disease and are more likely to develop Legionnaires' disease. Some of the factors that can increase the risk of getting the disease include:

·         Organ transplants (kidney, heart, etc.)

·         Age (older persons are more likely to get disease)

·         Heavy smoking

·         Weakened immune system (cancer patients, HIV-infected individuals)

·         Underlying medical problem (respiratory disease, diabetes, cancer, renal dialysis, etc.)

·         Certain drug therapies (corticosteroids)

·         Heavy consumption of alcoholic beverages

Early treatment reduces the severity and improves chances for recovery. The drugs of choice belong to a class of antibiotics called macrolides. They include azithromycin, erythromycin, and clarithromycin. In many instances physicians may prescribe antibiotics before determining that the illness is Legionnaires' disease because macrolides are effective in treating a number of types of pneumonia, according to OSHA.

Avoiding water conditions that allow the organism to grow to high levels is the best means of prevention, according to OSHA. Specific preventive steps include:

·         Regularly maintain and clean cooling towers and evaporative condensers to prevent growth of Legionella. This should include twice-yearly cleaning and periodic use of chlorine or other effective biocide.

·         Maintain domestic water heaters at 60°C (140°F). The temperature of the water should be 50°C (122°F) or higher at the faucet.

·         Avoid conditions that allow water to stagnate. Large water-storage tanks exposed to sunlight can produce warm conditions favorable to high levels of Legionella. Frequent flushing of unused water lines will help alleviate stagnation.

If you have people living with you who are at high risk of contracting the disease, then operating the water heater at a minimum temperature of 60°C (140°F) is probably a good idea. Consider installing a scald-prevention device. More detailed information is located at this website: https://www.osha.gov/dts/osta/otm/legionnaires/faq.html.

Legionnaires’s Disease can be deadly if not properly diagnosed. Any incident you experience of flu-like symptoms, especially if you’ve been traveling, should be reported to your doctor or a health care professional. Don’t take chances that it may be something minor like a cold or other type of nominal illness. Not many individuals contract this disease, but those who do should take immediate action to get prompt medical attention.

Until next time.