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Legionnaire’s Disease
Case study:
Legionnaire’s Disease and Saunas.
Causative organism:
Legionella pneumophila
Acquired name:
First recognized in 1976 when an outbreak of a respiratory disease occurred among many delegates of the American Legion members attending a convention in Philadelphia.
182 people contracted pulmonary disease and 29 died.
Characteristics:
Small, thin microbe (2-10 micrometers in length).
Cell wall-high lipopolysaccharide content.
Gram negative aerobic rod (bacillus).
Facultative intracellular parasite.
Definition:
An acute respiratory infection caused by the bacterium Legionella pneumophilia, which can cause a broad spectrum of disease from a mild cough and fever to a serious pneumonia by influenza-like illness, with high fever, chills, headache, and muscle aches.
Anatomy or system affected:
Chest, lungs, and respiratory system.
Location:
Found in warm water environments such as rivers, lakes, ponds, streams, hot tubs (spas) and unclorinated tap water.
Airborne microbes in wind gusts
Water delivery systems, cooling towers, air conditioning systems of large buildings including hospitals and hotels.
Soil
Pathogenicity/Infection:
Incubation period (2-10 days)
First symptom is cough (mucous) and diarrhea.
Most common in the summer months-air conditioning.
Mode of Transmission:
Through the respiratory route. (must reach the lungs)
Inhalation of small particles of contaminated water (aerosols) or soil.
Spread in indoor environments-cooling towers, evaporative condensers, hot water tanks, hot water propelled from shower heads and faucets, and whirlpool spas.
Symptoms:
General discomfort, uneasiness or ill feeling, cough (of mucous or blood), headaches, shaking chills, nausea, vomiting, diarrhea, high fever (over 104 degrees).
Chest pain, shortness of breath, aching muscles, stiffness, joint pain, loss of energy, lack of coordination.
Mental changes: confusion, disorientation, hallucination, and loss of memory(extent of the fever),
Diagnosis/Signs and tests:
Organism can be cultured from the airway and also isolated from natural waters.
Best grown on a selective charcoal-yeast extract medium nutrients such as amino acids, vitamins, and iron are included in the medium while the charcoal removes potentially toxic material.
Sputum DFA (Direct Fluorescent antibody) staining method- detects antigens
Urine antigen test may be positive.
Chest X-ray shows pneumonia.
Gene probes and Polymerase chain reaction tests detects bacterial DNA.
Risk Factors:
Being middle-aged or elderly (especially in men over 50).
People with suppressed immune systems. Workers-in sealed buildings that maintain water-cooling towers in air-conditioning systems. Soil disturbed by bulldozing.
Epidemiology/Current status:
Fairly common, even if unrecognized.
2.4 million cases have pneumonia each year estimated 10,000 to 100,000 have Legionella.
More than 1000 cases reported each year.
Mortality rate ranges from 15-60%.
Morality rate develop while hospitalized is close to 50%(especially when antibiotics are started late).
Treatment:
Goal-stop infection with antibiotics.
Drug- Erythromycin.
Supportive treatment-hospitalization for fluid and electrolyte replacement and oxygen administration.
Complete recovery-several weeks.
Prevention:
Good engineering practices in the operation and maintenance of air and water handling systems.
Active surveillance of infections, detection, and treatment.
Corroded parts-replace
Growing algae-remove
Examine, clean or replace air filters.
Hot water tanks-clean regularly to prevent the water from stagnation. (Thrive in warm stagnant water).
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