What You Should Know About Legionnaires

In 1976, a mysterious illness affected people after an American Legion Convention in Philadelphia at the Bellevue-Stratford Hotel (now the Hyatt at the Bellevue). From that outbreak was named Legionnaire’s Disease, documented in the ICD-10 as A48.1. It has been well contained since, and nearly forgotten.

Hyatt at the Bellevue, site of 1976 American Legion Convention
Photo credit: updrd.com

A Forgotten Problem

Several cases of Legionnaire’s have been reported recently in New York this year. At least twelve of the infected people have died due to complications of the disease. After an investigation of cooling systems and public pools by the New York City Department of Health, the outbreak was traced to the Opera House Hotel in the South Bronx.

Twelve cases of Legionnaire’s were reported in the Bronx during December of 2014 and twelve more cases were reported in January. In April and May of 2015, ten additional cases were brought to the attention of the health department. All these in New York alone as thousands of cases are reported worldwide each year.

What causes Legionnaire’s Disease?

The bacterium Legionella pneumophila is thought to be responsible for Legionnaire’s Disease and for Pontiac Fever. The main difference between Legionnaires and Pontiac Fever is that the people with Pontiac Fever typically recover on their own, while people with Legionnaire’s will more than likely need medical treatment. Pontiac Fever is not accompanied by pneumonia.

Pools are a primary suspect due to the sheer numbers of people using it, making the chlorine work overtime. Also, chlorine does not do well with hardier bacteria such as E Coli, Norovirus, Legionella and cryptosporidium. Cooling systems are suspect because they collect reservoirs of contaminated water and then spread bacteria by cooling fans and ductwork. Less efficient buildings create higher humidity fostering more mold and bacteria to be spread around. More energy efficient buildings with airtight features and proper ventilation can significantly reduce humidity and water condensation.

Otherwise, pools of water, such as lakes or bird baths, have used fountains to cut down on stratification and promote healthier bacterias.  

Symptoms and Diagnosis of Legionnaires

The first signs of Legionnaire’s disease are: cough, high fevers, muscle aches, headaches, and shortness of breath.

Doctors have a hard time diagnosing Legionnaire’s. The disease shares many symptoms with other medical conditions, leaving doctors to come to a diagnosis after a process of elimination. Legionnaire’s has an incubation period of between two and fourteen days after exposure to the bacteria.

Most commonly, the disease is detected through urinary antigen testing. If a person has pneumonia and has a positive urine sample, then a diagnosis can be made for Legionnarre’s.

Number of Legionnaires cases each year

Researchers believe that as many as eighteen thousand people are hospitalized due to complications of Legionnaires Disease each year in the United States. The biggest problem with the facts on Legionnaires is that only about three thousand cases are reported to the Center for Disease Control each year.

Complications Associated with Legionnaire’s Disease

People with Legionnaire’s Disease often succumb to the devastating complications that can accompany the disease. These complications include: acute kidney failure, respiratory failure and septic shock.

Treatments and Prevention for Legionnaire’s Disease

Legionnaires can be treated. Some people will be affected more severely by the bacteria. These people include: chronic lung conditions like asthma or COPD, elderly, infants, people who smoke tobacco products and people with weakened immune systems.

Primary treatment is through the use of antibiotics, particularly azithromycin. The best defense against any disease is prevention. To prevent the bacteria from growing and spreading the disease, water systems in cooling towers, swimming pools, and spas need to be maintained. Health codes have been established for this purpose and are adapted to keep Legionella and other bacteria from developing in them.

Check your pool water using test strips to make sure that you have the proper amount of chemicals present in the water. The Center for Disease Control recommends chlorine levels between two and four parts per million, bromine levels between four and six parts per million, and pH levels between 7.2 and 7.8.

Though Legionnare’s comes with some serious complications and can be deadly, it is preventable and can be treated. More can be learned about Legionnaire’s from a 1991 film produced by the UK Health Safety and Executive.

Authors Bio:

“Daniel is a freelance writer and observationist, former English teacher and failed comedian. His interests include mindfulness, poverty, the environment and support for disenfranchised people worldwide. He is an ardent champion of terrestrial, freeform radio and a DJ at Radio Boise.”