We've all heard of "pneumonia," right? Some of us may have. We usually think of pneumonia as a single disease. But there are actually many different types of germs that can cause pneumonia. Today we're going to talk about a slightly more special, and potentially dangerous, type of pneumonia. This is called "Legionnaires' Disease." You may not have heard of this name, but it's important to know about it.
Simply put, what is Legionnaires' Disease?
Legionnaires' Disease is an infection of your lungs, a type of pneumonia to be precise. It is caused by a type of bacteria called Legionella . You get the disease when you breathe in tiny droplets of water containing this bacteria.
This disease mainly affects your lungs. But sometimes it can also affect your brain and digestive system (intestines). There is another minor illness caused by this Legionella bacteria, called Pontiac fever . It is not as serious as this, it comes on like a common cold and then goes away. But Legionnaires' Disease can be life-threatening, so we need to be careful about it.
Now you may be wondering, "What's the difference between regular pneumonia and Legionnaires' Disease?" The difference lies in the germ that causes the disease. Legionnaires' Disease occurs when a bacteria called Legionella enters the lungs. Although most hospitalized patients have a fever and cough, other symptoms such as diarrhea and confusion are also common in this disease.
Who is most at risk of developing this disease?
In fact, even though Legionella bacteria are present in the environment, not everyone who inhales it will develop the disease. If our body's immune system is strong, it will fight off this bacteria and protect us. But some people are more at risk of contracting this disease than others. Let's see who they are.
| Risk category | A simple explanation |
|---|---|
| People over 50 years old | As we age, the body's natural immunity decreases, making us more susceptible to germs. |
| People who smoke or have smoked in the past | Because the lungs are damaged by smoking, they are less able to fight infections. |
| People with weak immune systems | Conditions such as HIV, diabetes, cancer, kidney or liver disease, or certain medications (e.g., anticancer drugs, steroids) can reduce the body's ability to fight disease. |
| People with chronic respiratory diseases | This infection can severely affect people with lung diseases such as COPD (Chronic Obstructive Pulmonary Disease) or emphysema. |
| People who have been hospitalized or live in nursing homes | This is because there is a potential for this bacteria to grow in the water systems of large buildings. |
| People who have recently undergone surgery | The body may be temporarily weakened, especially if surgery was performed under anesthesia. |
| Organ transplant recipients | After an organ transplant, the body is given immunosuppressive drugs to prevent it from rejecting the new organ. Therefore, the risk of infection is very high. |
What are the symptoms of this disease?
Symptoms of Legionella begin to appear between two and 14 days after infection with the bacteria. Although these are similar to those of pneumonia, there are some unique features.
- High fever: Fever can usually be higher than 40 degrees Celsius (104 Fahrenheit).
- Cough: It may start as a dry cough. Sometimes, a little blood may come out with the phlegm (hemoptysis).
- Difficulty breathing: You may feel short of breath even with mild exertion (dyspnea).
- Muscle pain: Severe pain may occur in the body.
- Headache: A severe headache may occur.
In addition, there are several other characteristics that are unique to this disease.
- Diarrhea: Diarrhea along with pneumonia is a major symptom of Legionnaires' Disease.
- Vomiting and nausea: Vomiting may accompany an upset stomach.
- Confusion: Brain-related symptoms such as confusion, agitation, and inability to remember where you are or what time it is may occur.
You can see that this is a very different and more serious symptom than a regular cold.
How is this disease transmitted? The most important thing!
This is the most important thing everyone needs to know. Legionnaires' Disease is not a disease that can be spread from person to person. This means that you cannot catch it from being around someone who has it, when they cough or sneeze. It is spread through the environment.
Legionella bacteria are naturally found in lakes, ponds, rivers, and soil. But they don't cause us much harm when they're in those places. The problem starts when this bacteria gets into man-made water systems and starts to grow rapidly in the warm environment there.
Think of an air conditioning system (AC) in a large hotel, office, or hospital. These large systems use water to cool them. The temperature in those water tanks is a breeding ground for this bacteria. The tiny droplets of water (aerosolized water) that form from that water can spread throughout the building through the air conditioning system. When people breathe that air, the bacteria go straight to their lungs.
Also, sometimes when we drink water or rinse our mouths, if we accidentally "aspirate" some water, that is, if it goes into the airway, it can cause infection if there are bacteria in that water.
This bacteria is most commonly found in:
- Hot tubs: This bacteria grows well in hot water.
- Shower heads and faucets: Especially when using a shower that hasn't been used in a while.
- Air conditioning (AC) and water systems in large buildings: hotels, hospitals, office complexes.
- Decorative water features: Water features found in shopping malls.
- Humidifiers: Devices that add moisture to the air.
- Soil: In rare cases, even inhalation of dust from soil while gardening can cause health problems.
How to diagnose the disease?
If you have the symptoms mentioned above, your doctor will first examine you. He or she will also ask about your recent travel history (e.g., did you stay in a hotel?), employment history, and any other medical conditions you may have.
Several tests are performed to confirm the disease.
- Urine and sputum tests: This is the most common test. A sample of your urine can be tested for Legionella antigens. A sample of your sputum can also be taken and the bacteria can be cultured.
- Blood tests: Blood tests look for antibodies against the bacteria in the blood. Blood tests also help to see how the body's organs (kidneys, liver) are functioning.
- Chest X-ray or CT scan: These tests help to see what the condition of the pneumonia is in the lungs and how far it has spread.
- Bronchoscopy: In some severe cases, a thin tube with a small camera attached is passed through the nose or mouth into the lungs, where a sample of cells is taken and examined.
- Thoracentesis: If there is fluid around the lungs (pleural effusion), a thin needle is inserted into the chest and a small amount of the fluid is removed to test for bacteria.
How is it treated?
The good news is that Legionnaires' Disease is completely curable with antibiotics , but it's important to start treatment as soon as possible.
Patients are usually treated by being hospitalized.
- Antibiotics: Initially, they are given as IV antibiotics. Once you feel better, you are switched to oral antibiotics. The most commonly used antibiotics are Azithromycin, Levofloxacin, and Doxycycline .
- Providing oxygen: If you have difficulty breathing, supplemental oxygen is given through a nasal tube or mask.
- Mechanical Ventilation: If the disease is very severe and the lungs are unable to function on their own, the patient is admitted to the Intensive Care Unit (ICU) and connected to a machine to help them breathe.
What happens after recovery?
Even after you go home from the hospital, it is essential to take the full course of antibiotics prescribed by your doctor for the full duration. This will help the infection to clear up completely.
Also, it takes a while for the body to recover from such a severe infection. For several months, you may experience the following:
- Fatigue
- Body ache
- Balance problems when walking
- Slight difficulty speaking
If these symptoms persist, talk to your doctor about it.
Possible complications of this disease
If not treated on time or if the disease becomes very severe, several life-threatening complications can occur.
- Respiratory failure: The lungs are unable to supply the blood with the required amount of oxygen. In this case, mechanical ventilation becomes necessary.
- Acute kidney injury (AKI): The kidneys are unable to filter waste products from the blood. This requires medication or dialysis.
- Encephalopathy: Symptoms such as confusion and balance problems may become more severe.
- Septic Shock: Infection spreads throughout the bloodstream, causing blood pressure to drop dangerously low, and organ failure.
- Rhabdomyolysis: Muscles are damaged, and their proteins can accumulate in the blood and damage the kidneys.
These things can be scary to hear. But remember, if the disease is diagnosed early and treated properly, most people will make a full recovery. If left untreated, the risk of death can be as high as 30% - 80%. But with proper treatment, this risk can be reduced to 5% - 10%.
When should you see a doctor? When should you go to the ETU?
If you have symptoms of Legionnaires' Disease, especially high fever, cough, and diarrhea, see your doctor immediately.
Also, if you have recently stayed in a hotel or hostel and there is news that Legionnaires' Disease is spreading there, it is wise to speak to a doctor for advice, even if you do not have symptoms.
If you have any of the following severe symptoms, go to the nearest hospital Emergency Department (ETU) without delay.
- Very high fever
- Extreme difficulty breathing
- Coughing up blood
- Confusion, mental confusion, or difficulty speaking
- Severe chest pain
Take-Home Message
- Legionnaires' Disease is a severe pneumonia caused by the bacteria Legionella. It is spread by breathing in droplets containing the bacteria.
- This is not contagious from one person to another.
- People over the age of 50, smokers, and those with weakened immune systems (such as diabetics and cancer patients) are at higher risk.
- High fever, cough, difficulty breathing, diarrhea, and confusion are typical symptoms.
- This is a disease that can be completely cured with antibiotics, so it is essential to seek medical treatment as soon as possible.
- If you have severe symptoms such as severe difficulty breathing, high fever, or confusion, go to a hospital's Emergency Treatment Unit (ETU) immediately.
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