Let's learn more about Legionnaires' Disease! Let's talk!

Have you ever heard of Legionnaires' disease? The name may sound a bit strange, right? But it's actually an infection that affects our lungs, and it can be quite dangerous at times. It's caused by a bacteria. Today, we're going to talk about Legionnaires' Disease in a simple, easy-to-understand way.

What is Legionnaires' Disease?

Simply put, Legionnaires' disease is a serious infection of our lungs caused by a type of bacteria called `(Legionella)`. It is similar to pneumonia. It can affect not only our lungs, but sometimes our brain and even our gastrointestinal tract.

There is another mild fever caused by the same bacteria, called Pontiac fever. It is not as severe as Legionnaires' disease, and causes symptoms similar to a common cold, such as fever and body aches. However, Legionnaires' disease can be life-threatening, so it is important to be aware of this.

What is the difference between pneumonia and Legionnaires' disease?

Now you're probably thinking, "So pneumonia and Legionnaires' disease are two different things?" Yes, they are. Pneumonia is a common name for a lung infection. Legionnaires' disease is a similar type of pneumonia, but it specifically occurs when a bacteria called `(Legionella)` enters the lungs.

Most people who contract the disease and are hospitalized have symptoms such as fever and cough. However, some may also experience other symptoms such as diarrhea and confusion (loss of consciousness).

Who is more likely to develop Legionnaires' disease?

In fact, not everyone who is exposed to the `(Legionella)` bacteria will develop this disease. However, some people are at higher risk of developing it. See if these facts apply to you:

• If you are over 50 years old.
• If you are a smoker, or have smoked in the past.
• If your body's immune system is weakened. Some medical conditions (for example, HIV infection, diabetes mellitus, cancer, kidney or liver disease) and some medications can also lower your immunity.
• If you have a long-term respiratory condition, such as COPD (Chronic Obstructive Pulmonary Disease) or Emphysema.
• If you live in a long-term care facility, such as a nursing home.
• If you have recently been hospitalized.
• If you have recently undergone surgery under anesthesia.
• If you have recently undergone an organ transplant.

These people are more prone to developing Legionnaires' disease than others.

How common is Legionnaires' disease?

In a country like America, about 18,000 people are hospitalized every year due to this disease. It is most often seen from June to October. Similar situations can be reported in Sri Lanka too, so it is good to be aware.

What are the symptoms of Legionnaires' disease?

Symptoms of Legionella begin to appear within two to fourteen days of exposure to the bacteria. Symptoms that resemble pneumonia are the first to appear. In addition, symptoms involving the nervous system (brain) and the gastrointestinal system (intestines) may also occur.

Let's look at some of the main symptoms:

• Fever (often exceeding 40 degrees Celsius (104⁰ F/40⁰ C))
• Cough (often a dry cough)
• Difficulty breathing (Dyspnea)
• Diarrhea
• Muscle pain
• Headache
• Nausea (feeling sick)
• Confusion (confusion, disorientation)
• Coughing up blood (Hemoptysis)
• Abdominal pain

If you have one or more of these symptoms, you should see a doctor immediately.

What causes Legionnaires' disease?

As we mentioned earlier, the main cause of this disease is the bacteria `(Legionella)`. Although there are about 60 types of `(Legionella)` bacteria, the most common one that causes Legionnaires' disease is `(Legionella pneumophila). This disease occurs when this bacteria enters our lungs and causes an infection.

This `(Legionella)` bacteria naturally lives in lakes, streams, and soil. However, it is often spread to people through places like the water systems and air conditioning systems in large buildings. For example, if these systems in hotels, hospitals, and large offices are not properly maintained, this bacteria can grow and be released into the air as water droplets. When we breathe in those water droplets, they can go directly to our lungs. Or, contaminated water in our mouths can accidentally "go up the throat" and into our lungs (this is called `(aspiration)`).

How does Legionnaires' disease spread to us?

This disease is mainly transmitted by breathing in small droplets of water (aerosolized water or mist) contaminated with Legionella bacteria. Or, by inhaling contaminated water directly into the lungs (aspiration).

Outbreaks of Legionnaires' disease have been reported in places such as hotels, hospitals, nursing homes, and cruise ships. However, these are often reported as isolated incidents.

There are several places where this disease can be transmitted:

• Hot tubs and jacuzzis
• Shower head (shower in bathrooms)
• Water tap
• Humidifiers
• Decorative water features such as fountains
• Heating and cooling systems in large buildings
• Intubation during surgery
• Soil (especially from breathing dust at construction sites)

Important: Legionnaires' disease is not spread from person to person. That is, it is not a contagious disease. You only get it if you get the bacteria from the environment.

How is Legionnaires' disease diagnosed?

If you have symptoms of Legionnaires' disease, when you see a doctor, they will first ask you about your symptoms, your health history, and any recent travel history. Then they will do a physical exam.

The following tests can be done to confirm the disease:

• Urine test or sputum test: These are the most common tests. They look for Legionella bacteria in a sample of your urine or a sample of sputum that comes out of your cough.
• Blood tests: A sample of your blood can be taken to check for antibodies or parts of the bacteria that your body has made against the Legionella bacteria. This can also check how well your other organs are working.
• Chest X-ray or CT scan: These images can help determine if you have an infection in your lungs, such as pneumonia.
• Bronchoscopy: Sometimes, the doctor may need to insert a thin, camera-equipped tube into the lungs. This allows the doctor to directly examine the inside of the lungs and take samples for testing.
• Thoracentesis: If there is fluid around the lungs, a sample of that fluid can be taken and tested for Legionella bacteria.

These tests are the only way to accurately determine whether or not you have Legionnaires' disease.

How is Legionnaires' disease treated?

Legionnaires' disease is treated with antibiotics . These antibiotics may be given as an injection into a vein (IV - intravenous) or as pills, depending on the severity of the disease.

If you have difficulty breathing, you may need to be given oxygen. Treatment for this condition often requires a hospital stay.

Some of the main types of antibiotics used for treatment are:

• Azithromycin
• Levofloxacin, Moxifloxacin or Ciprofloxacin
• Tetracycline, doxycycline , or minocycline
• Rifampin (given together with other antibiotics)

In some severe cases, if you are unable to breathe on your own, you may need to be given breathing assistance with the help of a machine (mechanical ventilation).

What can we do to protect ourselves from Legionnaires' disease?

There are things we, and building managers, can do to reduce this risk.

• Managers of large buildings: It is essential to properly maintain and disinfect your building's plumbing, air conditioning, and cooling towers. This can help control the growth of Legionella bacteria.
• Things we can do at home:
• Clean things like shower heads, faucets, hot tubs, and humidifiers regularly.
• Do not use plain water instead of windshield wiper fluid in your car, as this bacteria can grow in that water tank as well.

What can you expect if you develop Legionnaires' disease?

Legionnaires' disease can make you very sick, often requiring hospital treatment. But the good news is that it can be treated with antibiotics.

You will need to take medication even after you get home from the hospital until the infection is completely gone. Some people may have these symptoms for several months after they recover:

• Feeling very tired (Fatigue)
• Problems with balance or coordination
• Difficulty walking
• Slurred speech
• Muscle pain

If symptoms like these persist, it is important to talk to your doctor.

Complications of Legionnaires' disease

Sometimes, Legionnaires' disease can cause serious complications. These can affect our organs and muscles.

• Respiratory failure: When the lungs are unable to supply enough oxygen to the blood, it is called respiratory failure. In this case, breathing is provided with the help of a machine (mechanical ventilation).
• Acute kidney injury (AKI): When the kidneys stop working, they are unable to filter waste products from the blood. This is treated with medication or a blood-cleansing machine (dialysis).
• Encephalopathy: Symptoms related to the nervous system (confusion, balance problems, difficulty speaking) may worsen.
• Empyema: A pus-filled cavity in the space around the lungs. This may require a chest tube to drain the pus.
• Inflammation of your heart: Bacterial infections of the heart can cause inflammation. These can sometimes be treated with medication.
• Rhabdomyolysis: A condition caused by muscle damage and breakdown. This is treated by removing toxins from the body.

These complications do not occur in everyone, but if the disease becomes severe, these things can happen, so it is very important to seek treatment quickly.

Can you survive Legionnaires' disease?

Although Legionnaires' disease is a serious condition, most people recover from it. With proper treatment, the mortality rate from lung infections caused by Legionella is between 5% and 10%. However, if left untreated, the risk of death can be as high as 30% to 80%. Therefore, seeking medical advice as soon as symptoms appear can be life-saving.

When should I see a doctor?

If you have symptoms of Legionnaires' disease (such as the fever, cough, shortness of breath, diarrhea, and confusion we discussed earlier), see a doctor immediately.

Also, if you learn of an outbreak of Legionnaires' disease where you work or stay, ask your doctor what precautions you should take.

When should I go to an Emergency Treatment Unit (ETU) ?

If you have a high fever, severe difficulty breathing, coughing up blood, or symptoms related to the nervous system (balance problems, slurred speech, confusion), go to the nearest emergency room immediately.

What questions should I ask my doctor?

If you are diagnosed with Legionnaires' disease, you may want to ask your doctor questions like these:

• How long will it take for me to recover?
• How exactly should I use this medicine?
• What new or ongoing symptoms should I be concerned about?

Finally, what to remember (Take-Home Message)

So, Legionnaires' Disease, which we talked about today, is a condition that we really need to be concerned about, and can sometimes be life-threatening. But, the most important thing is that it is a treatable and curable disease .

Remember:

* If you develop symptoms of this disease, do not waste time and seek medical advice immediately.

* Be especially careful about this if you belong to a risk group (such as over 50, a smoker, or someone with a weakened immune system).

* Proper maintenance of the water systems around us, especially those in large buildings and hotels, is very important to prevent the spread of this disease.

* Keep things like faucets and shower heads clean at home.

I hope this information is useful to you. Stay healthy!

Legionnaires ' Disease, Pneumonia, Legionella, Lung Infection, Bacteria, Breathing Difficulty, Antibiotics