Legionnaires’ disease
DEFINITION
Legionnaires’ disease is a severe form of pneumonia — lung inflammation usually caused by infection. Legionnaires’ disease is caused by a bacterium known as legionella.
You can’t catch Legionnaires’ disease from person-to-person contact. Instead, most people get Legionnaires’ disease from inhaling the bacteria. Older adults, smokers and people with weakened immune systems are particularly susceptible to Legionnaires’ disease.
The legionella bacterium also causes Pontiac fever, a milder illness resembling the flu. Separately or together, the two illnesses are sometimes called legionellosis. Pontiac fever usually clears on its own, but untreated Legionnaires’ disease can be fatal. Although prompt treatment with antibiotics usually cures Legionnaires’ disease, some people continue to experience problems after treatment.
CAUSES
The bacterium Legionella pneumophila is responsible for most cases of Legionnaires’ disease. Outdoors, legionella bacteria survive in soil and water, but rarely cause infections. Indoors, though, legionella bacteria can multiply in all kinds of water systems — hot tubs, air conditioners and mist sprayers in grocery store produce departments.
Although it’s possible to contract Legionnaires’ disease from home plumbing systems, most outbreaks have occurred in large buildings, perhaps because complex systems allow the bacteria to grow and spread more easily.
How the infection spreads
Most people become infected when they inhale microscopic water droplets containing legionella bacteria. This might be the spray from a shower, faucet or whirlpool, or water dispersed through the ventilation system in a large building. Outbreaks have been linked to a range of sources, including:
- Hot tubs and whirlpools on cruise ships
- Cooling towers in air conditioning systems
- Decorative fountains
- Swimming pools
- Physical therapy equipment
- Water systems in hotels, hospitals and nursing homes
Although legionella bacteria primarily spread through aerosolized water droplets, the infection can be transmitted in other ways, including:
- Aspiration. This occurs when liquids accidentally enter your lungs, usually because you cough or choke while drinking. If you aspirate water containing legionella bacteria, you may develop Legionnaires’ disease.
- Soil. A few people have contracted Legionnaires’ disease after working in the garden or using contaminated potting soil.
SYMPTOMS
Legionnaires’ disease usually develops two to 10 days after exposure to legionella bacteria. It frequently begins with the following signs and symptoms:
- Headache
- Muscle pain
- Chills
- Fever that may be 104 F (40 C) or higher
By the second or third day, you’ll develop other signs and symptoms that may include:
- Cough, which may bring up mucus and sometimes blood
- Shortness of breath
- Chest pain
- Gastrointestinal symptoms, such as nausea, vomiting and diarrhea
- Confusion or other mental changes
Although Legionnaires’ disease primarily affects the lungs, it occasionally can cause infections in wounds and in other parts of the body, including the heart.
A mild form of Legionnaires’ disease — known as Pontiac fever — may produce signs and symptoms including fever, chills, headache and muscle aches. Pontiac fever doesn’t infect your lungs, and symptoms usually clear within two to five days.
When to see a doctor
See your doctor if you think you’ve been exposed to legionella bacteria. Diagnosing and treating Legionnaires’ disease as soon as possible can help shorten the recovery period and prevent serious complications. For people at high risk, prompt treatment is critical.
