What Is Legionnaires' Disease? NYC Outbreak Has Left 70 Sick, 3 Dead

Forbes

20 hours ago

This is what can happen when bad stuff in mist gets, well, missed. A Legionnaires' disease outbreak in New York City has already left at least 70 people sick and three dead. All of these cases have been occurring in Central Harlem, which made the New York City Department of Health and Mental Hygiene suspect that something was amiss about the mist being emitted by the cooling towers in the area. Testing of 11 cooling towers there subsequently revealed the presence of Legionella pneumophila bacteria, which the NYC DOHMH believes caused the outbreak.
Cooling Towers Seem To Be The Source of the Legionnaires' Disease Outbreak
As you can imagine, cooling towers normally should not have such dangerous bacteria in them. Cooling towers are those things on the roofs of buildings that are part of the cooling systems such as air conditioning systems for the buildings. These towers help disperse heat from the buildings into the air in the form of a vapor or mist.
Although such cooling towers are not exactly safe enough to lick, the mist that they emit shouldn't normally contain dangerous microbes. But when any water source remains too stagnant for too long with too little cleaning and disinfection, too many different nasty things can grow in it. Legionella bacteria is one of the more dangerous microbes that can enter and grow in such water.
Such contamination can essentially turn a cooling tower or whatever might be dispersing water droplets from that source into a Legionella spray bottle or aroma therapy dispenser of sorts. Therefore, if you inhale the resulting vapor or mist, you could end inhaling a whole lot of Legionella. From there the Legionella can get into your lungs and give you Legionnaire's disease, which could bring a legion of problems. But more on that later.
That's the typical way of getting infected with Legionella and not through person-to-person transmission. When someone has a legionellosis, which is a Legionella infection, you don't have to treat them as if they are radioactive. But you do want to find what water source might be harboring Legionella like a water fountain, swimming pool, air conditioning system, sauna, hot spring or dental equipment.
Legionella Can Cause Other Things Besides Legionnaires' Disease
What Legionella can do depends on where it goes on or in your body. If it comes into contact with any breaks in your skin such as wounds, it can result in a skin or soft tissue infection, otherwise known as cellulitis if you want to sound all medical. If Legionella somehow gets into your sinuses, joints or bloodstream, it can cause infections in such locations as well. Legionella in your bloodstream can end up in your heart, causing bad stuff like endocarditis, myocarditis or pericarditis.
Now, just because you inhale Legionella and get a respiratory infection doesn't mean that you will necessarily develop full-blown Legionnaires' disease. You could end up with a much milder respiratory infection. Well, mild if you consider flu-like symptoms to be mild. These certainly aren't pleasant symptoms and include things like fever, chills, headaches, muscle pains, fatigue, nausea, vomiting and diarrhea. This is known as Pontiac Fever, not because it makes you desire that now-defunct car, but because the first recognition of this syndrome was in 1968 when an outbreak occurred in Pontiac, Michigan. While Pontiac Fever can put you through a period of significant unpleasantness sort of like having an uncomplicated case of the flu, unlike Legionnaires' disease it should resolve on its own without needing a specific treatment.
How Legionnaires' Disease Got Its Name
While the aforementioned problems with Legionella may range from not good to very, very bad, getting Legionnaires' Disease tends to shade more on the bad to really, really bad side. Legionnaires' Disease bears its name not because it has anything to do with becoming a Legionnaire, as I have written before for Forbes. This disease and the bacteria causing the disease got their names because they were essentially discovered from a mysterious outbreak occuring at an American Legion meeting held in Philadelphia, Pennsylvania, back in 1976. At that meeting, a number of the American Legion meeting attendees, known as Legionnaires, there came down with a mysterious disease, characterized by an atypical pneumonia with a fairly high death rate. This made headlines and a bit of a panic at the time as people for a while had no idea why this was happening. It sent disease detectives scrambling for a cause until the causative bacteria was identified in January 1977 and subsequently named Legionella due to the event.
What Are The Symptoms Of Legionnaires' Disease
The symptoms of Legionnaires' Disease usually begin two to 10 days after the bacteria has gotten into your body. You may start with a headache, muscle aches and a high fever, like 104 degrees Fahrenheit (40 degrees Celsius) or higher. Respiratory symptoms like a cough, shortness of breath and chest pain can develop in the ensuing days. The cough may or may not be productive. It could even be bloody. You may also have gastrointestinal symptoms like nausea, vomiting and diarrhea. Things could even get to the point where you have mental status changes like confusion.
Prompt diagnosis and treatment with antibiotics is key with Legionnaires' Disease. Otherwise the risk is that the disease could progress to life-threatening problems like respiratory failure, septic shock or acute kidney failure. All of these complications are more likely if your immune system is weaker because you are older than 50 years of age or have some type of chronic medical condition or your respiratory system is compromised because you have an existing lung disease or are a smoker. The Centers for Disease Control and Prevention lists the risk of death if you have Legionnaires' Disease as ranging from 10% to 25%, which are odds that no one should like.
How Do You Diagnose Legionnaire's Disease
You can't tell whether you have Legionnaires' Disease from symptoms alone. A physical exam and chest X-ray can reveal that you have some kind of pneumonia. But pneumonia is a very non-specific term like haircut or pants and simply means that you have some kind of inflammation and fluid in your lungs. Lots of different microbes can cause a pneumonia. Your white blood cell and platelet counts may be off, your liver enzymes may be elevated or your kidney function tests may be decreased. But ultimately the only way to definitively diagnose Legionnaires' Disease is to find Legionella bacteria in your sputum.
How Do You Treat Legionnaire's Disease
Again, getting a prompt, proper diagnosis is important. The longer you wait, the tougher it is to treat the infection and the more damage can be done. Not all antibiotics are effective against this bacteria. The typical treatment is either fluroquinolones such as levofloxacin and moxifloxacin or macrolides like azithromycin and clarithromycin. These are rather 'big gun' antibiotics that can kill a lot of different microbes. Doxycycline can be used if there is some reason you can't take fluroquinolones or macrolides.
Oral antibiotics may suffice if you catch the disease early and things have not progressed to the uh oh range. But if your disease is severe enough to require hospitalization, you may need to go straight to intravenous antibiotics. This will allow you to ensure that you've got high enough levels of the antibiotics to kill the bacteria in your lungs.
How Do You Prevent Legionnaire's Disease
Naturally, Legionnaire's Disease is the type of thing that you don't want to experience just for the heck of it. It's best to avoid this disease and Legionella as much as possible. So, it's important to be mindful of the different water sources around you and ensure that they are as safe and free of the bacteria as possible. This means keeping any water carrying, storing or dispensing systems up-to-date, working, clean, well-serviced and properly tested. Don't depend on rusty pipes or faucets, drains or pumps that don't work. Remember if proper service and testing of water sources and systems are missed, you could end up with something you don't want in the resulting mist.