The Mysterious Epidemic: Legionnaires Disease

Ashley Altieri, senior

Legionnaires’ disease is a mysterious epidemic that has been sweeping many major cities in the United States, including New York and Pittsburgh. Between February of 2011 and November of 2012, an outbreak of Legionnaires’ sickened 22 and caused the deaths of 6 in Pittsburgh1. President Obama commented on the issue during his visit in July and said “… it was a tragedy, and whenever there are missteps, there is no excuse.”2 However, despite the talk of what happened, there has been little education concerning Legionnaires’ disease and the measures that can be taken to prevent future outbreaks. So, what is Legionnaires’ disease and where does it come from? L disease
Legionella bacteria can be found in natural aquatic environments, and ideally grow in warm water. The bacteria live in water or vapor droplets, and can be found in cooling towers, hot tubs, decorative fountains, and the drinking water systems in buildings4. The next time you soak and unwind in the hot tub, it is a good idea to consider the last time the pH and chemicals were tested because unchecked, Legionella will grow and if you ingest it, you will develop Legionnaires’ disease.
Legionnaires’ disease is more commonly found in people with chronic conditions such as diabetes, cancer, or kidney failure, people with respiratory issues such as chronic obstructive pulmonary disease, past or current smokers, those over the age of 55, and people on drugs that suppress the immune system, such as chemotherapy4. People with Legionnaires’ disease exhibit symptoms such as muscle aches, headache, fatigue, fever, diarrhea, nausea, vomiting, productive cough, and abdominal pain4. A urine test and culture of sputum, blood, and lower respiratory tract samples can detect the Legionella bacteria3. It is spread through droplets containing high amounts of Legionella that can be inhaled from the vapor or ingested4. Legionnaires’ disease is severely underreported and underdiagnosed, partially due to the vague symptoms such as nausea and diarrhea3. According to the CDC, 3,000 cases are reported each year, while 8,000-18,000 people are hospitalized with Legionnaires’ disease per year4.
Sr. Mary Meyers, who is known for her extensive knowledge of public health and nursing experience, recounts a personal encounter with Legionnaires’ disease:
“…He had initially presented in the ER with vague kinds of symptoms – fever, achiness, SOB, productive cough and initially they thought he had some exacerbation of his COPD with pneumonia. As part of the routine work-up, they tested his urine for the Legionella antigen and sure enough, it was positive. Because of his history of COPD, he was less able to fight the disease and went into acute respiratory failure.

He was mechanically ventilated on pretty high settings initially and sedated. For the first 4 days, he ran high fevers and we thought we were going to lose him from sepsis, but finally at around day 6, his fevers broke, and slowly we began weaning the ventilator. Gradually, his Chest x-rays improved, his WBCs began to trend down, and on Day 10, he was extubated to see if he would – to use CVICU jargon – “fly” off the ventilator. Indeed he did. He was extremely weak and deconditioned, but since he was only 65 years old, he went to a rehab facility after he got out of Mercy and was able to return to full health. And, he swore he’d never smoke another cigarette!”

As future nurses, we can do our part by being knowledgeable and spreading awareness for a healthier world and advocating for the prevention of this horrible disease.

1 http://pittsburgh.cbslocal.com/2015/07/08/report-clears-pittsburgh-va-of-legionnaires-allegations/

2 http://www.post-gazette.com/news/nation/2015/07/21/VA-secretary-says-great-progress-made-in-addressing-department-problems-veterans-affairs/stories/201507210155

3   http://www.sciencedirect.com.authenticate.library.duq.edu/science/article/pii/S0140673615600782?np=y

4 http://www.cdc.gov/legionella/about/index.html

5 http://www.pearsonitcertification.com/articles/article.aspx?p=1636985&seqNum=6

Image from Yahoo News

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