A Family Doctor's Tale - LEGIONNAIRE'S DISEASE

DOC I HAVE LEGIONNAIRE'S DISEASE

Legionnaire's disease is getting more common especially in air-conditioned offices or factories with poor ventilation.

The bacteria causing Legionnaire's disease grows in water and soil.

It is transmitted through the air from contaminated air from dirty air-conditioners.

The patient usually presents with a high fever, cough and breathing difficulty.

Diagnosis is confirmed if there is a high legionna bacteria antibodies in the blood.

Treatment is with antibiotics such as erythromycin.

Complications are pneumonia, liver dysfunction and kidney failure.

However prognosis is usually good.


Legionnaire's Disease is an acute, infectious disease of the respiratory tract caused by the bacillus Legionella pneumophilia, a Gram negative, non-sporulating aerobic micro-organism.

Legionnaire's Disease has nothing to to do with the mercenary French legionnaire.

It was named because in 1976 during the American Legion Convention a major outbreak of infectious bacterial disease occur in Philadelphia. The bacteria found was named the Legionella bacillus because of the American Legion Convention.

The bacteria is found mostly in soil and water.

Legionnaire's Disease is transmitted through the air or in dust associated with movement of soil or contaminated air from air conditioner units, hot water tanks or cooling towers.


It is highly infectious.


Incubation period is 2-10 days.


The organism enters the blood and then enter the cells of the lower respiratory tract

The infections occur in persons of all ages but peak incidence is 50-60 years.

Males are affected twice as often as females.


Predisposing factors are:
1. Patients with pre-existing lung disease


2.heavy smoking


3.low immune patients such as cancer

Symptoms start off with:
1. sudden onset of malaise


2. high fever of 39-40 degrees centigrade


3. chills and rigors


4. headache and body aches


5. dry cough


6. diarrhea


7. upper and lower gastrointestinal bleeding


8. difficult breathing


9. slow heart rate


10. confusion and dilerium

Diagnosis  of  Legionnaire's Disease is through:
1.Symptoms of
a.prodromal viral like disease (myalgia, malaise, headache)
b.dry cough, confusion, diarrhea
c.lymphopenia without neutropenia
d.hyponatremia

2.ESR raised very high sometimes > 80


3.moderate leucocytosis with lymphopenia


4.low blood sodium


5.low blood calcium


6.abnormal liver function tests with albumin and raised SGOT


7.Urine shows protein and blood


8.Chest x-ray show patchy consolidation usually confined to one lobe


9.Indirect legionna bacterial antibody higher than 1.256


10.symptoms of renal failure

The complications of Legionnaire's Disease are:
1.pneumonia


2.liver infection and dysfunction


3.renal failure

Treatment of Legionnaire's Disease is with:


Isolation in hospital is unnecessary.
1.Antibiotics (erythromycin or rifampicn) are used in the treatment of Legionnaire's Disease.


2.Tetracycline can be given


3.pulmonary care -

a.nebuliser,

b.oxygen,

c.deep breathing exercises may be necessary if there is breathing difficulty

4.Besides antibiotics, the following will help:
a.Steam inhalation


b.cough mixtures


c.avoid smokes, dust, moist air, sudden temperature change

Prevention for Legionnaire's Disease is by:


1.Avoiding dust


2.Proper cleaning of air conditioners and ventilation system

Prognosis of Legionnaire's Disease is usually good:
1.Early therapy with antibiotics produce good results


2.Low mortality rates as early cases are detected


3.Rarely pulmonary fibrosis develops as remnant from disease.