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

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 contraptions that you see on roofs that are part of the cooling 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 too little 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 of a water source can essentially turn a cooling tower that’s connected to that source into something akin to a Legionella spray bottle or aroma therapy dispenser. 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.

Inhaling contaminated water droplets is 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 around the person might be harboring Legionella like a water fountain, swimming pool, air conditioning system, sauna, hot spring or dental equipment and in turn got the person infected.

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, the bacteria 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.

If Legionella goes up your nose or into your mouth it could find its way into your respiratory tract. That doesn’t necessarily mean that you will develop full-blown Legionnaires’ disease. You could end up with a much milder respiratory infection— with mild being a relative term since flu-like symptoms aren’t exactly a walk in the park. These can include fevers, chills, headaches, muscle pains, fatigue, nausea, vomiting and diarrhea. This syndrome 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, unlike Legionnaires’ disease it should resolve on its own without needing any 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 occurring at an American Legion meeting held in a hotel 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 were like “what’s going on” for a while. It sent disease detectives scrambling for a cause.

Eventually, scientists identified the causative bacteria in January 1977 and subsequently named it Legionella due to the meeting. This bacteria was found to be multiplying in, guess what, the cooling tower of the hotel’s air conditioning system. The moist air circulated by the air conditioning system in turn had spread it throughout different parts of the hotel, infecting Legionnaires, many of whom were older and particularly susceptible to very bad outcomes. And that’s how the term Legionnaires’ disease was born.

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 respiratory tract. 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. The Centers for Disease Control and Prevention lists the overall risk of death if you have Legionnaires’ Disease as ranging from 10% to 25%, The risk of complications and death go up if your immune system is weaker because you are older than 50 years of age or have some type of chronic medical condition. Things that weaken your respiratory system like being a smoker or having existing lung disease can make you more susceptible to worse outcomes too.

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 “bigger 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 detect 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.