Legionnaires' disease (LEE-juh-nares) is caused by a type of bacteria called Legionella. The bacteria got its name in 1976, when many people who went to a Philadelphia convention of the American Legion suffered from an outbreak of this disease, a type of serious pneumonia (lung infection). Although this type of bacteria was around before 1976, more illness from Legionnaires' disease is being detected now. This is because we are now looking for this disease whenever a patient has pneumonia.
Each year, between 8,000 and 18,000 people are hospitalized with Legionnaires' disease in the U.S. However, many infections are not diagnosed or reported, so this number may be higher. More illness is usually found in the summer and early fall, but it can happen any time of the year.
Legionnaires' disease can have symptoms like many other forms of pneumonia, so it can be hard to diagnose at first. Signs of the disease can include: a high fever, chills, cough, and fatigue or weakness. Some people may also suffer from muscle aches and headaches. Chest X-rays are needed to find the pneumonia caused by the bacteria, and other tests can be done on sputum (phlegm), as well as blood or urine to find evidence of the bacteria in the body.
These symptoms usually begin 2 to 14 days after being exposed to the bacteria.
A milder infection caused by the same type of Legionella bacteria is called Pontiac Fever. The symptoms of Pontiac Fever usually last for 2 to 5 days and may also include fever, headaches, and muscle aches; however, there is no pneumonia. Symptoms go away on their own without treatment and without causing further problems.
Pontiac Fever and Legionnaires' disease may also be called "Legionellosis" (LEE-juh-nuh-low-sis) separately or together.
Legionnaires' disease can be very serious and can cause death in up to 5% to 30% of cases. Persons who experience Legionnaires' disease are usually hospitalized and often require intensive care. Most cases can be treated successfully with antibiotics [drugs that kill bacteria in the body], and healthy people usually recover from infection. Early diagnosis and treatment is important for recovery.
The Legionella bacteria are found naturally in the environment, usually in water. The bacteria grow best in warm water, like the kind found in hot tubs, cooling towers, hot water tanks, large plumbing systems, or parts of the air-conditioning systems of large buildings. They do not seem to grow in car or window air-conditioners.
People get Legionnaires' disease when they breathe in a mist or vapor (small droplets of water in the air) that has been contaminated with the bacteria. One example might be from breathing in the hot water during a shower when the building’s water system is contaminated. Limiting showering and taking short showers may help reduce your risk of getting Legionnaires’ disease.
The bacteria are NOT spread from one person to another person.
Outbreaks are when two or more people become ill in the same place at about the same time, such as patients in hospitals. Hospital buildings have complex water systems, and many people in hospitals already have illnesses that increase their risk for Legionella infection. Other outbreaks have been linked to aerosol sources in the community, or with cruise ships and hotels, with the most likely sources being whirlpool spas, cooling towers (air-conditioning units from large buildings), and water used for drinking and bathing.
People most at risk of getting sick from the bacteria are older people (usually 65 years of age or older), as well as people who are smokers, or those who have a chronic lung disease (like emphysema).
People who have weak immune systems from diseases like cancer, diabetes, or kidney failure are also more likely to get sick from Legionella bacteria. People who take drugs to suppress (weaken) the immune system (like after a transplant operation or chemotherapy) are also at higher risk.
Most people exposed to the bacteria do not become ill. If you experience symptoms of Legionnaires' disease, talk to your doctor or seek health care immediately. Be sure to mention that you may have been exposed to Legionella bacteria. To assist with the public health investigation, please ask your health care provider to perform a Legionella respiratory culture to allow for comparison to environmental samples that have been collected.
A person diagnosed with Legionnaires' disease is not a threat to others because the disease does NOT spread from one person to another.
Most people with Legionnaires’ disease will have pneumonia (lung infection) since the Legionella bacteria grow and thrive in the lungs. Pneumonia is confirmed either by chest x-ray or clinical diagnosis. Several laboratory tests can be used to detect the Legionella bacteria within the body. The most commonly used laboratory test for diagnosis is the urinary antigen test, which detects Legionella bacteria from a urine specimen, or sample. If the patient has pneumonia and the test is positive, then the patient is considered to have Legionnaires’ disease. Additionally, if the Legionella bacteria are cultured (isolated and grown on a special media) from a lung biopsy specimen, respiratory secretions, or various other sites, the diagnosis of Legionnaires’ disease is also considered confirmed. Finally, paired sera (blood specimens) that show a specific increase in antibody levels when drawn shortly after illness and several weeks following recovery, can also be used to confirm the diagnosis.