What must it have been like for the American Legionnaires celebrating at a bicentennial gathering in Philadelphia when some of them began falling ill and dying of a mystery disease the day after the celebration started? The 1976 epidemic was named “Legionnaires’ Disease,” because it appeared that they were the ones being affected. Later, the causative agent was named legionella  bacteria, for legionella pneumonia is the havoc wreaked from the bacteria.

Legionnaires Disease Symptoms
Initially headaches, chills, muscle pain and fever above 104० shows up. Then, cough (may be bloody), shortness of breath, chest pain, loss of appetite, nausea, vomiting or diarrhea, and mental changes like confusion appear on day 2 or 3.

It primarily affects the lungs yet it can cause infections in wounds and the heart. The disease symptoms can be like other forms of pneumonia so chest ex-rays are needed to find the bacteria causing the pneumonia. Also blood, phlegm, and urine tests can be done to find the bacteria.

Since so many people falling ill from the mystery disease in 1976 were at the hotel (in Philadelphia) where the convention was being held, there was much innuendo and surmise about what was happening. Just from the symptoms listed, it does seem that people were catching the disease from each other, but they weren’t.

How the Legionella Bacteria Spreads
It spreads by inhalation of microscopic drops of water that carry the bacteria. The hotel in the 1976 epidemic was spreading it through the air-conditioning system, unknown, of course. The organism lived in the water of cooling towers, and many were infected who had been inside the hotel, or walked past it (not necessarily all American Legionnaires). The bacteria are not spread from person to person.

The bacteria could be dispersed from a shower spray, a faucet, a whirlpool, or a ventilation system in a big building. Water systems in hotels, hospitals, and nursing homes are not immune from an outbreak. In fact, just recently a posh resort and casino on the Las Vegas strip reported that guests were exposed to the deadly disease and six guests had recovered from it although many were exposed to it. The culprit (how it was spread hadn’t been determined yet). Likely candidates are:
  • decorative fountains
  • swimming pools
  • hot tubs
  • physical therapy equipment.

The amount of exposure needed to get the disease differs with people. Some develop it after inhaling for just a few minutes. One strange but makes-sense-way of contracting it is by aspiration. If water accidentally gets in your lungs that has the bacteria, you could become ill.

Treating contaminated water delivery systems is a great prevention for the spread of the bacteria. Improperly cleaned whirlpool spas can easily become homes for the bacteria. Water treatment companies should be well aware of the disease causing bacteria, and how to help prevent it from spreading.

It took six months from the 1976 epidemic to nail the causative bacteria, and in the meantime America was going through some rough birthing pains about the handling of the associated panic, and the shock that medicine hadn’t found a cure for this mystery. Effective communication among the many health agencies and researchers needed to happen, and still does, for outbreaks to become contained. Officials need to be accountable for their responses to these mysteries, as do journalists. State health workers, and CDC epidemiologists were working hard to investigate the epidemic. Repetitious news accounts fostered concern over any visits to the state. The final count was 221 known cases and 34 deaths. Yes, the legionella bacteria can be fatal.

Humans who are suspected of having the disease get treatment before test confirmation. Antibiotics are given immediately. Some commonly used are:

  • Quinolones (ex. ciprofloxacin)
  • Macrolides (ex. azithromycin).

Some people are given oxygen, and fluid (electrolytes) replacement.

The most important thing is to get to a doctor if you think you have been exposed or if you have any type of breathing problem.

Susceptible to Infection to Fatality
People 50 years old and above are more susceptible to the disease. Of course smoking doesn’t help either. People with weakened immune systems from HIV/AIDS or drugs (corticosteroids) that have been used to treat certain medical conditions are also more likely to get the disease. Other chronic diseases like cancer, kidney, emphysema or diabetes are on the list. Often drugs are used to suppress the immune system in treatment of such diseases (like chemotherapy), and people are left susceptible to Legionnaires’. Also, if one is working in the cooling towers for air conditioning systems, he or she is at risk.

According to the CDC website, 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 year.

The prognosis for death for hospital patients with the disease is nearly 50%. When antibiotics have been started too late, the outcome can be fatal. Lung failure, respiratory failure, septic shock, and acute kidney failure are complications leading to death from Legionnaires’. 

Amidst all the trial and error and mis-communications between all the parties involved in solving the outbreak, a CDC laboratory scientist, Dr. Joseph McDade, proved that this was a newly recognized, yet old disease! The bacterium had been isolated before by scientists, however, it was believed to only interact with animals, not humans. 

Now, Most outbreaks and cases have been traced to contaminated water in places like shower heads, air-conditioning systems and medical respiratory devices. The largest outbreak, in Spain in 2001, affected nearly 700 people. (Lawrence K. Altman)

Although this epidemic from 35 years ago shocked, frightened, and confused a nation about how helpless medical and governmental powers truly can be, perhaps some needed growth happened. It is an example of a tragedy to have learned from. Just remember that any machine that produces mist can be carrying the bacterium. Awareness is part of the prevention.