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Legionnaires' disease (legionellosis)

Legionnaires' disease (legionellosis)

Legionellosis is an infection caused by specific bacteria: Legionella. You can run easily or cause a dangerous pneumonia - Legionnaires' disease

 

What is Legionnaires' disease?



When Legionellosis is an infection with certain bacteria called Legionella. They are used worldwide in freshwater before: in groundwater and in soil, lakes and rivers, in the hot water (including cooling towers, Rückkkühlern and car washes) as well as in drinking water can you find them, for example.

In warm water to Legionella proliferate well. Therefore, hot water systems, as well as air conditioning, swimming pools and hot tubs particularly susceptible to colonization by Legionella and can be the source of infection. (More on this in Chapter causes).

Swallows is the bacteria - for example, with a glass of water - they normally cause any discomfort. But reach the pathogens by water droplets or spray (aerosol) in the lungs , they can cause problems.

What symptoms do occur?

Pontiac fever: An infection may extend mild. For milder forms of legionellosis among the so-called Pontiac fever with cough , colds and elevated temperature.
Legionnaire's disease: 


In some cases a dangerous pneumonia , Legionella pneumonia, also known as Legionnaires' disease. Common symptoms include - depending on the severity - discomfort to severe malaise, high fever , chills, shortness of breath , rapid pulse, dry cough and chest pain . Also abdominal pain , diarrhea and vomiting are possible. (More on this in Chapter symptoms). Legionnaires' disease can be fatal if it is treated too late or incorrectly.

Most elderly people suffer from a legionellosis, as people with a weakened immune system or chronic diseases.

The diagnosis has been confirmed, if the pathogens can be detected in the body - for example, (indirectly) in a urine sample or in lung secretions. The pathogen detection is notifiable.

How is it treated a legionellosis?



Legionnaires' disease is treated with certain antibiotics. A slight legionella infection often heals by itself again.

Since the year 2011, the Drinking Water Ordinance stipulates that not only public, but also commercial operators and landlords equipment must be examined for heating of water above a certain size to Legionella. About the detailed rules, for example, informed the Federal Environment Agency (Link below).

The name Legionnaires' disease goes back to the first described the disease outbreak: If a US veterans meeting in 1976 affected 182 of the 4400 participants, because they had been infected through the air conditioning in their hotels with legionella. Of them died 29th

Legionellosis: Causes

Legionellosis is caused by bacteria that enter through inhalation into the lungs. There they can cause severe pneumonia

 It is the causative agent of Legionnaires' disease to rod-shaped bacteria. They belong to the genus Legionella, of which about fifty species are known. To people is important especially Legionella pneumophila. Translated, the name means as much as "lung loving Legionella". Legionella are found worldwide and are found in the (warm) freshwater.

Which sources of infection are there?



In warm water, in particular at temperatures between about 20 and 45 degrees Celsius, Legionella can multiply - especially if the water is over a longer period (stagnant).

At temperatures above 60 degrees Celsius upwards Legionella die. However, at least 73 degrees Celsius are required for safe destruction in water pipes.

Large hot water systems with an extensive pipe system, air conditioning and hot tubs are particularly susceptible to colonization with Legionella. Why must as hospitals, large apartment buildings, homes and hotels particularly close attention to a maintenance of their hot water systems, otherwise they could be source of infection.

Even rarely used water pipes in new buildings can be colonized with the bacteria. From large cooling systems also assumes a risk.

As it comes to infection?



Get with finely sputtered water legionella in the air, they can in this way the lungs reach. This can happen for example when showering: This produces a fine spray (aerosol), which is inhaled. But even a running faucet may under adverse conditions be the source of infection - as hot tubs, air conditioning, Inhalers or humidifier.

Drinking water containing Legionella is relatively uncritical. Gargling or inhaling the contents can be problematic, however. People with swallowing it is also conceivable that when drinking small amounts of water accidentally get into the airway and then at least lead to an infection.

According to current knowledge, the disease can not be transmitted from person to person. Patients therefore not qualify as "contagious".

Legionella live in single-celled organisms



In the environmental Legionella live mostly in the company of or even inside of unicellular organisms (for example, amoebas) or other bacteria, because they benefit from their metabolism.

Legionella also search in the human body a "good sheltered spot" where they are safe from many common antibiotics: The pathogens infect with fondness the phagocytes (macrophages) of the human immune system and entrench themselves in them. The task of these phagocytes, it is actually just harmful bacteria such as legionella "eat up", thus rendering them harmless.

But at the legionella to bite the macrophages - figuratively speaking - the teeth. The bacteria can even propagate inside the phagocytes and finally destroy the macrophages. Substances thereby pass into the surrounding tissue, which normally uses the macrophage to "digest" pathogens. These substances cause tissue inflammation and attract other immune cells.

Legionellosis: Symptoms

Infection with Legionella may remain completely asymptomatic, it can cause flu-like symptoms or cause a life-threatening pneumonia

 Do not ever causing an infection with Legionella symptoms. Whether a legionellosis turns slightly or heavily depends on various influencing factors:
  • on the amount of captured Legionella
  • on the type of recording
  • on the type of the recorded Legionella. The bacteria differ in their pathogenic effect.
  • of the defense system of the body: Are the defenses weakened, increasing the risk for a severe course of illness. This is for example the case with chronic diseases such as diabetes mellitus when certain drugs are taken, the the, after severe surgery or immune vapors.
  • the patient's age: Elderly people suffer more frequently from severe legionellosis than younger.
  • from lifestyle: smoking or high alcohol consumption increases the risk of serious illness.

Pontiac fever: Light History

The rather mild running Pontiac fever begins approximately one to two (rarely up to five) days after the pathogen has been spilled into the body.
It comes to flu-like symptoms such as fever, sore throat , dizziness , headache and body aches. However, the Pontiac fever does not lead to the lungs (pneumonia). Sufferers usually recover within a few days completely. A particular therapy is usually not necessary. Severe cases are the exception.
The name goes back to the US Pontiac place where there was a cluster of cases of illness.

Legionnaire's disease: severe course with pneumonia



The first symptoms of Legionnaires' disease appear two to ten days after infection (incubation period).

Often the disease begins relatively suddenly - with malaise, fever up to 40 degrees Celsius, chills, headache and muscle pain. Cough, chest pain and shortness of breath are other typical symptoms. In some cases, it also leads to abdominal pain with diarrhea and vomiting . If the nervous system is affected by the Legionnaires, so the sick person is dazed and confused policy.

When Legionnaires' disease is a dangerous developed pneumonia , which can spread over large parts of the lungs. Especially among the chronically ill and immunocompromised patients, it can be life-threatening. Under the appropriate treatment, the disease usually improves within a few days back. But even if it is over, sometimes long-term consequences may remain as a pulmonary fibrosis or impaired lung function.

A by another Legionellenart (L. micdadei) caused pneumonia to bezeichet as Pittsburg pneumonia. The symptoms are similar.