Legionnaire’s disease is a pneumonia caused by the bacterium Legionella rmeumophila. The organism, which normally dwells in pond water, was given its popular name after being identified as the cause of an outbreak of a mysterious, highly virulent pulmonary infection among 200 people attending a 1976 American Legion convention in Philadelphia. Since that time, nearly 20 species of the disease causing bacterium have been identified. These organisms are transmitted through the air. In the 1976 epidemic, the bacteria were present in a hotel air conditioning system. Since then, numerous smaller outbreaks have been traced to central air conditioning systems, where the bacteria thrive in pools of stagnant water and are circulated through air ducts. Symptoms of Legionnaire’s disease comeon suddenly after an incubation period ranging from 2 to 10 days. Characteristic indications include general malaise, chills, nausea, vomiting, diarrhea, headache, muscle aches, disorientation, a fever that may rise as high as 105°F and a cough. The cough usually starts out dry but gradually progresses to produce gray or blood streaked sputum. About IS percent of all untreated cases are fatal.
Diagnostic Studies And Procedures
If Legionnaire’s disease is suspected, a chest X-ray will be taken; it may reveal fluid in one or both lungs and perhaps lung abscesses. Laboratory cultures of sputum must be done to identify the organisms that are causing the disorder. To collect the tissue samples and secretions for these studies, bronchoscopy may be used. This procedure involves passing a long, flexible viewing tube through the mouth and windpipe and into the bronchial tubes, thus enabling the doctor to study the interior of the airways as well as to collect tissue and fluid samples. Blood tests may detect antibodies to the bacterium.
Antibiotic therapy is the cornerstone of treatment, erythromycin being the drug of first choice. In addition to erythromycin, seriously ill patients might receive rifampin, an antibiotic most commonly used to treat tuberculosis. The drugs may be given intravenously at first, then by mouth, once a patient’s condition has improved. Treatment usually continues for three weeks or more, and all prescribed medication should be taken, even when symptoms abate. Severely ill patients may be hospitalized in an intensive care unit, where oxygen can be administered and vital signs monitored continuously These precautions help prevent such complications as shock, delirium, heart failure, kidney failure, and development of an irregular heartbeat.
Only antibiotic treatment can cure Legionnaire’s disease, but alternative therapies may help relieve symptoms.
To treat pneumonia of all types, Western herbalists recommend tea made of giant Solomon’s seal, an herb that may also be used to make a poultice for application to the chest two or three times a day. Other herbal remedies include hyssop tea and garlic, boneset, or mullein capsules.
Among the substances practitioners use in treating pneumonia are aconitum, arsenicum album, and the ABC formula. Bacillinum may be given once a week but should not be repeated if the first dose brings no improvement. Hepar is said to be effective when phlegm is thick, greenish, or foulsmelling.
Complete bed rest until acute symptoms abate is the most important aspect of self-care, even for mild cases. Until the illness is over, which can take two to four weeks, do not try to exercise other than to practice deep breathing and gentle range of motion exercises of the limbs, neck, and shoulders. A cool mist humidifier increases the moisture in the air, which helps thin lung secretions so they can be coughed up more easily. Drinking extra fluids also helps thin mucus. A heating pad can relieve chest pain, but be sure to turn it off before going to sleep. Keep warm. Avoid singing and talking loudly, both of which can trigger coughing. If your cough is painful but produces no sputum, ask your doctor about a nonprescription cough suppressant. If it does produce sputum, an expectorant makes the secretions easier to cough up. To reduce a mild fever, take aspirin or acetaminophen. Call your doctor immediately if any of these symptoms appear:
A fever of 102°F (38.9°C) or higher.
Severe chest pain.
Increased shortness of breath.
Bluish color of the nails, lips, or skin.
Other Causes of Pulmonary Symptoms
Similar symptoms occur in other lung infections, especially other types of bacterial pneumonia.