My mother entered the hospital with complaint of gastrointestinal problems.  She was told by admitting physician lungs were clear.  Three days later she was diagnosed with pneumonia.  I have spoken with several families in ICU they state their family members entered hospital without any respiratory symptoms yet they developed legionella pneumonia.  I would like some guidance on how to proceed to get this hospital water system tested, I fully believe she contracted the pneumonia in the hospital. How in the world can we get this water tested and what laws do physicians have governing their reporting Legionnaires’ disease in a hospital. Should the hospital water be tested?   

        It is a requirement that the hospital inform the health department of your mother’s case of Legionnaires’ disease.  The CDC also recommends that when a case of Legionnaires’ disease occurs in a hospital, the hospital water supply should be cultured since this is a likely source.  You should point this fact out to the doctor taking care of your mother.  You can also call the county health department and ask that they investigate.  You have asked an important question. I hope that the hospital has already taken steps to investigate.

I developed legionella disease in a hospital.  They sent me home with a low-grade fever and a cough.  1 week later my daughter found me on the floor of my bedroom, unconscious and covered in feces.  I was taken to the hospital by ambulance and admitted into ICU, where 3 days later they diagnosed me with legionnaires’ pneumonia.  What I don’t understand is why the hospital was not held responsible for my illness (they did a test on their HVAC system and found Legionnaires’ in the water).  

I was sprayed in the face with water that had been sitting in the pipes of the spa for about 10 days. I immediately washed myself thoroughly, went to the doctor and he prescribed erythromycin for 12 days. This is my 5th day on the antibiotic and I haven't shown any symptoms. I am normally a healthy person. Should I be worried about the possibility of having contracted the disease?

        The mode of transmission as discussed in the FAQ on www.legionella.org is usually aspiration. Aerosolization can also transmit Legionella, but the aerosolization must be intense. For example cooling tower drifts and air conditioners, despite the publicity in newspapers, rarely, if ever, transmit Legionella. The few studies in peer review journals almost never consider other likely sources including potable water from residences or workplace and culture selection is heavily biased towards cooling towers. Vapors from water devices colonized with Legionella can transmit Legionella. So, being directly sprayed with water is unlikely to cause Legionnaires’ disease. The use of erythromycin essentially reduced a minute risk to zero.

        Please inform your physician that erythromycin is no longer the drug of choice for Legionnaires’ disease. Other drugs (azithromycin, clarithromycin, levofloxacin, ciprofloxacin) are more potent and have fewer side-effects.

We have rented a vacation condo for June, at which time one of the members of our family will be a 4 month old baby. There have been recent reports of Legionnaire's disease in this condominium building. Will it by safe by June to take my newborn there, and are newborns more at risk of contracting the disease?

        Legionella is contracted most commonly by aspiration of water containing legionella. You probably have consumed Legionella in drinking water for years without contracting Legionnaires' disease. The individuals with greatest risk in the general population are elderly cigarette smokers. So the risk to you and your newborn is extremely low. Newborns have been reported to contract Legionnaires’ disease, but almost always in the hospital where the hospital water supply is contaminated.

My husband has finished both rounds of antibiotics but still has evidence of pneumonia upon x-ray. An ENT physician wants to give him prednisone for nasal polyps since he has been experiencing a probable sinus infection and stuffiness with secretions, probably from the polyps. I am against this as I think with his compromised immune system with Legionnaires’ disease, the possible adverse side effects of prednisone outweighs the good it will do for the sinus issue for now. It has been about a week and a half since finishing all antibiotics and since his last chest x-ray. He is short of breath walking up stairs, fatigued, coughing, mostly in the morning, productive with brownish-dark yellow tinge, and no fever. Are these symptom expected to persist at this time? When should he have another x-ray to detect any remaining pneumonia?

        The information that you provided is insufficient to answer your question and your physicians have a more accurate perspective of your husband’s diagnosis.

        That said, prednisone is a risk factor for many pneumonias including Legionella. It might be prudent to withhold the prednisone until the chest x-ray has cleared and your husband is more stable. Chest x-rays do not have to be performed routinely once effective therapy has commenced and the patient has responded. In your husband’s case, if prednisone is to be given, a repeat chest x-ray would be useful. Finally, it is not uncommon for the chest x-ray to lag behind clinical improvement.

I got ill like this last year from Feb. to Oct., I went to an Infectious Disease physician, and a Pulmonary specialist, had a spinal tap also, and no one could figure it out. The symptoms subsided, and I was able to function, but never really felt 100% well. I started feeling really crummy again, and my physician took 8 tubes of blood within a week, and it came back positive for Legionnaire's disease. My physician told me it's really only fatal in old people or if you immune system is compromised. I've been on Tequin for 10 days, and it didn't work, I actually feel a little bit worse. I'm just finishing my second 5 day Z-pak. I still feel pretty awful, and I'm wondering if I'm ever going to get over this! My question is, is what kind of antibiotics should I be taking, what strength, and for how long? Last year I took Ketek, Biaxin, and it didn't help.

        The blood test means that you have been exposed to Legionella, but you probably do not have Legionnaires' disease now. Legionnaires’ disease is pneumonia. Ketek, Biaxin, Tequin and Z-pak are highly effective against Legionella, so you need no further antibiotic therapy.

        You may have a chronic fatigue-like syndrome associated with a past infection and it may be prolonged for about a year. Our recommendations are that you must try, no matter how difficult, to be active at home and work. You should get more exercise, not less. You should follow a healthy diet, and quit smoking. If you are overweight, lose weight. No more antibiotics are warranted. Our recommendations must be validated by your physician since we have insufficient information and have not examined you.

Can you test for Legionnaires’ disease after you have been treated and the pneumonia has subsided?

        A blood test, antibody serology, can be performed. It is most accurate 4-12 weeks after the pneumonia. The ideal circumstance is to have a blood test obtained during the pneumonia (acute sera) followed by a repeat test 4-12 weeks later (convalescent sera). Another test is the urinary antigen test, but the accuracy of this test decreases 1 month after the pneumonia.

The water piping in my house is plastic instead of the commonly used copper piping. Does that increase the risk of contracting the Legionella bacteria?

        Various plumbing materials have been evaluated for their ability to support the growth of Legionella (and other bacteria). Copper pipe is inhibitory, whereas plastic (PVC) pipe will support the attachment and subsequent growth of bacteria- including Legionella. If the hot water system temperature is maintained at or above 130oF, growth will be inhibited regardless of pipe materials.

Are children under the age of 2 years at risk of contracting Legionella? If they do contract the infection what is the prognosis or mortality?

        Children do, indeed, contract Legionella. The ones at greatest risk are immunosuppressed (e.g. transplant recipient, receipt of corticosteroids) or those hospitalized (especially neonates). In the hospital, the disease is contracted by Legionella in the drinking water. The mortality in reported cases was 33%.

        If you are a physician, we can send you a preprint of details of the 76 children who have contracted LD. If you are not a physician, you should know the risk is extremely low.

We are planning a trip overseas. We will be in the cabin of an airplane for over 18 hours. Should we wear a mask to avoid Legionnaires’ disease?

        Legionnaires’ disease is not transmitted person-to-person, so you need not be worried. Masks are useful for some pneumonias, but not Legionnaires’ disease.

Could Legionella be the cause of an enlarged liver a few years after I had this infection? (I am not a heavy drinker!)

        Although liver function tests commonly become abnormal during Legionnaires’ disease, a persistently enlarged liver is not caused by Legionnaires’ disease.

I had pneumonia (shown on chest x-ray, single-lobe/105oF fever) 5 months ago. Is there a test for the Legionnaires’ disease antibodies that can be taken at this point to prove or disprove that it was Legionnaires’ disease? I still feel tired and breathless most of the time. I have had diarrhea for quite a while now. My doctors don’t think it is an issue.

        You can have a blood test for Legionella performed (Legionella serology for antibodies). If the test is positive, this is circumstantial evidence that the pneumonia was Legionnaires' disease.

        Your doctors may be right about the issue of Legionnaires’ disease. You have been treated successfully and you need no further antibiotics. In the FAQ on www.legionella.org, we provide information that many patients who contract Legionnaires’ disease will experience fatigue for more than a year, although almost all will recover. Diarrhea is common, but it should resolve when the pneumonia resolves, so consult your physician if it has not resolved. Clostridium difficile colitis is a syndrome caused by antibiotics and this diagnosis might be considered. We recommend that patients with Legionnaires’ disease must quit smoking and continue to be active even if they feel fatigued.

I am a 15 year kidney transplant patient on immunosuppressants. I was diagnosed with Legionella bacteria this past weekend at the hospital. After reading the literature and ways of contracting this disease, I believe there is a good chance that I contracted from a dental visit earlier in the week. My dentist uses a water cooled drill. I had a severe coughing episode when water entered my throat.

        Dental procedures involving water has the potential of transmitting microorganisms including Legionella. Your dentist and any other doctor you see should know you are a transplant patient on immunosuppressive medications. You should inform the dentist of your concern. I would recommend culturing the dental water supply.

        Epilogue: Although the dentist gave us permission to culture his dental water supply, he disinfected the dental lines beforehand. And he refused to allow our technician to culture the water tank of the facility since the tank would still have harbored the Legionella even if he disinfected the water line.

I had a severe asthma attack at work yesterday. The air conditioning system was not used during the summer months throughout the classrooms. The remodeled building was made for air conditioning therefore many areas are closed off to the outside and there are no windows. I was in such a room for 6 hours. I spoke with the janitors about the possibility of a mold problem because that was what triggers my asthma. They told me that they have been chasing after mold on pipes that carry the cool air into the building all summer. The mold keeps returning on pipes and blower units. One janitor told me that the mold looks like moss hanging from a tree...hanging on a pipe. They have brought in an outside firm to wipe down the pipes. School starts in a few days. Could this scenario be a breeding ground for Legionella? What do I need to look for when I get into my classroom?

        The scenario that you describe is not likely to include Legionella as a risk to healthy students and teachers. As is described elsewhere, air conditioners are not likely disseminators of Legionella. Legionnaires’ disease has not been linked to mold contamination.

My 62-year old brother has just spent 3 weeks in hospital fighting a very severe case of Legionnaires' disease (which was initially diagnosed as flu and then pneumonia). He has been a smoker for years but, of course, has had to give that up. He is extremely weak having only been on the path to recovery for one week. He is also suffering side effects of Legionella suddenly, i.e. inflamed joints. A joint suddenly swells up and becomes very stiff, hot and painful. His right knee and both elbows are really bad at the moment. What can he do to expedite recovery?

        Symptoms of joint pain after recovery is common, but inflamed joints that swell up are not. If he does not improve in a few weeks, he should see an arthritis specialist.

Our home water supply is infected with Legionnaires’. I am really concerned. I don't drink tap water but my question is do I have to worry about showering, the use of the dishwasher, washing my clothes and especially brushing my teeth.

        We have found that the risk of acquiring Legionnaires' disease from your home water system is quite low. Generally, those who have contracted the disease from their home water systems are usually smokers.

        Legionella can be isolated from a small percentage of residential water systems. If the bacteria is present, the risk of disease to the average person (with no serious underlying illness) is extremely low. It is also likely to be found in water faucets as well as showers. The role of showers in the transmission of Legionella is overemphasized. Elevated hot water temperature (about 130oF or 55oC) can minimize the chance that Legionella will grow in a water system. Consideration should be given to the risk of scalding to small children and impaired adults if the water temperature is set at this high temperature.

        With respect to your question, there is no risk with use of a dishwasher, washing clothes, and showering. For immunosuppressed patients, we recommend that tap water not be drunk. It is theoretically possible to contract Legionnaires’ disease from brushing your teeth with tap water.

I need your advice. My condominium association has received a proposal from a company to check our water for Legionella on a quarterly basis. As far as I know, we have had no cases. My inclination is to say no, but I want to consult an expert.

        The brief answer to your query is "don't culture buildings unless the building houses a high risk group of individuals (chronic lung disease, immunosuppressive illnesses, illnesses requiring chemotherapy/transplant rejection meds/corticosteroids).

The rationale is at least 2.

        1. Miniscule attack rate.

        Please download the article on the home page of www.legionella.org by Pedro-Botet on Coming of the 3rd Plague. We do recommend that convalescent care facilities housing a notable number of debilitated patients culture their water supply once a year (Seenivisan, J Amer Geriatrics Society 2005 in our Publications section).

        2. Maintenance measures directed at water supplies colonized with legionella are not evidence-based; in fact data from our lab shows that virtually all recommendations involving maintenance do not affect legionella colonization.

        So, what should the residents of your condominium association do to prevent Legionella infection? 1) Smokers should quit smoking. 2) High risk groups should not drink tap water (Singh, Transplant Infect Dis 2004 on the home page of www.legionella.org). Tap water should be boiled, then cooled and refrigerated for drinking for high-risk patients.

My 82-year old father in law was diagnosed 4 weeks ago and has been in hospital. He was discharged two weeks ago but still has diarrhea and sickness. He is losing weight and is now quite weak. He has also been diagnosed with Barret’s Oesophagus.

        The acute symptoms of Legionnaires’ disease respond readily to antibiotic therapy including fever and diarrhea. However, weakness and fatigue can persist for months as the FAQ on the Home Page of www.legionella.org shows. The possibility of persistent diarrhea induced by antibiotic therapy should be considered (Clostridium difficile colitis). This illness can be checked by a laboratory test using the patient's stool.

Epilogue: You were absolutely correct - my father in law was diagnosed with Clostridium difficile. However, he sadly died ten days ago. Many thanks for your reply.

My pulmonary specialist says it is interstitial lung disease, with an underlying disease causing it. He and the Internal Medicine physician ruled out vasculitis and lupus. The infectious disease control doctor tested me for Legionnaires’ disease and the test was positive. Whatever it is, is causing intestinal problems. I still have fevers, headaches, joint pains, shortness of breath, diarrhea, and am tired all the time. I have received four months of antibiotics and am now taking Zithromax without getting better. Could test results could have been wrong about Legionnaires’ disease?

        Please request that your Infectious Disease doctor fax us the test results.  You have not responded to therapy that should have been curative for LD.

We have been notified that a fish pond with Japanese carp will have to be cleared due to the health risk of Legionnaires’ disease. Is it not possible to eliminate the risk in such a confined public area? If the pond has to be cleared, wouldn't all outside ponds need to be cleared?

        Although Legionella may be found in extremely low numbers in natural aquatic bodies of water (like a pond), there is little opportunity for amplification (growth) and transmission. We are not aware of any reported cases of Legionnaires' disease associated with natural ponds. So, we see little risk of contracting Legionnaires’ disease and would not be concerned. No guidelines for ponds, including fish ponds, have been formulated with respect to Legionnaires’ disease. On the other hand, rare cases of Legionnaires' disease have been linked to natural hot springs.

Have there been any confirmed cases of Legionnaires’ disease being caused by water droplets from a decorative fountain? Would it help if I added bleach to this water? (I do not use bleach in the fountain water since we have three cats)? If so, how much would I need to add to it and how often?

        A few cases of Legionnaires’ disease have been linked to fountains, but the risk is low. The bleach probably would be helpful. The concentration is 1-2 parts per million, but it would corrode your fountain. Using boiled water after it has cooled would reduce the risk to zero.

I have a small decorative water fountain in my dining room. I use distilled water in it. What are the chances that my family could contract Legionnaire's Disease from the water running in this fountain?

        Distilled water is less likely to be colonized with Legionella than tap water. The risk is very low regardless.

What % of people die from contracting the disease?

        The figures below are crude estimates.

        Immunocompetent (healthy individuals) given appropriate antibiotics early, 0-9%; immunocompetent individuals not given appropriate antibiotics early, 20%-35%; immunosuppressed individuals (transplant patients, cancer patients, etc.) given antibiotics early, 5-20%; immunosuppressed individuals not given antibiotics early, 40-50%.

I work in a leisure centre which has just been shut to the public because they have found Legionella in the tanks underneath the swimming pool. We have been told that the staff can stay in the building and work because it is not in the water supply e.g. showers etc. Nobody at work is convinced and we feel we should not be in the building. Can you tell us if it is safe as we are concerned for our health?

        The information given above is inadequate to answer your question. Who frequents the leisure center and has a case of Legionnaires' disease occurred in this center? Assuming that the patrons of the leisure center are the general population and that a case has not occurred, it is probably safe to enter and work in the building. It also may be safe for the public. Legionella poses the greatest risk to patients with risk factors such as smoking, who may be exposed to contaminated drinking water.

Can Legionella infect animals?

        Elevated serum antibody levels have been found in horses. A fatal case of pneumonia due to L. pneumophila was diagnosed in a calf. However, only 1.7% (2/112) of the other cattle in the herd had serological evidence of exposure to Legionella (antibody blood test). The disease was linked to exposure to a hot water system colonized with Legionella.

Fabbi M, Castellani-Pastoris M, Scanziani E, et al. Epidemiological and environmental investigations of Legionella pneumophila infection in cattle and case report of fatal pneumonia in a calf. J Clin Microbiol 1998; 36(7):1942-1947.

My husband, 52, is non-smoker, previously healthy, and has contracted Legionnaires’ disease. He has been very ill from it. He uses our hot tub almost daily. I recently swapped out the filter with the alternate filter which I store in an outdoor shed. Also, our pool maintenance man added a floater for the tablets which he had stored at his home. I do not use the tub often, however, before having knowledge of this diagnosis on Sunday, I used the hot tub and now I have a deep moist cough but no fever. I do not want to drain the tub without first discovering if it is the source of LD. How do I go about getting it tested and then how do I effectively disinfect the tub? Of course, I plan to discard both the filter and the floater.

        We are skeptical of some reported outbreaks linked to hot tubs. We also know that Legionella can be acquired simply through the home drinking water. But your question is a reasonable one. If you husband has confirmed Legionnaires’ disease, then the physician is required to report the case to the local health department. The health department can decide whether or not to culture the hot tub.

Can infection alone result in kidney dysfunction?

        Legionella can infect the kidney, but this is very rare. However, kidney dysfunction is a common complication of Legionnaires’ disease. So, if the antibiotics are effective (and they usually are), the kidney dysfunction can resolve.

This is a general question about lab tests for Legionella, but I thought you may be able to help me. I know that the Pittsburgh VA is an authority on Legionella. We recently tested water samples from a camp that hosts retreats for both children and adults, after a Legionellosis case in our region occurred and the patient claimed he had visited the camp a few days before developing symptoms, We sent the samples to our state’s public health laboratory and they all came back culture-negative but positive by PCR. The public laboratory sent the results to us saying that this test is still experimental, but they could not explain what that means in terms of control measures. I get the impression that PCR detects Legionella DNA, but only a positive culture can define if the Legionella is viable enough to infect a person. Is this correct? Are repeat tests recommended?

The director of this camp is very concerned that any of the lab results came back positive and is thinking about repeating testing. He has looked into this and found a lab that will charge upwards of $1000 for each investigation. Could you also tell me an estimate of the cost of sending samples to the Pittsburgh VA Lab?

        You are correct that the meaning of a positive PCR/negative culture is unclear. It is for this reason that culture remains the “gold standard” for investigation of cases. We would expect that the cultures would be positive if a water reservoir at the camp was the source of exposure – unless a disinfection procedure had been applied.

        An individual that is active enough to go to a camp also would have had the opportunity to be exposed to Legionella in locations besides the camp. The camp director has done all that is necessary and follow-up cultures are not indicated. If they want to culture anyway, our prices can be found under “Laboratory Services.”

I was quite ill about four weeks ago with fever chills fatigue and cough, now I am left with cough, sweats and fatigue but have not yet had antibiotics. I feel a lot better than I did. However, could Legionnaires flare up to make me ill again before my doctor starts me on antibiotics. I had the blood test two weeks ago which showed positive and I’m to have another blood test soon.

        The information that you have provided is insufficient to answer your question. Legionnaires' disease (LD) is pneumonia. To address the issue of antibiotics, your chest x-ray should show evidence of pneumonia. If the chest x-ray shows pneumonia, then antibiotic therapy including quinolones (levofloxacin) or macrolides (azithromycin) are highly effective. If the chest x-ray does not show pneumonia, then you may not have active Legionnaires’ disease at the current time and your physician must use his clinical judgment as to the interpretation of the blood test. Another test that is more specific (medical term) is the Binax urinary antigen which may assist your physician in deciding whether you should be treated for Legionnaires’ disease. Please refer your physician to our website, www.legionella.org.

I contracted Legionnaire's pneumonia and was in the hospital for 12 days, 4 of which I spent in ICU. The physicians had difficulty diagnosing my illness and I was treated with a variety of drugs. For the past 6 years I have suffered from a variety of health problems including asthma, hyperthyroidism, anxiety attacks, memory loss and difficulty concentrating as well as having a suppressed immune system. I was wondering if there is any connection between my illness and current health since I was healthy before contracting Legionnaires’ disease.

        Most patients recover completely although it may take many months. See General Information on www.legionella.org. A few individuals have complained of subsequent asthma in queries to our website. As for your other symptoms, we are unable to ascertain if they are associated with your Legionnaires’ disease.

I have auto-immune vitiligo and hypothyroidism. I would like to know why after contracting Legionnaires’ disease while on holiday in France and admitted to ICU on my return to England, where I was placed on life support, and three months later developed asthma/COPD though prior to infection suffered nothing. Asthma is prevalent in my family, my brother died from it after late onset at 31 - died at 41. Is this indicative of my future! My hair has fallen out in immense quantities, but I have slowly regained strength. I find my memory is a little troubling in that I forget, names etc.

        Numerous patients with Legionnaires' disease have asked why they developed asthma shortly thereafter. We have no clear-cut explanation, but we have never seen the development of asthma in our patients and it is not reported in the medical literature. Nevertheless, given the number of queries on this issue, we formulated a questionnaire to be completed by the physicians of these patients; this questionnaire included medical history and documentation of the asthma as well as confirmation of Legionnaires' disease. Over the next 3 years, we continued to receive such queries from patients, and asked these patients to give the questionnaire to their physicians. We received a not a single documenting questionnaire from a physician.

 I have personally been infected by Legionnaires’ disease. What can I do to increase awareness of this infection so that others could be spared this terrible disease?

       The most important problem that we face as physician researchers in this field is that a startling amount of misinformation is present and scientifically validated information that would allow prevention of this infection is not disseminated by public health authorities. It is a fact that Legionella is commonly found in the drinking water supply of large buildings. 

       Since the discovery of the source of the organism in 1982 (Stout, N Engl J Med 1982), this important fact has not been exploited for prevention.  Most public health authorities are not interested because of the panic and media exposure that it may bring.  Likewise, hospitals are afraid of negative publicity, overlooking the fact that if patients learn that they contracted the infection from being admitted into a hospital that did not check their water supply for Legionella that they would not only sue, but they would win. 

       The one thing that you can do if you have contracted Legionella from a hospital is to ask the following question.  Did the hospital have a preexisting policy to culture the water supply?  This approach is recommended by state health departments of Maryland and Allegheny Health Department (Pittsburgh).  However, Denmark, France, and Barcelona, Spain have also established guidelines for hospitals to culture their water supplies.  In 2003, after much foot-dragging, the CDC recommended that all hospitals performing bone marrow and solid organ transplants should culture their water supply.  Unfortunately, many cases occur in non-transplant patients.  Regardless, we feel that all hospitals should culture their water supplies.  CDC has argued in the past that it’s expensive, but culture material, including formulation of the Pittsburgh media, is now commercially available, and the cost for materials is probably less than $500 a year.  Nevertheless, they have balked at this recommendation.

          Hundreds of outbreaks from hospitals have been reported.   Nosocomial (Greek for hospital-acquired) Legionnaires’ disease is now commonplace and has become a well known complication. 

          Approaches for preventing any patients from contracting the disease within a hospital have been published by the State of Maryland and Allegheny County (Pittsburgh) Health Departments. Both health departments recommend that the hospital water supply be cultured for Legionella.  If Legionella is found, the physicians are informed so that if the patient contacts pneumonia while in the hospital, tests for Legionella should be immediately available in-hospital.  This is a matter of common sense.  Moreover, if many of the water sites are positive (for example, greater than 30%), the hospitals can disinfect their water supply.  Copper-silver ionization is now the most widely used modality and there are a number of reputable manufacturers for such devices.

          Inexplicably, a major obstacle to this approach is the Centers for Disease Control in Atlanta, Georgia, which has been very slow in moving forward on this issue.  In 1993, CDC guidelines actually discouraged hospitals from performing routine environmental cultures.  They claimed that the evidence was insufficient despite that fact that several hundred reports had documented that Legionella could be contracted from hospitals including their own investigations.  One of their reasons (which has been convincingly refuted) is that since the organism is ubiquitous, it could exist in hospitals without harming the patients (Yu VL.  Resolving the controversy on environmental cultures of legionella.  Infect Control Hosp Epidemiol, 1998).  We and others now have presented data to show that as many as 70% of hospitals. In some cities harbor Legionella (in San Antonio, the number is 100%); this information is critical to disseminate to physicians in the affected hospitals.  

          In summary, the current approach throughout the world, with some exceptions, is to ignore the problem altogether. 

My 5 year friend got leukemia and is now in maintenance chemotherapy phase.  Do you have any data about the effects of Legionella on such patients?   What the best way to avoid the infection?

        With the exception of hairy cell leukemia which has a disturbingly high incidence of Legionnaires' disease, leukemia is not a major risk for Legionnaires’ disease except for the time they spend in hospitals.  The greatest risk comes from hospitals that have Legionella in the hospital drinking water, but are unaware or do not want to be informed of its presence.  A few hospitals test their water supply for Legionella, and their patients are safe.  Unfortunately, most do not.  The CDC now recommends that hospitals in which bone marrow transplants are performed should culture their water supply.  We recommend that immunosuppressed individuals not drink tap water, but water that has been sterilized by boiling and then cooled.
 

Can Legionnaires' be ingested and give symptoms of nausea and vomiting and migrate to the lungs via the digestive route?

        Your scenario above is not quite correct, but close. Click onto General Information and there is some discussion on Aspiration. Nausea, vomiting, diarrhea can occur. The Legionella bacterium, enters the lung not through the digestive tract, but is aspirated through the windpipe (trachea).
 

The building I work in has tested positive for Legionella bacteria.  One individual fell sick last week.  What are the risks to me if I keep showing up for work and inhaling the air conditioned air?  Do you think I should leave?  Some hot spots were found in the building...two in air conditioning water cooler towers and one in a ladies bathroom sink one floor beneath me. An outside Legionella risk management company came in to the building to conduct independent testing and found no Legionella bacteria present in the water supply.  Then, the City Health Department then conducted their tests;  Legionella was present and potent.  Is there still a risk if the building has been cleaned?  Can you please give some direction.  No one is telling us anything.

        It is not well-known to the public that Legionella in large building water supplies is commonplace.  The fact that Legionella was found in the workplace water systems of a sick person does not necessarily mean that this was the source of infection.  If the Legionella organism was isolated from the patient, molecular typing can be done on both this organism and the Legionella recovered from the water systems.  If they match, then there is a stronger probability that the workplace was the source.
       The reason for not being overly concerned is that unless you have an immunosuppressive underlying illness or smoke cigarettes, you are at little, if any risk.  Healthy individuals have many potential sources for exposure to Legionella in the community, as well as from home water systems. Although we understand your concern, no guidelines on workplaces or public buildings have been formulated because the risk is so low.

The health department in our state has discovered that my husband's place of employment has the Legionella bacteria in their water.  Should he be tested to see if he is infected? 

        No.  Individuals who are not susceptible hosts (e.g., cigarette smokers, transplant recipients) are not at high risk for Legionnaires’ disease. If your husband has signs of pneumonia (high fever, cough), then he should consult his physician for a chest x-ray.  If he seems healthy, testing is unnecessary for your husband.

We moved into a new building 4 months ago, a 2 level office building with under floor ventilation (air conditioning).  Over the Christmas period one of the pipes broke and leaked approximately 1 foot in areas of water into the under floor system (approx 2 foot deep) where all of our electrics were running along with the air conditioning system, which continues to blow cool air.  The building must be half a quarter of mile long if not more and the whole of the underground floor was flooded in various depths.  The maintenance men have continued to pump out the water for 2 days and regain electrical connections, but the water may have been sitting there for a period of up to two weeks. Should the water be tested for Legionella?

        We would not be concerned about the risk for Legionnaires' disease in the situation that you describe. We believe that aspiration is the major mode of transmission, not aerosolization (See General Information on the Home Page for a fuller explanation). Regardless, the risk is very low for either mode of transmission.

I have read recently that home hot water pipes may be a breeding ground for Legionella. Is there any kind of filtration system for the home that would solve this or is boiling the only remedy?

        You may want to read the paper on our web site “Legionnaires' disease contracted from patient homes.” Unless you are at increased risk of contracting Legionnaires' disease (chronic lung disease, immunosuppression, transplant recipient), you are at such a low risk of becoming infected that there is no need for any action on your part. For individuals at high risk, we recommended increasing the hot water temperature to approximately 60^oC (140^oF) max. setting on the hot water tank and flushing the outlets for 30 min. with the hot water. This can be done on a quarterly to annual basis to reduce the level of Legionella within the system. However, this procedure is unnecessary for most homes.  There is a risk of scalding with water at this temperature, so caution must be exercised if elderly or small children use the water.

       Filtration would be expensive because the filter would have to remove particles the size of bacteria (0.2 microns) and they would have to be changed frequently.

I had new piping put in my house and the plumbers didn't do the job right.  Mold formed inside the house in three of the bedrooms and I became sick with pneumonia.  It was later diagnosed as Legionnaires’ disease.  Can Legionnaries’ disease be caused by mold? Or affect the air conditioner in my house where the spores would be spread around the house?

        Legionella can be contracted, not by mold, but by the water in your home water distribution system.  Your doctor is required to report your case to the Health Department, perhaps, they may culture your drinking water for Legionella.  If you live in Pennsylvania, Ohio, and New York, these Health Departments will do this free for you in collaboration with our laboratory.  Although air conditioning is popularly thought to be linked to Legionnaires’ disease in the original 1976 American Legion outbreak, it is now known the source may have actually been the hotel water distribution system. The role of air conditioners in disseminating Legionnaires’ disease is not supported by scientific studies. 
 

Is there any data about contracting Legionella from swimming pools especially if they have not been used all winter long?  

        The risk from contracting Legionnaires’ disease from swimming pools is negligible. 
 

I have been asked to clean bathroom tiles and shower heads in a chain of hotels. Will dry steam cleaning machines kill this bacteria?  Would ordinary steam cleaning machines kill this bacteria?

       Heat above 170^oF and drying will kill Legionella.   However, bathroom tiles, even when wet, will not transmit Legionella. So you need not worry about Legionella in that situation.

What are the chances of getting Legionella from open system of hydronic radiant heat where you get your house heating and drinking water from the same source?

       The risk from hydronic heating is unknown, but we know of no cases of Legionnaires’ disease from such sources.  However, as the article on our Home Page shows, one can contract Legionella from home water distribution systems and large building water systems.  But the risk is extremely low and close to zero if you are not a cigarette smoker.  And, if you were a smoker, I would quit smoking and not worry about the hydronic heat.

Is it common for a person to have a blood test positive for Legionella without a history of illness?  Is there any reason for concern for future illness?

          The blood test (antibody serology) is most accurate when a person is ill with pneumonia.  If the person has no pneumonia and does not have an abnormal chest x-ray, this person may have encountered Legionella many years ago and is ok now.

          Based on our studies, we suspect that presence of antibody may be protective, since we never encountered patients who have contracted Legionnaires' disease twice. 

My goldfish died last week.  I thought I overfed it.  But, an outbreak of Legionnaires’ disease occurred at a large aquarium in our country (Australia). Could my fish have died of Legionnaires’ disease?

          We think you overfed the goldfish.

My husband has been diagnosed with Legionnaires’ disease, but has no underlying risk factors that we know of.  He was cured with erythromycin.  He is 38 years old.  Should we be concerned about his immune system and should his doctor be looking for reasons that he contracted this?

         The answer may be yes, since it is unusual for nonsmokers to contract Legionnaires’ disease.  Did he stay at a hotel or other large building in the 10 days before symptoms?

His case has been reported to the local Health Dept. and they conducted a phone interview, but they won't be doing anything to determine where he was exposed. 

         They should try to locate the source.  If you live in Maryland, New York, Ohio, or Pittsburgh, these Health Departments are more experienced with Legionella investigations. 

       Minor point:  Erythromycin is effective, but azithromycin is more potent, has fewer side-effects, and can be given once daily for a shorter duration.  It also is more expensive.  Levofloxacin is also highly potent.  Your doctor should be congratulated for making the diagnosis.

The Health Dept. did conduct a limited phone survey, but did not come to the house for an inspection.  We have been advised that I probably inhaled or aspirated some standing water.  After 3 weeks, I am back to work, but my strength and stamina are low.  We are trying to determine the source of the Legionella so we can take corrective action.

 I would appreciate your thoughts regarding the two likely sources in our home:

 1.  A portable air conditioner that has a 1/2 liter reservoir to catch the condensate.  The instructions say to pour this accumulated water down the drain whenever it gets full, which is about once a week during normal use in the summer.  One week before I got sick, I began to clean this air conditioner and noticed the reservoir had developed a pink mold.  I poured out a small amount of water into the sink.  I then began to vacuum and clean the insides of the air conditioner, so I could put it away and store it for next summer...

2.  I use a dental night guard every night; it is a formed plastic mold of my teeth that keep me from grinding my teeth.  I store it in a glass of water every day, and sometimes I forget to change that glass of water for a week or more.  Maybe I pulled the night guard out of the "dirty" water and went to bed.  Sometimes I cough after putting it in my mouth, and maybe some of the water went down the "wrong pipe" and got into my lungs (aspiration). How could I get this air conditioner tested?  Right now I'm afraid to use it and we spent $500 on it.  I don't want to throw it away and I wouldn't sell it if I thought it was dangerous. Also, can you provide any information on how to properly disinfect this air conditioner and would you think it is safe to use again?

       The air conditioner is not the likely source.

       The dental night guard soaked in tap water may be the source.  This can be proven by culturing the home water supply and the "dirty water."  If the health dept will not provide this service, we can do it gratis if the Legionella has been isolated from culture of your sputum.  Otherwise, merely use boiled water for storing your dental guard.  Let it cool before dropping your dental mold into it.

Has the Legionnaire's disease and its media coverage had any adverse social impact like did AIDS in the first few years of its discovery and then was understood better?

          The impact of the lay media has been both positive and negative.

          Negative: Bad publicity to a hospital or organization can result because the primary source is the drinking water;  cooling towers or air conditioners are overemphasized by the authorities since the public is more alarmed by drinking water sources than by localized sources such as cooling towers.  The truth can bring panic and a flurry of lawsuits.

          So, hospitals often do not want to know about Legionella in their drinking water.  Nor do public health agencies want to push this issue because of the inflammatory nature of the truth.  On the other hand, we believe that knowledge about the hospital drinking water can allow preventive measures to be taken by the hospital and alerting the MDs such that the disease can be prevented or treated earlier.

          Positive:  Revelations by the lay media have stimulated many hospitals to take preventive measures. The best example is the 1998 TV exposè by New York City Fox news.  Their reporters went into NYC hospitals and cultured legionella from the drinking water of most hospitals. Unbeknownst to the TV reporters is that in one hospital that was culture-negative in their report, Legionnaires’ disease had been discovered in the patients and the hospital water supply was the source.