Legionnaire's disease

Outbreaks of Legionnaire's disease in the USA and Europe have focused attention on this problem with its as yet undefined epidemiology and potential serious impact on countries with a large tourist industry.

The bacterium has been associated with cooling towers and evaporative condensers that form part of the air conditioning system. The cooling towers circulate large quantities of warm water where bacteria multiply easily. The escaping water carries the bacteria in the air. The disease can be contracted if people inhale high concentrations of bacteria. Hot tubs and spas are also suspected as possible sources of infection.

Severe Legionnaires' disease has an overall mortality rate of 10% to 30%, and 30% to 50% of patients require admission to an intensive care unit One of the most important determinants of outcome is the early initiation of adequate therapy after admission. The early symptoms of [Legionella pneumonia] include malaise, myalgia, anorexia, headache, profuse sweating and chills. In some series patients have developed confusion or delirium during the first week of illness, and diarrhoea, abdominal pain, and vomiting may also result.

The disease was first identified in 1976 after an outbreak at an American Legion convention, which killed 30 people.
Since the first outbreak of Legionnaires' disease in Philadelphia in 1976, several outbreaks have been described that were linked to hospitals, hotels, cooling-towers and whirlpool baths. In March 1999, one of the largest outbreaks of Legionnaires' disease occurred in the Netherlands. The outbreak originated at an annual flower show and was associated with a contaminated whirlpool spa located in the hall with a consumer products exhibition. The flower show was visited by 77,061 persons, and Legionnaires' disease developed in at least 188; at least 18 died of causes definitively linked to Legionnaire's disease.

Almost all reported outbreaks of Legionella in the USA and Europe have occurred during the summer and autumn, with a mortality rate at about 10-12.5%.

(E) Emanations of other problems