I was at our summer home in upstate NY with my father. Three days later he was admitted to ICU and tested positive for Legionella & E. coli. The results of his culture have not been completed yet.
I have done some extensive research online about Legionella. I have also recorded everything he was doing prior to being admitted. From what I know, the environmental conditions seem apparently ripe for L. pneumophila as well as L. longbeachae. He was drinking well water with high iron content, worked near a fresh-water stream, he had an open wound on his hand working with soil, he was sawing rotting wood by back door and not wearing a mask. I recall the smoke detector going off, so he was inhaling what seemed like thick heavy saw dust. There was also lots of rain around this time as well.
He is 76 yrs old and has had CLL for the past 10-12 yrs and for which no treatment has been required. I know that L. longbeachae is not that prevalent in the USA. Does this strain need to be tested for specifically? If it is the L. pneumophila-type could he have developed the infection from the open wound in his hand by taking a bath?
We will need a bit more info.
Is your father a cigarette smoker?
What were his whereabouts in the 12 days prior to becoming ill? That is, how many days did he display symptoms prior to seeing a physician?
What were his symptoms? Did he have diarrhea?
What was the name of the laboratory test that showed he had Legionnaires’ disease? Was it a urine test?
What was the antibiotic used to treat him and when did he get his first dose? Was the first dose given in the hospital? What is the name of the hospital?
Follow-Up:
My father did not smoke cigarettes but he did occarionally smoke a pipe. He arrived in Upstate NY on July 8th. He was admitted to the ER at NY Presbyterian Weill Corenll Hosp. on July 20th.
Upon admission he given a dose of ceftriaxone. His symptoms were shortness of breath, mild cough, green productive sputum, occasional sweats, and a fever of 38ºC. He did not complain of diarrhea.
Upon testing positive for Legionella and E.coli by urine antigen on July 22nd, he was treated with azrithromycin, vancomycin, and zosyn. A sonogram of the kidneys on July 23rd revealed renal failure, and dialysis was started on evening of July 25. To date, his mental status is not alert but improving.
I was with my father until the evening of July 16th. He did mention around July 15th that we has feeling a bit of malaise, more tired, and had low energy. He generally doesn’t like to complain of being sick and did not give me any indication of something more. When I phoned him on July 18th, he said he had a headache and was feeling a bit tired and weak and that he would be going to sleep. I noticed his speech seemed slurred. On July 20th, my cousins stopped by and said he looked pale, and was running fever and could hardly walk.
Reply:
Azithromycin is curative, and it appears that your father is recovering.
Some patients feel rundown and tired for a few months after recovery from their pneumonia. Since your father is recovering, I would hope that the kidney failure is transient, and that this problem is also resolving; kidney failure is common in untreated Legionnaires’ disease.
The source of the infection is most likely drinking water. Inhaling dust and having an open wounds are not risk factors for Legionnaires’ disease. Many healthcare workers including physicians believe aerosolisation (breathing water droplets) is the mode of transmission. It is not – drinking the water (aspiration) is the way Legionella is transmitted.
Recommendations for the future:
Your father should never drink tap water. Boil tap water, cool it, and save it for drinking. This is applicable everywhere including restaurants or other homes. Bottled water is safe (although the supporting data is limited).
The heat and flush procedure would disinfect the mobile home water, but would need to be repeated at periodic intervals.