Symptoms | Legionella.org

My doctor diagnosed me with pneumonia and treated me with
azithromycin for five days. A week later, I showed up in his office
with erythema nodosum on my lower legs. He decided to test me for
Legionella (results were 1:256), Chlamydia pneumonia (IgG
was 1:256) and coccidioidomycosis (+). Because the
coccidioidomycosis result showed positive, he treated me with
fluconazole (600 mg/day). A CT scan was taken which showed a small
infiltrate in my upper right lob. Over the next five months, I
slowly regained my health and the infiltrate calcified and
decreased.  

My problem is that I’m not sure what I had because when my
primary doc sent me to a pulmonologist, the pulmonologist said I
never had cocci! He said I had Legionella pneumonia and
that it is cured. My symptoms were night sweats, nausea, anxiety,
pressure in my left lung area, sharp pain in my upper left
shoulderblade, terrible fatigue and slight hematuria for 3 months.
Is it possible that I had Legionella and not Valley Fever
(coccidioidomycosis)?

1. Does Legionella cause infiltrates that calcify?
2. Does Legionella cause erythema nodosum?
3. Does Legionella cause the other symptoms I
   experienced? 

1. No, but Valley Fever commonly causes calcifications. 
2. It is rare in Legionnaires’ disease, and not uncommon for
   Valley Fever. 
3. Legionella causes acute pneumonia which generally
   requires hospitalization. What was the exact serologic test
   performed for coccidioidomycosis? The coccidioidomycosis serology
   performed before IgM antibody has a relatively high false positive
   rate, while the IgG antibody is more specific. I believe you more
   likely had Valley Fever (coccidioidomycosis).

On your website I read that 79% of survivors in one study
suffered neuromuscular symptoms. I am experiencing chronic pain in
my elbows and knees that started fairly suddenly 3 years ago which
have been treated with steroids and anti-inflammatories with little
success. I haven’t been diagnosed or treated for legionnaires
disease but have some concerns. I also work around a large 5 cell
cooling tower and am inside the tower cleaning it once per year.
Can a person get legionnaires and get well without specific
treatment? If that is the case and, by chance, I were suffering
effects from it, can it still be diagnosed? Would it eventually go
away on its own? Is there any treatment? Thank you for any
information on this.

As you know from our website, we do not believe that
cooling towers play a notable role in Legionnaires’ disease. And,
in our FAQ, we note that a CDC survey of cooling tower workers
showed no evidence that these workers had any evidence of
Legionnaires’ disease as measured by a blood test for legionella
antibodies as compared to non-cooling tower workers. So, you would
not be at risk for Legionnaires’ disease based on your
profession.

Patients with Legionnaires’ disease can recover
without antibiotics if the disease is mild and they are generally
healthy. However, those that had neuromuscular symptoms in the
study from the Netherlands had lung infection (pneumonia) with
Legionella. However, joint pains are common and Legionnaires’ disease
is not. So, the chances that Legionnaires’ disease precipitated
your pains is highly unlikely.
The treatment is the same for both: a period of rest followed by
exercise and antinflammatory medicines. I assume that you have
undergone a thorough medical examination since a number of
infections and other illnesses can precipitate arthritis symptoms.
Good luck.

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 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.

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.

My 82-year old father in law was diagnosed 4 weeks ago and
has been in the 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. 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.

Can Legionnaires’ disease cause 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.

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 About the Disease 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.

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 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?

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%.

My aunt and grandma went on a cruise to Greece. They both
returned sick and still suffer from shortness of breath, fatigue,
and muscle weakness, including pulmonary edema. Their MD says there
is nothing wrong and they have a mental problem causing these
symptoms. I wonder if they could have Legionnaires’ disease. What
are your suggestions? 

It is unclear if Legionnaires’ disease is the cause of their
symptoms. I suggest that your relatives consult an infectious
disease specialist. A chest x-ray taken at the time of their
illness may be especially useful. Both a blood test for
Legionella antibodies (serology) and possibly a urine
antigen for Legionella may be useful diagnostic aids.

Your relatives may also notify their local health dept or
the health dept where the cruise ship is located. Many
outbreaks of Legionnaire’ disease have been linked to cruise
ships.

Does Legionella lead to ARDS? My brother was
hospitalized with the former and now has the later.

Legionnaires’ disease can be complicated by ARDS. I hope
that with antibiotic therapy that he will recover, but the hospital
course may be stormy. Good luck.

Follow Up Question: 

Thank you for your reply.  Unfortunately, the storm
has arrived.  He is on many antibiotics with his fever
unrelenting. We are now bringing in Infectious Diseases to look for
other sources of infection. 60% c-Pap administered oxygen, all
complicated by a poor performance of mitral heart valve repaired
ten years ago. He is a 66-year-old practicing judge/attorney.
Thanks again.

Follow Up Answer:

Please give the Infectious Disease consultant and the
ICU Attending the message below: 
Unrelenting fever in a patient with persistent pulmonary
infiltrates in a patient with confirmed Legionnaires’ disease may
be a result of 2 unsuspected diagnoses:

• Legionella endocarditis (!) This is rarely diagnosed and there
  is virtually no literature on this except for our publications. I
  would ask the ID attending to look at these two articles describing
  a cluster of cases of prosthetic valve endocarditis at Stanford
  that occurred in the 80’s

Tompkins, L.S., B. Roessler, S.C. Redd, L. Markowitz
and M.L. Cohen. 1988. Legionella prosthetic valve endocarditis. New
Engl. J. Med. 318:530-35

Lowry, P.W., R.J. Blankenship, W. Gridley, N.J. Troup
and L.S.Tompkins. 1991. A cluster of Legionella sternal-wound
infections due to postoperative topical exposure to contaminated
tap water. New Engl. J. Med. 324:109-112.

• Nosocomial endocarditis due to Staph aureus. If TTE shows
  vegetations, empiric quinolone at super maximal
  doses (levofloxacin 750 q 12 or cipro 500 q 8 – adjusted for
  renal dysfunction)) should be strongly considered.
  Short-course rifampin in combination with a quinolone may
  break the fever. Although drug interactions and rising serum
  bilirubinemia will always be problematic. Note that quinolone plus
  rifampin is also active therapy against MRSA. Finally, if
  vegetations are present, surgical resection of the valve should be
  performed – although cardiothoracic surgery will have to be
  persuaded.

I was a guest at Polo Towers, Las Vegas in September during a
Legionella outbreak there. I stayed a week and became very
ill. I went to the doctor, the ER, and the pulmonary specialist. I
was prescribed Leviquin twice a week. It did nothing. I then went
to a clinic in Puerto Rico and got two Z packs that worked. I got
home to find a letter from Polo Towers and Nevada CDC saying I was
exposed and asking if I was tested for Legionella at the
time. I was told it’s not a common thing to test for and I was not
at the time. Is it true that you cannot test for it after
recovery?

A blood test (Legionella antibody serology) or urinary
antigen tests for Legionella are 2 tests
for diagnosis. The antibody serology blood test still may be
useful in diagnosing your illness.

Follow Up Question:

Thank you so much for the fast response. This will be accurate
even seven months after recovery?

Follow Up Answer:

If the test is positive, it is circumstantial evidence that you
contracted Legionnaire’s disease during the course of your illness.
If the pulmonary specialist diagnosed pneumonia based on chest
x-ray, the evidence is overwhelming. If the test is negative, the
results have little meaning:

Two possibilities:

1. You did not have Legionnaires’ disease
2. You did have Legionnaires’ disease, but the antibody titer
   declined because the test was drawn late. 

However, the antibody titer often reaches its peak 3 – 6 months
later, and the rest remains positive for years in a few patients.
So this test should be performed given the context of your letter
from Nevada DOH. The Health Dept or your pulmonary specialist can
arrange for the test. The pulmonary specialist should be given the
info about the Nevada DOH letter. He might be able to assist
you in confirming the diagnosis.

I was discharged from hospital after suffering from a
Legionella infection. I was prescribed with Levofloxacin
which I took for four months. I have had all the expected after
effects of the illness such as fatigue, lack of concentration,
appetite loss, nausea, etc. Over the past few days I have found
that my bowel has become looser. Is this is an after effect of the
condition? Could it be due to the fact that I am now eating more
than I was initially? The drastic gastro-intestinal effects which
heralded the illness make me concerned that it is
returning. 

For most patients, a 10 – 14 day course of levofloxacin is
sufficient. Levofloxacin beyond that time may cause diarrhea, and
if this is occurring, you should stop the levofloxacin and contact
your physician for further instructions. He can be informed about
my reply to you. The diagnosis to be ruled out is called C
difficile colitis.

My mom went into the hospital for nausea, diarrhea, and she had
severely enflamed lungs. She was diagnosed with Legionnaire’s
disease. She almost died and was on a ventilator for 11 days. She
was extubated last night and was doing better, but now the nausea
and diarrhea are back. She had a severe rash during her treatment.
The doctors have discontinued her broad spectrum antibiotic. She
still can’t get the nausea under control. Any thoughts?

There are some possibilities that should be considered.
Antibiotics and other medications commonly cause diarrhea and
nausea. If the Legionnaires’ disease is under control
(e.g. fever has resolved); perhaps the antibiotics can be
discontinued. 7 – 10 days of antibiotics is usually sufficient.
Also, Clostridium difficile colitis (called “c diff”) could
have occurred following Legionnaires’ disease and your doctors can
test for this possibility using a test for stool. There could
possibly be a gastrointestinal complication which can be
investigated by CT scan. Good luck and congratulations to your
doctors for making a difficult diagnosis.

Follow Up Question:

Thank you for such a quick response. The CT scan showed a
hematoma outside the stomach. It has been contained and now we are
hoping the body will absorb 100% oxygen at this point. Her levels
are currently high 90’s. She is in severe pain, but stable.

Follow Up Answer:

Rifampin is an antibiotic that is occasionally given to
patients with severe Legionella pneumonia. If this
antibiotic was used (and it probably was not), it should be
discontinued immediately – it interacts with anticoagulant drugs
(blood thinners).

I suspect that I have Legionnaires’ and I’m in Indonesia. I have
been to the hospital for tests. They have done a lung X-ray and
they have been testing for TB without luck because I’m not spitting
anything to get a clean result. I started with an ear infection a
few days after being exposed to water. I got a fever and flu-like
symptoms and then bronchitis. I am having night sweats, lethargy,
and chest pains. It has been almost 35 days now. The first three
days I took Zithromax (one tablet a day) as my ears were sealed up.
There is no test here for Legionnaires’ and I’m told my blood must
be sent to America from here and take a month for results. I think
it is time to self-prescribe because the system is not so good
here. Should I use the mix of erythromycin and rifampin? 

Legionnaires’ disease is a pneumonia that is diagnosable by
chest x-ray. If the x-ray is negative, you do not have
Legionnaires’ disease. Ear infection is not associated with
Legionnaires’ disease. If you have symptoms for 35 days, it is
unlikely that the infection is due to Legionella. TB must
be excluded. Regardless, erythromycin and rifampin are no longer
the drugs of choice for Legionnaires’ disease. Azithromycin or
levofloxacin is effective.

Follow Up Question:

Thanks for your quick response. When you say TB must be
excluded, what does that mean? In regards to the X-ray, how would
they diagnose with out any experience? What do they look for? The
X-ray had much web like texture in the lower area but said that the
upper area did not show the normal signs of TB though they said it
could be in the lower area already. From experience any diagnosis
here is shoddy at best.

Follow Up Answer:

You need to consult a physician that you trust.