Symptoms
Legionella on autopsy?
My son in law died on 6/12/09 from what has been determined
swine flu. His place of work did test positive for
Legionella. He was taken to the hospital 6/1/09 then air
lifted later that evening to U of M medical center. He died 10 days
later. We did receive a call during this time saying he checked
positive for Legionella, and then it was later called a
weak positive. My question for you is after 10 days of treatment
for something they were not sure of, (massive doses of antibiotics,
etc) will an autopsy still show Legionnaires’?
Special stains for Legionella including PCR,
fluorescent direct antibody, and various molecular techniques may
yield the Legionella. Culture is most useful while
the patient is alive. Following death, any microorganism may not
survive, especially after a period of weeks. So, special stains and
molecular methods are used for an autopsy.
I have symptoms of Legionnaires’, but the tests were
negative?
negative?
My husband (57 yrs old) went to the ER with a 104oF
temperature and shaking chills. He was diagnosed with pneumonia,
but he had normal blood work, including WBC count. His condition
deteriorated and he was intubated. He was critically ill and in ICU
for 10 days and developed congestive heart failure. He recovered
after heavy doses of antibiotics, including Rifampin, but tested
negative for Legionella through urine and blood. They
diagnosed him with suspected Legionnaires’ & sepsis based on
clinical presentation.
Prior to the night he was hospitalized, I had an episode of
shaking chills. While he was hospitalized, I had night sweats and a
dry non-productive cough but no fever. After he was discharged,
those symptoms persisted and I was extremely fatigued. I went for
blood work and a chest X-ray. The X-ray and blood work were normal,
except for mildly elevated liver enzymes. A week later, my
liver enzymes were normal, but Hep-B core AB, IgM was reactive. A
follow up for Hep-B surface AB was nonreactive. The doctor
suspected cross reactivity, and ordered repeat tests in 6 months.
The Legionella pneumophila AB, IgG IF was 128. Due
to my husband’s condition, I was treated with a two week course of
Levaquin, followed by more blood tests in 2-3 weeks. After 2 days
on Levaquin, my cough and fatigue are gone, but night sweats
continue. I have no weight loss or enlarged lymph nodes.
I was wondering if night sweats are associated with
Legionnaires’? How likely is it that this could be due to
Legionella? How long will it take for night sweats to go
away once antibiotics were started? My husband and I both work
together in a school.
Your husband’s symptoms are consistent with pneumonia including
Legionnaire’s disease. The blood and urine test can be negative
because the tests may not detect some Legionella subtypes
(serogroups and species).
Your case is more difficult with respect to diagnosis. The chest
X-ray is the test that confirms pneumonia, but your X-ray did not
show pneumonia. Your IgG blood test suggests Legionnaires’ disease,
but a second test 6-12 weeks after the first test is necessary for
confirmation. I agree with your doctor to treat for Legionnaires’
disease. Symptoms of Legionnaires’ disease typically resolve after
five days of antibiotics, if antibiotics are started early.
Follow-Up Questions:
I hope you don’t mind a few additional questions
1. Are night sweats a symptom of Legionnaires’?
2. You say symptoms typically resolve within five days if
antibiotics are started early. I first had chills on Mar.
10th, cough/night sweats began March 14th, blood test done on March
26th and I received lab results & began antibiotics on April
6th. Is that early or should I expect it may take longer for
night sweats to go away? My cough resolved in 48 hours.
3. My doctor is recommended repeat blood test in 2-3 weeks. Should
the numbers quadruple in order for a positive diagnosis? Will that
be long enough? I see you recommend 6-12 weeks.
4. Is this something we should inform the school about?
Follow-Up Reply:
Night sweats accompany the fever, so if fever resolves, so
should the night sweats. Your doctor is well-informed. However, for
Legionnaires’ disease the time of maximal seroconversion (technical
lingo) is 6 to 12 weeks. No need to inform if your blood
Legionella antibody titer is not elevated. Perhaps, your
husband should have a repeat titer done also. Does he have a
chronic underlying disease or does he smoke?
If none of your colleagues have contracted pneumonia recently,
probably not a concern for your school. If your titer is elevated,
feel free to email me again.
Persistent headache following Legionnaires’ disease?
My partner nearly died from this disease some 4 months ago. She
had to be aspirated and was in intensive care for 3 days. She is
suffering severe migraines on a daily basis. Her doctor seems to
think it is residue of the Legionnaires’. I beg to differ. I’m
interested in your thoughts. It is 4 months down the track and she
is plagued by these pounding headaches. She has never been a
sufferer of headaches before. Are headaches (chronic) on a daily
basis a part of Legionnaires’?
Although headaches are common during the onset of Legionnaires’
disease, we have never encountered a patient with persistent
headache months following recovery. Neurologic complications have
occurred in patients who recovered, but this is rare. She should be
seen by a neurologist to investigate other causes. We would be
interested in follow up as to what the final diagnosis or solution
was.
Does Legionnaires’ cause hallucinations?
My daughter was diagnosed during a recent hospital stay. Could
aerosol spray tanning be a source of Legionella exposure?
Is it common for patients with Legionnaires’ pneumonia to have
visual and auditory hallucinations?
The hospital reported her case to County Public Health. Is she
responsible for notifying her employer and property manager? Both
her work and residence have large water delivery systems.
She is a cigarette smoker and the most likely source is drinking
water, not aerosol tanning. Hallucinations are uncommon, but they
could occur.
This is the duty of the health department. While the Pittsburgh,
PA Health Dept would investigate possible drinking water sources,
this is rarely done elsewhere. She may inform the property manager
and ask if other residents have contracted pneumonia.
Are dysphagia, ulcers, and red eyes caused by Legionnaires’
disease?
disease?
My 17 year old son has a fever and is not responding to
3rd generation cephalosporins (400mg). He suffers from
fatigue, headaches, extremely red eyes, cough, throat ulcers,
dysphagia, weight loss, and anorexia. Despite giving him a full
course of medication (cefspan and levofloxacin), he still has a
productive cough and hand tremors. Are these symptoms a result of
Legionnaires’ disease, and if so, why is he not responding to
treatment?
Perhaps, he doesn’t have Legionnaires’ disease. Red eyes, throat
ulcers, dysphagia, and weight loss are not symptoms of
Legionnaires’ disease. Moreover, Legionnaires’ disease will respond
to levofloxacin.
How long will Legionnaires’ cause fevers after being discharged
from the hospital?
from the hospital?
My friend (previously healthy 53 year old male) was diagnosed
with Legionella via a positive urine culture. He was
hospitalized and the first three doses of antibiotics were
intravenous and he was then discharged on oral form (Levaquin-250
mg).
Today is his seventh day out of the hospital. He still has
fevers and sweats, albeit not as intense. He is still quite
fatigued. His appetite is better. He never had respiratory or GI
symptoms. He has a doctor’s appointment in three days. How long can
I expect his fevers and fatigue to last? I was very unimpressed by
the hospital staff on their directions.
The information that you have provided is insufficient to answer
your question with confidence. However, it appears that he may
have been discharged prematurely. The criteria that we
use for discharge are their fever response and ability to take
food. So, many patients can be discharged on day five on oral
antibiotics.
On the other hand, Levaquin is the right antibiotic, and he is
improving. The dose should be 500 or 750 mg (not 250 mg). He
also has no GI symptoms, which is a good sign. If he had
nausea or diarrhea, intravenous antibiotics should have been
continued. By the time he sees his physician, his temperature
should be normal. If not, he should be re-evaluated. Fatigue
will persist for a few weeks, but should gradually resolve given
his previous good state of health.
Did he have recent travel history? If so, the water that he
consumed may have been the source of Legionella. Good
luck!
Sequelae after Legionnaires’ disease?
I had a very serious case of Legionella in May 2011,
and returned to work about six months later, but I am now on sick
leave due to concentration problems, lack of energy, and occasional
breathing problems. I have seen reports that this is quite common,
but do you have any statistics on how long it takes and if/how
large a share of patients will have to live with this?
The patients with the longest sequelae (fatigue and difficulty
concentrating are common problems) are those who were
hospitalized for long periods in the ICU. In some of these
patients, symptoms persisted for a year to 18 months. However,
virtually all make a full recovery eventually.
I generally recommend to continue working despite the fatigue,
since resting over a long period of time also contributes to lack
of energy, prolonging the recovery. Stopping cigarette smioking is
a major step forward.
Keep in mind that when I first encountered Legionnaires’
disease, the mortality was an incredible 40%. You have been
cured with a few weeks of powerful antibiotics. The mortality is
now <5% for those patients who receive the correct antibiotic
early in the course. I would focus on activities including
exercise, extra-curricular activities, and work to hasten your
recovery.
Good Luck!
How long would it take for symptoms of Legionnaires’ disease to
appear?
appear?
I have previously corresponded with you last year about a case
against our hot tub company. If you do not mind, I have a few more
questions for you.
Are there any symptoms of Legionella infection before
48 hours? All nine of the patients were ill between 8-24 hours of
the alleged exposure and it is my understanding that there would be
no symptoms that soon. None of the patients have tested positive
for Legionella in blood or urine samples. One of the
patients even had three antigen tests done in the following
months.
There is no objective evidence of Legionnaires’ disease –
pneumonia which can be life threatening – in the above question.
Most patients will show evidence of Legionnaires’ disease by blood
or urine tests.
Follow-Up:
The water sample from our hot tub showed the presence of the
Legionella bacteria, but it had been in transport for 144
hours until it arrived at the testing center. Could this transport
time affect the results?
Reply:
Legionella grows readily in water at room temperature.
The time of transport will have little effect on the presence of
Legionella – either in increasing or decreasing the
number.
Follow-Up:
Public health was called onsite, they saw the hot tub, and
immediately declared that it was the source of the infection. They
did not investigate any other possible sources. Are there
food-borne bacteria that cause symptoms similar to what these
patients experienced?
Public health stated that the hot tub was the source of
Legionnaires’ to all the parties before any testing had been done.
I believe that Legionella may be in a high percentage of
hot tubs but the rate of incidence is very low because it is
overstated as a source.
Reply:
You did not list the symptoms that the patients had. Typical
symptoms of Legionnaires’ are high fever, cough, and presence of
pneumonia on a chest x-ray. Unless the drinking water was also
tested, it is inappropriate and unscientific for Public Health to
conclude that the Legionnaires’ disease was contracted from the hot
tub.
Recommendations for fatigue problems?
I am currently working as a health coach (background as a
dietitian) and I am seeing a young girl in her twenties who
contracted Legionnaires’ a couple of years ago.
She has ongoing problems with fatigue. Are there any specific
treatments, supplements, or dietary approaches you would recommend
to help with her fatigue?
Chronic fatigue for more than one year after apparent recovery
from Legionnaires’ disease is more common than realized. My advice
is to return to work soon after Legionnaires’ disease treatment has
ended and after consulting with your physician.
I would recommend to gradually increase activity and exercise to
pre-illness levels regardless of fatigue (within reason); ideally,
supervision by a trainer or a physical medicine rehabilitation
professional would be ideal.
Coughing from Legionnaires’ 25 years ago?
I have had a chronic cough for 25 years. Sometimes it’s a lot of
clear mucus. I had Legionnaires’ disease in 1990. I was sick for
several months before someone figured it out what was wrong. When I
get a cold it’s horrible. I can no longer remember NOT coughing.
People really avoid me with the cough as it is frequently
uncontrollable.
Is this cough most likely fallout from the Legionnaires’ 25
years ago?
The cause of your chronic cough is not from Legionnaires’
disease. If you have not already done so, you should consult a
physician.
Mental illness from Legionnaires’ disease?
My mother had Legionnaires’ disease. During the illness, she had
mental problems. She did not recognize family members, and she made
up stories about what happened in her life. She felt continutally
threatened. A few months later, the mental health issues
disappeared.
Now, ten years later, the mental illness symptoms have suddenly
reappeared. Why might this be? Can we cure it?
It is not unusual to experience neurological problems (the most
common is confusion). These problems usually subside over a period
of a few weeks if Legionnaires’ disease is treated early in the
course with effective antibiotic therapy.
So, it is likely that the new symptoms of mental illness are due
to a cause other than his Legionnaires’ disease from so many years
ago (e.g. age-related disease). Your mother should consult a
physician.
Recovery from Legionnaires’ disease without antibiotics?
While waiting for the results of the urine antigen test, I
started to feel better so I declined the use of anitbiotics. It has
been two weeks since I experienced the first symptons, but I have
done the usual for a bad cold (lots of liquids, rest, vitamin C,
zinc, etc).
Would NOT taking the antibiotics cause trouble for me down the
road? Should I be retested to make sure I am Legionnaires’
free?
Legionnaires’ disease is a bacterial pneumonia that can be cured
by antibiotics. The antibiotics used for Legionnaires’ disease are
remarkably safe. Some patients with Legionnaires’ disease survive
without receiving antibiotics.
One missing piece of info:
Was a chest x-ray ordered by your physician when the urine
antigen test was done? If the chest x-ray was done, then you merely
have to have a repeat chest x-ray now. If the chest x-ray shows
pneumonia, then take your antibiotics as originally prescribed –
usually azithromycin (Z-pak), levofloxacin (Levaquin), moxifloxacin
(Avelox).
If the chext-ray shows that your pneumonia has resolved without
antibiotics, and you feel fine, then you “dodged a bullet” and
should go to church this Sunday and make a donation!