Respiratory illnesses are no fun, but they typically go away on their own with at-home treatments to ease symptoms. But one respiratory illness that can have serious complications and even become life threatening if it goes untreated is Legionnaires’ disease.
Legionnaires’ disease is a type of pneumonia that isn’t very common, but it can be difficult to avoid because it’s contracted through breathing in contaminated water or soil particles. And since its symptoms are like those of other respiratory illnesses, you may not even know you have it.
The best way to protect yourself from Legionnaires’ disease is by understanding where it can be found. Read on to learn what Legionnaires’ disease is, including where the bacteria can live and common symptoms you may experience, plus tips to avoid infection.
The symptoms of Legionnaires’ disease you may experience
Legionnaires’ disease is a type of severe pneumonia caused by a bacteria called Legionella. There are more than 60 species of the Legionella bacteria, but Legionnaires’ disease is most commonly caused by Legionella pneumophilia.
You can get Legionnaires’ disease if you breathe in mist that contains the bacteria, and it can affect your lungs, brain and your gastrointestinal (GI) tract. It depends on the severity of the infection, but it usually requires a stay in the hospital and prescription medications to clear up.
Legionella bacteria can also cause you to experience a milder form of Legionnaires’ disease called Pontiac fever, which is a mild respiratory disease that causes flu-like symptoms. But unlike Legionnaires’ disease, Pontiac fever will typically resolve on its own with at-home treatment.
The first sign of infection is pneumonia-like symptoms
Symptoms of Legionnaires’ disease usually begin within 2-14 days of exposure to the bacteria, but in some cases, it can take longer to develop. Symptoms are similar to pneumonia, and can include:
- Cough (usually dry)
- High fever (over 104°F/40°C)
- Shortness of breath
- Headache
- Muscle aches
Other less common symptoms include:
- Diarrhea
- Nausea
- Confusion
- Coughing up blood
The difference between pneumonia and Legionnaires’ disease
While Legionnaires’ disease and pneumonia have similar symptoms and treatments, they’re not the same thing. Legionnaires’ disease is a type of pneumonia, but it can only be caused by Legionella bacteria and isn’t contagious. Pneumonia can be caused by several different types of bacteria, some of which are contagious and can be spread from person to person.
Common causes of Legionnaires’ disease and where it’s found
Legionella bacteria are found naturally in soil, streams and lakes, but can also be found in contaminated air and drinking water systems, especially in large buildings and where water has been sitting for a while (a week or more).
You can become infected with Legionnaires’ disease by breathing small droplets of water or mist into your lungs, or if you aspirate water accidentally into your lungs (when water “goes down the wrong tube”).
You’re not at risk of Legionella bacteria contaminating your home central air, or window and car air conditioning units as these don’t use water to cool the air. But other places where Legionella bacteria can grow and spread include:
- Hot tubs
- Showerheads
- Sink faucets
- Humidifiers
- Large, complex plumbing systems, like those found in nursing homes, hospitals and hotels
- Cooling systems and towers
- Hot water tanks and heaters
- Intubation during surgery, when a tube is inserted through the mouth or nose, then goes down into the airway
- Decorative fountains and water features
Legionnaires’ disease is not contagious and can’t spread from person to person
Although Legionnaires’ disease is usually part of an outbreak – where many people can become infected at the same time after being exposed to the same Legionella-contaminated source – if you get it, you can’t infect other people.
You typically contract Legionnaires’ disease by inhaling contaminated water, and less typically from aspirating contaminated water or breathing in Legionella-contaminated soil.
What the risk factors are for Legionnaires’ disease
If you’re healthy, you can be exposed to the bacteria and not become sick. But for others, there are risk factors that make them more likely to develop an infection after exposure, including:
- Being over the age of 50
- Being a current or former smoker
- Having a chronic (long-lasting) lung disease, like COPD or emphysema
- Having a chronic illness such as diabetes
- Having a weakened immune system
- Having surgery that required anesthesia
- Living in a long-term care facility
- Staying in a hospital
- Taking medications that suppress the immune system, like those taken after an organ transplant
Because Legionnaires’ disease can look like many other diseases, your doctor will begin by asking about your symptoms and exposure. They’ll likely do a physical exam and ask about your past health. Then, they may order tests, such as a chest X-ray or CT scan to rule out other conditions, like pneumonia.
If your doctor thinks you have Legionnaires’ disease, they may try to determine the source of the disease by asking about your working conditions, if you’ve traveled recently, and if you’ve been around hot tubs, decorative fountains or water features. They may also order a blood test, urine test or a mucus culture to see if Legionella bacteria are present in your body.
How Legionnaires’ disease is treated and how long it lasts
Legionnaires’ disease affects everyone differently. Some people may only have a few symptoms, and others may experience life-threatening complications. About 1 out of 10 people infected with Legionnaires’ disease will die from complications of the illness, so prompt diagnosis and treatment is incredibly important.
Medications can help with symptoms and clear up the infection
Hospitalization is almost always required for treating Legionnaires’ disease. Doctors will use strong antibiotics given intravenously or with a course of pills, and treatment usually lasts five days.
If you have a fever, it usually goes away within the first few days of treatment, and if you have a cough, it shouldn’t linger for much longer than that. Generally, you should start to feel better within the first few days of treatment, with full recovery taking from two to four months.
Legionnaires’ disease can cause ongoing symptoms and serious complications
Legionnaires’ disease can cause extremely serious health complications, especially if it goes untreated. This includes respiratory failure, kidney and multiple organ failure, septic shock, and in rare cases, brain damage – so getting treatment right away is crucial.
Even after treatment, you may still need to take medication to ensure that the infection is completely cleared. However, you may still experience symptoms for several weeks or months, or even longer, including:
- Balance and coordination problems
- Difficulty walking
- Fatigue
- Muscle aches
- Slurred speech
Although it’s completely normal to experience symptoms well after the infection goes away, it can be concerning. If you’re experiencing symptoms that are disrupting your daily life, speak with your doctor. They can recommend treatments that may help.
Prevention is key when it comes to Legionnaires’ disease
Legionnaires’ disease outbreaks most commonly occur where large groups congregate, like cruise ships, conferences and in hotels, because the water systems are large, complex and difficult to maintain, which is the ideal environment for Legionella bacteria to thrive. But there are things you can do to avoid infection when using and staying at these facilities.
Take precautions against infection when traveling
Your first step before you go should be to check for outbreaks where you’re traveling. This can help shape your itinerary, and determine whether or not you should reschedule your trip. Other things you can do when you get to your destination include:
- Running the hot water – If you’re staying someplace with a shower or a sink, it can be helpful to run both with hot water for a few minutes before using it. Make sure to leave the bathroom and open any windows or doors to avoid inhaling the steam.
- Avoiding risk factors – If you’re not sure how well something is maintained, like a hot tub or shower at a hotel, it’s best to avoid using them if possible. Decorative fountains can foster Legionella bacteria too, so if they look poorly maintained, avoid any contact.
- Drinking bottled water – Bottled water helps you avoid potential infection as tap water and even ice can harbor bacteria.
- Keeping the AC off – Air conditioning units in large buildings rely on cooling towers, which are a common source of the bacteria. If possible, avoid turning on the air conditioning where you can, like in hotel rooms, especially if you’re unsure how frequently or recently it’s been used.
How to prevent Legionnaires’ disease in your home
Because you likely use water sources daily in your home, and you’re usually personally responsible for their maintenance, it’s less likely you’d be exposed to Legionnaires’ disease in your home. But it can be helpful to take precautions like:
- Running your water regularly – This includes using showerheads regularly to help prevent the growth of bacteria. If you’ve been away from home for more than a week, make sure you run hot water for a few minutes before using any faucets.
- Check your water temperature – Setting your water temperature above 120°F can help prevent Legionella. Make sure to test the water temperature before use to prevent burns.
- Properly maintaining devices that use water – Follow manufacturer’s recommendations to ensure you’re cleaning, using and maintaining things like portable humidifiers, showerheads, neti pots and nasal rinses, and water heaters the way you’re supposed to.
- Making sure the water in your home is safe to use – Sometimes, water flow to your home can be disrupted, whether that’s planned, like your water utility company is making improvements to your water system, or unplanned, like a water main break. This can introduce bacteria into your water supply.
- Signing up for notifications about your water – Your utility company or local alert system will tell you when there are water quality advisories in your area. Be sure to follow their recommendations, like boiling water before using it. And if you notice changes to your water, like discoloration, contact your water utility for more information.
- Keeping your private water source safe – If you live in a home that has a private water source like a well, ensure you’re properly maintaining it with routine testing and treatment.
- Checking with your building manager, owner or landlord – If you rent, it’s the duty of the manager, owner or landlord of your property to protect residents against bacteria in the water. Speak to them about what steps they’re taking to properly maintain the water sources.
Prompt treatment of Legionnaires’ disease is important
Prevention is the most effective way to protect yourself from Legionnaires’ disease, but if you think you’ve been exposed to it or you’re experiencing symptoms, seek treatment immediately. Most people recover from the disease with few complications. But for those with risk factors and those who don’t get treatment right away, Legionnaires’ disease can cause complications that are life threatening.
If you know you’ve been exposed to Legionella bacteria, and/or you’re experiencing symptoms, go to urgent care or make an appointment with a primary care doctor who can diagnose and treat Legionnaires’ disease, so you can get on track to feeling better.
