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*** We can help your facility put together a Legionella Management Plan to comply with the Dept. of Health's new regulations. ***

 

 

Legionnaires' Disease

There is a lot of discussion and some misconceptions about Legionnaires' Disease.  We here at M.I.S. of America, have been following this topic and the development of information about it since the 1970's.  Here are some of the more common questions we are asked and the answers:

What is Legionnaires' Disease?

It is a respiratory illness.  It is caused primarily by the bacteria L. Pneumophila serogroup 1.  When the bacteria are inhaled into the lungs, it invades the alveoli. These are the sacks that transfer oxygen to our blood.  The symptoms are similar to pneumonia and include an elevated temperature as a result of the white blood cells fighting the bacteria.  This is followed by congestion in the lungs, followed by a high fever, chills, cough and achy joints and muscles.  These symptoms typically develop a few days or up to 2 weeks after exposure.

What is Legionella bacteria?

This bacteria is a gram negative, aerobic water borne pathogen.  There are over 50 species with more than 70 serogroups that make up this genus.  However, only 20 are known to be associated with human infection.

Where is Legionella bacteria found?

Legionella is a water-borne pathogen.  So it is typically found in water.  Ponds, rivers, and lakes can be a source of the bacteria.  It has also been found in ornamental fountains and cooling towers.  Another common source for the bacteria is in potable water such as faucets, showers, hot tubs and hot water tanks.

Why is it called Legionnaires' Disease?

The bacteria was first identified after an outbreak in 1976 at an American Legion Convention in Philadelphia, PA at the Bellevue Stratford hotel.  Following the convention, many of the attendees suffered pneumonia like symptoms.  Eventually 37 people died.  The Center for Disease control investigated the incident and identified a bacterium that had not been identified before.  Hence the name Legionella Pneumophila.

Who is at risk for Legionella infection?

Legionella infection can occur in a variety of hosts.  The incidence of Legionnaires' disease depends on the degree of water contamination, the intensity of the patient's exposure to that water and the susceptibility of the patient.

The presence of the bacteria in the above listed systems does not in and of itself constitute a dangerous condition or disease threat to healthy individuals.  Legionella in a hospital water system increases the risk of hospital acquired infection, particularly for those patients with comprised immune systems and those with underlying diseases.  Transplant patients are at risk for infection.  Similarly, people who have been heavy smokers, have chronic lung disease, and immunosuppressive treatment, are at an increased risk.

How do you contract Legionnaires' Disease?

The bacterium is a water borne pathogen and must be inhaled into the lungs.  Some examples of transmission include: Breathing in droplets or mist from a hot tub or cooling tower that is not properly taken care of. Aspiration of drinking water "went down the wrong pipe". Once someone is infected it cannot be spread from person to person. 

How is Legionnaires' Disease diagnosed?

  • There are several ways to detect the presence of the bacterium.
  • The simplest is a urine test.  (urinary antigen test)
  • Second is a blood test
  • Finally is a culture of the bacteria on selective media

Is the infection difficult to treat?

Actually once the disease has been diagnosed there are several antimicrobial agents available such as macrolides and quinolones.  There is presently no vaccine for the disease.

Can the bacteria be identified in water sources?

Yes, a sample of the water can be sent to an approved laboratory.  Once there it will be cultured and the specific serogroup will be identified and a colony count determined. There are specific colony count recommendations depending on the type of system.

How can Legionella be controlled in water systems?

Some examples of methods used to control the growth of the bacterium in water sources are:

Cooing Towers      -         Accurate regimen with proven biocides

Ornamental fountains -    Use of oxidizing biocides

Hot tubs and spas  -         Use of chlorine or bromine

Potable hot water systems  - various methods include:

  • Chlorine addition
  • Heat and Flush
  • Monochloramine
  • Chlorine Dioxide                   

      Consult your M.I.S. of America representative for more information.

      What is ASHRAE 188P?

      The American Association of Heating Refrigeration and Air Conditioning Engineers is a non profit group which sets standards for our industry.  While they are not "Laws" most of our industry accepts them as the guide for good practice.

      ASHRAE has a task committee dedicated to learning about this problem and then making recommendations for control.  The first ASHRAE paper on Legionnaires' disease (ASHRAE 12-2000) gave us a guide to sources and remedial treatment.  There has been a tremendous amount of new information in the past 14 years.  ASHRAE 188P will give us guides to prevention and control.

      Click here for N.Y.S. Dept. of Health Regulations For Cooling Towers