8 Symptoms of Legionnaire’s disease

Legionnaire’s disease is a form of atypical pneumonia, which is caused by the bacterium Legionella spp. The condition got its name after the outbreak at the American Legion convention in Philadelphia, where it was first identified in the year 1976. The microorganism that causes this naturally lives in standing waters, but it can colonize air conditioners, hot water tanks, hot tubes, cooling towers, etc. People are infected by inhaling the aerosol, usually in places with artificial ventilation. This microorganism is not transmitted from one person to another, so if there is an outbreak of Legionnaires disease the most reasonable step to take would be to check the water supplies and air conditioners. Symptoms usually occur after 7 to 10 days of incubation, and the recovery begins 4 to 5 days from the onset of the symptoms. Full recovery time takes a couple of months. Diagnosis of Legionnaire’s disease can be difficult sometimes because clinical and radiological signs are nonspecific. The gold standard is a culture diagnosis, but it requires 7 to 10 days to obtain a positive result. For these reasons, doctors nowadays use a simple urine test that detects Legionella urinary antigen. Legionnaire’s disease is a severe condition, and the key to successful recovery is early diagnosis and treatment. Some common symptoms are: 1. Fever. In the early stages of Legionnaire’s disease, the patient will feel cold, the skin will be pale, and they will have shivers. As the condition progresses, the body temperature increases, usually going over 40°C. This increase in temperatures leads to exhaustion and severe headaches. The second phase is the opposite; the temperature quickly lowers, the patient feels warm and will sweat profusely. After a few hours, the temperature increase/decrease cycle starts over again, but with the right medication, these cycles can be successfully interrupted. 2. Headache. This is a common symptom of Legionnaire’s disease, and it is related to the rise in body temperature. These headaches can be unbearable, but once the body temperature starts to go down after 4 or 5 days, the pain gradually decreases. More symptoms on next page... 3. Muscle pain. Muscle pains in Legionnaire’s disease are caused by an immune response and increased body temperature. In the beginning, muscles are painful due to damaged muscle fibers. As the process of regeneration starts, patients report stiffness which sometimes causes difficulties in moving. The process of regeneration might take 4 to 6 days to kick in and is usually one of the first signs of recovery. This time-frame does not apply to immune-compromised patients who typically suffer a complicated form of the disease which lasts longer. 4. Cough. Coughing is the primary respiratory symptom in patients with Legionnaire disease because it unequivocally suggests that the bacterium has reached the respiratory system (lungs). Most often it is manifested as a dry, unproductive cough (no sputum). A cough is very exhausting and causes severe chest pains and shortness of breath. After a few days, patients will start feeling increased fatigue. Seeing a doctor at this time is strongly advised because timely treatment improves the chances of recovery without complications. 5. Gastrointestinal Symptoms. Gastrointestinal symptoms, such as nausea, vomiting, and diarrhea can also appear among some patients with Legionnaire’s disease. However, they are not very common, so, this could lead the doctor to incorrect diagnosis. These symptoms are related to an increase in body temperature, which affects gut flora and peristaltic movements (progressive wavelike contractions) which altogether results in unpleasant gastrointestinal symptoms. 6. Confusion. Some underlying conditions (usually complications) can confuse people with Legionnaire’s disease. It could be the accompanying symptom of fever or a severe headache, but it could also appear as the consequence of exhaustion after spending hours in bed coughing. Patients are sometimes unaware of their surroundings, time of the day, date, or simply get disoriented. Although the confusion may be frightening, it is a transitional symptom that will diminish as soon as the recovery begins. 7. Heavily changed mental status. In some cases, Legionnaire’s disease may change the mental status of a patient. This could be the consequence of a central nervous system affection by the bacteria known as acute disseminating encephalomyelitis, which is an acute immune-mediated disease affecting the brain and spinal cord. The condition includes behavioral changes, such as aggression and bradyphrenia (which is a medical term that represents slowness of thought). Also, some motor disorders such as apraxia (the inability of planning and performing moves), unsteady gait (walk) or even heightened reflexes (which is often a sign of damaged neurons) may occur. An unsteady walk could also be a sign of cerebellar affection (known as ataxia). 8. Neuropathy. It's possible for Legionella also to affect the peripheral nervous system leading to peripheral neuropathy. It is a condition consisting of sensory and motor disorders. Sensory symptoms can range from numbness, tingling and pricking sensations (paresthesia). Motor symptoms include muscle weakness both in arms and legs. Summary... Most often, there are two groups of symptoms among patients with Legionnaires disease: one is caused by high temperature and fever (chilliness, headache, muscle pain, exhaustion), and the other caused by infection of the respiratory tract (a cough, chest pain and shortness of breath). In severe cases, these are accompanied by gastrointestinal or nervous system symptoms.

4. Cough

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