Sick with Legionnaires’ disease?
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Legionnaires’ disease is on the rise in West Virginia.

Just months after an outbreak in Hancock County, Brooke County has experienced a cluster of six cases of Legionnaires’ disease – a serious, pneumonia-like illness – in the past two months.

“It’s certainly something that sent up a red flag because typically we don’t have many cases,” said Mike Bolen, Brooke County Health Department administrator. “At this time, there appears to be no related link to the cases.”

In October, six cases of Legionnaires’ disease were reported to the Hancock County Health Department, including an outbreak that infected four employees at Mountaineer Casino, Racetrack and Resort. There have been “no new cases in Hancock County” since that time, according to Hancock County administrator Jackie Huff.

The western borders of the two neighboring counties are on the Ohio River, and their eastern borders are on the Pennsylvania state border.

There are approximately 20 to 30 annual cases of Legionnaires’ disease in West Virginia.

Outbreak? Cluster? Community-acquired?
The terms “cluster” and “outbreak” are used when multiple cases are reported in or around the same proximity and within a designated period. The term “community-acquired” is used when there are no commonalities; these kinds of cases are the most common.

If two or more illnesses occurred in the same general vicinity within a period of three to 12 months, the term “cluster” would be used, such as the occurrence of six cases in Hancock and Brooke counties in such a short period of time.

If two or more cases are reported within days or weeks, rather than months, and occurred in a more limited geographic area – meaning officials can pinpoint a specific area within a city where illnesses occurred, such as at Mountaineer – then the term “outbreak” would be used.

Legionnaires primer

The Centers for Disease Control and Prevention (CDC) estimates about 25,000 annual cases of pneumonia due to Legionella bacteria (Legionella pneumophila). Only 5,000 cases are reported, however, because of the disease’s nonspecific signs and symptoms.

Legionnaires’ disease – which is also known as legionellosis and Legionella pneumonia – is treatable with antibiotics if diagnosed early. If that does not occur, however, severe complications can develop, and the disease can become deadly.

Disease symptoms
Legionnaires’ disease is similar to other types of pneumonia, and symptoms can even resemble those of influenza (flu), which is why it often goes under-reported. Early symptoms generally include:

  • severe headaches
  • muscle aches
  • suppressed appetite
  • fever (104 degrees or higher) and chills.

Symptoms can then worsen to include:

  • pleuritic chest pain (pain caused by inflamed lungs)
  • dyspnea (difficulty breathing)
  • cough, which can produce blood and mucus
  • gastrointestinal problems such as diarrhea, nausea, and vomiting (about one-third of Legionnaires cases produce these symptoms)
  • mental agitation and confusion.

About 10 percent of people infected with Legionella bacteria (Legionella pneumophila) will die from the infection.

High-risk categories
Anyone can become ill from Legionella, but those most susceptible to infection include:

  • people 50 years of age or older
  • smokers, both current and former
  • heavy drinkers of alcoholic beverages
  • people with chronic lung disease
  • people with compromised immune systems
  • recipients of organ transplants
  • individuals who are on specific drug protocols (corticosteroids, to name one).

Legionella sources
Legionnaires’ disease outbreaks and clusters have been linked to a number of sources, including:

  • water systems, such as those used in hospitals, nursing homes, and hotels
  • large plumbing systems
  • hot-water tanks and heaters
  • cooling towers of air conditioning systems
  • showers and faucets
  • mist machines and hand-held sprayers
  • swimming pools
  • hot tubs and whirlpools
  • equipment used in physical therapy
  • decorative fountains.

Pontiac fever
A milder type of Legionella illness is Pontiac fever, which produces symptoms – including fever, chills, headaches and muscle pains – that are similar to Legionnaires’ disease. Pontiac fever, however, does not infect the lungs, and symptoms usually clear within two to five days.