Legionnaires Disease Research Paper

Legionnaires Disease

“Legionnaires’ disease is a bacterial infection caused primarily by the species Legionella pneumophila, it was initially recognized as the cause of a 1976 outbreak of respiratory disease outbreak in Philadelphia. Legionellosis infection occurs after persons have breathed mists that come from a water source. The most recent outbreak of Legionnaires’disease is in New York City, in the Bronx, with a total of ten deaths and more than one hundred outbreaks, which were traced to a cooling tower, deaths have also been reported in Michigan, and Ohio.

The Economics of Natural and Human Resources in Agriculture are dependent on water, according to Underhill (2015). “Legionnaires is associated a high mortality rate. The authors collected

3,495 water samples in Seoul, Korea, between 2010 and 2012 from public facilities cooling towers, public baths, hospitals, and decorative fountains, which are considered the major habitats of Legionella pneumophila”, according to Changkyu, Sujin, Jihun, Younghee, Yeonsun, Jaein, & Young (2015).
Research was obtained by searching academic databases, google scholar, CDC website as well as other reputable websites. Keywords used to perform the search were, New York, disease, bacteria and infection. Depending on which word was used for the search the responses were from the thousands and narrowed to about sixty with approximately ten being useful for my research.

Prevalence and Incidence
According to Farnham, Alleyne, Cimini, & Balter, (2014) Legionnaires’ disease is a bacterial infection caused primarily by the species Legionella pneumophila, was initially recognized as the cause of 221 cases in 1976 at a convention in Philadelphia. Incidence of Legionnaires disease is increasing United States after a review of the risk factors associated with 1,449 cases that were reported from January 1, 2002 - December 31, 2011 by the New York Health Department through routine surveillance. According to the CDC “fact the bacterium was named after the outbreak in Philadelphia. ‘Legionella bacteria are found naturally in the environment, usually warm water” (CDC, n.d.). As reported by Emerging Infectious Disease there are two categorized separate diseases, Pontiac fever and Legionnaires’ disease; Pontiac fever is a milder illness that does not involve pneumonia.
Since the outbreak in Philadelphia other outbreaks have been reported the most
current being in New York City, in the Bronx, Michigan, Illinois, and Ohio just to name a few, has been linked to hospitals, cooling towers, hotels and whirlpools. Research shows, the overall mortality rate was 36% “with the ICU mortality rate being 13%. Incubation was approximately seven days regardless of age, According to (CDC, n.d.) regardless to age. Legionnaire’s disease is contracted through breathing in most vapors from droplets of contaminated water.
The interest I have in Legionnaires’ disease is the drinking water and learning how safe and where the bottle water is coming from has heightened my interest. While exercising the whirlpool is one of relaxation after a strenuous workout, and my kids and grandchildren love to swim, so this has really increased my interest to learn as much information as possible to educate myself to the environmental factors, and the possibility of this becoming an epidemic in our community. The research I have posted in the discussion forum will also inform, and educate my peers on Legionnaires’ disease and how it is transmitted.
The Information obtained could help the CDC understand how to adequately maintain the
public water systems to decrease the outbreaks of Legionnaires’ disease and make the water
system safe.
According to Farnham, Alleyne, and Cimini, & Balter, (2014), overall, incidence of “Legionnaires ‘disease in the city of New York increased 230% from 2002 to 2009 and followed a socioeconomic gradient, with highest incidence occurring in the highest poverty areas. Among patients with community-acquired cases, the probability of working in transportation, repair, protective services, cleaning, or construction was significantly higher for those with Legionnaires' disease than for the general working population. Further studies are required to clarify whether neighborhood-level poverty and work in some occupations represent risk factors for this disease”.
According to Underhill (2015) “What is your water supply?” was one of the most repeated questions asked during the early days of journalists asked by readers unfamiliar with Tombstone, Arizona, about its natural resources, surroundings, and infrastructure. Skeptics quickly replied that without an abundance of water, no matter what the other resources may have been, there could be no extensive prosperity. The construction of safe drinking water and wastewater infrastructures is indispensable for civilizations to flourish and to prevent the spread of waterborne infectious diseases” according to Yamaguchi, Ichijo, & Nasu, (n.d). The water supply for the communities as a whole, if the water towers are not properly maintained the diseases in water would eventually become an epidemic. Without water the world could not survive. This information researched is very alarming to me even though this research was eight years prior to date, just how safe is our drinking water. According to Yoder, Roberts, Craun, Hill, Hicks, Alexander, & Roy (2008), American has become so dependent with everything that is quick such as fast food and bottle drinks with no thoughts of where these products are originating from.

Farnham, A., Alleyne, L., Cimini, D., & Balter, S. (2014) “indicate that most Legionella
species live in water and transmission to humans occurs through inhalation of small water droplets in which the pathogen is aerosolized or by inhaling of contaminated water into the lungs.

Known host and risk factors for legionellosis are smoking, chronic obstructive pulmonary disease, diabetes, immune system compromise, older age fifty years or older and had a transplant or has received chemotherapy. Environmental risk factors associated with legionellosis outbreaks are travel, residence in a health care facility, and proximity to cooling towers, whirlpool spas, decorative fountains, and grocery produce misters. However, only partial studies have been prepared concerning socioeconomic and occupational risk factors for community-acquired cases; some studies have recognized driving as a likely occupational risk factor. To define the epidemiology of Legionnaires’ disease in New York, New York, researchers analyzed surveillance data for 2002–2011. In addition to overall incidence, they measured the relations between acquisition of Legionella infection and socioeconomic and occupational group.”

The prevalence of legionnaire’s disease has on the world today according to

Yamaguchi, Ichijo, & Nasu, M (n.d). , the unnecessary load on environments might

disrupt
infectious environments, which will result in outbreaks of pathogenic germs and the growth
of infectious diseases. A case review to determine the epidemiology and looking at the risk
factors the New York City Health Department of Mental Hygiene described the case rate per
1000,000 the highest in 2009. According Farnham, Alleyne, Cimini, & Balter,
(2014), incidence of Legionnaires’ disease in the United States is increasing. Legionnaires’
disease are different from other diseases because this disease cannot be transferred from one
person to another. The scary situation is you will not know you have the disease because it is so
closely related to pneumonia. This is one topic I think should definitely be watched, and studied with more public information and awareness.

Significance
The bacteria Legionella pneumophila is the cause for most cases of Legionnaires' disease. Outside, legionella bacteria thrives in soil and water, but seldom cause infections. Inside, legionella bacteria can grow in all kinds of water systems such as hot tubs, air conditioners and grocery store produce departments where mist is being sprayed. According to the Mayo Clinic (2014), you can contract the disease through home plumbing systems, although the outbreaks have usually occurred in large facilities because the systems are more vulnerable for bacteria to grow and spread. Research indicates Legionnaires disease cannot be spread from person to person. The majority of people become infected when they inhale water droplets containing legionella bacteria.
The significance of this disease is the incubation period of legionnaire’s disease, it usually progress after two to ten days of someone being infected by the bacteria. The signs and symptoms to be aware of are chills, fever above 104 degrees, and muscle pains. As the disease progress, other symptoms will began to show, mucus or blood may come up while coughing, chest pain, nausea, diarrhea, and confusion or mental changes, Mayo Clinic (2014) There are two types of characterized diseases, Pontiac fever and Legionnaires’ disease, Pontiac fever is a milder illness that does not involve pneumonia as indicated by the CDC (n.d) Emerging Infectious Disease.
Background
Legionella was first discovered at the Bellevue Stratford Hotel in Philadelphia July of 1976. The American Legion was holding a Convention with over a thousand people in attendance. During the second day of the Convention people began to get sick, some of the symptoms experienced were coughing, fever and difficulty breathing. Over the next few days, the people started to die, by the end of the epidemic 221 people had been affected, and a total of 34 had died. January 18, 1977 they began to realize what was killing the people, but never found the cause of the disease as indicated by the History of Legionnaires.
When affected with Legionnaires the bacteria are attacked by the white blood cells trying to fight off the disease, but the disease strives on the white blood cells and causes the disease to escalate.
According to Winn “the source of the infecting bacteria are environmental, and geographic variation in the frequency of infection has been documented. Airborne dissemination of bacteria from cooling towers and evaporative condensers has been responsible for some epidemics, but potable waters systems are perhaps most important sources. According to the History and Clinical findings “Legionnaires disease began thirty three years before the Philadelphia epidemic, when Legionella micdadei was isolated from human blood. Multiple isolations of several different Legionella spp. were made prior to 1976, and it was known by 1968 that tetracycline therapy prevented deaths in L. pneumophila-infected chicken embryos; the epidemic provided the scientific focus and resources necessary to determine that L. pneumophlia caused epidemic pneumonia and to show that epidemics of Legionnaires’ disease had occurred worldwide many years before 1976. Despite a surfeit of available resources and expertise, the efforts to isolate the aetiological agent succeeded solely on the basis of one person’s determination to solve a scientific problem and his willingness to re-examine his assumptions about prior laboratory results.”