Yet another reason to issue a travel warning for Bali; the Australian Government Department of Health has issued a warning to travelers who have recently returned from Bali to be on alert for symptoms which are consistent with Legionnaires’ disease. Two Western Australians and one Victorian who recently returned from Bali have been diagnosed with severe pneumonia due to infection caused by Legionella pneumophilia.
What is Legionnaires’ disease?
Legionnaires’ disease is caused by a type of bacteria called Legionella. The bacteria got its name in 1976, when many people who went to a Philadelphia convention of the American Legion suffered from an outbreak of this disease, a type of pneumonia (lung infection). Although this type of bacteria was around before 1976, more illness from Legionnaires’ disease is being detected now due to better diagnostic services.
What are the symptoms of Legionnaires’ disease?
Legionnaires’ disease can have symptoms like many other forms of pneumonia, so it can be hard to diagnose at first. Signs of the disease can include: a high fever, chills, and a cough. Some people may also suffer from muscle aches and headaches. Chest X-rays are needed to find the pneumonia caused by the bacteria, and other tests can be done on sputum (phlegm), as well as blood or urine to find evidence of the bacteria in the body. These symptoms usually begin 2 to 14 days after being exposed to the bacteria. A milder infection caused by the same type of Legionella bacteria is called Pontiac Fever. The symptoms of Pontiac Fever usually last for 2 to 5 days and may also include fever, headaches, and muscle aches; however, there is no pneumonia. Symptoms go away on their own without treatment and without causing further problems.
How serious is it? What is the treatment?
Legionnaires’ disease can be very serious and can cause death in up to 5% to 30% of cases. Most cases can be treated successfully with antibiotics [drugs that kill bacteria in the body], and healthy people usually recover from infection.
Where do Legionella bacteria come from?
The Legionella bacteria are found naturally in the environment, usually in water. The bacteria grow best in warm water, like the kind found in hot tubs, cooling towers, hot water tanks, large plumbing systems, or parts of the air-conditioning systems of large buildings. They do not seem to grow in car or window air-conditioners.
How do people get Legionnaires’ disease?
People get Legionnaires’ disease when they breathe in a mist or vapor (small droplets of water in the air) that has been contaminated with the bacteria. One example might be from breathing in the steam from a whirlpool spa that has not been properly cleaned and disinfected. The bacteria are NOT spread from one person to another person. Outbreaks are when two or more people become ill in the same place at about the same time, such as patients in hospitals. Hospital buildings have complex water systems, and many people in hospitals already have illnesses that increase their risk for Legionella infection. Other outbreaks have been linked to aerosol sources in the community, or with cruise ships and hotels, with the most likely sources being whirlpool spas, cooling towers (air-conditioning units from large buildings), and water used for drinking and bathing.
Who gets this disease?
People most at risk of getting sick from the bacteria are older people (usually 65 years of age or older), as well as people who are smokers, or those who have a chronic lung disease (like emphysema). People who have weak immune systems from diseases like cancer, diabetes, or kidney failure are also more likely to get sick from Legionella bacteria. People who take drugs to suppress (weaken) the immune system (like after a transplant operation or chemotherapy) are also at higher risk.
How is Legionnaires’ disease diagnosed?
Most people with Legionnaires’ disease will have pneumonia (lung infection) since the Legionella bacteria grow and thrive in the lungs. Pneumonia is confirmed either by chest x-ray or clinical diagnosis. Several laboratory tests can be used to detect the Legionella bacteria within the body. The most commonly used laboratory test for diagnosis is the urinary antigen test, which detects Legionella bacteria from a urine specimen, or sample. If the patient has pneumonia and the test is positive, then the patient is considered to have Legionnaires’ disease. Additionally, if the Legionella bacteria are cultured (isolated and grown on a special media) from a lung biopsy specimen, respiratory secretions, or various other sites, the diagnosis of Legionnaires’ disease is also considered confirmed. Finally, paired sera (blood specimens) that show a specific increase in antibody levels when drawn shortly after illness and several weeks following recovery, can also be used to confirm the diagnosis.
Prevention
Heating and air conditioning equipment, misters and spas should be serviced at least once a year. Annual servicing includes cleaning the system, checking for any problems or potential problems and adjusting for peak efficiency. The benefits include:
• Increased dependability.
• Find potential problems and fix them quickly.
• Provide maximum efficiency which lowers energy costs.
• Prolongs the life-span of the equipment.
• Maintains safe and healthy operation.
• Can help to protect the environment.
Kim Patra is a qualified registered nurse and midwife who has been living and working in Bali for almost 20 years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com or Hp. 081 2366 0000.
