Quite an unusual case of Legionnaire’s disease arose in 2010 and is now being thoroughly investigated. Why so strange? A healthy 67 year old man contracted Legionnaire’s through a cut on his hand while handling compost in his garden. This week’s edition of The Lancet reports the full details based on a Case Report by Dr. Simon M Patten, Royal Alexandra Hospital, Paisley and his colleagues.
In March 2010, this fit senior in the United Kingdom arrived at the Royal Alexandra Hospital possessing eight days delirium, fever with shakes, lethargy, and shortness of breath. Signs of left-sided pneumonia and an elevated body temperature hinted at Legionnaire’s. A full body cavity X-ray displayed the left lung completely opaque, meaning it was neither transparent nor translucent. Initial tests, including one for urinary legionella bacteria detected nothing. The gentleman’s health continued to seriously decline. He was transferred to the ICU (intensive care unit).
In the ICU, a very extensive cleaning was done on the man’s opaque lung. Alas, a sputum (matter that is expelled from the respiratory tract) sample tested positive for Legionella longbeachae, undetectable in urine, as previous tests verified. The cut the man acquired from his gardening hobby was deemed the culprit and point of the organism’s entry. Thankfully, levofloxacin, used to treat severe or life-threatening bacterial infections, was immediately administered. After another week hospitalized, his condition rectified itself and he was discharged. All was well at his follow up session in May 2010.
In a recent development stemming from these incidents, The UK Royal Horticultural Society has issued warnings about the risk of contracting Legionnaire’s from direct handling of compost. Furthermore, bags of potting compost will now carry printed cautions.
Legionnaire’s disease acquired its name in July 1976 when an outbreak of pneumonia occurred among people attending a convention of the American Legion in Philadelphia. When caused by the bacteria Legionella pneumophila, which accounts for 90% of all cases, Legionnaire’s disease is a simple pneumonia.
However, when caused by L. longbeachae, occurrences are far less common. In the United Kingdom, only nine cases have been reported since 1984. Curiously enough, L. longbeachae cases show up in higher volume in the Asian Pacific, namely Australia, New Zealand, and Japan. Here is where 30% of all Legionnaire’s cases are found.
Treatments using antibiotic are universal, no matter what organism is guilty for causing the infection. The authors of the report do insist that in odd cases such as this, antibiotic treatments should be continued until all types of legionella have been exhausted, especially those found while you are gardening with compost.
Dr Simon M Patten MBChB,, Emma Sur MBChB, Radha Sundaram FRCA , Barbara Weinhardt FRCPath
The Lancet, Volume 376, Issue 9743, Page 844, 4 September 2010
doi:10.1016/S0140-6736(10)60890-2Cite or Link Using DOI
Written by: Sy Kraft, B.A. – Journalism – California State University, Northridge (CSUN)