Legionnaires’ Disease Symptoms: Doctors Share Warning Over Signs Most People Miss
Nursing home outbreaks are on the rise. Here are the warning signs doctors want you to watch for now
If you have a loved one in a nursing home, recent news about Legionnaires’ disease outbreaks may have your heart racing with worry. That’s completely understandable—when someone you love is living in a care facility, their safety is everything. The good news? Understanding the most common Legionnaires’ disease symptoms and knowing what questions to ask can help you feel more confident and in control. Here’s what doctors want you to know about the chronic lung disease, warning signs to watch for and the practical steps you can take to help protect your loved one.
What is Legionnaires’ disease?
“Legionnaires’ disease is a severe pneumonia (lung infection) that impairs normal breathing and oxygen exchange,” says Eve Elizabeth K. Pennie, MD, a general practitioner and clinical research professional with experience in epidemiology and clinical trial management. “Pneumonia is a lung infection caused by germs (bacteria), viruses or fungi.”
The disease is not spread through person-to-person contact. Instead, people are exposed through certain environmental water sources.
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“A person develops Legionnaires’ disease after inhaling tiny drops of water contaminated with Legionella bacteria,” says Dr. Pennie. “After reaching the lungs, these bacteria cause irritation and fluid accumulation, leading to serious consequences if not treated promptly.”
And here’s what makes Legionnaires’ disease so concerning: The bacteria can be much closer to home than you think. Dr. Pennie says Legionella bacteria can grow and spread in still, warm water at temperatures similar to the human body, though you don’t typically contract it from drinking water. Potential sources include:
- Showers
- Sinks
- Plumbing systems
- Water heaters
- Cooling towers and air conditioning
- Decorative fountains
Most common Legionnaires’ disease symptoms to watch for
When Legionnaires’ disease causes a lung infection, it triggers an inflammatory response in the body, says Dr. Pennie. There are several key symptoms to watch for that typically develop within two to 14 days. They include:
- Fever
- Chills
- Cough
- Shortness of breath
- Fatigue
- Headache
- Muscle aches
4 sneaky symptoms of Legionnaires’ disease you might miss
Beyond these more obvious signs, there are other symptoms that might not immediately signal Legionnaires’ disease—but are just as important to recognize. Dr. Pennie says sneaky Legionnaires’ disease symptoms include:
- Diarrhea
- Nausea
- Vomiting
- Confusion
“These symptoms arise because Legionella can infect and damage multiple organs,” says Dr. Pennie. “Toxins produced by the body’s inflammatory response to the infection can also impact the digestive tract and nervous system. Older adults may experience confusion as a symptom of their illness and may exhibit this as one of the first indicators of severe illness.”
Who’s most at risk of Legionnaires’ disease?
Anyone can develop Legionnaires’ disease, but Dr. Pennie says certain groups have an increased risk compared to generally healthy people, including:
- Older adults
- Smokers
- People with compromised immune systems
- Cancer patients
- People who use immunosuppressive medications
Why the disease is such a concern in nursing homes
Recent outbreaks have understandably raised concerns. In 2022, five people died from Legionnaires’ disease at a nursing home in Upper Manhattan, per the New York Times. And earlier this year, two Legionnaires’ disease cases were connected to a nursing home in Bloomingdale, Illinois, per NBC Chicago.
So what is the connection between nursing homes and Legionnaires’ disease cases? “Nursing homes often have large, complex plumbing systems where water can sit in pipes for long periods,” says Tyler Evans, MD, MS, MPH, CEO, Chief Medical Officer and Co-Founder of Wellness Equity Alliance. “Residents are also more medically vulnerable, which makes infection more likely once exposure occurs.”
“Transmission in nursing homes primarily occurs through inhalation of water droplets from showers, faucets and other devices, with aspiration (accidental inhalation during swallowing) of contaminated water being an important route, especially in elderly residents with swallowing difficulties,” says Steven Goldberg, MD, MBA, clinician and Chief Medical Officer of HealthTrackRx.
What to ask your loved one’s nursing home
“Caregivers should be reassured that, when nursing homes adhere to established water management protocols, the risk of Legionnaires’ disease is substantially minimized,” says Dr. Goldberg.
His advice for advocating for your loved one: “Inquire whether the facility has a documented water management program, regular environmental monitoring, maintenance of hot water temperatures above 50°C (122°F) at the tap, avoidance of water stagnation and adequate disinfectant residuals,” says Dr. Goldberg.
5 ways to minimize your risk of Legionnaires’ disease
While anyone may still develop Legionnaires’ disease, there are habits that decrease the risk. Dr. Goldberg and Dr. Pennie share five helpful tips below:
- Maintain good oral hygiene: This prevents aspiration of Legionella bacteria, says Dr. Goldberg.
- Clean regularly: Doing so removes the number of bacteria in a space, says Dr. Goldberg.
- Avoid high-risk exposure: Steering clear of high-risk places, such as hot tubs, reduces the risk of inhaling contaminated water droplets, says Dr. Goldberg.
- Get regular checkups with your doctor: “This decreases your risk of undiagnosed or undertreated lung and other chronic medical conditions,” says Dr. Goldberg.
- Stop smoking: “Smoking impairs the lung’s defense mechanisms and increases susceptibility to infections,” says Dr. Pennie. (See our best tips to quit smoking.)
When someone you love is in a nursing home, it’s natural to worry about their health and safety. But by understanding the symptoms of Legionnaires’ disease, asking the right questions and knowing what steps facilities should be taking, you’re already being the advocate your loved one needs.
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