A patient with a severe infection caused by the Legionella bacteria was saved at the Burgas University Hospital. After several weeks of intensive treatment in the intensive care unit, the 28-year-old man is now out of danger and will continue his recovery in the specialized pulmonary hospital. What to know about Legionella bacteria in the summer… Dr. Daniela Lyutskanova (left), head of the Department of Anesthesiology and Intensive Care, and Dr. Kalina Tsankova, head of the Microbiology Laboratory at the hospital, speak to FACT.
- Dr. Lyutskanova, Dr. Tsankova, Legionella infection often remains unrecognized at first. Which symptoms should alert doctors and patients to the suspicion of Legionnaires' pneumonia?
- Dr. Daniela Lyutskanova: Legionnaires' infection begins with symptoms that closely resemble the flu or other respiratory infection - high fever, chills, dry or wet cough, fatigue, muscle aches. What should draw attention is the rapid deterioration of the condition, the appearance of shortness of breath and the lack of effect of standard treatment.
- Dr. Kalina Tsankova: Some patients also experience gastrointestinal symptoms or confusion. That is why, in case of severe pneumonia with an atypical course, it is important to think about Legionella in a timely manner.
- How critical was the condition of the 28-year-old patient when he was admitted to the hospital and at what point did you realize that you were literally fighting for his life?
- Dr. D. L.: The patient was admitted in an extremely serious general condition with rapidly developing severe respiratory failure. Despite immediate treatment, prolonged mechanical ventilation was required for almost two weeks. It was clear in the first hours that the infection was progressing aggressively and that any delay could be fatal. Thanks to timely diagnosis, correct antibiotic therapy and the efforts of the multidisciplinary team, we were able to control the disease.
- Many people associate severe pneumonia with elderly or chronically ill patients. How did such a severe course occur in a person who is only 28 years old?
- Dr. K. Ts.: It is true that most often severe legionella infections are observed in elderly people or patients with concomitant diseases. But Legionella can also cause severe disease in young people, especially if they have reduced immunity or concomitant diseases such as diabetes. In this case, the infection was extremely aggressive, but it did not appear suddenly - the patient had not felt well for at least a week before, he self-medicated with common symptomatic medications. This shows that age alone is not a guarantee of a mild course and that severe pneumonia can develop in anyone.
- How much time can be lost if the patient is treated as for a simple viral infection or standard bacterial pneumonia? What are the risks of such a delay?
- Dr. D. L.: In legionella infection, the time to diagnosis is extremely important. Standard antibiotics, which are often used for bacterial pneumonia, do not always work against Legionella. If the diagnosis is delayed, the condition can quickly progress to severe respiratory failure, sepsis and multi-organ failure. Therefore, early recognition and the right choice of antibiotic can be life-saving.
- Within three months, this is the second case of Legionella infection in your hospital. Are we talking about a random cluster of cases, or are there grounds for more serious attention to this bacterium?
- Dr. D. L.: The two cases within a few months should not be considered an epidemic outbreak, but they are a reminder that Legionella is a pathogen that should be actively considered in severe pneumonias with an atypical or rapidly worsening course. This is an infection that probably went undiagnosed in some cases in the past, as it was not always investigated purposefully.
- Dr. K. Ts.: Today we have the capabilities for rapid microbiological diagnosis, and the most important thing is good interaction between clinicians and microbiologists, because early identification of the causative agent changes the treatment and prognosis of the patient.
- Where is the Legionella bacteria most often found? Should people be worried about hotel air conditioners, water heaters, showers, public buildings or other water installations?
- Dr. D. L.: Legionella is a waterborne bacterium. It thrives in stagnant or poorly maintained hot water and can be found in plumbing systems, boilers, showers, cooling towers and some air conditioning systems. Infection occurs by inhaling fine water aerosols, not by drinking water, and is not transmitted from person to person. Good maintenance of water systems significantly reduces the risk.
- Is there a way to protect oneself from Legionella infection and what measures should hotels, hospitals, businesses and building owners take to reduce the risk?
- Dr. K. Ts.: The most important prevention is proper maintenance of water installations - regular cleaning, control of water temperature, prevention of stagnation and periodic microbiological control when necessary. This is especially important for hospitals, hotels and large public buildings. There is no specific vaccine or prophylactic treatment for the individual, but the risk is minimal when the systems are maintained properly.
- After such a severe illness and almost two weeks of mechanical ventilation, what recovery awaits the patient? Will there be permanent consequences for the lungs or does he have a chance to return to a normal lifestyle?
- Dr. D. L.:A gradual recovery awaits, which can last weeks or months. After such severe pneumonia, the body needs time to restore lung function and physical endurance. In young patients, the prognosis is usually good and there is a real chance of a full recovery if irreversible complications have not occurred.
- What is the most important message you would send to people? When is a high fever, cough and shortness of breath no longer a "ordinary flu", but a signal for immediate medical attention?
- Dr. D. L.: The message is simple – do not underestimate the symptoms. If the high temperature persists, if the cough intensifies, shortness of breath appears or the general condition sharply worsens, medical help should be sought immediately.
- Dr. K. Ts.: The earlier the correct diagnosis is made and the correct treatment is started, the greater the chances of a full recovery. This case shows how crucial timely diagnosis, teamwork and modern microbiology can be in saving human lives.