WEBVTT - Ep 77 Legionnaires' Disease: A Killer Mist 0:00:01.200 --> 0:00:02.920 It was the end of the month and I was 0:00:02.960 --> 0:00:05.960 helping a friend paint her home. Her house was about 0:00:05.960 --> 0:00:08.280 thirty five miles away from mine, which is in the 0:00:08.320 --> 0:00:11.200 city of Boston, so in lieu of driving home, she 0:00:11.240 --> 0:00:13.399 opted to get me a room because I was going 0:00:13.400 --> 0:00:16.319 to be helping her the following day. Once I opened 0:00:16.360 --> 0:00:19.279 the hotel door, it was hot and musty, and you 0:00:19.320 --> 0:00:21.800 could tell no one had entered that room for a while. 0:00:22.400 --> 0:00:24.759 I turned on the ac and was hit in the 0:00:24.800 --> 0:00:28.520 face with a musty mist. That smell still lingers with 0:00:28.560 --> 0:00:32.280 me today. Didn't think anything of it, ate food and 0:00:32.320 --> 0:00:35.880 went to sleep. Continued with my weekend as scheduled, basically 0:00:36.040 --> 0:00:39.800 the gym and sleep. That following Monday, I felt out 0:00:39.840 --> 0:00:43.559 of it. I wasn't sick, just exhausted. I thought it 0:00:43.600 --> 0:00:45.879 was simply from going to the gym. I didn't have 0:00:45.960 --> 0:00:48.880 work because it was Memorial Day and wasn't due back 0:00:48.920 --> 0:00:51.760 to work until Wednesday. But I stayed in bed the 0:00:51.800 --> 0:00:55.320 whole holiday and the day after. I just remember being 0:00:55.360 --> 0:00:58.840 at work tired. I thought it was from oversleeping, and 0:00:58.920 --> 0:01:01.840 the best cure for that was more sleep. As the 0:01:01.880 --> 0:01:05.040 weekend rolled around, I was back at my friend's house, painting, 0:01:05.360 --> 0:01:07.800 but I noticed I needed a break every five to 0:01:07.840 --> 0:01:10.480 ten minutes or so. I was a bit sore and 0:01:10.560 --> 0:01:15.760 always out of breath and sweating profusely. Monday rolled around, 0:01:15.840 --> 0:01:17.680 and it had been nine days since I was at 0:01:17.720 --> 0:01:20.800 the hotel. I went to bed, and when I awoke, 0:01:21.120 --> 0:01:23.959 I could no longer walk straight. I was slamming into 0:01:24.000 --> 0:01:26.880 walls and couldn't see straight. When I awoke, it was 0:01:26.920 --> 0:01:30.520 already midnight. I overslept again, but now I lost all 0:01:30.680 --> 0:01:33.880 motor skills, couldn't walk at all, and my speech was 0:01:33.920 --> 0:01:37.240 slurring so Siri didn't recognize my voice. I had to 0:01:37.319 --> 0:01:39.600 crawl to use the restroom and had a hard time 0:01:39.720 --> 0:01:42.640 not knocking things over when I did. I awoke in 0:01:42.720 --> 0:01:45.000 my bed to my mom asking me about the mess 0:01:45.000 --> 0:01:48.040 in the bathroom. She immediately knew I was sick once 0:01:48.040 --> 0:01:51.160 she heard me speak. I woke up in the hospital 0:01:51.320 --> 0:01:54.600 surrounded by nurses and doctors trying to figure out why 0:01:54.680 --> 0:01:57.120 I couldn't talk or walk and why I had a 0:01:57.160 --> 0:02:00.640 fever of one hundred and six degrees. It took about 0:02:00.680 --> 0:02:04.200 four days before they figured out it was Legionnaire's I 0:02:04.280 --> 0:02:06.920 still had a temperature of one hundred and three, still 0:02:06.960 --> 0:02:10.359 couldn't walk, no motor skills at all, and was unable 0:02:10.400 --> 0:02:14.040 to speak. Hallucinating at this point was the most enjoyable 0:02:14.080 --> 0:02:16.520 part of the day. I know I had rooms of 0:02:16.520 --> 0:02:19.360 family and friends, and by the look on their faces, 0:02:19.440 --> 0:02:22.120 I could tell they were told the severity of everything 0:02:22.520 --> 0:02:25.920 which I didn't even know. I was in the hospital 0:02:25.919 --> 0:02:28.560 and rehab for about three and a half weeks. I 0:02:28.560 --> 0:02:31.480 can walk and talk again, and all my motor skills 0:02:31.480 --> 0:02:34.359 have returned. I drop things a lot, and I'm very 0:02:34.360 --> 0:02:37.920 forgetful at the minor tasks. I had to relearn what 0:02:37.960 --> 0:02:40.680 I did for a living and how to drive. I 0:02:40.800 --> 0:02:43.679 used to love working out, but it's so dangerous now 0:02:43.720 --> 0:02:46.960 because I can't balance weights like I should and walking 0:02:47.040 --> 0:02:50.160 hurts after a while. My joints feel like they are 0:02:50.200 --> 0:02:53.240 on fire most of the day. Steps are my new 0:02:53.360 --> 0:02:56.200 arch nemesis. My knees feel like they are about to 0:02:56.240 --> 0:02:59.440 buckle and crumble whilst walking up or down them. I 0:02:59.480 --> 0:03:02.320 have dizzy spells, get tired at the drop of a dime, 0:03:02.720 --> 0:03:05.840 and lose my train of thought halfway through tasks. It 0:03:05.919 --> 0:03:08.880 has been interesting, and I am glad to know I 0:03:08.919 --> 0:03:11.120 am not the only one out there dealing with these 0:03:11.160 --> 0:04:01.200 side effects and that things can get better. Wow. Yeah, 0:04:01.600 --> 0:04:08.840 that sounds very horrible and terrifying. Yeah, so that was 0:04:09.080 --> 0:04:13.600 from a website called legionella dot org, where under a 0:04:13.640 --> 0:04:15.200 section called share your Story. 0:04:15.680 --> 0:04:19.039 I didn't realize until kind of reading through some of 0:04:19.040 --> 0:04:23.200 those first hand accounts and researching this episode how long 0:04:23.279 --> 0:04:26.560 lasting some of the effects of infection with Legionella can be. 0:04:27.200 --> 0:04:31.120 Oh yeah, No, it's like I think there is a 0:04:31.160 --> 0:04:37.560 lot more under the surface than as per usual then 0:04:37.600 --> 0:04:41.800 we think there is at the beginning of these episodes. Hi, 0:04:42.080 --> 0:04:45.279 I'm Aaron Welsh and I'm Aaron Alman. Update and this 0:04:45.400 --> 0:04:47.000 is this podcast will Kill You. 0:04:47.560 --> 0:04:52.039 And today, of course we're talking about Legionella, the causative 0:04:52.080 --> 0:04:54.200 agent of Legionnaire's disease. 0:04:54.640 --> 0:04:59.960 Yeah, and pontiac fever and pontiac fever other things. It's 0:05:00.000 --> 0:05:02.520 it's gonna be an interesting I have lots of biology 0:05:02.600 --> 0:05:05.040 questions already, so cool. 0:05:06.240 --> 0:05:08.719 I knew that was coming, and I like hope that 0:05:08.800 --> 0:05:11.279 I know the answers to them. But you're probably not 0:05:11.320 --> 0:05:13.279 gonna like a lot of them as usual. 0:05:13.960 --> 0:05:16.320 You mean, like it's I'm not gonna like them because 0:05:16.360 --> 0:05:19.880 it's well, we don't quite know. Yep. Yeah, great, great, great, great, 0:05:21.960 --> 0:05:25.800 they're not satisfying answers. Dang it. That's okay. Well we'll 0:05:25.800 --> 0:05:30.400 get there, but first we do some podcast stuff. 0:05:30.760 --> 0:05:33.960 We should yeah, because it's let me check quarantin any time. 0:05:34.360 --> 0:05:37.560 It is quarantin any time. What are we drinking this week? 0:05:37.960 --> 0:05:40.040 We're drinking losing your Cool? 0:05:40.800 --> 0:05:44.080 Yeah, for reasons I think we always say this, but 0:05:44.120 --> 0:05:47.919 that will become more clear as the episode goes on. Basically, 0:05:48.080 --> 0:05:52.360 we're talking about air conditioning, we're talking about fevers. You're 0:05:52.360 --> 0:05:53.320 just gonna lose your cool. 0:05:53.440 --> 0:05:56.960 You're gonna lose your cool, and what's in losing your cool? 0:05:57.080 --> 0:06:01.200 Eric It is a I think it's actually a really 0:06:01.200 --> 0:06:06.080 delicious one. So it has normal rum, pineapple rum, lime juice, 0:06:06.200 --> 0:06:10.400 Apricot liquor, and simple syrup. And we will post the 0:06:10.520 --> 0:06:13.880 full recipe for losing your cool on our website This 0:06:13.920 --> 0:06:16.600 podcast will kill You dot Com, as well as on 0:06:16.640 --> 0:06:20.839 all of our social media channels like Twitter, Facebook, Instagram, 0:06:20.960 --> 0:06:23.119 and those are the places where you can also find 0:06:23.200 --> 0:06:27.000 the non alcoholic place seburrita recipe exactly. 0:06:27.440 --> 0:06:30.800 Speaking of our website, this podcast with you dot Com 0:06:31.040 --> 0:06:33.039 check it out if you haven't already. We have so 0:06:33.080 --> 0:06:36.680 many things there like merch and a bookshop dot org 0:06:37.000 --> 0:06:39.919 affiliate account. We've got a good Reads list, we have 0:06:39.960 --> 0:06:44.479 a Patreon, we have links to Bloodmobile, our music. We 0:06:44.560 --> 0:06:47.800 have transcripts for so many of our episodes, soon to 0:06:47.839 --> 0:06:48.520 be all of them. 0:06:49.000 --> 0:06:54.000 So definitely check out our website. Yes, check it out. Uh. 0:06:54.680 --> 0:06:57.080 I guess like, I feel like this was a really 0:06:57.200 --> 0:07:00.279 fast intro, but I'm I'm like I do. I don't 0:07:00.320 --> 0:07:02.760 know what else to do here. 0:07:03.240 --> 0:07:05.920 I'm excited about this episode, so maybe let's take a 0:07:06.000 --> 0:07:07.719 quick break and then just get started. 0:07:08.000 --> 0:07:31.600 Let's do it. So. 0:07:31.840 --> 0:07:36.679 Legionella is a genus of bacteria that has a whole 0:07:36.680 --> 0:07:39.800 bunch of species, way more than I realized. I think 0:07:39.920 --> 0:07:41.160 at least over fifty. 0:07:41.920 --> 0:07:45.120 Yeah. I think that's been a fairly recent development. 0:07:45.960 --> 0:07:49.680 Yeah, and I believe that at least thirty of these 0:07:49.720 --> 0:07:54.960 bacterial species can be pathogenic to humans. And in general, 0:07:55.200 --> 0:07:58.240 these are a much more interesting group of bacteria than 0:07:58.280 --> 0:08:01.480 I realized. I feel bad because I was just like, oh, 0:08:01.960 --> 0:08:07.080 they're another gram negative like waw. They're much more interesting 0:08:07.120 --> 0:08:11.080 than that. They are gram negative little rods. And when 0:08:11.080 --> 0:08:15.440 they're not infecting us humans, they live in freshwater sources, 0:08:15.840 --> 0:08:19.920 but not just free floating in modern No. 0:08:19.920 --> 0:08:22.600 No, I'm so glad you're going to talk about those. 0:08:22.840 --> 0:08:24.440 Oh yeah, it's so cool. 0:08:25.520 --> 0:08:28.120 So they don't just live free floating in the environment. 0:08:28.400 --> 0:08:34.640 They exist as pathogens of amibe uh huh. 0:08:34.400 --> 0:08:37.840 And other protozoa. I was when I was reading that, 0:08:37.880 --> 0:08:40.720 because I was like reading about the evolutionary history and 0:08:40.800 --> 0:08:42.560 I came across that, and I was like, this is 0:08:42.600 --> 0:08:47.959 so well timed with our Nicleeria Fleriye episode exactly. It's wild. 0:08:48.160 --> 0:08:51.200 And also I was like, oh, this is definitely an error, 0:08:51.320 --> 0:08:54.160 Like I'm reading too much about Aaron's biology section. I 0:08:54.160 --> 0:08:57.640 need to stop. Yeah, it's so fascinating. 0:08:57.679 --> 0:09:00.280 So I always thought of them as just a water 0:09:00.360 --> 0:09:05.080 born bacteria, which they are, but in water they can 0:09:05.160 --> 0:09:09.200 live and persist free floating as well as in biofilms, 0:09:09.280 --> 0:09:11.719 which is what makes them very difficult to deal with 0:09:11.800 --> 0:09:15.640 in pipes or water heaters, air conditioning coolers. 0:09:15.480 --> 0:09:15.960 Et cetera. 0:09:16.520 --> 0:09:22.000 But they only multiply inside of another organism like an 0:09:22.040 --> 0:09:23.679 amiba or another protozella. 0:09:24.240 --> 0:09:29.880 It's really cool because that also has implications for like 0:09:29.960 --> 0:09:32.439 why it infects humans or how to affects humans. 0:09:32.800 --> 0:09:35.680 Just gonna say, but I'm going to put a pin 0:09:35.679 --> 0:09:37.560 in that, but keep that in mind, because when we 0:09:37.600 --> 0:09:40.720 talk about the sort of pathophysiology of how it gets 0:09:40.760 --> 0:09:41.720 us sick, Yeah. 0:09:41.520 --> 0:09:44.520 It makes complete sense. M hm. Okay. 0:09:45.760 --> 0:09:48.959 So we have a lot of different species of Legionella, 0:09:49.080 --> 0:09:53.880 but the one that's most famous and probably the most 0:09:53.880 --> 0:09:56.640 common pathogen of humans, at least in the US and 0:09:56.679 --> 0:10:01.640 throughout Europe is Legionella pneumophila, which has a whole number 0:10:01.679 --> 0:10:05.760 of different subgroups and then specific strains within those subgroups, 0:10:05.960 --> 0:10:10.600 so it's a pretty large overall group of bacteria. And 0:10:10.679 --> 0:10:13.840 so this is an environmental pathogen, and the way that 0:10:13.880 --> 0:10:18.160 people get infected with it is through contact, generally aerosol 0:10:18.280 --> 0:10:23.160 contact with water that is contaminated with Legionella and also 0:10:23.280 --> 0:10:27.880 amiba of course, and Legionella in general grows well at 0:10:28.080 --> 0:10:32.560 warm temperatures like twenty five to forty five celsius, just 0:10:32.640 --> 0:10:35.280 like the amibas that we talked about in our Nigeria 0:10:35.360 --> 0:10:39.520 palrite episode. It's happiest around thirty five celsius, which is 0:10:39.559 --> 0:10:43.520 like ninety five fahrenheit. It's pretty warm water. Yeah, And 0:10:43.600 --> 0:10:46.920 what's interesting is that although this is a bacterial species 0:10:47.000 --> 0:10:51.080 that's found naturally in aquatic environments across the globe. It 0:10:51.160 --> 0:10:54.600 generally doesn't reach high enough levels to get you sick 0:10:54.960 --> 0:10:56.599 in those natural environments. 0:10:57.520 --> 0:10:59.920 So what's the infectious dose? 0:11:00.120 --> 0:11:02.360 Then, Aaron, I knew you were going to ask that 0:11:03.160 --> 0:11:04.360 I have it in bold. 0:11:04.880 --> 0:11:10.960 We don't know you have in bold. We don't know, well, no, 0:11:11.080 --> 0:11:13.400 I have in bold. What is infectious dose? 0:11:16.600 --> 0:11:19.720 Because yeah, that was my biggest question too, because all 0:11:19.720 --> 0:11:22.800 these papers say, you know, it's in human altered environments 0:11:22.920 --> 0:11:26.839 where we're artificially heating water. Then you have this disproportionate 0:11:26.920 --> 0:11:31.559 growth of Legionella the bacteria in comparison to the amibe, 0:11:32.200 --> 0:11:35.240 and that's what leads to human infection. But there isn't 0:11:35.320 --> 0:11:40.120 a well established dose response relationship or even a clear 0:11:40.760 --> 0:11:44.400 infectious dose or lethal dose. There are some papers that 0:11:44.480 --> 0:11:48.040 list numbers, but those studies were in guinea pigs, so 0:11:48.160 --> 0:11:49.679 we really don't know how accurate they are. 0:11:50.120 --> 0:11:53.120 Well. And it's really interesting too, because, as I'm sure 0:11:53.160 --> 0:11:57.439 you'll talk about, there's a wide range of like host susceptibility, 0:11:57.520 --> 0:12:00.480 where like your immune system and your age and you're 0:12:00.679 --> 0:12:04.320 whatever risk factors must change a lot of like the 0:12:04.360 --> 0:12:07.240 infectious dose for one person might not be the infectious 0:12:07.280 --> 0:12:09.199 dose for somebody else exactly. 0:12:09.280 --> 0:12:11.280 And we'll talk a little bit more about that when 0:12:11.280 --> 0:12:13.560 we talk about the symptoms of like the kind of 0:12:13.679 --> 0:12:16.360 range of symptoms that you see in these disorders, because 0:12:16.360 --> 0:12:19.480 I think that plays a huge part in it. Okay, Yeah, 0:12:19.679 --> 0:12:22.520 it also makes it difficult in terms of prevention and 0:12:22.600 --> 0:12:26.200 control to like do environmental monitoring because we don't know 0:12:26.240 --> 0:12:28.720 what is a safe level versus an unsafe level of 0:12:28.800 --> 0:12:36.080 Legionella in water sources. Yeah, yeah, great question, Eric, But 0:12:36.480 --> 0:12:40.600 in general, this is not a pathogen that's transmissible person 0:12:40.640 --> 0:12:44.240 to person asterisk. It has happened maybe a handful of 0:12:44.280 --> 0:12:48.920 times at least once that I saw documented, but that's 0:12:49.080 --> 0:12:52.280 very rare, and in general, outbreaks that happen are from 0:12:52.280 --> 0:12:53.720 a shared environmental source. 0:12:54.200 --> 0:12:58.280 What were the circumstances of the person to person transmission? 0:12:58.480 --> 0:12:59.120 It was a. 0:12:59.040 --> 0:13:02.439 Mom who was caring for someone who was very severely 0:13:02.480 --> 0:13:04.720 ill for like over eight hours a day in a 0:13:04.840 --> 0:13:09.120 very small room without any ventilation and so presumably and 0:13:09.160 --> 0:13:11.520 she didn't have contact with that same water source that 0:13:11.559 --> 0:13:11.920 he had. 0:13:11.800 --> 0:13:15.600 Had contact with. Okay, interesting, that was the one that 0:13:15.720 --> 0:13:18.120 I saw. Yeah, So. 0:13:19.520 --> 0:13:23.000 All right, so let's talk about what happens when these 0:13:23.320 --> 0:13:26.160 bacteria get inside of our body because I think it's 0:13:26.200 --> 0:13:29.120 really fascinating. I might go into more detail than I 0:13:29.160 --> 0:13:32.320 sometimes do on this, but I think it's gonna be fun. 0:13:32.640 --> 0:13:33.880 Okay, let's do it. 0:13:34.559 --> 0:13:38.360 So, since these are bacteria that generally live inside of 0:13:38.559 --> 0:13:42.280 ambae when they're in the environment, it's not surprising that 0:13:42.480 --> 0:13:46.120 once they get inside our body via inhalation into our 0:13:46.120 --> 0:13:51.520 respiratory tract. These are also intracellular bacteria like Ricketsia and 0:13:51.679 --> 0:13:54.800 chlamydia and a lot of other bacteria that live and 0:13:54.880 --> 0:13:56.959 multiply inside of our cells rather. 0:13:56.800 --> 0:13:58.280 Than just in our bodies. 0:13:59.440 --> 0:14:02.960 So in us, what they do is these bacteria adhere 0:14:02.960 --> 0:14:06.880 to our cells. I think from what I read they 0:14:06.920 --> 0:14:11.440 can infect other cells like our respiratory cells, our epithelial cells, 0:14:11.920 --> 0:14:18.680 but primarily they infect Macrophagious Macrophasias are white blood cells 0:14:19.080 --> 0:14:23.360 that normally serve the function of gobbling up bacteria and 0:14:23.400 --> 0:14:28.080 then killing them. But Legionella is able to persist inside 0:14:28.120 --> 0:14:32.880 these macrophages. Here's how they do it. Normally, when a 0:14:32.920 --> 0:14:36.640 macrophage gobbles up a bacteria, you can imagine them taking 0:14:36.680 --> 0:14:40.440 their little macrophages kind of almost look like amiba. They 0:14:40.480 --> 0:14:44.120 have like wiggly arms and they take those wiggly arms 0:14:44.240 --> 0:14:47.240 and they wrap it around a bacterium like a giant 0:14:47.320 --> 0:14:51.480 hug and then they bloop it inside of the macrofage cell. 0:14:51.920 --> 0:14:54.280 But once it gets inside the cell, it's wrapped in 0:14:54.360 --> 0:14:58.520 a little bubble of macriphage cell membrane. M hm. It's 0:14:58.560 --> 0:15:03.080 called the phagosome. Yeah, yeah, you know this erin And 0:15:03.120 --> 0:15:07.680 now normally, once that fhagosome is inside the macrophage, all 0:15:07.720 --> 0:15:10.800 of these other mechanisms inside of the macrofage cell would 0:15:10.800 --> 0:15:14.320 see that bubble and be like, ugh, there's another bacterium. Boop, 0:15:14.360 --> 0:15:17.560 and they'd pop that bubble, release the bacterium. 0:15:17.120 --> 0:15:18.440 And kill it mm hmm. 0:15:18.920 --> 0:15:22.880 But lee Janella prevents that bubble from ever popping, So 0:15:22.920 --> 0:15:28.000 they persist inside a bubble inside a macrophage, and they 0:15:28.040 --> 0:15:31.760 replicate and replicate and replicate. The reason I think this 0:15:31.800 --> 0:15:34.680 is fascinating is because it's exactly the same thing that 0:15:34.720 --> 0:15:40.280 they do inside an amoba. Because amibas eat bacteria the 0:15:40.400 --> 0:15:42.240 same way that our macrophages do. 0:15:42.880 --> 0:15:47.200 Right, it's also very virus like behavior. 0:15:47.040 --> 0:15:52.080 It is, it's very viral huh yeah. And then inside 0:15:52.120 --> 0:15:54.600 of us they do the same thing that they do 0:15:54.680 --> 0:15:57.720 to amiba. They kill our cells just like they would 0:15:57.800 --> 0:16:02.840 kill an amiba. So that's how we get infected, how 0:16:03.000 --> 0:16:06.640 we get sick. What does the disease that Legionella causes 0:16:06.680 --> 0:16:10.920 actually look like? Kind of like in our chicken pox episode, 0:16:10.960 --> 0:16:13.080 And we already mentioned this at the top, there are 0:16:13.120 --> 0:16:17.120 two different named diseases that are associated with infection with 0:16:17.240 --> 0:16:22.440 Legionella bacteria. But I as I was reading this, I 0:16:22.480 --> 0:16:25.600 was like, I find it annoying that we have these 0:16:25.600 --> 0:16:31.120 two different named diseases because they're not truly really different. 0:16:31.280 --> 0:16:35.320 They're kind of just a spectrum of symptoms which all 0:16:35.360 --> 0:16:41.280 seem possible after a Legionella infection, including asymptomatic infection. There's 0:16:41.360 --> 0:16:45.760 evidence of people who become infected zero convert, so they 0:16:45.840 --> 0:16:49.640 show evidence of infection and immunity, but never have any 0:16:49.640 --> 0:16:55.200 symptoms of infection with legionella. So some places have started 0:16:55.240 --> 0:16:58.760 just sort of naming this legionellosis as a spectrum of 0:16:58.800 --> 0:17:02.640 disease rather than legionnaire's disease versus pontiac fever. 0:17:03.360 --> 0:17:05.560 Right, I mean? And I also think that probably the 0:17:05.720 --> 0:17:08.840 likelihood of someone being diagnosed with pontiac fever is much 0:17:08.960 --> 0:17:12.399 lower than with legionnaire's disease, and like if the exposure 0:17:12.520 --> 0:17:16.080 is the same, Okay, I guess that leads into the 0:17:16.160 --> 0:17:20.520 question of why are there two diseases? Like why are 0:17:20.520 --> 0:17:23.399 there two name diseases? I mean, historically it makes sense, 0:17:23.440 --> 0:17:26.600 but like why did that differentiation persist for so long? 0:17:27.119 --> 0:17:29.080 Great question? And I knew that you were going to 0:17:29.119 --> 0:17:33.760 ask this question. That's another place I have it in bold. 0:17:34.600 --> 0:17:41.560 We don't know, no, yeah, yeah, I So my big 0:17:41.640 --> 0:17:44.680 question was is it species specific? Is it different species 0:17:44.720 --> 0:17:50.480 of Legionella that are causing pontiac fever versus legionnaire's disease? Maybe, 0:17:50.520 --> 0:17:53.360 but not really as far as I can tell from 0:17:53.400 --> 0:17:56.760 all of my research, because not only do we mostly 0:17:56.800 --> 0:18:00.439 test for Legionella pneumophilla zero group one, and so like 0:18:00.520 --> 0:18:06.600 one specific group of Legionella numophila, that particular bacterial species 0:18:07.080 --> 0:18:10.000 has been found to cause both legionnaires and pontiac fever, 0:18:10.280 --> 0:18:15.399 as well as asymptomatic infections. So it can't be entirely 0:18:15.440 --> 0:18:17.680 based on zero group, and it can't be entirely based 0:18:17.720 --> 0:18:20.679 on species of bacteria, because again, there's a lot of 0:18:20.680 --> 0:18:25.719 different species of Legionella, so there's likely a huge amount 0:18:25.720 --> 0:18:28.200 of host factors that go into it. We know there 0:18:28.240 --> 0:18:31.320 are risk factors that make Legionnaire's disease a lot more likely, 0:18:31.800 --> 0:18:34.399 things like if you smoke or have any kind of 0:18:34.480 --> 0:18:38.720 chronic lung disease, an older age, especially anyone over age 0:18:38.760 --> 0:18:42.520 fifty is at higher risk than people younger, and any 0:18:42.600 --> 0:18:46.600 kind of immunal compromise, especially immuno compromise associated with cancers 0:18:46.840 --> 0:18:51.359 or being on cancer therapy or steroid treatment. So those 0:18:51.400 --> 0:18:53.800 things we know make it more likely that someone exposed 0:18:53.840 --> 0:18:58.120 to Legionella will develop Legionnaire's disease. But like you said, Erin, 0:18:58.160 --> 0:19:01.480 we also just don't know as much about pony because. 0:19:01.200 --> 0:19:02.400 It's pretty mild. 0:19:02.800 --> 0:19:07.040 So pontiac fever is basically just a mild flu like 0:19:07.080 --> 0:19:12.520 illness caused by legionella. It's fever, body aches, maybe some 0:19:12.640 --> 0:19:16.280 respiratory symptoms, but it lasts for a few days and 0:19:16.320 --> 0:19:20.200 then you get better. No pneumonia, no death, No pneumonia, 0:19:20.359 --> 0:19:21.480 no death exactly. 0:19:22.640 --> 0:19:22.880 Yeah. 0:19:23.680 --> 0:19:28.879 Legionnaire's disease, on the other hand, is a pneumonia, and 0:19:28.920 --> 0:19:31.800 we've talked about pneumonia a lot, actually, even this season 0:19:32.560 --> 0:19:35.560 in our coxsidioidomcosis episode. 0:19:35.640 --> 0:19:37.879 That's what kept popping into my head when I was 0:19:37.920 --> 0:19:40.800 reading about this, Yeah, definitely. So. 0:19:41.000 --> 0:19:45.160 The symptoms of Legionnaire's pneumonia generally start anywhere from two 0:19:45.200 --> 0:19:48.639 to fourteen days after infection, so that's the incubation period. 0:19:48.680 --> 0:19:52.280 It can be quite long. It starts very often with 0:19:52.320 --> 0:19:55.280 a fever, and like you heard in the first hand account, 0:19:55.320 --> 0:19:59.520 this fever can get quite high. Often you'll have chills 0:19:59.560 --> 0:20:04.639 which are osociated with such high fevers, a cough. Unlike 0:20:05.000 --> 0:20:09.240 some of the more quote typical pneumonias, this cough is 0:20:09.280 --> 0:20:11.600 not often very productive, so you don't have a ton 0:20:11.640 --> 0:20:14.840 of phlegm that you're bringing up, but you still likely 0:20:14.880 --> 0:20:18.679 have a cough. You'll probably have some difficulty breathing and 0:20:18.760 --> 0:20:22.520 some chest pain because there's intense inflammation happening in the lungs. 0:20:23.960 --> 0:20:27.119 And if you read the kind of classic descriptions of 0:20:27.200 --> 0:20:31.159 Legionnaire's disease, it's often described as having GI involvement, so 0:20:31.280 --> 0:20:37.359 like diarrhea, nausea, vomiting, But in reality, this can happen 0:20:37.400 --> 0:20:42.400 with other atypical pneumonias as well. Atypical pneumonia just means 0:20:42.440 --> 0:20:46.400 a pneumonia that doesn't fit the old school, very classic 0:20:46.480 --> 0:20:51.679 definition of pneumonia that's generally caused by streptococcus pneumonia or 0:20:51.760 --> 0:20:55.920 clebcila or something like that. So there's a whole group 0:20:56.000 --> 0:20:58.920 of atypical pneumonias of which Legionnaire's disease is. 0:20:58.920 --> 0:21:03.359 One, right, Yeah, I was I kept wondering what a 0:21:03.480 --> 0:21:09.080 typical Like, what distinguishes atypical pneumonia from typical pneumonia. 0:21:09.280 --> 0:21:12.960 Yeah, there's there are things like maybe the X rays 0:21:13.000 --> 0:21:17.200 will look a little bit different than pneumonia with strep pneumo, 0:21:18.119 --> 0:21:21.399 But there isn't any one specific X ray finding that 0:21:21.800 --> 0:21:25.679 tells you this is Legionnaire's disease versus something else. So 0:21:26.040 --> 0:21:28.679 it's kind of it's a very non specific way of 0:21:28.720 --> 0:21:30.440 grouping pneumonia's. 0:21:30.760 --> 0:21:33.919 So like if somebody came in with symptoms of pneumonia, 0:21:34.480 --> 0:21:38.240 some kind of pneumonia, like, what would make you go, oh, 0:21:38.280 --> 0:21:42.200 that's typical pneumonia versus atypical Would it be like you, you know, 0:21:42.359 --> 0:21:45.960 screen them for strap or you look at the X ray? 0:21:46.080 --> 0:21:49.960 Is it a combination? Like yeah, it's a really good question. 0:21:51.200 --> 0:21:54.280 There's not a good answer to that because what we 0:21:54.400 --> 0:21:57.080 end up doing is just treating for all of it 0:21:57.760 --> 0:22:02.480 very often. Okay, Yeah, so there are X ray findings 0:22:02.480 --> 0:22:07.439 that are maybe more specific for a strip pneumo pneumonia 0:22:07.560 --> 0:22:11.120 versus more atypical pneumonias, like maybe the X ray will 0:22:11.119 --> 0:22:14.520 be a little bit more diffuse and patchy versus like, Oh, 0:22:14.640 --> 0:22:16.960 here's a pneumonia in one lobe of your lung. Very 0:22:17.000 --> 0:22:21.639 clearly defined, but that's not specific, right, None of the 0:22:22.359 --> 0:22:24.320 kind of ways that we used to diagnose, like oh, 0:22:24.600 --> 0:22:28.760 is your cough productive versus not productive? Are you very 0:22:28.920 --> 0:22:33.359 very very sick versus your X ray looks terrible, but you. 0:22:33.280 --> 0:22:34.320 Don't look that sick. 0:22:34.480 --> 0:22:38.080 That's something that's usually associated with an quote atypical pneumonia 0:22:38.240 --> 0:22:40.439 is the X ray might look really bad, but the 0:22:40.480 --> 0:22:42.320 person doesn't seem that sick. 0:22:42.880 --> 0:22:46.560 Clinically, gotcha. Also, like I said, GI. 0:22:46.440 --> 0:22:50.640 Involvement, right, classically you would think, well GI involvement, Maybe 0:22:50.680 --> 0:22:53.920 I'm thinking legionella is more likely, but that can happen 0:22:53.960 --> 0:22:56.679 in other pneumonias as well. So there's no like one 0:22:56.720 --> 0:23:01.120 specific thing that if someone walked in you would say, oh, well, 0:23:01.160 --> 0:23:04.040 this is most definitely this one cause. 0:23:03.920 --> 0:23:05.320 Et cetera, et cetera. M hm. 0:23:06.320 --> 0:23:10.320 And that's what makes pneumonia in general difficult because it's 0:23:10.359 --> 0:23:15.919 often difficult to test for direct causative agents, especially if 0:23:15.960 --> 0:23:18.320 someone doesn't have a lot of phlegm that they can 0:23:18.359 --> 0:23:21.280 cough up that you can use as something to culture. 0:23:21.720 --> 0:23:25.679 Right for legionella, there is another test that you can 0:23:25.800 --> 0:23:28.760 use on urine. It's a urine antigen test that can 0:23:28.800 --> 0:23:31.440 test directly for the presence of the bacteria. 0:23:31.080 --> 0:23:32.560 Which is very cool. 0:23:32.840 --> 0:23:37.760 It is very cool, and so that is something that 0:23:37.800 --> 0:23:39.520 you can do to test directly for it. 0:23:39.520 --> 0:23:41.639 It's of course not a perfect. 0:23:41.640 --> 0:23:44.600 Test, just like any diagnostic test, but it is effective, 0:23:44.680 --> 0:23:47.359 So that's pretty awesome. And it's a lot faster than 0:23:47.440 --> 0:23:52.440 something like culture, which takes many days. Yeah, so that's 0:23:52.520 --> 0:23:54.600 kind of what it would look like if somebody was 0:23:54.680 --> 0:24:01.520 infected in general Legionari's disease, legionellosis with pneumo has about 0:24:01.520 --> 0:24:05.000 a five to ten percent fatality rate that's with treatment. 0:24:06.280 --> 0:24:09.560 Is that just because of just how fast the bacteria 0:24:09.680 --> 0:24:12.439 is like already cause damage before it's caught, or is 0:24:12.480 --> 0:24:15.400 it like the efficacy of treatment isn't as great as 0:24:15.440 --> 0:24:17.320 for other pneumonias, Like why is that? 0:24:17.560 --> 0:24:21.440 So it's actually pretty similar to the fatality rate for 0:24:21.480 --> 0:24:22.560 pneumonia's in general. 0:24:22.880 --> 0:24:26.760 Okay, that's just a bad it's just a bad pneumonia. 0:24:26.880 --> 0:24:30.800 And I think that historically Legionnaire's disease was considered a 0:24:30.840 --> 0:24:34.320 more severe form of pneumonia, and if untreated, the mortality 0:24:34.400 --> 0:24:36.920 rate can be a lot higher than for other forms 0:24:36.960 --> 0:24:39.040 of pneumonia. It can be as high as forty to 0:24:39.119 --> 0:24:42.840 eighty percent, whereas for other pneumonias it might be less 0:24:43.080 --> 0:24:48.000 like thirty percent or so. But as we've gotten better 0:24:48.040 --> 0:24:51.800 at recognizing Legionaire's disease, I think people get diagnosed earlier, 0:24:52.119 --> 0:24:56.600 and so we've seen that it's not always necessarily the 0:24:56.640 --> 0:24:59.399