LEGIONNAIRES' DISEASE

form of pneumonia first identified in 1976 as caused by a previously unknown bacillus subsequently named Legionella pneumophila. The name of the disease (and of the bacterium) derives from a 1976 state convention of the American Legion, a U.S. war veteran's organization, at a Philadelphia hotel where 182 Legionnaires contracted the disease, 29 of them fatally. Medical detective work by the U.S. Centers for Disease Control in Atlanta, Ga., pieced together clues and laboratory work, discovering that the organism had many unique properties and was unlike any bacterium previously encountered in medical bacteriology. Investigators found that L. pneumophila would grow slowly and only in a greatly enriched, moist culture medium within a narrow range of acidity (optimally pH 6.9 to 7.0) and that the bacterium could survive for a year in tap water. Later studies of stored tissue and serum samples revealed that a number of mysterious outbreaks of unknown pneumonia-like diseases at widely separated placesWashington, D.C.; Pontiac, Mich.; Benidorm, Spain; Nottingham, Eng.; even a Los Angeles hospitalactually were episodes of Legionnaires' disease. Typically, but not uniformly, the first symptoms are general malaise and headache, followed by high fever, often accompanied by chills. Coughing (often without sputum production), shortness of breath, pleurisy-like pain, and abdominal distress are common, and occasionally some mental confusion is present. Although healthy individuals can contract Legionnaires' disease, the most common patients are elderly or debilitated individuals or persons whose immunity is suppressed by drugs or disease. Although it is fairly well documented that the disease is rarely spread like pneumococcal pneumonia through person-to-person contact, the exact source of the outbreakswhich have appeared in several European countries and in travelers returning from Chinahas yet to be determined. It is suspected that contaminated water in central air-conditioning units can serve to disseminate Legionella pneumophilia in droplets into the surrounding atmosphere. Potable water and drainage systems are suspect, as is water at construction sites. Treatment for Legionnaires' disease is the antibiotic erythromycin, augmented in unusually severe cases by rifampin. A vaccine is in prospect, but a quick test for the disease had not been developed by the late 1980s. Legionella pneumophilia has also been associated with a syndrome called Pontiac fever, an influenza-like illness characterized by fever, headache, and muscle pain.