A 77-year-old man’s mysterious symptoms, fever, and frequent falls due to fatigue left doctors puzzled for days until they diagnosed him with a potentially fatal Legionnaires’ disease, linked to his vacation swimming in an Iowa lake.
According to the case published in CMAJ, the unidentified patient was admitted to a Winnipeg hospital with fever, cough, and multiple sudden falls due to fatigue. Tests showed an elevated blood cell count, indicating an infection, along with high levels of creatine kinase, suggesting potential kidney damage. Further testing revealed that the patient had developed severe pneumonia.
The patient was initially treated for five days with antibiotics piperacillin-tazobactam, a broad-spectrum antibiotics for pneumonia but his condition did not improve. Doctors then performed a bronchoscopy but could not identify the specific bacteria from the sample.
Although doctors initially requested Legionella testing of the bronchoalveolar lavage culture, the laboratory declined due to a lack of clinical justification. However, after the doctors highlighted the patient’s risk factors including recent travel, exposure to stagnant water, and pneumonia unresponsive to standard antibiotics, the lab proceeded with the test.
While the bronchoalveolar lavage culture tested negative, a urine test confirmed the presence of Legionella. The negative culture result was likely due to recent antibiotic use.
Once Legionnaires’ disease was confirmed, doctors prescribed a 10-day course of antibiotics levofloxacin (750 mg daily). By the fourth day of treatment, the patient had improved significantly and no longer needed supplemental oxygen, allowing him to be discharged from the hospital to continue his recovery at home.
Legionnaires’ disease develops within 10 days after exposure to Legionella bacteria, which enters the body through inhalation from water or soil. Outbreaks have been linked to various water sources, including hot tubs, whirlpools, cooling towers in air conditioning systems, hot water tanks, heaters, decorative fountains, swimming pools, birthing pools, and drinking water.
The initial signs of the infection include headache, muscle aches, and a high fever. Within three days, additional signs may appear, including cough, shortness of breath, chest pain, gastrointestinal issues, and confusion. Though it primarily affects the lungs, it can sometimes lead to infections in other parts of the body, such as wounds or the heart. If left untreated it can lead to life-threatening complications including septic shock, and lung and kidney failure.
A milder form of the infection from the same bacteria causes Pontiac fever, with similar symptoms but doesn’t affect the lungs and generally resolves in a few days.
