Legionnaires’ disease is under scrutiny in Cyprus after a newborn was diagnosed with the infection at a private clinic in Nicosia and transferred to Makarios Hospital for intensive care.
The case prompted concern among the relevant state services and renewed attention to how the disease spreads, where the bacteria thrive and who is most at risk.
Legionnaires’ disease is an acute respiratory infection caused by bacteria of the Legionella genus. The most common species associated with human illness is Legionella pneumophila.
There are two main clinical conditions associated with Legionella infection: Pontiac fever, which typically causes a flu-like illness and resolves on its own, and Legionnaires’ disease, a more serious form that usually causes pneumonia and can be fatal.
How does Legionnaires’ disease spread?
Legionnaires’ disease is usually contracted by inhaling tiny water droplets containing Legionella bacteria. These droplets can become airborne when contaminated water is dispersed, for example when someone takes a shower.
The infection is not normally transmitted from person to person.
Legionella bacteria occur naturally in water and soil. They can multiply in water systems, particularly where water remains stagnant or flows poorly through pipes and storage tanks.
Water temperatures between 20°C and 45°C are favourable for bacterial growth.
Where can Legionella bacteria grow?
Buildings with water storage and distribution systems can provide conditions that allow Legionella to multiply, particularly when maintenance is inadequate or water remains stagnant.
Potential sources include:
- Hot and cold water systems, including showers
- Cooling towers associated with air-conditioning systems
- Water storage tanks and reservoirs
- Hot springs and thermal baths
- Hot tubs and whirlpool baths
- Decorative fountains
- Air humidifiers and respiratory equipment that uses water
Hospitals, private clinics, hotels, guesthouses, schools, universities, care homes and other facilities with complex water systems may be vulnerable if appropriate water management measures are not in place.
The accumulation of sediment, mineral deposits and biofilms on the internal surfaces of pipes and tanks can also encourage bacterial growth.
Who is most at risk?
Although Legionella exposure does not always lead to illness, certain groups face a higher risk of developing severe disease.
These include:
- People aged over 50
- Smokers
- People with chronic lung diseases or diabetes
- People with kidney failure or cancer
- Organ transplant recipients
- People taking corticosteroids or other treatments that suppress the immune system
- People with weakened immune systems for other reasons
Legionnaires’ disease can cause severe pneumonia, making early medical assessment particularly important for people in higher-risk groups who develop compatible symptoms after possible exposure.
What is the difference between Pontiac fever and Legionnaires’ disease?
The two main illnesses linked to Legionella differ in their severity.
Pontiac fever is generally a self-limiting illness with flu-like symptoms. Legionnaires’ disease is more serious, primarily affecting the lungs and causing pneumonia. The latter can be fatal, with reported case fatality rates varying according to the population affected and the circumstances of infection.
The diagnosis of Legionnaires’ disease in a newborn in Nicosia has brought renewed attention to the importance of identifying possible sources of contamination and maintaining water systems safely.
Also read: Newborn with Legionnaires’ disease remains critical
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