Legionella on Tap

Last October, Johns Hopkins Hospital staff reported finding trace amounts of Legionnaires’ disease bacteria in the hospital’s water supply. Was that a serious problem? Well, yes and no. Yes, if you were a hospital patient suffering from a chronic lung disease or your immune system had been undermined by disease, advanced aged, chemotherapy or other drugs. No, if you were otherwise healthy. Legionnnaires’ disease is a pneumonia caused by the bacterium, Legionella pneumophila. People usually become infected by inhaling tiny water droplets contaminated with the bacteria. It does not spread from person to person, unlike influenza and the common cold. The bug has been around forever, but no one recognized it until 1976 when it made a dramatic appearance at the American Legion Convention in Philadelphia. Over two hundred aging conventioneers came down with pneumonia. Thirty-four of them died. Before that, the Legionella bacteria had been going about their lives nameless and unrecognized. People occasionally died of a pneumonia that could not be attributed to known suspects, but no one spotted Legionella until after the outbreak in Philly. Since the 1976 outbreak, the appearance of L. pneumophila in water pipes, showerheads, cooling towers and spa whirlpools has usually been greeted with alarm, sometimes with panic, and always with intense news coverage. Last September, for example, two Harford County schools shut down for several days because of “elevated levels” of L. pneumophila in the water systems. Back in the summer of 1999, four nursing home residents—also in Harford County—


contracted Legionnaires’ disease and two of them died. That fall, Georges Benjamin, then the Secretary of Maryland’s Department of Health and Mental Hygiene, organized a committee of experts to survey the state’s 92 hospitals and 270 nursing homes about their ability to detect Legionella and diagnose patients, and to make recommendations about dealing with Legionella in the state’s water systems. The following year, the committee recommended acute-care hospitals raise their hot water temperature from 110 to 122 degrees Fahrenheit, conduct regular surveillance of their water, and be able to diagnose Legionella infections in 24 to 48 hours. Still, Maryland has recorded 189 cases of Legionnaires’ disease during the last three years. The truth is it’s not unusual to find Legionella in water pipes and tanks. Legionella’s natural habitat is water. It likes the kind of warm, slow moving water you might find in a Maryland reservoir, an apartment building’s labyrinth of copper pipes, or the hot water heater in your basement. According to Janet Stout, Director of the V.A. Medical Center’s Special Pathogens Lab in Pittsburgh, most of the cases of Legionella acquired outside hospitals and nursing homes are probably from “exposure to residential water systems.” That tap water in your home is remarkably clean and safe to drink. It is filtered and treated with chlorine before it reaches your water glass or icemaker. But it isn’t sterile. All kinds of harmless microbial things live in it, including things like Legionella. “The media and lay public are not aware that Legionella is a common colonizer of water distribution systems,” wrote Stout, noting there is “a strong bureaucratic tendency to publicly avoid consideration of drinking water as the source [of infection].”


So why doesn’t everyone get sick? Well, partly because Legionella pneumophila is a wimpy pathogen. It goes after people who are already ill with chronic lung diseases or suffering from the immunosuppressive effects of chemotherapy drugs. Also, it is not found in every house. In her native Pittsburgh, Stout found only 6.4% of surveyed homes had Legionella. Stout’s colleague, Victor Lu, is even more adamant about getting out the facts on Legionella. In an editorial in the Journal of Infectious Diseases, he wrote, “The public must be informed that Legionella species are common colonizers of man-made water-distribution systems, they are rarely pathogenic for immunocompetent hosts, and that [Legionnaires’ disease] is not a contagious disease. Ignorance leads to panic, and panic lead to irrational actions.” If the idea of bugs in your pipes bothers you, or there is someone at home with health problems, there are a few things you can do to reduce the risk of Legionella infection. Raise the hot water temperature to 122 degrees Fahrenheit, and run the water for 20 to 30 minutes. This should be done every two or three months. Run the hot water for a few minutes before showering, and install a faucet filter. AIDS patients are advised to boil their drinking water or use bottled water to guard against water-borne microbes. People worried about their susceptibility to Legionella infections should consider doing the same thing. The rest of us should try to remember that water, including our tap water, is really an ecosystem containing microbes, minerals, and trace gases. Just like us. For more information about Legionella, visit www.legionella.org.