We have three people who got sick in a building and we think it might the legi9nnaire disease. The building is located in a third world country. We are trying to privé advice toe the manager that aligns with the Canadian practices, can you help . I should mentioned that we are not responsible for the building. I need to provide advice on managing the situation with the building, but also measures for the employees. Do we get them out of th building? Would your response be different if I tell you it is not in a secured country. Do I ship them to a third country for testing, what type of testing…

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# What are the signs and symptoms of Legionnaires' disease? Legionnaires' disease is a severe type of pneumonia that usually develops 2 to 10 days after exposure to the Legionella bacteria. Common early signs and symptoms include: - Headache - Muscle pain - General feeling of malaise After a couple days, other signs and symptoms will develop, which may include: - Fever (up to 40-40.5°C or about 104-105°F) - Gastrointestinal symptoms (nausea, vomiting, diarrhea) - Dry cough - Chest pain - Shortness of breath or difficulty breathing - Confusion or other mental changes (disorientation, hallucination, loss of memory) Most patients develop pneumonia, a condition in which some of the lungs' air sacs fill with fluid or pus. If pneumonia symptoms are developed, contact a doctor or healthcare professional for guidance. Laboratory tests are necessary for a diagnosis of Legionnaires' disease. Complete recovery may take several weeks. About 15-25% of known cases of Legionnaires' disease have been fatal. ## How is Legionnaires' disease recognized and treated? To distinguish Legionnaires' disease from other types of pneumonia, laboratory tests are needed that are not normally carried out on patients with fever and pneumonia. Therefore, if there is a possibility of exposure to the Legionella bacteria, the doctor must be informed to conduct the required tests. The diagnosis is confirmed by laboratory examinations that isolates Legionella from respiratory secretions (sputum) or testing a patient's blood or urine. Legionnaires' disease is treated with antibiotics. Early treatment helps reduce the chance of serious complications. Legionnaires' Disease CCOHS

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# What are the signs and symptoms of Legionnaires' disease? (cont.) ## Who is more likely to get Legionnaires' disease? (cont.) - Kidney or liver failure - Chronic lung diseases (like emphysema or chronic obstructive pulmonary disease (COPD)) Smoking may also increase the risk of illness. ## What occupations are at risk for Legionnaires' disease? Workers most at risk are those with occupations that require them to work in sealed buildings including those workers who maintain water cooling towers in air conditioning systems. Since Legionella is found naturally outdoors near water sources, some outdoor occupations may be considered at risk as well; however, the number of bacteria found in these locations is generally not high enough to cause disease in people. Soil disturbed in areas where surface or aerosolized water discharge occurs has the potential to cause exposure to the microorganism In a few cases, the Legionella bacteria from cooling towers has survived and spread into the air of ventilation systems and air ducts for distances of several kilometers. ## How can we prevent Legionnaires' disease? The likelihood of Legionella exposure may be reduced by good engineering practices which includes proper maintenance and operation of air and water handling systems and mist- producing devices. These devices include shower heads, hot tubs, humidifiers, and whirlpool bathtubs. In all cases, follow the manufacturer's instructions for operation, cleaning, and maintenance. Cooling towers and evaporative condensers should be inspected and thoroughly cleaned at least once a year. Corroded parts, such as drift eliminators, should be replaced. Algae and accumulated scale should be removed. These measures will not only control the growth of bacteria, but will also maintain operating efficiency. Never enter a confined space without proper instruction or training. All safety procedures must be followed if required to enter a confined space for cleaning or de-scaling. …

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CCOHS CCHST Canadian Centre for Occupational Health and Safety Centre canadien d'hygiène et de sécurité au travail # Diseases, Disorders and Injuries # Legionnaires' Disease ## On this page What is Legionnaires' disease? What is the cause of Legionnaires' disease? What are the signs and symptoms of Legionnaires' disease? How is Legionnaires' disease recognized and treated? How is Legionnaires' disease transmitted? How are Legionella bacteria spread in indoor environments? Who is more likely to get Legionnaires' disease? What occupations are at risk for Legionnaires' disease? How can we prevent Legionnaires' disease? ## What is Legionnaires' disease? The name "Legionnaires" disease" was first used in 1976 after an outbreak of a type of pneumonia that affected many delegates attending a American Legion Convention in Pennsylvania. Eventually, the bacteria that was responsible for the disease was isolated and named as Legionella pneumophila. Two distinct illnesses, Legionnaires' disease and Pontiac fever, have been associated with the Legionella bacteria. Legionnaires' disease is a severe type of pneumonia. Pontiac fever's symptoms are primarily fever and muscle aches (but not pneumonia). In this document, we refer only to Legionnaires' disease. ## What is the cause of Legionnaires' disease? The bacterium responsible for Legionnaires' disease belongs to the genus Legionella. There are many Legionella species known to produce the disease, however Legionella pneumophila is responsible for 85-90% of the cases. Legionella species are commonly found in any freshwater aquatic environments. They can survive for several months in a wet environment and multiply in the presence of algae and organic matter. Legionnaires' Disease CCOHS

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# What are the signs and symptoms of Legionnaires' disease? (cont.) ## How is Legionnaires' disease transmitted? The normal presence of Legionella in water and soil is not automatically associated with an outbreak of the disease. Aspiration, although less common, is another way that the Legionella microbes can enter into the lungs. Aspiration is defined as the entry of a liquid or solid into the trachea or lower respiratory system directly though the oral or nasal cavity, or indirectly by vomiting. In other words, aspiration occurs when instead of something going from your mouth or nose to your stomach (other than air), it enters the lungs. Evidence of person-to-person transmission has not been found, nor is there any documentation of animal-to-person transmission. Warm, stagnant water can promote bacteria growth, including the growth of Legionella. In buildings, Legionella can be spread through ventilation systems when circulated air picks up droplets of contaminated water. If the droplets are small enough, they can be inhaled, and the bacteria can enter the lung. ## How are Legionella bacteria spread in indoor environments? Cooling towers are part of large air-conditioning systems. They are used to cool water and dissipate unwanted heat through evaporation. Warm water flows into the top of the cooling tower through spray nozzles (as shown in Figure 1). When the water passes through the nozzles, tiny aerosols are formed, providing maximum contact between the water and the air moved through the tower by fans. To prevent droplets from fusing into larger ones, splash bars are placed below the nozzles. Air/Water Vapour Drift Drift Eliminators Cooling Water Inlet Water Sprays Packing Material or Splash Bars Air Make-up Bleed Off Legionnaires' Disease CCOHS