Legionnaires' Disease: What Pharmacists Can Do

Two New Yorkers have died in a Legionnaires’ disease outbreak, and now a college in Pennsylvania is treating its cooling towers after an employee tested positive for the flu-like disease.

In light of this, Leigh Anne Hylton Gravatt, PharmD, an assistant professor in the department of pharmacotherapy and outcomes science at Virginia Commonwealth University, told Pharmacy Times that pharmacists should focus on patient education.

According to the US Centers for Disease Control and Prevention (CDC), Legionnaires’ disease is caused by bacteria called legionella that are often found naturally in water.

Individuals may fall ill with the disease if they breathe in mist or vapor with the bacteria from sources such as hot tubs, cooling towers, hot water tanks, large plumbing systems, or decorative fountains.

However, most of those exposed to the bacteria do not contract Legionnaires’, according to the CDC. Patients who smoke, use corticosteroids, or have chronic kidney disease or cancer may be more susceptible to the disease.

Dr. Gravatt said pharmacists can remind patients that the disease cannot be spread person-to-person. Instead, they should tell patients to make sure that their water systems, including hot tubs and decorative pools, have the right amount of chemicals, such as chlorine or bromine, and maintain the desired pH (7.2-7.8). Cleaning and scrubbing can also help reduce the risk of Legionnaires’ bacteria growth.

“The good news is that this infection can easily be treated with antibiotics,” Dr. Gravatt told Pharmacy Times. “It is important that there is prompt recognition of symptoms—which are similar to signs of pneumonia, such as cough, fever, headache, and sometimes gastrointestinal symptoms—with appropriate triage to a physician so that the patient can be treated with appropriate antibiotics as soon as possible.”

Patients may receive macrolides (azithromycin and clarithromycin), fluoroquinolones (levofloxacin and moxifloxacin), and tetracyclines (doxycycline) to treat the disease. Dr. Gravitt said delays in obtaining these antibiotics have been linked to poorer patient outcomes.

“These drugs all have the potential for several drug-drug and food-drug interactions, so making sure that the patient is counseled on how to optimally administer their antibiotics in regards to other drugs and foods is very important, as well,” Dr. Gravitt said.

The New York Legionnaires’ outbreak has affected 31 individuals in the South Bronx since July 10, 2015, and 2 of them have died, according to The New York Times. The neighborhoods where these cases have been popping up—High Bridge, Morrisania, Mott Haven, and Hunts Point—have at least 15 affected cooling towers in the area, but the 31 individuals were not clustered in a single building or workplace.

Jay Varma, deputy commissioner for disease control at the New York City Department of Health and Mental Hygiene, told The New York Times that the 31 individuals were mainly “older adults with other medical problems.”

In Pennsylvania, West Chester University began treating 8 cooling towers on campus after they were found to have higher-than-acceptable levels of Legionnaires’ bacteria, according to Daily Local News.

The university sent an e-mail to all employees notifying them that an unnamed individual on campus had tested positive for Legionnaires’ on July 29, 2015.

The disease was first recognized in 1976 at an American Legion conference in Philadelphia, Pennsylvania, where 221 Legionnaires fell mysteriously ill. The CDC investigated the incident and determined that an air conditioning system was the source of the bacteria.