|Type of paper:||Research paper|
Respiratory diseases due to bacteria are among the common conditions in the modern world. One of the less talked about, disease, is the Legionnaire's disease, commonly caused by Legionella bacteria. The most common species of the bacteria is the Legionella Pneumophila which is the easiest to identify in a laboratory setup. In the US, the disease is among the most preferred types of acquired bacterial pneumonia, and Travel acquired Pneumonia. Research has shown that although the condition rarely causes epidemics, it is highly virulent resulting in the hospitalization of a majority of the victims. Also, figures from across the globe reckon that about 10% of the infected people succumb to the disease (Cunha, Burillo & Bouza, 2016). A death rate of 10% is a very significant figure, and there is a need to reduce the number. Researchers have also shown that the number of new infections has greatly increased in recent years. Although this increase may be due to various lifestyle factors, many have associated it to the improvement in diagnostic methods in use (Edelsen & Christian, 2015). An overview of the literature touching on the disease shows that more needs to be done to improve the knowledge reservoir for the same. This research, therefore, has the potential to add knowledge on the disease and how its prevention or treatment.
Legionnaire's disease burst into the limelight two decades ago when an epidemic occurred in a Legion Convention in Philadelphia, USA. It is due to this catastrophic event that the name Legionnaires disease was coined. Since then, however, a significant amount of resources and time have been invested in the area which has resulted in the accumulation of knowledge regarding the epidemiology, microbiology, control, infection and even prevention measures against the bacteria. These bacteria are found in a freshwater environment, lakes, and streams (Edelsen & Christian, 2015). The disease is caused when aspiration of the bacteria of contaminated water finds its way to the lungs of an individual. In spite of some suggesting that drinking of contaminated water can cause the disease, no literature can be seen to back up the claim. Generally, it has been observed that the disease does not spread from one person to another (Cunha et al., 2016). Technology has contributed to understanding the distribution and natural history of Legionnaires' disease, and inform outbreak investigations.
Legionnaire's disease is an acute pneumonia infection caused by Legionella bacteria. Etiological data from research show that a gram-negative bacillus named Legionella pneumophila is the most prevalent species of the bacteria and is easily the leading cause of community-acquired pneumonia in the US (Edelsen & Christian, 2015). Although it is an essential study in children's health, Legionella pneumophila is rarely seen infecting them. Since the discovery, the number of species associated with the bacteria has continued to rise dramatically. Up to 13% of all community-acquired pneumonia requiring hospitalization are associated with the Legionnaire bacteria. The legionella bacteria cause two types of diseases: legionnaire disease and the Pontiac fever. Of the two, the former is the most virulent while the latter can exist without the victim realizing (Cunha et al., 2016).
Control of Legionnaires disease outbreaks relies on rapid ascertainment of descriptive epidemiological data, combined with microbiological information to identify the source and implement control measures. Further research is required to determine the actual burden of disease, factors that influence susceptibility, key sources of infection, and differences in virulence between strains of Legionella species. Other requirements are improved, specific, sensitive, and rapid diagnostic tests to accurately inform management of Legionnaires' disease, and controlled clinical trials to ascertain the optimum antibiotics for treatment (Garrison, Kunz, Cooley, Moore, Lucas, Schrag & Whitney).
On infection by the disease, the legionella bacterium replicates inside the macrophages and monocytes of the alveolar. The bacteria do not, however, combine with the host's lysozyme. It has been shown by studies that resistance spearheaded by macrophages and the susceptibility of an individual are genetically mediated. The eventual immune system reaction against the bacteria is depended on cytokines induction and activation of macrophages (Edelsen & Christian, 2015).
Signs and Symptoms
The advent of the legionnaire disease usually happens after ten days. However, initial signs and symptoms observed are headaches, pain in the muscles, chills and a high fever. Other signs develop days after infection and may consist of Coughing out mucus or blood, shortness of breath, and chest pains (Edelsen & Christian, 2015).
In recent years, the disease has erupted in many areas around the world more so in the US. The increased cases can be attributed to increased surveillance and lifestyle of the residences in various areas. Current incidences and trends for the state of Michigan and the whole of America show an increase in cases of Legionnaire disease reported (Michigan Department of Health and Human Services (MDHHS), 2018).
A graph showing Michigan Statewide Legionnaires' Disease Incidence Trends (MDHHS, 2018).
A graph showing National Legionnaires' Disease Incidence Trends (MDHHS, 2018).
Current Surveillance Methods
Legionnaire's disease is divided into different exposure categories
Travel - If a patient spent at least a night away from home ten days before the onset of symptoms. However, this excludes any time spent with a healthcare facility. Such a case is surveilled on a day to day basis with the purpose of identifying clusters. From this, preventive measures are initiated to curtail subsequent cases (CDC, 2011).
Definite and possible healthcare - A case is determined definitely when a patient showed symptoms of the disease after spending the entire ten days in a healthcare facility. However, if the patient only spent a portion of the ten days in a healthcare facility. Surveillance of these cases
Assisted Living - If symptoms appear after the patient spent a portion of 10 days in a facility providing custodial care without skilled nursing services. Such a case is monitored consistently on a daily basis to ensure other patients are not infected from the same source of the bacteria (CDC, 2018).
Ultimately, surveillance of Legionnaire's disease is done with the goals of; monitoring and describing trends from the incidences reported. Surveillance also helps identify locations where people are more exposed to the disease. With proper surveillance, opportunities for prevention and control help in administering effective interventions (ECDC, 2017).
LD is difficult to detect due to its low attack rate, short interval between exposure and appearance of symptoms, poor diagnosis rates and eventual dispersal of infected people from the outbreak's source. As such, surveillance is paramount since it helps identify new cases to investigate outbreaks. State and local public health officials are therefore the best positioned to track the course of the disease and report to the CDC (Center for Disease Control) through the National Notifiable Disease Surveillance System (NNDSS) (CDC, 2011).
In the European Union, identified cases are grouped into clusters according to the location of outbreaks. Once a cluster is identified, an accommodation site is designated for requisite investigations. The report of such an investigation is then reported to the European Center for Disease Control (ECDC). The ECDC is mandated with publishing these results and accommodation sites on its website (ECDC, 2017).
Descriptive Epidemiology Analysis
Legionnaire's disease mainly affects people above the age of 50 years. According to data collected by the CDC between 2000 -2009, 64percent of all patients were male with Legionellosis occurrence increasing across all age groups spanning from 8percent of persons under nine years and 287percent for people aged above 80 years. Racially, 78percent of the cases were white, 19percent black and 3percent Native American (BodexTrident, 2018).
Most incidences were reported during summer and early fall with the period between June and October having 62percent of all cases reported in a year. Discovery of LD in premises is often devastating in human and financial terms. Most importantly, a facility is subject to fines if and a fatality occurs within its confines without requisite prevention and treatment in place (CDC, 2011). This is because such a case is treated as a case of neglect under various laws and regulations. In some cases, custodial sentences are often issued for a period of between one to two years. On a human level, LD is a serious disease with a short period between infection and manifestation of symptoms (BodexTrident, 2018).
The Action Plan for Addressing the Epidemiology of the Disease
The study of the Legionnaires pneumophila epidemiology is critical in the understanding of the cause as well as the spread of the diseases (Sakamoto, 2015). In addition to that, the study is also critical I evaluating the organism pathogenesis. The incubation period of the disease occurs within 36 hours. The bacteria responsible for the disease thrive in moist conditions and droplets of water. It is important to note that the bacteria can infect an entire moist region. This type of illness takes two forms that are the Pontiac fever as well as Legionnaires disease (Ozen et al. 2017). The most severe form of the disease is Legionnaires and can be fatal.
Action Plan One: Educating the vulnerable and prone regions concerning the signs and symptoms associated with the disease. This is critical because early diagnosis means early treatments before the manifestation of adverse signs and symptoms (Falkinham et al. 2015). The need for educating communities living in vulnerable areas is essential. This will empower such people with the knowledge on how to prevent the disease. The training can be done via social media platforms such as posters as well as the use of brochures and posters. The outcome of the action can be evaluated by the reduction of the prevalence's rates in the region.
Action Plan Two: Educating members of the public especially prone areas how the disease is spread from one person to another. This can be done using brochures and posters or through community programs. The action can be evaluated by determining if the prevalence rate of the disease has been reduced.
Action Plan Three: Following up with the ministry of health and undertaking susceptibility test. This is critical in evaluating the potency of the drugs used to treat the disease (Mohabati Mobarez et al. 2017). Importantly, it will play a critical role in the monitoring of disease resistance. The outcome can be evaluated by evaluating the understanding of the mode, mechanism, and potency of the drugs used to treat the disease.
BrodexTrident. (2018). What are the Financial Consequences of Legionnaires Disease? Retrieved from, < http://www.brodextrident.com/blog/what-are-the-financial-consequences-of-legionnaires-disease>
CDC (2011). Morbidity and Mortality Weekly Report: Legionellosis United States 200-2009. Retrieved from < https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6032a3.htm>
Centers for Disease Control and Prevention (CDC) (2016). CDC Surveillance Classifications. Retrieved from <https://www.cdc.gov/legionella/health-depts/surv-reporting/surveillance-classifications.html> European Center for Disease Prevention and
Control (ECDC). (2017). Surveillance and Disease Data for Legionnaire's Disease. =Retrieved from, < https://ecdc.europa.eu/e...
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