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DESCRIPTION
Legionnaires' disease is a serious lung and bronchial tube infection caused by bacteria of the genus Legionella, especially Legionella Pneumophila. It was first identified following an outbreak that affected 182 people attending an American Legion convention in July 1976 (hence the name) in Philadelphia. Of 147 people admitted to hospital in this outbreak, 29 died (there were 34 deaths in 180 infected individuals). On January 18, 1977 the causative agent was identified as a previously unknown bacterium, subsequently named Legionella. The bacteria live primarily in water Over 90% of legionellosis cases are caused by Legionella pneumophila, a bacterial that lives primarily in water and thrives in warm environments and are transmitted through airborne vapor droplets, although they are sometimes found in excavation sites and newly plowed soil. The incubation period is from 2 to 10 days after exposure to the bacteria. The disease does not spread from one person to another.
Legionellosis takes two distinct forms:
- Legionnaires' Disease is the more severe form of the infection and produces pneumonia. The onset of this form of the disease is usually two to 10 days after infection but can occur up to 16 days later.
- Pontiac Fever is caused by the same bacterium, but produces a milder respiratory illness without pneumonia which resembles acute influenza. Pontiac fever develops from hours to two days after initial infection and resolves spontaneously.
An estimated 8,000 to 18,000 people get legionellosis in the United States each year. An additional unknown number of people can be infected with the Legionella bacterium and have only mild symptoms or no illness at all. Outbreaks of Legionnaires' disease receive significant media attention. However, this disease usually occurs as a single, isolated case not associated with any recognized outbreak. When outbreaks do occur, they are usually recognized in the summer and early autumn, though cases may occur at any time of year. The fatality rate of Legionnaires' disease has ranged from 5-30% during various outbreaks.
Since the bacterium of Legionnaires' disease was identified in 1976, numerous hospital-acquired outbreaks of the disease have been reported. These outbreaks have enabled researchers to study epidemics of legionellosis.
CAUSES
Legionnaires' disease is an acute respiratory infection caused by the bacterium Legionella pneumophila bacteria. The bacteria can cause a broad spectrum of disease from mild cough and fever to serious pneumonia. Legionella is found naturally in moist environments such as lakes, creeks, rivers, mud and other water sources. No cases of Legionnaires' disease have been proven to be caused by Legionella present in the natural environment.
The bacteria thrives at temperatures between 69°F (20.5°C) and 122°F (50°C) and may be traced in water supply, central heating and air conditioning systems. Legionella populations can also occur in water heaters, showers, taps, spa pools, nebulizers in respiratory therapy, cooling water systems for refrigeration equipment and air compressors, industrial heat exchangers when opened for cleaning, decorative fountains and water features, spray irrigation systems, industrial water-based cutting fluid systems, and potting mix. Water contaminated with Legionella presents a risk when it is dispersed into the air as an aerosol. Transmission occurs through the inhalation of Legionella contaminated aerosols or very fine particles (as in the case of potting mix). There is no evidence that Legionnaires' disease occurs through transmission from one person to another. Note: Any water system with operating temperatures between 69°F (20.5°C) and 122°F (50°C) is a potential legionella source. Special attention should be taken for:
- Cooling towers and evaporative condensers.
- Scrubber systems with low temperatures.
- Low temperature hot water supply systems.
Regularly cleaning, heat and chemical treatment are often necessary to avoid potential development of the bacteria.
- Keep basins and sumps free of mud and organic debris.
- Use chemical and organic inhibitors where recommended.
- Avoid water stagnation by circulating the water through the system.
- Avoid leaks from processes to the cooling water since process water may contain nutrients that may feed the bacteria.
The Legionella bacteria cannot survive water temperatures above 131°F (55°C) for more than five or six hours. Instantaneous destruction of the bacteria occurs at temperatures above 158°F (70°C). General protection against the bacteria can be achieved by designing an operating water temperature of at least 140°F (60°C).
For water temperatures below 140°F (60°C) special initiatives are necessary regarding cleaning and chemical treatment procedures.
IDENTIFICATION OF THE LEGIONELLA BACTERIA
Identification of the organism responsible (which was subsequently named Legionella pneumophila) was a classic medical detective story. These bacteria do not grow on the routine media used in bacteriology to isolate organisms. They require cysteine and additional nutrients to grow, so they were initially difficult to isolate and identify. We now know that Legionella bacteria are widespread in man-made hot-water systems and cause both focal outbreaks and sporadic cases of legionellosis worldwide.
Recent research shows that the bacteria can travel quite a distance from the source of infection An epidemic of 86 cases of Legionnaires disease in northern France in 2003-4 originated from a cooling tower in a petrochemical plant, and some of the people infected lived as far as 67 kilometers (41.63 miles) from the plant.
MICROBIOLOGICAL ASPECTS OF LEGIONELLA
The genus Legionella comprises over 50 species of bacteria, the majority of which are relatively slow-growing, harmless, aquatic saprophytes. These are Gram-negative, non-spore forming bacteria. Legionella pneumophila is common in fresh water environments where it replicates within protozoan host cells, mostly amoebae. The fact that this bacterium is an opportunistic intracellular pathogen which is also able to grow inside human macrophages is related to these origins. This one species, Legionella pneumophila, is responsible for more than 98 percent of Legionnaires' disease cases, while other species in the genus are rarely pathogenic in humans. Once inside a host, an incubation period of up to two weeks is followed by flu-like symptoms with fever, chills, and a dry cough. In advanced stages of the disease, the organism spreads from the respiratory tract to the gastrointestinal tract and to the nervous system, causing diarrhea and nausea in addition to the primary bacterial pneumonia.
However, in general, Legionnaires disease is not a threat to healthy individuals and tends to cause harm only in people with a compromised immune system, and in the elderly. Consequently, it is particularly important to ensure good maintenance of hot water systems in nursing homes and hospitals.
After being breathed in, the bacteria reach the alveoli in the lungs where they are engulfed by macrophages. However, once inside these cells, phagosomes form which do not enter the classical endolysosomal pathway. The bacteria remain inside the phagosome, where they are able to inhibit acidification and lysosomal fusion, which prevents them from being harmed. Within their protected vacuoles, the bacteria proliferate and after 16-20 hours, these pathogen-containing vacuoles merge with lysosomes, which provide nutrients for bacterial replication. As nutrient levels decline, the bacteria enter the transmissive phase, during which they express many virulence determinants which allow them to be released and transmitted to new host cells.
So Legionella pneumophila leads a complicated, biphasic life. Replicative bacteria found inside intracellular vacuoles are unflagellated, while the post-exponential phase bacteria which escape from the host cell are flagellated, highly motile and virulent. This change in life style requires expression of a whole new set of genes.
The genome of L. pneumophila contains approximately 3000 genes. Similarly to other completely sequenced bacterial genomes, the functions of 30-40 percent of these genes are unknown at present, and around 20 percent of the genes are unique to the genus Legionella. Interpretation of possible virulence determinants in the Legionella pneumophila genome is complicated by the biphasic life cycle of the organism. The availability of multiple genome sequences from Legionella species will pave the way for in depth comparative genomics and the identification of virulence determinants in this opportunistic pathogen.
Wikipedia: Legionella
Legionella pneumophila pathogenesis: A fateful journey from amoebae to macrophages. Ann Rev Microbiol. 2000 54: 567-613
Legionella pneumophila - a human pathogen that co-evolved with fresh water protozoa. Cell Mol Life Sci. 2007 64: 432-48
FREQUENT SIGNS & SYMPTOMS
People with Pontiac fever experience a self-limiting influenza-like illness with fever, chills, headache, and muscle aches but, by definition, do not have pneumonia. They generally recover in 2 to 5 days without treatment.
Legionnaires' disease is a pneumonic illness which often requires hospitalization. The time between the patient's exposure to the bacterium and the onset of illness for Legionnaires' disease is 2 to 10 days. Symptoms start as a mild respiratory illness, similar to symptoms of the flu (influenza), but within 48 hours the condition worsens. The first symptoms include:
- Body achiness. Myalgia (muscle pain)
- Fatigue (tiredness).
- Headache.
- Moderate fever.
- Loss of appetite.
The disease then progresses to include these symptoms:
- Abrupt onset of high fever (up to 105°F).
- Chills.
- Coughing, which may be dry (begins without sputum but eventually produces sputum that is gray or blood-streaked). Laboratory blood studies and cultures of the sputum aid in diagnosis.
- Diarrhea.
- Loss of coordination (ataxia).
- Disorientation and mental confusion.
- Nausea and vomiting.
- Severe
- Abdominal pain.
- Shortness of breath, and as a result of inadequate oxygen supply, a bluish tinge to the lips, nails, or skin.
- Legionnaires' disease at its worst can cause a severe pneumonia, seriously affect breathing, even lead to respiratory failure and adult respiratory distress syndrome (ARDS).
Laboratory tests may show that a patient's renal functions, liver functions and electrolytes are deranged, including hyponatremia. Chest X-rays often show pneumonia with bi-basal consolidation. It is difficult to distinguish Legionnaires' disease from other types of pneumonia by symptoms or radiologic findings alone; other tests are required for diagnosis.
THE RISK OF CONTRACTING LEGIONNAIRES' DISEASE
Susceptibility to the disease is increased by age, underlying disease, heavy smoking and excessive alcohol consumption.
The risk of contracting the Legionnaires' disease increase with chronic illness such as diabetes, emphysema, or kidney failure, and with immune-suppressing lifestyle habits such as smoking, alcohol consumption and recreational drug use. Young adults usually recover fully from the disease, whereas elderly people, especially those in poor health, are at greater risk of developing respiratory failure.
INFECTIONS & LEGIONELLA
Intestinal Infections: These may only occur as part of respiratory infections, and where gastrointestinal symptoms have on occasion been described.
Extraintestinal Infections: L. pneumophila is specifically considered as a pathogen of the respiratory tract, where it is a cause of atypical pneumonia, also known as Legionnaires' disease. Other infections have also been reported, including hemodialysis fistula, pericarditis and wound and skin infections. Bacteremia is often associated with Legionnaires' disease.
Animal Infections: None specifically recorded.
Infections of Protozoa: Protozoa such as Harmanella vermiformis and related protozoa have been shown to be able to support the growth of L. pneumophila in tap water. Also Acanthamoeba, Naegleria and Tetrahymena can be infected by L. pneumophila. This pathway may be how these organisms survive in the environment.
TREATMENT
DIAGNOSIS
People of any age may get Legionnaires' disease, but the illness most often affects middle-aged and older persons, particularly those who smoke cigarettes or have chronic lung disease, as these individuals have a greater likelihood of developing any respiratory illness. Immunocompromised patients are also at elevated risk. These include people whose immune systems are suppressed by diseases such as cancer, kidney failure requiring dialysis, diabetes, or AIDS. Those who take medications that suppress the immune system are also at risk.
Pontiac fever most commonly occurs in people who are otherwise healthy.
TRANSMISSION OF LEGIONELLA
Legionellosis infection occurs after inhaling water droplets that originated from a water source contaminated with Legionella. It must be inhaled through a fine aerosol of tiny water droplets that are strung with the bacteria. (It is often thought that a water spray is an aerosol but in fact the water droplets involved are very tiny and evaporate very quickly leaving only a dry nucleus which is invisible to the naked eye but can be inhaled into the lungs.) This often occurs in poorly ventilated areas such as prisons or airplanes where a condensating air conditioner can spread it throughout the entire room, infecting anyone not immune to the strand of bacteria. Potential sources of such contaminated water include cooling towers used in industrial cooling water systems as well as in large central air conditioning systems, evaporative coolers, hot water systems, showers, whirlpool spas, architectural fountains, room-air humidifiers, ice making machines, misting equipment, and similar disseminators that draw upon a public water supply. The disease may also be spread in a hot tub if the filtering system is defective. Freshwater ponds, creeks, and ornamental fountains are also potential sources of Legionella. The disease is particularly associated with hotels, cruise ships and hospitals with old, poorly maintained pipework and cooling systems. People may be exposed to these aerosols in homes, workplaces, hospitals, or public places. Infection cannot be acquired from another person with legionellosis, and there is no evidence of people becoming infected from auto air conditioners or household window air-conditioning units.
Legionella will grow in water at temperatures from 20°C to 50°C (68°F to 122°F). However, the bacteria reproduce at the greatest rate in stagnant water at temperatures of 35°C to 46°C (95°F to 115°F).
Legionella longbeachae, an organism in the Legionella family, is found in soils and compost. Thus, the dust from purchased bags of soil, compost, or potting mix is also a potential source of Legionella.
EPIDEMIOLOGY OF LEGIONNAIRES' DISEASE
Much has been learned about the epidemiology of Legionnaires' disease since the organism was first identified in 1976. National surveillance systems and research studies were established early, and in recent years improved ascertainment and changes in clinical methods of diagnosis have contributed to an upsurge in reported cases in many countries. Environmental studies continue to identify novel sources of infection, leading to regular revisions of guidelines and regulations. Between 1995 and 2005 over 32,000 cases of Legionnaires' disease and more than 600 outbreaks were reported to the European Working Group for Legionella Infections (EWGLI). In the future, there may be an increase in cases as the population becomes more elderly and climate change perhaps leads to an increased risk of exposure to infection in many countries. There is a shortage of data on Legionella in developing countries and it is likely that Legionella-related illness is under diagnosed worldwide. Improvements in diagnosis and surveillance in developing countries would be expected to reveal far higher levels of morbidity and mortality than are currently recognized. Similarly, improved diagnosis of human illness related to legionella species and serogroups other than legionella pneumophila would improve knowledge about their incidence and spread.
DIAGNOSIS OF LEGIONNAIRES' DISEASE
Laboratory tests may include a modest increase in white blood cells, mild abnormalities in liver function studies, and even some decreased function of the kidneys, but these features can also be seen with a variety of different types of pneumonia. Chest X-rays often demonstrate abnormal densities (areas of that lungs that on the X-ray film appear whiter). However, it is difficult to distinguish Legionnaires' disease from other types of pneumonia by symptoms and chest X-ray alone. Additional specific tests are required for diagnosis.
The most useful diagnostic test is to detect the identifiable proteins of the Legionnaires's bacterium (Legionella antigens) in a urine sample. Additionally, detecting the bacteria in a culture of the sputum may be helpful. Comparing antibody levels to Legionella in two blood samples obtained 3 to 6 weeks apart showing a fourfold rise in the antibodies in the blood against the bacterium can be confirmatory after the disease is gone. The urine antigen test is simple, quick, and very reliable; however it will only detect Legionella pneumophila serogroup #1. Also the urine antigen test will not identify the specific subtyping so it cannot be used to match the patient with the environmental source of infection.
Because these tests complement each other, a positive result from each test when Legionnaires' disease is suspected increases the probability of confirming the diagnosis. However, because none of the laboratory tests is 100% sensitive, the diagnosis of legionellosis is not excluded even if one or more of the tests is negative. Of the available tests, the most specific is culture isolation of the bacterium from secretions from the respiratory tract.
PREVENTION
Prevention is aimed at improving the design and maintenance of cooling towers and plumbing systems. The goal is limiting the growth and aerosolization of Legionella organisms. During outbreaks, health investigators seek to identify the source of disease transmission and recommend appropriate prevention and control measures, such as decontamination of the water source. Detailed guidelines for the prevention of Legionnaires' disease both in hospitals with no identified cases ("primary prevention") and in hospitals with reported cases ("secondary prevention") have been published and are available in the U.S. from the Centers for Disease Control and Prevention.
Legionellosis is an infection that is caused by a bacterium that thrives in the mist that is sprayed from air conditioning ducts and can infest an entire building resulting in people getting sick from Pontiac fever (the mild form) or Legionnaires' disease (the more severe form) resulting in severe pneumonia and respiratory failure, which can be fatal. Although antibiotics are effective for treatment, the most useful approach is prevention.
CONVENTIONAL MEDICAL TREATMENTS
Current treatments of choice are the respiratory tract quinolones (levofloxacin, moxifloxacin, gemifloxacin) or newer macrolides (azithromycin, clarithromycin, roxithromycin). The antibiotics used most frequently have been levofloxacin and azithromycin. Macrolides are used in all age groups while tetracyclines are prescribed for children above the age of 12 and quinolones above the age of 18. Rifampicin can be used in combination with a quinolone or macrolide. Tetracyclines and erythromycin led to improved outcome compared to other antibiotics in the original American Legion outbreak. These antibiotics are effective because they have excellent intracellular penetration and Legionella infects cells. The mortality at the original American Legion convention in 1976 was high (34 deaths in 180 infected individuals) because the antibiotics used (including penicillins, cephalosporins, and aminoglycosides) had poor intracellular penetration. Mortality has plunged to less than 5 percent if therapy is started quickly. Delay in giving the appropriate antibiotic leads to higher mortality.
Pontiac fever requires no specific antibiotic treatment.
CLASSES OF ANTIBIOTICS USED TO TREAT LEGIONELLOSIS
There are three major classes of antibiotics that are effective in treating legionellosis. These include:
- The Fluoroquinolones
- Ciprofloxacin (Cipro, Cipro XR, Proquin XR)
- Levofloxacin (Levaquin)
- Moxifloxacin (Avelox)
- The Macrolides
- Erythromycin (E-Mycin, Eryc, Ery-Tab, Pce, Pediazole, Ilosone)
- Azithromyocin (Zithromax, Zmax)
- Clarithromycin (Biaxin)
- Tetracyclines
- Doxycycline (Vibramycin, Oracea, Adoxa, Atridox and Others)
The choice of antibiotic is often dependent on the patient's clinical state, tolerance to the medication, and degree of certainty as to the diagnosis.
In severe cases of Legionnaires' disease that seem more resistant to a single antibiotic, a second drug called rifampin may be added.
Although Legionnaires' disease is treated with a course of antibiotics, many people experience fatigue, loss of energy and difficulty concentrating for several months after the onset of the disease.
HOLISTIC RECOMMENDATIONS
HERBS
ClearLungs from RidgeCrest Herbals is a Chinese herbal formula that protects the lungs. Take 2 capsules 3 times daily.
Catnip tea is good for reducing fever. Catnip herb has also been used to treat anxiety, colds, flu, inflammation and general aches and pains.
Herbal Remedies: Catnip Herb, Nature's Way, 380 mg, 100 Caps
Herbal Remedies: Catnip Herb Tincture, 2 fl. oz.
Echinacea is a powerful immune stimulant.
Herbal Remedies: Echinacea Herb, Nature's Way, 400 mg, 180 Caps
Herbal Remedies: Echinacea Root Complex, Nature's Way, 180 Caps
Herbal Remedies: Echinacea Extract, Standardized, Nature's Way, 340 mg, 60 Caps
Herbal Remedies: Echinacea Purpurea Tincture, 2 fl. oz.
Herbal Remedies: Echinacea & Olive Leaf Extract, Standardized, Nature's Way, 60 Caps
Herbal Remedies: Echinacea Tincture for Children, Orange Flavor, Alcohol Free, 100% Organic, 1 fl. oz.
Herbal Remedies: Echinacea Tincture, Alcohol Free, Nature's Way, 1 fl. oz.
Eucalyptus helps to open up air passages. The oil can be used as an inhalant for asthma, diphtheria, sore throats, sinus and respiratory problems. The chest rub can be used to ease congestion and enhance breathing and provide relief.
Herbal Remedies: Eucalyptus Oil, 100% Pure Foods, 1 fl. oz.
Herbal Remedies: Eucalyptus Essential Oil, 100% Pure Foods, 4 fl. oz.
Herbal Remedies: Tea Tree Therapy Eucalyptus Chest Rub, 2 oz.
Herbal Remedies: Unker's Eucalyptus Spray Sanitizing Mist Liquid, All Natural Room Spray
One or two sprays of Unker's Eucalyptus Spray Sanitizing Mist will rid your home of offensive odors such as cigarette smoke, pet odors, sickbed odors, mold and mildew.
Goldenseal is a natural antibiotic. Caution: Do not take Goldenseal internally on a daily basis for more than one week at a time, do not use it during pregnancy, and use it with caution if you are allergic to ragweed.
Herbal Remedies: Goldenseal Herb, Nature's Way, 400 mg, 180 Caps
Herbal Remedies: Goldenseal Root, Nature's Way, 570 mg, 100 Caps
Herbal Remedies: Echinacea & Goldenseal Supplement, Nature's Way, 180 Caps
Herbal Remedies: Goldenseal Root Tincture (Hydrastis Canadensis), 100% Organic, 2 fl. oz.
Herbal Remedies: Echinacea & Goldenseal Tincture, Nature's Way, Alcohol Free, 1 fl. oz.
Olive Leaf extract helps protect against bacterial and viral infections. It has proven effective against pneumonia and sore throat.
Herbal Remedies: Olive Leaf Herb, Nature's Way, 470 mg, 100 Caps
Herbal Remedies: Olive Leaf Extract, Standardized, Nature's Way, 500 mg, 60 Caps
Herbal Remedies: Olive Leaf With Echinacea & Vitamin C, 100 Caps
Herbal Remedies: Olive Leaf Extract Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Bio Defender, Antibacterial, Antiviral & Antifungal Formula With Olive Leaf Extract, Balanceuticals, 56 Caps
RECOMMENDATIONS
Avoid any and all contact with tobacco. Tobacco smoke is the single most dangerous thing anyone suffering from lung problems can encounter. If you have lung disorders and smoke, you must quit. Avoid areas where people smoke and do not allow smoking in your home, your care, or anywhere near you.
Consume no alcohol. Avoid fried and greasy foods, salt, sugar along with all foods that cause excess mucus to be formed in the gastrointestinal tract, lungs, sinuses, and nasal cavity. Foods that lead to the formation of mucus include meats, eggs, all dairy products and cheese, processed foods, tobacco, junk foods, and while flour products. Read labels carefully; these are sometimes "hidden" ingredients in food products.
Eat a diet consisting of 75 percent raw foods and very lightly steamed vegetables.
Use a cool mist humidifier to increase the amount of moisture in the air and to thin lung secretions.
Keep warm. Do not get chilled, as this will worsen the disease.
Consume fresh raw onions and garlic daily. Both of these will help fight infections.
Practice deep breathing exercises. See link below for information about deep breathing.
MoonDragon's Health Therapy: Pain Control - Deep Breathing Techniques
Use a heating pad or hot water bottle on the chest to relieve pain.
Be aware that recovery from Legionnaires' disease takes time. Allow yourself 2 to 4 weeks for recovery, and be sure to get adequate rest. Do not push yourself to resume normal activities prematurely.
CONSIDERATIONS
Legionnaires' disease progresses rapidly and can be very dangerous. Hospitalization and aggressive treatment with intravenous antibiotics and oxygen may be necessary.
Legionella bacteria may inhibit heating and cooling systems. It is wise to have the heating and cooling systems in both your home and workplace cleaned and inspected regularly, and to change filters often.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended here are for adults. For children between the ages of 12 and 17, reduce the dose to 3/4 the recommended amount. For children between 6 and 12, use 1/2 the recommended dose, and for children under the age of 6, use one quarter the recommended amount. The supplements recommended do not take the place of conventional medical treatment for Legionnaires' disease but should be used to supplement home care, recovery and dietary-nutritional requirements.
NUTRIENTS Supplement Suggested Dosage Comments Essential Garlic (Kyolic) 2 capsules 3 times daily, with meals. Aids in destroying bacteria. An immunity enhancer and detoxifier for protection against pneumonia.
Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.,
Garlic Bulb Cloves, Garlic Supplement, Nature's Way, 580 mg, 100 Caps,
Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels,
Garlic Supplement, Kwai, Triple Concentrated, 180 Tabs,
Every Day Garlic Supplement, Kwai, 30 Tabs,
Garlic Tincture, 100% Organic, 2 fl. oz.,
Aged Garlic Extract, Cardiovascular Formula 100, Wakunaga Kyolic Supplements, 300 Caps,
Kyolic Liquid Aged Garlic Extract, Cardiovascular, Vegetarian, Wakunaga Kyolic, 4 fl. oz.,
Kyolic Aged Garlic Extract, One-A-Day, Vegetarian, 1000 mg, Wakunaga Kyolic, 30 Caps,
Aged Garlic Extract, Cholesterol Formula 104, Wakunaga Kyolic, 200 CapsVitamin A 25,000 IU daily. If you are pregnant, do not exceed 10,000 IU daily. Needed for repair of lung tissues and for the immune system. Emulsion form is recommended for easier assimilation and greater safety at higher doses.
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 SoftgelsPlus
Natural Beta-Carotene
Or
Carotenoid Complex
25,000 IU daily.
As directed on label.A precursor of Vitamin A that protects the lungs. Needed for repair of lung tissues and for the immune system.
Beta Carotene (Natural Dunaliella Salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels,
Multi-Carotene Antioxidant, Nature's Way, 60 SoftgelsVitamin C With Bioflavonoids 3,000 3 times daily mg daily.
100 mg bioflavonoids twice daily.Powerful antioxidants that help kill bacteria. Strengthens immune response and aids healing of inflamed tissue. Intravenous treatment of bioflavonoids may be beneficial (under a health care provider's supervision).
Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz.,
Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs,
Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps,
The Right C, Nature's Way, 1000 mg, 120 TabsVery Important Coenzyme Q-10 60 mg daily.
As directed on the label.A powerful antioxidant that increases and regulates immunity. Carries and enhances oxygen in the lungs and cells. Supports and boosts the immune system.
Aids in removing toxins from the body.
CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps,
CoQ10, Now Foods, 400 mg, 60 SoftgelsPlus
Coenzyme A
(From Coenzyme A Technologies)As directed on label. Works well with CoQ10 in ridding the body of impurities.
Pantethine (Coenzyme A Precursor), Highly Active Form of Vitamin B-5, NOW Foods, 300 mg, 60 Softgels,
Chlorophyll
(Kyo-Green from Wakunaga is a good source.)As directed on label 3 times daily. Aids in clear breathing.
Chlorophyll With Alfalfa Powder, NOW Foods, 100 mg, 90 Caps,
Chlorofresh Chlorophyll Supplement, Nature's Way, 50 mg, 90 Softgels,
Chlorofresh Liquid Chlorophyll, Mint Flavor, Nature's Way, 16 fl. oz.,
Chlorella Powder, NOW Foods, 100% Pure, 4 oz.,
Vital Greens, Vital Earth, 180 Caps,
Lactobacillus Bulgaricus As directed on label. Aids digestion and destroys harmful bacteria.
Ultimate Probiotic Supplement, 4 Billion, 45 Tabs,
Complete Cleansing & Anti-Toxin System, 2 Part System,
Macro Greens Nutrient-Rich Super Food Supplement, 30 Day Supply, 10 oz.,L-Carnitine
Plus
L-Cysteine500 mg each twice daily, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B-6 and 100 mg vitamin C for better absorption. Important in immune function. Protects lung tissues. See Amino Acids for more information.
L-Cysteine Structural Support W/Vitamin B-6 & C, Vegetarian, NOW Foods, 500 mg, 100 Caps,
L-Carnitine, Stable Tartrate Form, NOW Foods, 500 mg, 60 CapsVitamin B complex 100 of each major B vitamin (amounts of individual vitamins in a complex will vary. A complex of vital coenzymes needed for cellular function and protection.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 CapsImportant Intenzyme
(Biotics Research)2 tablets3 times daily, on an empty stomach. Stimulates the immune system and reduces inflammation in the body. Raw Thymus Glandular
And
Raw Lung GlandularAs directed on label
As directed on label.Glandulars that potentiate thymus and lung function and enhance immune function.
Thymus Organic Glandular, Hypoallergenic, Allergy Research Group / Nutricology, 75 Caps
Vitamin E Emulsion: 200 IU daily twice daily.
Capsules: 200 IU daily or 400 IU every other day.An important antioxidant that protects lung tissue. Use d-alpha-tocopherol form. Emulsion form is easier to assimilate.
Ester E Natural Vitamin E, California Natural, 400 IU, 60 Softgels,
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels,
Vitamin E-1000, NOW Foods, 1000 IU, 100 Gels,
Vitamin E, d-alpha-tocopherol, 400 IU, 100 Softgels
Zinc 80 mg daily. Do not exceed a total of 100 mg daily from all supplements. Works as an antioxidant and is important for immune response. Enhances oxygen in the lungs.
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.,
Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges,
Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges,
Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 CapsPlus copper 3 mg daily. Needed to balance with zinc.
Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.,
Free-Form Amino Acid Complex As directed on label. Important for repair of lung tissue.
Amino 1000 Complete (20 Essential & Non-Essential Amino Acids), NOW Foods, 120 Caps,
Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 TabsClear Lungs
(From RidgeCrest Herbals)2 capsules 2 times daily. Reduces inflammation and mucus, opening up the airways to the lungs and promoting free breathing. Pycnogenol
Or
Grape Seed Extract30 mg 3 times daily.
As directed on label.Powerful antioxidants and anti-inflammatories that help protect the lungs.
Pycnogenol W/Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs,
Grape Seed (Grapeseed) Oil, 100% Pure, NOW Foods, 16 fl. oz.,
Grape Seed Extract, Standardized, Nature's Way, 100 mg, 30 Capsules,
Grape Seed Extract, 350 mg, 90 CapsHelpful Aerobic 07
(Aerobic Life Industries)9 drops in water once daily or as directed on label. Supplies oxygen and kills bacteria. Dioxychlor DC-3
(American Biologics)As directed on label. A potent antibacterial, antifungal, and antiviral agent. Or
Infla-Zyme Fort
From
American BiologicsAs directed on label. A balance of potent enzymes and cofactors as a powerful inflammatory inhibitor.
Or
Oxy-5000 Forte
From American BiologicsAs directed on label. A potent nutritional antioxidant for health and stress that destroys free radicals.
LEGIONNAIRES' DISEASE & RESPIRATORY DISORDERS SUPPLEMENTS
Information and supplements to help with legionellosis / Legionnaires' disease, an infection caused by the bacterium Legionella pheumophila. Included on this list are supplements and products for chronic respiratory conditions to treat lung and respiratory inflammation and breathing difficulties and to assist immune function.
African Ginger, 100 mg, 60 Tabs
African Ginger is used for tension headaches, flu, sinusitis and premenstrual cramps.Agastya Haritaki, 100% Organic, 8 oz. Bulk
Useful in coughs, asthma, digestion, heart condition.Alive! Whole Food Energizer Multi-Vitamin & Mineral with Naturally Occurring Iron (No Iron Added), Nature's Way, 90 Tabs
No other supplement contains more life-giving nutrients than Nature's Way ALIVE! It is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.Aloe Vera Juice, Herbal Aloe Force, Organically Grown Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.
Herbal Aloe Force Re-Natures the cells, tissues, glands, organs and all systems of the body to function as originally designed.Aloe Vera Juice, Pure Aloe Force, Organically Grown Unprocessed Whole Raw Aloe Vera, 33.8 fl. oz.
The magnificent Aloe plant, that is designed to be self-sufficient & thrive in the desert, feeds us in unique ways with its 250+ naturally occurring constituents including: enzymes, amino acids, essential fatty acids, vitamins, minerals, glycoproteins, sterols, growth factors, & all sizes of uniquely complex Aloe polysaccharides and mannans.Amino 1500, Chewable Blend of 20 Amino Acids, Predigested, NOW Foods, 150 Tabs
This Amino 1500 contains a balanced blend of 20 essential and non-essential amino acids in a chewable format.Astragalus Root Tincture, 100% Organic, 2 fl. oz.
Astragalus root is used to stimulate the immune system and astragalus root improves adrenal gland function and digestion.Bio Defender, Antibacterial, Antiviral & Antifungal Formula, Balanceuticals, 56 Caps
This unique antibacterial, antiviral and antifungal formula is a clinical nutritionist response to bio terrorism such as anthrax.Black Seed Plain, 500 mg, 100 Caps
Suitable natural alternative for all types of allergic and infectious disorders of the respiratory tract, such as asthma, allergies, chronic bronchitis, emphysema, hacking cough, and other cold-like symptoms.Black Seed Herbal Honey, Energizing, 16 fl. oz.
A sensational blend of honey and herbs in three different formulations that offer a natural boost of energy, immune support, or relaxation that's great for anyone who wants to enjoy the benefits of Black Seed without taking capsules or oil. This rich tasting honey can be added to tea, smoothies, shakes, or deserts, and may be used in cooking.Black Seed Theramune Ultimate With Garlic, 100 Caps
Promotes healthy circulation, useful for arthritis and cardiovascular & respiratory support. It also supports digestion and is a natural remedy for ulcers. Garlic is known to lower cholesterol naturally.Breathe Aid, for Bronchial Asthma, 100 Caps
Breathe-Aid Bronchodilator formula utilizing powerful natural ingredients in a supportive herbal base.Brigham Tea, 415 mg, 100 Caps
Brigham Tea was used anciently to promote circulation.Bronchitis & Asthma Aide, Homeopathic Asthma Treatment, Boericke & Tafel, 100 Tabs
Bronchitis & Asthma Aide, Homeopathic Asthma Treatment, helps loosen phlegm (mucus) and thin bronchial secretions to rid bronchial passageways of bothersome mucus and drain bronchial tubes.CAL/MAG/ZINC, Calcium Magnesium Zinc Supplement, 90 Tablets
This unique Calcium Magnesium Zinc Supplement formula perfectly balances calcium, magnesium, and zinc with over 70 minerals and trace elements found in ConcenTrace for maximum absorption and utilization by the body.Cell Rejuvenator, Peter Gillham's Natural Vitality, 8 oz.
Cell Rejuvenator is a precisely engineered formula designed to give cells the exact nutrients they need to rejuvenate quickly and in the best condition possible.Chlorofresh Chlorophyll Supplement, Nature's Way, 50 mg, 90 Softgels
Chlorofresh, Chlorophyll Supplement, is used chiefly as an aid to reduce odor from a colostomy or ileostomy and to reduce fecal odor due to incontinence.cold's & Flu Chewable For Children's Alpha CF, Homeopathic Boericke & Tafel, 100 Tabs
Children's Alpha CF, Colds & Flu, Chewable by Boericke & Tafel temporarily relieves fever and symptoms associated with colds and the flu.Cold's & Flu Alpha CF, Homeopathic Boericke & Tafel, 40 Tabs
Alpha CF Colds & Flu Homeopathic Remedy is clinically proven as an all natural cold and flu remedy that offers relief for your cold or flu in a great homeopathic remedy! Take it for runny nose, fever, chills, stuffy nose and aches.Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Copper is a pure liquid Copper supplement. Copper influences protein metabolism and general healing, improves vitamin c oxidation and is integral in the formation of RNA.CoQ10, Vegetarian Coenzyme, NOW Foods, 30 mg, 60 VCaps
A coenzyme for several key steps in the production of energy within each cell, and an antioxidant important in its clinical effects. It is these two properties make CoQ10 one of the best supplements available today.CoQ10, All Natural Hypoallergenic, Nature's Way, 60 mg, 60 Softgels
CoQ10 is vital for cellular energy production and is a powerful antioxidant and free radical scavenger.Co-Q10 Liquid, Trace Minerals, 4 fl. oz.
Liquid Co-Q10 is an all-natural, enzymatic, dietary supplement providing assistance to the body's cells by helping to maintain and protect against oxidative stress for increased cell integrity and energy.Cordyceps Cs-4, 400 mg, 90 VCaps
Clinically, Cordyceps is used to build and support immune function in various immune compromised conditions including chronic fatigue, cancer, and respiratory conditions.Cough & Bronchial Syrup With Zinc, Homeopathic Boericke & Tafel, 4 fl. oz.
Cough & Bronchial Syrup with Zinc temporarily relieves coughs due to minor throat & bronchial irritation occurring with a cold or inhaled irritants.Cough & Bronchial Syrup, 99% Alcohol Free, Homeopathic Boericke & Tafel, 4 fl. oz.
Cough & Bronchial Syrup, 99% Alcohol Free is a natural cough expectorant.DHA, 250 mg w/ 500 mg EPA & Omega 3 from Fish Oil, 120 Softgels
Numerous published studies have provided strong evidence that the Omega-3 fatty acids found in fish oil may reduce the risk of coronary artery disease (CAD) and sudden death from cardiac causes.DMG Supplement N,N Dimethyl Glycine, NOW Foods, 125 mg, 100 Caps
NOW Foods' DMG Supplement is a methylated amino acid found in all cells. DMG is an antioxidant and methyl donor that has a number of beneficial effects. It has shown to have potential in increasing immune response to the flu and salmonella.Echinacea Herb, Nature's Way, 400 mg, 180 Caps
Echinacea herb supports the Immune System and promotes general well-being in cold and flu season.Echinacea With Goldenseal Root, Nature's Way, 450 mg, 100 Caps
Echinacea with Goldenseal supports the immune system.Elecampane Root Tincture, 100% Organic, 2 fl. oz.
Today Elecampane root is regarded as a long term treatment for respiratory diseases such as bronchitis and asthma.FenuZyme Bronc Care, 60 Caps
FenuZyme Bronc Care from Nature's Way Help to relax bronchial passages, open airways, loosen phlegm and generally act as a phlegm remedy. It is also effective for hay fever and other allergies.Garlicin HC, Healthy Circulation Formula With Odor Free Garlic Supplement, Nature's Way, 90 Enteric Coated Tabs
Garlicin HC garlic supplement supports cardiovascular health with the help of hawthorn, cayenne and vitamin e.Garlic Oil Tincture, Alcohol Free, Nature's Way, 1 fl. oz.
Garlic oil is often used to soothe the ear and as an antibiotic but most often used as a food and herb and also to lower serum cholesterol and blood pressure and to improve circulation as well as possibly inhibiting the growth of ulcer causing bacteria.Ginkgo Biloba Extract Standardized, 60 mg, 120 VCaps
Supports circulation to the brain as well as the extremities. This is achieved by maintaining healthy blood vessel tone and reducing blood viscosity. Additionally, Ginkgo biloba is a proven free radical scavenger and antioxidant.Holy Basil Extract, 500 mg, 90 VCaps
Holy Basil has been used to enhance the body's ability to respond to stress and minimize the negative effects of stress on the body.Horehound Tincture, 100% Organic, 2 fl. oz.
Horehound herb is often used to treat respiratory disorders and has 350 years of history as a soothing expectorant.Hydrogen Peroxide & Ozone By Conrad LeBeau
Reveals documented details of the use of hydrogen peroxide as a successful treatment for many disorders, including arthritis, cancer and AIDS.Hyssop Herb, 445 mg, 100 Caps
Hyssop herb (Hyssopus officinalis) regulates blood pressure, purifies the blood & promotes circulation, excellent aid for the eyes, hoarseness, lungs, mucous buildup, nervous disorders and skin problems.Hyssop Throat Comforts, Natural Herb Comforts, 61 Lozenges
Throat Soothers with natural Hyssop can be used to comfort the throat while undergoing ear candling treatments.Lobelia Herb, 425 mg, 100 Caps
Lobelia has been traditionally revered for its soothing properties that nourish the nervous system. Lobelia also enhances the function of the respiratory system and has antispasmodic effects.Lobelia Tincture, 100% Organic, 2 fl. oz.
Lobelia may reduce cravings and nervousness from smoking withdrawals.Lung Support Formula Tincture, 100% Organic, 8 fl. oz.
Use the Lung Support Formula to support the health and function of the lungs.MSM Supplement (Methylsulfonylmethane), 1000 mg, 120 Caps, Pure Lignisul with Free 4 oz. Lotion
Buy MSM Supplement caps and get a 4 oz. Lotion free. MSM supplement plays a beneficial role in connective tissue and joint flexibility, immune health, arthritis, osteoporosis, rheumatoid arthritis, inflammation, pain, hair, skin, nails, athletic injuries, acne, wrinkles and allergies.Natural Cough & Bronchial Syrup, Daytime, Boericke & Tafel Homeopathic, 4 fl. oz.
Temporarily relieves coughs due to minor throat & bronchial irritation occurring with a cold or inhaled irritants.Natural Cough & Bronchial Syrup, Nighttime, Boericke & Tafel Homeopathic, 4 fl. oz.
Don't let a cough keep you awake! B&T Nighttime Cough & Bronchial Syrup combines an all-natural, non-narcotic sleep aid with America's favorite homeopathic cough medicine.Nettle Herb, 435 mg, 100 Caps
Nettle herb from Nature's Way is wild harvested, gently dried and ground to a usable form and encapsulated. Nettle herb contains no chemicals, additives or artificial coloring.Nettle Tincture, 100% Organic, 2 fl. oz.
Nettle leaf has become a popular treatment of allergies (hay fever) and it can improve goiter, inflammatory conditions, and arthritis.Noni Juice, Trace Minerals, 32 fl. oz.
Trace Minerals Noni Juice product may provide nutritional support for Bio-Electric Health and Body Mineral Balancing.Pantothenic Acid 100% Natural Vitamin B5, 250 mg, 100 Caps
Pantothenic acid vitamin B-5 is converted to coenzyme A, which is involved in the biochemical cycles responsible for conversion of fats, proteins and carbohydrates into energy.Pastilles, Olbas, 100% Natural, Swiss Made, 27 Herbal Cough Drops
Olbas Herbal Cough Drops, pastilles, temporarily controls cough due to minor throat and bronchial irritations associated with the common cold or inhaled irritants.Peppermint Oil (Mentha piperita), 100% Pure Essential Oil, 1 fl. oz.
Peppermint oil stimulates and counters insomnia, shock, mental fogginess, and lack of focus. Stimulating the mind and calming the nerves makes peppermint oil ideal as a physical tonic and emotional soother.Peppermint Tea with Black Cumin Seed, 20 Tea Bags
A unique new way to enjoy the nutritional benefits of Black Cumin Seed in refreshing herbal Peppermint tea.Respir-Ease 2 (Asthma Tincture), 100% Organic, 2 fl. oz.
Respir- Ease 2 (Asthma Tincture) herbal remedy is used for asthma, bronchitis, croup and emphysema.Sinus & Lung Congestion Formula Tincture, 100% Organic, 2 fl. oz.
The Sinus & Lung Congestion Formula was created to help clear the lungs and sinuses of congested matter.Smoke Less Aromatherapy Inhaler With Lemon, Pine & Eucalyptus
Each pocket-sized Smoke Less Aromatherapy Inhaler with Lemon, Pine & Eucalyptus helps to address our unhealthy habits and daily concerns.Stabilized Oxygen OxyDrops, Liquid Electrolytes, Sodium Chlorite Solution, 4 fl. oz.
WaterOz stabilized oxygen is the highest quality, strongest and most stable of all the liquid electrolytes of oxygen available on the market.Sutherlandia (Sutherlandia frutescens), 300 mg, 60 Tabs
Sutherlandia powerfully assists the body to mobilize its own immunological physiological resources to cope with diverse physical, mental and chemical stressors.Talisadi Churna, 450 mg, 120 VCaps
Talisadi Churna is very effective in fighting common colds, cough, asthma, and helps to liquefy phlegm.Ultimate B (Vitamin B Complex Formula), 60 Tabs
Superbly formulated, Ultimate B, vitamin B Complex Formula, is a synergistic blend of herbs, superfoods, and enzymes made of 33% food ingredients for easy absorption.Umcka Cold Care Menthol Flavor Syrup, Nature's Way, 4 fl. oz.
Umcka Cold Care shortens the duration and reduces the severity of symptoms associated with the common cold and throat, sinus, and bronchial irritations.Umcka Cold Care, 99% Alcohol Free, Homeopathic, Cherry Flavor Syrup, 4 fl. oz.
Shortens duration and reduces severity of symptoms associated with the common cold and throat/sinus/bronchial irritations. Umcka ColdCare is a natural cold flu remedy that will helps you recover faster!Umcka Cold Care, Original Formula Drops, Nature's Way, 1 fl. oz.
Shortens duration and reduces severity of symptoms associated with the common cold and throat, sinus, bronchial irritations. Shortens duration & reduces severity of upper respiratory symptoms.Upper Respiratory Support, TheraVeda Pavan, 60 VCaps
One of the problems with most herbal remedies for upper respiratory infections is, if you are sensitive to aspirin, you're probably also sensitive to the herbs for colds and flu.Violet Leaf Tincture, 100% Organic, 2 fl. oz.
Violet leaf can be used for coughs, sore throats, asthma, tumors, acne, swollen glands and headaches.Vitamin A, 100% Natural, Nature's Way, 10,000 IU, 100 Softgels
Nature's Way vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.Vitamin B-100 Complex, With Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
A complete Vitamin B complex of 8 essential vitamins. B Vitamins are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin C 1000 with Bioflavonoids, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.Vitamin C 500 with Rosehips, 100% Natural, 500 mg, 250 VCaps
Nature's Way Vitamin C with Rosehips offers a rich whole plant source of vitamin C and provides antioxidant protection for many of the body's important enzyme systems.Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.
WaterOz Ionic Zinc is a pure liquid Zinc supplement. Zinc moves through all the fluids in the body, it creates a defense against infection-causing bacteria and viruses trying to enter the body and stops bacterial and viral replication.
HerbalRemedies: Legionnaires' Disease / Legionellosis Information
HerbalRemedies: Legionnaires' Disease / Legionellosis Supplements & Products
CONTROLLING LEGIONNAIRES' DISEASE OUTBREAKS
LEGIONELLA & SCALDING FACTS
(Obtained From Cashacme.com: Legionella Facts)
Hot water temperature and its impact on the incidence of scalding and Legionnaires' disease is a hot topic in the industry at the moment. The issue is being discussed at Plumbing Code hearings and not a month goes by that the subject is not mentioned in the trade magazines. We have assembled a range of information here related to the issues. We hope you find it interesting and informative.
Scalding Facts: Destroying the bacteria that causes Legionnaires' disease requires raising the temperature of water to at least 140°F (60°C). But, at the temperature 140°F (60°C), water can cause third-degree burns in children in one second and adults in five seconds. The U.S. Consumer Product Safety Commissions states that approximately 3,800 injuries and 34 deaths are directly related to dangerously hot tap water in residences (The National Safe Kids Campaign lists the number of scalding injuries as high as 6,500). The answer to preventing both Legionnaires' disease and harmful water temperatures is to store the water at a high temperature and temper it to a safer temperature before distribution to the fixture.
Limitations of the Water Heater: The thermostat of a water heater is a static control device intended only to allow the heater to perform its intended function as a hot water generator and storage device. The thermostat can be "set" with an accuracy of +/-5°F (+/-3°C) at best. The difference between the "off" and "on" points of the water heater can be as much as 15°F (9°C), resulting in decreased efficiency.
Ideal Conditions for Legionnaires' Disease: Legionella Pneumophilia, the bacteria that causes Legionnaires' disease, thrives in warm, stagnant water. The bacteria can be found where there is scale and sediment in the water and when there are certain free-living amoebae organisms in water capable of supporting intracellular growth of legionellae. A water temperature of 120°F does not kill the bacteria; a minimum temperature of 140°F is required. A water heater set at 120°F can contain water as low as 100°F. To eliminate the bacteria, several steps need to be taken, including eliminating dead-legs and system flushing. But, without a storage temperature of 140°F, all other steps cannot solve the problem.
Legionnaires' Disease in Residential Enviroments: In a recent test, 24 percent of a 21-family test group was found to have Legionella bacteria in their home water. A combination of new and old research now suggests that the bacteria may thrive in residential hot water pipes, and the water supply used in residential homes may be directly responsible for 20 percent of Legionnaires cases. Bacteria in natural water sources (not unlike those used by residential dwellings) do not undergo the processes of filtration and chemical disinfection that municipal water supplies go through. Instead, natural water sources must be treated by the private owner, a process which is often inconsistent or incomplete.
Canada Leaps Ahead of the U.S.: A change has recently been made to Canada's plumbing code that requires water supplied to fixtures in residential buildings to be a maximum temperature of 49°C (120°F). The change is expected to be adopted by January 2004 and fully implemented by mid-2004. The reasons for changing the code are listed specifically as the prevention of scalding and Legionnaires' disease. The solutions stated in the code are installing a master mixing valve at the water heater or a mixing valve at each individual fixture.
How the Issue is Being Addressed Around the World: Several countries around the world, including many in Europe, have adopted regulations requiring water to be stored at 140°F or higher and delivered at 120°F or lower. The aggressiveness with which countries have addressed this issue indicates the importance of water storage safety.
Product Standards: There have been several new innovations and updates to the product standards in the water temperature control industry.
CONTROLLING THE POTENTIAL GROWTH OF LEGIONELLA IN COOLING TOWERS & AIR SCRUBBERS
(Obtained from HC Information Resources: Legionnaires' Disease.)
Various studies have shown that some 40-60 percent of cooling towers tested contained Legionella.
A recent research study provided evidence that Legionella pneumophila, the causative agent of Legionnaires' disease, can travel at least 6 kilometers (3.72 miles) from its source by airborne spread. It was previously believed that transmission of the bacterium was restricted to much shorter distances. A team of French scientists reviewed the details of an epidemic of Legionnaires' disease that took place in Pas-de-Calais in northern France in 2003-2004. There were 86 confirmed cases during the outbreak, of whom 18 perished. The source of infection was identified as a cooling tower in a petrochemical plant, and an analysis of those affected in the outbreak revealed that some infected people lived as far as 6-7 kilometers (3.72-4.34 miles) from the plant.
A study of Legionnaires' disease cases in May 2005 in Sarpsborg, Norway wrote: "The high velocity, large drift, and high humidity in the air scrubber may have contributed to the wide spread of Legionella species, probably for more than 10 kilometers (greater than 6.2 miles)... "
Temperature affects the survival of Legionellae as follows:
- 70 to 80°C (158 to 176°F): Disinfection range
- At 66°C (151°F): Legionellae die within 2 minutes
- At 60°C (140°F): Legionellae die within 32 minutes
- At 55°C (131°F): Legionellae die within 5 to 6 hours
- Above 50°C (122°F): They can survive but do not multiply
- 35 to 46°C (95 to 115°F): Ideal growth range
- 20 to 50°C (68 to 122°F): Legionellae growth range
- Below 20°C (68°F): Legionellae can survive but are dormant
Removing slime is an effective control process, because up to 1,500 times more chemicals are needed to kill bacteria in slime than free floating bacteria.
Action levels following microbial monitoring for cooling towers
The European Working Group for Legionella Infections (EWGLI) was established in 1986 within the European Union framework to share knowledge and experience about potential sources of Legionella and their control. This group has published guidelines about the actions to be taken to limit the number of colony forming units (i.e., the aerobic count) of micro-organisms per mL at 30°C (minimum 48 hours incubation):
Aerobic Count Legionella Action required 10,000 or less 1,000 or less System under control. More than 10,000 - Up to 100,000 More than 1,000 - Up to 10,000 Review program operation. The count should be confirmed by immediate re-sampling. If a similar count is found again, a review of the control measures and risk assessment should be carried out to identify any remedial actions. More than 100,000 More than 10,000 Implement corrective action. The system should immediately be re-sampled. It should then be 'shot dosed' with an appropriate biocide, as a precaution. The risk assessment and control measures should be reviewed to identify remedial actions.
Aerobic count, cfu/ml at 30°C (minimum 48 hours incubation). Colony count determined by pour plate method according to ISO 6222(21) or by spread plate method on yeast extract agar.
Legionella, bacteria cfu/liter. Determined in accordance with ISO 11731(20).
Expect to find Legionella CFUs because almost all natural water sources contain Legionella. Legionella samples need to be run within 24 hours. Samples should be kept cold with ice packs, but not frozen, and should remain upright.
Many governmental agencies, cooling tower manufacturers and industrial trade organizations have developed design and maintenance guidelines for preventing or controlling the growth of Legionella in cooling towers. Below is a list of sources for such guidelines:
- Cooling Technology Institute - Best Practices for Control of Legionella, July 2006. [Page 6 of 12] As a minimum control... establish a free halogen residual of at least 1.0 ppm and hold this residual for no less than one hour each day.
- SPX (Marley) Cooling Technologies - ASHRAE Guideline 12-2000 - Minimizing the Risk of Legionellosis
- EWGLI Technical Guidelines for the Control and Prevention of Legionella in Water Systems
- Centers for Disease Control and Prevention - Procedure for Cleaning Cooling Towers and Related Equipment (pages 239 and 240 of 249)
- OSHA - How to maintain these systems - Frequency of cleaning
- OSHA page on Legionellosis - US Occupational Safety and Health Administration
- Association of Water Technologies - Legionella 2003
- California Energy Commission - Cooling Water Management Program Guidelines For Wet and Hybrid Cooling Towers at Power Plants
- SPX (Marley) Cooling Technologies - Cooling Towers Maintenance Procedures
- Marley Cooling Technologies - Cooling Tower Inspection Tips {especially page 3 of 7}
- Tower Tech Modular Cooling Towers - Legionella Control
- GE Infrastructure Water & Process Technologies Betz Dearborn - Chemical Water Treatment Recommendations For Reduction of Risks Associated with Legionella in Open Recirculating Cooling Water Systems
- Wisconsin Division of Health, Control of Legionella in Cooling Towers: Summary Guidelines, June 1987, Wisconsin Department of Health and Social Sciences.
REGULATIONS & ORDINANCES
The guidance issued by the UK government's Health and Safety Executive (HSE) now recommends that microbiological monitoring for wet cooling systems, using a dip slide, should be performed weekly. The guidance now also recommends that routine testing for legionella bacteria in wet cooling systems be carried out at least quarterly, and more frequently when a system is being commissioned, or if the bacteria has been identified on a previous occasion.
The City of Garland, Texas requires yearly testing for legionella bacteria at cooling towers at apartment buildings.
Malta requires twice yearly testing for legionella bacteria at cooling towers and water fountains. Malta prohibits the installation of new cooling towers and evaporative condensers at health care facilities and schools.
RELATED LINKS
- CLIRA Legionella Risk Assessment
- CDC Disease Info
- Legionellosis
- WHO LEGIONELLA and the prevention of legionellosis 2007, 276 Pages
- Illinois Department of Public Health page on Legionellosis
- Video on how Legionella pneumophila infects the body
- Directors of Health Promotion and Education page on Legionellosis
- European Working Group for Legionella Infections
- Legionella risk management
- Recent Outbreaks of Legionnaires' disease
- Legionella outbreak in Murcia, Spain,
- River Glomma may have spread the Disease
- Report of the public meetings into the legionella outbreak in Barrow-in-Furness, August 2002
- Q-Net: Legionnairs Disease Bugs of This World
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You or a family member experience symptoms Legionnaires' disease or may have been exposed to the Legionella bacterium.
You or a family member need help to quit smoking.
You or a family member experience any sudden, unexplained symptoms or your symptoms get worse despite treatment. Some sensitive individuals may experience allergic reactions to some medications and herbal formulas. Discontinue use immediately and consult your health care provider.
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