Legionellae are aerobic gram-negative facultative intracellular parasites of certain protozoa. They are found in freshwater environments worldwide and can cause respiratory disease (legionellosis) in humans. Legionella was first identified after an outbreak of pneumonia involving delegates of the 1976 American Legion Convention at a Philadelphia hotel. The genus Legionella currently has at least 50 species comprising 70 distinct serogroups. One species of Legionella, L. pneumophila, is the aetiological agent of approximately 90 % of legionellosis cases, and serogroup 1 (Sg1) accounts for about 84 % of these cases (WHO).

L. pneumophila multiplies itself at temperatures between 25 and 42 °C, with an optimal growth temperature of 35 °C. Legionella thrives in warm, stagnant water in the environment and in artificial systems such as cooling towers, evaporative condensers, hot and cold-water systems and spa pools that mimic the natural environment in which the organism thrives. These systems also provide the means by which aerosols/droplets are generated and the organism dispersed into the atmosphere. Legionellosis can be acquired by the inhalation of aerosols containing Legionella bacteria or by micro-aspiration of ingested water contaminated with Legionella. Person-to-person transmission is not thought to be a risk.

The likelihood of contracting Legionnaires’ disease depends on the level of contamination in the water source, the susceptibility of the person exposed, and the intensity of exposure. Legionnaires’ disease is characterized as an “opportunistic” disease that attacks individuals who have an underlying illness or a weakened immune system. Predisposing risks include increasing age, being male, heavy smoking, alcohol abuse, chronic lung disease, immunosuppressive therapy, cancer chemotherapy, organ or bone marrow transplant, and corticosteroid therapy. Legionellosis can appear in two distinct clinical presentations: Legionella pneumonia (Legionnaires’ disease) with an incubation period of approx. 2-10 days (may extend up to 16-20 days) and Pontiac fever (incubation period: normally 12-48 hours). Legionella pneumonia (Legionnaires’ disease) is a serious form of pneumonia that carries with it a case-fatality ratio of 10-15 %. Legionnaires’ disease patients initially present with cough, fever and nonspecific symptoms including malaise, myalgia and headache. Some patients develop shaking chills, chest pain, diarrhea, delirium or other neurologic symptoms. Extra pulmonary involvement is rare.

Pontiac fever is a milder form of the disease without manifestations of pneumonia and presents as an influenza-like illness. Symptoms may include headache, chills, muscle aches, a dry cough and fever. It is usually self-limiting and typically does not require treatment. The attack rate is much higher than for Legionnaires’ disease (up to 95 % of those exposed).

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