Can Legionnaires’ disease cause post-traumatic stress disorder?

Posted on August 30, 2017

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Blog post by our work experience 6th Form student Olivia Barbosa-Atkins.

Legionnaires’ disease is caused by the bacterium Legionella pneumophila which is found in both potable and non-potable water sources. Legionnaires’ disease (LD) is a grave form of pneumonia typically categorised by the onset of feelings of weakness and fatigue after the incubation period of 2 to 10 days (Legionella.org). Thereafter, the symptoms increase in severity ranging from a high temperature of above 39.5°C, violent coughing fits, diarrhoea and often vomiting and headaches. In the monthly legionella report published by Public Health England, there have been 346 reported cases of LD in the UK since 1st January 2017 (as of 4th August 2017). A total of 66 of those cases were reported during July 2017. (gov.uk).

Treatment for severe cases of LD may take place in the intensive care unit (ICU). For LD sufferers, a stay in ICU would typically entail the patient(s) being attached to ventilators to assist their breathing if they can’t do so on their own and constant monitoring by specially trained nurses and doctors (assisted by monitoring equipment to monitor heart rate, blood pressure, oxygen levels etc). Other equipment that may be used based on individual circumstances includes IV lines and pumps to provide fluids, nutrition and medication, feeding tubes if the patient is unable to eat normally and drains and catheters to remove excess blood and fluid or urine, respectively. (nhs.uk).

Post-traumatic stress disorder (PTSD) is an anxiety disorder that typically develops after a traumatic event or situation. Whilst PTSD is commonly associated with shell shocked soldiers, PTSD can develop from any highly distressing incident ranging from serious car accidents to sexual assault.

Whilst the link between PTSD and LD treatment in ICU may not be overtly evident on first appraisal, the development and subsequent treatment of LD has been linked with the development of PTSD. PTSD can cause long term changes in brain areas implicated in the stress response which includes the amygdala, hippocampus and prefrontal cortex. These changes can then result in intrusive thoughts, hyperarousal, flashbacks, insomnia and night terrors, changes in memory and concentration, and startle responses (Bremner 2006). Being a patient in ICU may trigger the onset of such changes as the period of stay can oftentimes be very distressing and overwhelming for the patient.

Links between LD treatment and PTSD have been reported in various studies. For example, Lettinga et al (2002) published in Clinical Infectious Diseases found a startling link between PTSD and survivors of an outbreak of LD in The Netherlands. The study involved collecting data from questionnaires delivered to 122 of said survivors. The questionnaires were delivered at 2 months and 17 months after antibiotic therapy completion (1st April 1999 for all patients). The first assessed whether the patients had any symptoms associated with LD and how these symptoms developed in severity over time and the second, the SF-36, was a 36-item test that addressed the 8 dimensions believed to reflect the patients’ quality of life. The latter would be used to provide an indication of whether the respondent was suffering from PTSD. The results from this study found that 15% of patients suffered from PTSD after their treatment for LD. Whilst this may not appear to be a significant statistic, the percentage of patients that developed PTSD in this study is in agreement with estimations that, in the aftermath of a disaster, 20-30% of victims develop PTSD.

In conclusion, whilst it is not LD itself which could lead to the development of PTSD; those who need to be placed in ICU due to the severity of their symptoms may indeed develop PTSD. Through no fault of the staff, stays in ICU are often traumatic times which can, as any traumatic experience, result in PTSD. With this knowledge, health care providers can better understand measures that may need to be put in place to help those at risk of PTSD after being treated for LD; especially those involved in outbreak situations where media coverage may intensify the trauma. With these precautions, it could be possible to improve the mental wellbeing of those who have suffered through LD.

If you’ve been affected or know those affected by PTSD, please seek help.

References

Bremner, J.D. (2006). Traumatic stress: effects on the brain. Dialogues Clin Neurosci 8(4):445–461.

Griffiths, J. (2007). The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Medicine 33(9):1506-1518.

Lettinga, K.D (2002). Health-Related Quality of Life and Posttraumatic Stress Disorder among Survivors of an Outbreak of Legionnaires Disease. Clinical Infectious Diseases 35(1):11–17.

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