As reported by the Waterbury Republican-American, October 10, 2006.

Legionnaires' Coming Back; Often Doctors Miss Diagnosis

By Randy James

Lauren Lang was sick and getting sicker, and no one seemed to know why.

The 30-year-old West Hartford woman had a fever and a nasty cough, but regular flu treatment did nothing to help. As her illness dragged into its third week and her temperature reached 104, doctors said they were stumped.

"I remember the doctor from the clinic coming to my parents' house, sitting upstairs in my bedroom, holding my hands and saying he didn't know what was wrong with me," she remembered. "I'll never forget that."

Lang wasn't suffering from the flu, but from Legionnaires' disease -- a severe, often deadly pneumonia that's drawing attention after it struck three Connecticut men in recent weeks.

Though relatively few cases are recorded, doctors suggest Legionnaires' may be considerably more common than widely thought because many infections go undiagnosed.

The recent infections have killed one of the men, a 56-year-old from West Haven, and left the other two hospitalized. Authorities say the most recent victim, diagnosed Friday, is a Naugatuck man in his 50s who worked for the U.S. Postal Service in Waterbury.

Government figures show Legionnaires' disease infects up to 18,000 people nationwide and 15 to 35 of Connecticut's 3.4 million residents a year. Waterbury Hospital has seen only a handful in the last decade.

But experts say Legionnaires' can easily be mistaken for the flu or ordinary pneumonia, and therefore identified late or, sometimes, never.

"Many times we'll never know what the organism is," said Dr. John Shanley, a professor of medicine and director of Infectious Diseases at the University of Connecticut Health Center. "You're sort of left with this quandary of often not being able to nail it down."

Lang's 1986 infection was finally recognized after at least three trips to the emergency room, she said. She was quickly given the proper antibiotics and eventually made a full recovery, though not before missing 40 days of work at Aetna insurance.

Most patients are severely ill by the time they're diagnosed with Legionnaires' at Waterbury Hospital, a doctor there said.

"Almost all the people I've seen with Legionnaires' end up in the ICU," said Dr. Merceditas Villanueva, the hospital's chief of infectious diseases.

Legionnaires' disease is usually diagnosed through dedicated tissue or urine tests, said Dr. Joseph S. Cervia, an infectious disease specialist at Albert Einstein College of Medicine in New York.

"If the clinician doesn't think of Legionnaires', and doesn't do the special tests, he may miss the diagnosis entirely," he said. "Small outbreaks and the occasional, sporadic case often get missed."

Kenneth Wallace contracted Legionnaires' disease 10 years after Lang, in 1996 -- but his doctors were also left scratching their heads, as the infection went undiagnosed for days even after he checked in to the hospital.

"None of the antibiotics were working at all," said Wallace, a 70-year-old civil engineer in Farmington, Mich. "They started testing for all kinds of pneumonias. ... Everything was negative."

Meanwhile, he battled nausea, breathing trouble and fevers nearing 107 degrees.

Finally, by process of elimination, doctors figured it must be Legionnaire's. "They said, 'It's the only thing we haven't tested.'"

The official diagnosis wasn't made until the day after Wallace left the hospital.

Doctors are making progress toward recognizing Legionnaires', experts say, as they become more accustomed to it. The bacteria was first identified just 30 years ago, after an outbreak at an American Legion convention in Philadelphia infected more than 200 people and killed 32.

Doctors say patients have a good chance of beating Legionnaires' if it's diagnosed early. But even if successfully treated, effects of the infection can linger long afterwards.

Wallace tried to return to the construction company he owned, but found himself drained of all energy.

"I tried it for three or four months, but I just didn't feel like doing anything," he said. "I shut the company down, I just couldn't take it."

Lang said it was several weeks before she could even sit up. She made a trip to buy wallpaper for her new home, but pain in her lungs kept her from leaving her car. She eventually chose the wallpaper from bed.

"It was horrible," she said. "I wouldn't want to go through that again."