Dr. Kevin Most: Legionnaire’s disease- Concussions, CTE, Youth football
We all saw the news of Gov Rauner and his weeklong stay at the veterans home downstate. This home had an outbreak of legionnaire’s disease in 2015, which resulted in the death of 13 veterans, we also heard that legionnaire’s bacteria was also found in the Capital Building and that staff were being told to be cautious around the use of water when washing their hands. I thought we would give you a short course on Legionnaire’s so we all would be educated about the disease.
First a little history, in 1976 in Philadelphia, 182 individuals from the same hotel came down with pneumonia. 29 of those individuals died from the infection. The cause of the infection was found to be an unknown bacteria and was named Legionella because the individuals who ended up with the infection were members of the American Legion and were in the Philadelphia Hotel where the outbreak occurred. The high rate of deaths at that time was due to the lack of an antibiotic that could penetrate the bacteria, we now have antibiotics to treat the infection however the mortality from this illness is still fairly high.
The infection is mainly noted to be in the lungs and often in individuals who were smokers or had a weakened immune system. Symptoms include fever, chills, muscle aches, loss of appetite and a cough. The infection can worsen and include neurological symptoms and stomach symptoms as well.
This bacteria lives in contaminated water. It is found in the air conditioning systems in buildings, it can also be found in humidifiers, whirlpool spas, ice machines and misting systems like you see in grocery stores. The transmission of the disease occurs when the water is aerosolized and then inhaled. The bacteria has been found in the Capital building following testing of the water after a water pipe had broken last week. Employees were told to wash their hands with “pencil sized streams of water” and to turn off any humidifiers that they may have on. These actions would limit the amount of bacteria that would be aerosolized. There have been no cases noted in the capital Building and this is being done as a precaution.
A few important things, individuals cannot get this infection by drinking the water, and patients are not contagious if they come down with the illness. The illness often comes in clumps of outbreaks and there have been many outbreaks around the world since this was first noted.
Concussion and a law being considered to stop youth tackle football
Well, concussions were back in the news the past week. Rob Gronkowski taking a big hit to the helmet in the NFL playoff game and receiving a concussion. The story now with him is will he play in the Super Bowl. Chicago Bulls guard Kris Dunn toke an awful fall on January 18th, and struck his face to the floor dislocating 2 teeth and having suffered a concussion as well, he is out indefinitely. Also just this week, State Rep Carol Sente introduced the Dave Duerson Act, this is a law that would ban tackle football for any children under the age of 12 in Illinois. Dave Duerson was a Chicago Bear
The law is being considered as more data is coming out on head trauma and the association with CTE Chronic Traumatic Encephalopathy, some of the more concerning thoughts are that sub concussive blows to the head may also lead to CTE. The current data shows that the longer an individual is exposed to blows to the head, the higher incidence of CTE is noted. However there has been no studies that have shown the impact of youth football and the risk of them ending up with CTE. The thought is that studies have shown the longer one is involved in heavy contact football the higher the incidence so not allowing contact until after age 12 they would see a decrease in CTE. This concept is called Dose Response Relationship, however this has not been looked at from a young individual who started football early on compared to an individual who started football later, it is currently being extrapolated to that thought.
Proponents for the bill also look at the fact that the equipment in young children is not as advanced or fit properly than the equipment that you see at the high school level. There is also the concern that high school games have physicians on the sidelines ready to determine when and if a concussion has occurred, in youth football that is not the case for many leagues. They also note that soccer and hockey have already taken steps including no heading of the ball until after the age of 11 and in hockey no body checking until age 13
There is a lot of activity going on around concussions. There are companies working on not only improving the equipment but also building into the equipment monitors that will identify a possible concussion early on. There are companies working on headgear, mouth guards , even the hardness of balls and playing surfaces are being researched in the hopes of decreasing concussions while still allowing the games to be enjoyed.
The healthcare field now has concussion clinics that are staffed with experts in concussion protocols and what to look for. The days of the pediatrician or family doctor making a simple clearance post-concussion are disappearing in many areas. We are also seeing a lot of research being done in this area. Including research done on adolescents all the way to armed forces personnel.
It is unclear how the law will play out here in Illinois but the impact of the data has certainly been felt as high schools are seeing fewer individuals joining the football team.