“Legionnaires’ disease is a multisystem disease which causes pneumonia due to gram-negative bacteria (Legionella spp.) found in freshwater environments around the world. Humans are infected by inhalation of aerosols containing Legionella. The infection can be fatal and outbreaks from a common environmental source can occur. Cases of Legionnaires’ disease are mainly reported in persons in older age groups, especially in males.  Legionellosis is an uncommon form of pneumonia. The disease has no particular clinical features that clearly distinguish it from other types of pneumonia, and laboratory investigations must be carried out to confirm the diagnosis. It normally takes between two to ten days to develop symptoms (typically five to six days) but very rarely some cases may take two to three weeks to develop symptoms.”

European Centre for Disease and Control (https://www.ecdc.europa.eu/en/legionnaires-disease/facts)

Who to Test for Legionnaires’ Disease:

·Patients who have failed outpatient antibiotic therapy

·Patients with severe pneumonia, in particular those requiring intensive care

·Immuno-compromised host with pneumonia

·Patients with pneumonia in the setting of a legionellosis outbreak

·Patients with a travel history [Patients that have traveled away from their home within two weeks before the onset of illness.]

·Patients suspected of healthcare-associated pneumonia

Diagnostic Tests done in checking for illness or infection of the lungs, in general:

Legionnaires’ disease is similar to other types of pneumonia. To help identify the presence of legionella bacteria quickly, your doctor may use a test that checks your urine for legionella antigens — foreign substances that trigger an immune system response. You may also have one or more of the following:

·Blood tests

·Chest X-ray, which doesn’t confirm Legionnaires’ disease but can show the extent of infection in your lungs

·Tests on a sample of your sputum or lung tissue

·A CT scan of your brain or a spinal tap (lumbar puncture) if you have neurological symptoms such as confusion or trouble concentrating.

How to test in particular for Legionnaires’ Disease Only:

·Urinary antigen assay & culture of respiratory secretions on selective media are the preferred diagnostic tests for Legionnaires’ disease

·Sensitivity varies depending on the quality and timing of specimen collection as well as technical skill of the laboratory performing the test.

TREATMENT:

·Legionnaires’ disease is treated with antibiotics. The sooner therapy is started, the less likely the chance of serious complications or death. In many cases, treatment requires hospitalization. Pontiac fever goes away on its own without treatment and causes no lingering problems.

LASTLY about “outbreaks of Legionnaire’s disease” are preventable, but prevention requires meticulous cleaning and disinfection of water systems, pools and spas.

Avoiding smoking is the single most important thing you can do to lower your risk of infection. Smoking increases the chances that you’ll develop Legionnaires’ disease if you’re exposed to legionella bacteria.

“Few people have heard of Pontiac fever, and yet most are aware of Legionnaires’ disease. It is intriguing therefore to discover that both illnesses are triggered by the same bacterium… called legionella. Pontiac fever is far milder and much less serious than Legionnaires’ disease. Indeed it may be possible for someone to contract Pontiac fever and assume they simply have the flu, since both present with very similar symptoms.  The main difference is pneumonia. Sufferers of Legionnaires’ disease will probably contract pneumonia and are therefore likely to require hospital treatment in order to make a successful recovery. This is why Legionnaires’ is more serious than Pontiac fever, which doesn’t present with this additional illness.  It is good to know that Pontiac fever is not as serious as Legionnaires’ disease. However it is still wise to identify it if at all possible. It may point to an outbreak of Legionnaires’ that could help others get more urgent treatment as a result.”

Legionella Control (https://legionellacontrol.com/legionella/pontiac-fever-legionnaires-disease/)

“Refrigerate perishable items within two hours of coming out of the oven or refrigerator. After two hours, perishable food enters the “Danger Zone” (between 40 F and 140 F), where bacteria can multiply quickly and cause food to become unsafe. Perishable food should be discarded if left out for longer than two hours, so refrigerate or freeze items to prevent food waste  .Use the Monday after Thanksgiving as a reminder that it is the last day you can safely eat leftovers. If you want to keep leftovers longer, freeze them within that four-day period. Frozen food stays safe indefinitely, though the quality may decrease over time (best quality if eaten within six months.  Make sure your reheated leftovers reach 165 F as measured with a food thermometer. Reheat sauces, soups and gravies safely by bringing them to a rolling boil.  When reheating in the microwave, cover and rotate the food for even heating. Arrange food items evenly in a covered microwave safe glass or ceramic dish and add some liquid, if needed. Because microwaves have cold spots, check the internal temperature of the food in several places with a food thermometer after allowing a resting time.”

The U.S. Department of Agriculture (https://www.usda.gov/media/blog/2021/11/22/leftovers-lets-keep-best-part-thanksgiving-safe)

“Based on fair evidence, excessive salt intake and deficient dietary consumption of fresh fruits and vegetables are associated with an increased risk of gastric cancer. Dietary intake of vitamin C contained in vegetables, fruits, and other foods of plant origin is associated with a reduced risk of gastric cancer. Diets high in whole-grain cereals, carotenoids, allium compounds, and green tea are also associated with a reduced risk of this cancer. However, it is uncertain if changing one’s diet to include more vegetables, fruits, and whole grains would reduce the risk of gastric cancer.”

National Cancer Society (https://www.cancer.gov/types/stomach/hp/stomach-prevention-pdq)

Measures for Prevention of Stomach (Gastric) Cancer Risk:

Smoking cessation

Based on solid evidence, smoking is associated with an increased risk of stomach cancer.  The 2004 Surgeon General’s report identifies cigarette smoking as a cause of stomach cancer, with an average relative risk (RR) in former smokers of 1.2 and in current smokers of 1.6.  Compared with persistent smokers, the risk of stomach cancer decreases among former smokers with time since cessation. This pattern of observations makes it reasonable to infer that cigarette smoking prevention or cessation would result in a decreased risk of gastric cancer.

H. pylori infection eradication

Based on solid evidence, H. pylori infection is associated with an increased risk of gastric cancer.

Treat stomach infections. If you have ulcers from an H. pylori infection, get treatment. Antibiotics can kill the bacteria, and other drugs will heal the sores in the lining of your stomach to cut your risk of cancer.

Diet

Eat healthy. Get more fresh fruits and vegetables on your plate every day. They’re high in fiber and in some vitamins that can lower your cancer risk. Avoid very salty, pickled, cured, or smoked foods like hot dogs, processed lunch meats, or smoked cheeses. Keep your weight at a healthy level, too. Being overweight or obese can also raise your risk of the disease.

Based on fair evidence, excessive salt intake and deficient dietary consumption of fresh fruits and vegetables are associated with an increased risk of gastric cancer. Dietary intake of vitamin C contained in vegetables, fruits, and other foods of plant origin is associated with a reduced risk of gastric cancer. Diets high in whole-grain cereals, carotenoids, allium compounds, and green tea are also associated with a reduced risk of this cancer. However, it is uncertain if changing one’s diet to include more vegetables, fruits, and whole grains would reduce the risk of gastric cancer.

TREATMENTS FOR STOMACH CANCER:

Many treatments can fight stomach cancer. The one you and your doctor choose will depend on how long you’ve had the disease or how much it has spread in your body, called the stage of your cancer.

Surgery. Your doctor might remove part of your stomach or other tissues nearby that have cancer cells. Surgery gets rid of the tumor and stops cancer from spreading to other parts of your body. If your disease is in a more advanced stage, your doctor might need to remove all of your stomach=Gastrectomy or in some other cases the Surgeon may only have to remove part of the stomach=Partial Gastrectomy.

Some tumors can keep food from moving in and out of your stomach. In that case, you might have surgery to put in a stent, a device that keeps the pathways open.

Chemotherapy. Drugs kill your cancer cells or keep them from growing. You can take them as pills or through an IV at a clinic. Chemo usually takes several weeks. The drugs can cause side effects, but your doctor can help you find ways to feel better during treatment.

Radiation. High-energy waves or particles can kill cancer cells and shrink tumors. Your doctor may use an X-ray or other machine to beam radiation at the spot where your tumor is.

Chemoradiation. Your doctor might use this mix of chemotherapy and radiation to shrink your tumor before surgery.

Targeted drugs. These newer drugs are different because they fight only cancer cells. Other treatments, like chemo and radiation, can kill healthy cells along with diseased ones. As a result, targeted therapies have fewer side effects than these other treatments.

“Stomach cancer is the fifth most common cancer worldwide. It is more common in countries in East Asia, Eastern Europe, and South and Central America than in the United States and other Western countries.  There are many known risk factors for stomach cancer (also called gastric cancer), but often it’s not clear exactly how these factors might affect how cells in the stomach become cancer cells. This is the subject of ongoing research.”

American Cancer Society (https://www.cancer.org/cancer/types/stomach-cancer/causes-risks-prevention/what-causes.html)

RISK FACTORS FOR STOMACH CANCER:

GENERAL

• Age: Stomach cancer is found most often in people over age 55.
• Gender: The disease affects men twice as often as women.
• Race: Stomach cancer is more common in African Americans than in Caucasians.
• Region: This type of cancer is more common in some parts of the world, such as Japan, Korea, parts of Eastern Europe and Latin America. People in these areas eat many foods that are preserved by drying, smoking, salting or pickling.

BODY

• Obesity: Obesity has been linked to an increased risk of stomach cancer

GENETICS

Certain gene mutations and some inherited conditions are considered stomach cancer risk factors. They include:

• BRCA1 & BRCA2: Inherited mutations on the BRCA1 and BRCA2 genes are often associated with higher risks for breast cancer. Individuals who have inherited these genetic mutations are also at an increased risk for stomach cancer
• E-cadherin/CDH1: Though rare, people who inherit this genetic mutation have a 70 to 80 percent chance of developing stomach cancer in their lifetime. Also, women with this genetic defect have an increased risk of breast cancer.
• Lynch syndrome: This condition may also be referred to as hereditary non-polyposis colorectal cancer (HNPCC), a genetic condition that runs in families. More commonly, this condition is associated with an increased risk for colon cancer. HNPCC also predisposes people to stomach cancers.
• Familial adenomatous polyposis (FAP): This syndrome causes polyps in the colon, stomach and intestines. Often caused by mutations of the gene APC, this syndrome greatly increases a person’s risk of colorectal cancer and may play a small role in increasing a person’s stomach cancer risk.

LIFESTYLE

• Smoking: There is evidence linking cigarette smoking to many types of cancer, including stomach cancer. Smokers have been found to be at greater risk of developing cancer than non-smokers.
• Diet: Scientists believe that eating foods preserved in these ways may play a role in the development of stomach cancer. On the other hand, fresh foods (especially fresh fruits and vegetables and properly frozen or refrigerated fresh foods) may protect against this disease.
• Working in the coal, metal or rubber industries: Chemicals that are released in these environments have been linked to the development of stomach cancer.

OTHER CONDITIONS

• H. pylori infection: Doctors have found that a long-term H. pylori infection may lead to inflammation and pre-cancerous changes to the stomach lining. In fact, stomach cancer patients typically have a higher incidence of H. pylori infections than people who do not have stomach cancer.
• Pernicious anemia: Some people with pernicious anemia may have gastric polyps, which can increase the risk of stomach cancer.
• Epstein-Barr virus infection: According to the American Cancer Society, Epstein-Barr virus is found in the cancer cells of about 5% to 10% of people with stomach cancer.

ENVIRONMENTAL AND OCCUPATIONAL EXPOSURES

The risk of stomach cancer is increased in people who

• work in the rubber or coal industry
• have been exposed to very high levels of radiation

Those at risk for Stomach Cancer:

People at elevated risk for gastric cancer include older adults with atrophic gastritis or pernicious anemia; patients with sporadic gastric adenomas, familial adenomatous polyposis, or hereditary nonpolyposis colon cancer; and immigrant ethnic populations from countries with high rates of gastric carcinoma.  Workers in the rubber and coal industries are also at increased risk.

There is consistent evidence that Helicobacter pylori infection, also known as H. pylori infection, of the stomach is strongly associated with both the initiation and promotion of carcinoma of the gastric body and antrum and of gastric lymphoma.

There is consistent and solid evidence that Epstein-Barr virus (EBV) infection is strongly associated with gastric cancer.

Compared with the general population, people with duodenal ulcer disease may have a lower risk of gastric cancer.

Risk factors for gastric cancer include the presence of precursor conditions such as chronic atrophic gastritis and intestinal metaplasia, pernicious anemia, and gastric adenomatous polyps.  Risk factors could include type A blood type. Environmental factors include low consumption of fruits and vegetables; consumption of salted, smoked, or poorly preserved foods; cigarette smoking; and radiation exposure.

Those at great increased risk for stomach cancer:

Hereditary diffuse gastric cancer (HDGC) is a rare inherited condition in which people have a greatly increased risk of stomach cancer, which often develops at a fairly early age. This rare syndrome is most often caused by an inherited mutation in the CDH1 gene.

It’s very important to recognize people and families with this inherited syndrome, because most people who have it will develop stomach cancer. Families with HDGC typically have two or more close relatives who develop stomach cancer (usually the diffuse type), and/or at least one person who is diagnosed before age 50. Some family members might also develop invasive lobular breast cancer.

Doctors often refer people who might have HDGC to a genetics professional, so they can discuss possibly getting genetic testing. If testing is done and shows a person has a mutation (abnormal change) in the CDH1 gene, doctors often recommend they consider having their stomach removed (typically between the ages of 20 and 30) before cancer develops. However, this operation (called a total gastrectomy) can lead to long-term changes in the way a person eats.

Some other hereditary cancer syndromes are also linked with an increased risk for stomach cancer, including Lynch syndrome, familial adenomatous polyposis (FAP), Li-Fraumeni syndrome, and Peutz-Jeghers syndrome. The risk of stomach cancer with these syndromes is not nearly as high as it is with HDGC, so removal of the stomach is not typically recommended for people who have these syndromes.

“Stomach cancer can happen in any part of the stomach. In most of the world, stomach cancers happen in the main part of the stomach. This part is called the stomach body.

In the United States, stomach cancer is more likely to start by the gastroesophageal junction. This is the part where the long tube that carries food you swallow meets the stomach. The tube that carries food to the stomach is called the esophagus.

There is adenocarcinoma stomach cancer,  gastrointestinal stromal tumors (GIST), carcinoid tumors – that are found in many area of the body that start in your neuroendocrine cells, and lymphoma is a cancer that starts in immune system cells. Most lymphomas that start in the stomach are a type of non-Hodgkin’s lymphoma.”

MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/stomach-cancer/symptoms-causes/syc-20352438)