1887

Abstract

Laboratory results of 67 cases of legionnaires’ disease caused by serogroup (Sg) 1 spanning a 6-year period were analysed by both phenotypic and genotypic methods. The methods compared were urinary antigen enzyme immunoassay (EIA), an immunofluorescent antibody (IFA) test, direct fluorescent antibody (DFA), culture and a 5S rRNA PCR with Southern blotting confirmation. Urine was available in 53 cases, of which 35 (66 %) were positive, with an antigen peak observed at 5–10 days after onset of disease symptoms. The IFA test was positive in 62 (92.5 %) cases, with 56 (90.3 %) cases producing a greater than fourfold rise in titre and 6 (9.7 %) giving presumptive high titres of ⩾1 : 128. There were two antibody peaks, one at 10–15 days and another at >25 days after onset. In 23 cases where samples were available, DFA and culture were respectively positive in 5 (22 %) and 10 (48 %) cases. There was a peak in culture-positives 5–10 days after onset of disease. A -specific 5S rRNA PCR on patient serum was positive in 54 (80.5 %) cases, with a peak in PCR positivity at 6–10 days after disease onset. In 22 of the 67 cases, the full panel of diagnostic methods was available for comparison. The relative sensitivity and specificity of the urinary antigen EIA and the serum PCR was 100 %. The IFA gave relative sensitivity and specificity values of 93.8 and 95 %. DFA and culture, although 100 % specific, produced only low sensitivities, of 19 and 42.8 %, respectively. This study has shown that urinary antigen and serum PCR are valuable tests in the acute phase of disease, with excellent sensitivity and specificity values. At present, the species causing infection requires to be verified by IFA serology and/or culture, but this could become unnecessary as new antigen and Sg 1-specific PCR tests become available.

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2004-03-01
2024-03-19
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References

  1. Birtles R. J., Harrison T. G., Samuel D., Taylor A. G. 1990; Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection. J Clin Pathol 43:685–690 [CrossRef]
    [Google Scholar]
  2. Chambers S. T., Town G. I., Neill A. M., Frampton C., Murdoch D. R. 1999; Legionella , Chlamydia pneumoniae and Mycoplasma infection in patients admitted to Christchurch Hospital with pneumonia. N Z Med J 112:222–224
    [Google Scholar]
  3. Cloud J. L., Carroll K. C., Pixton P., Erali M., Hillyard D. R. 2000; Detection of Legionella species in respiratory specimens using PCR with sequencing confirmation. J Clin Microbiol 38:1709–1712
    [Google Scholar]
  4. Dominguez J. A., Gali N., Pedroso P., Fargas A., Padilla E., Manterola J. M., Matas L. 1998; Comparison of the Binax Legionella urinary antigen enzyme immunoassay (EIA) with the Biotest Legionella Urin antigen EIA for detection of Legionella antigen in both concentrated and nonconcentrated urine samples. J Clin Microbiol 36:2718–2722
    [Google Scholar]
  5. Edelstein P. H. 1993; Legionnaires’ disease. Clin Infect Dis 16:741–747 [CrossRef]
    [Google Scholar]
  6. Fallon R. J. 1981; Laboratory diagnosis of Legionnaires’ disease. Assoc Clin Pathol Broadsh 99:1–15
    [Google Scholar]
  7. Fallon R. J., Abraham W. H. 1992; Crossreactions between Legionella and Campylobacter spp. Lancet 340:551–552 [CrossRef]
    [Google Scholar]
  8. Harrison T. G., Dournon E., Taylor A. G. 1987; Evaluation of sensitivity of two serological tests for diagnosing pneumonia caused by Legionella pneumophila serogroup 1. J Clin Pathol 40:77–82 [CrossRef]
    [Google Scholar]
  9. Helbig J. H., Uldum S. A., Bernander S., Luck P. C., Wewalka G., Abraham B., Gaia V., Harrison T. G. 2003; Clinical utility of urinary antigen detection for diagnosis of community-acquired, travel- associated, and nosocomial legionnaires’ disease. J Clin Microbiol 41:838–840 [CrossRef]
    [Google Scholar]
  10. Jaulhac B., Nowicki M., Bornstein N., Meunier O., Prevost G., Piemont Y., Fleurette J., Monteil H. 1992; Detection of Legionella spp.in bronchoalveolar lavage fluids by DNA amplification. J Clin Microbiol 30:920–924
    [Google Scholar]
  11. Joseph C. 2002; Surveillance of Legionnaires’ disease in Europe. In Legionella: Proceedings of the 5th International Conference on Legionella pp 311–317 Edited by Marre R., Abu Kwaik Y., Bartlett C., Cianciotto N. P., Fields B. S., Frosch M., Hacker J., Lück P. C. Washington, DC: American Society for Microbiology;
    [Google Scholar]
  12. Lieberman D., Porath A., Schlaeffer F., Lieberman D., Boldur I. 1996; Legionella species community-acquired pneumonia.A review of 56 hospitalized adult patients. Chest 109:1243–1249 [CrossRef]
    [Google Scholar]
  13. Lindsay D. S. J., Abraham W. H., Fallon R. J. 1994; Detection of mip gene by PCR for diagnosis of Legionnaires’ disease. J Clin Microbiol 32:3068–3069
    [Google Scholar]
  14. Lindsay D. S. J., Abraham W. H., Edwards G., Girdwood R. W. A. 2002; Detection of Legionella -specific DNA in serum. In Legionella: Proceedings of the 5th International Conference on Legionella pp 216–220 Edited by Marre R., AbuKwaik Y., Bartlett C., Cianciotto N. P., Fields B. S., Frosch M., Hacker J., Lück P. C. Washington, DC: American Society for Microbiology;
    [Google Scholar]
  15. Maiwald M., Schill M., Stockinger C., Helbig J. H., Luck P. C., Witzleb W., Sonntag H. G. 1995; Detection of Legionella DNA in human and guinea pig urine samples by the polymerase chain reaction. Eur J Clin Microbiol Infect Dis 14:25–33 [CrossRef]
    [Google Scholar]
  16. Matsiota-Bernard P., Vrioni G., Nauciel C. 1997; Use of the polymerase chain reaction for the detection of Legionella pneumophila DNA in serum samples. Clin Infect Dis 25:939– 939
    [Google Scholar]
  17. McDade J. E., Shepard C. C., Fraser D. W., Tsai T. R., Redus M. A., Dowdle W. R. 1977; Legionnaires’ disease: isolation of a bacterium and demonstration of its role in other respiratory disease. N Engl J Med 297:1197–1203 [CrossRef]
    [Google Scholar]
  18. McWhinney P. H., Ragunathan P. L., Rowbottham T. J. 2000; Failure to produce detectable antibodies to Legionella pneumophila by an immunocompetent adult. J Infect 41:91–92 [CrossRef]
    [Google Scholar]
  19. Murdoch D. R. 2003a; Diagnosis of Legionella infection. Clin Infect Dis 36:64–69 [CrossRef]
    [Google Scholar]
  20. Murdoch D. R. 2003b; Nucleic acid amplification tests for the diagnosis of pneumonia. Clin Infect Dis 36:1162–1170 [CrossRef]
    [Google Scholar]
  21. Murdoch D. R., Chambers S. T. 2000; Detection of Legionella DNA in peripheral leukocytes, serum, and urine from a patient with pneumonia caused by Legionella dumoffii . Clin Infect Dis 30:382–383 [CrossRef]
    [Google Scholar]
  22. Murdoch D. R., Walford E. J., Jennings L. C., Light G. J., Schousboe M. I., Chereshsky A. Y., Chambers S. T., Town G. I. 1996; Use of the polymerase chain reaction to detect Legionella DNA in urine and serum samples from patients with pneumonia. Clin Infect Dis 23:475–480 [CrossRef]
    [Google Scholar]
  23. Musso D., Raoult D. 1997; Serological cross-reactions between Coxiella burnetii and Legionella micdadei . Clin Diagn Lab Immunol 4:208–212
    [Google Scholar]
  24. Sopena N., Sabria-Leal M., Pedro-Botet M. L., Padilla E., Dominguez J., Morera J., Tudela P. 1998; Comparative study of the clinical presentation of Legionella pneumophila and other community-acquired pneumonias. Chest 113:1195–1200 [CrossRef]
    [Google Scholar]
  25. Wilkinson H. W., Cruce D. D., Broome C. V. 1981; Validation of Legionella pneumophila indirect immunofluorescence assay with epidemic sera. J Clin Microbiol 13:139–146
    [Google Scholar]
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