Diagnosis of Legionnaires' disease. An update of laboratory methods with new emphasis on isolation by culture

Zuravleff, Jeffery J.; Yu, Victor L.; Shonnard, John W.; Davis, Bridgett K.; Rihs, John D.

doi:10.1001/jama.250.15.1981

Cited by 44 publications

(31 citation statements)

References 18 publications

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“…Culture requires special media, processing, and technical expertise, and 3 to 5 days are required to obtain a positive result. Serological testing for Legionella has little impact on clinical practice, as 20% to 30% of patients with LD do not develop a detectable antibody response if tested too early (55) or at all (56). The most common method currently used for diagnosing LD in the clinical setting is UA detection of L. pneumophila serogroup 1 (57).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

et al. 2016

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bThe diagnosis of Legionnaires' disease (LD) is based on the isolation of Legionella spp., a 4-fold rise in antibodies, a positive urinary antigen (UA), or direct immunofluorescence tests. PCR is not accepted as a diagnostic tool for LD. This systematic review assesses the diagnostic accuracy of PCR in various clinical samples with a direct comparison versus UA. We included prospective or retrospective cohort and case-control studies. Studies were included if they used the Centers for Disease Control and Prevention consensus definition criteria of LD or a similar one, assessed only patients with clinical pneumonia, and reported data for all true-positive, false-positive, true-negative, and false-negative results. Two reviewers abstracted data independently. Risk of bias was assessed using Quadas-2. Summary sensitivity and specificity values were estimated using a bivariate model and reported with a 95% confidence interval (CI). Thirty-eight studies were included. A total of 653 patients had confirmed LD, and 3,593 patients had pneumonia due to other pathogens. The methodological quality of the studies as assessed by the Quadas-2 tool was poor to fair. The summary sensitivity and specificity values for diagnosis of LD in respiratory samples were 97.4% (95% CI, 91.1% to 99.2%) and 98.6% (95% CI, 97.4% to 99.3%), respectively. These results were mainly unchanged by any covariates tested and subgroup analysis. The diagnostic performance of PCR in respiratory samples was much better than that of UA. Compared to UA, PCR in respiratory samples (especially in sputum samples or swabs) revealed a significant advantage in sensitivity and an additional diagnosis of 18% to 30% of LD cases. The diagnostic performance of PCR in respiratory samples was excellent and preferable to that of the UA. Results were independent on the covariate tested. PCR in respiratory samples should be regarded as a valid tool for the diagnosis of LD.) is a life-threatening pulmonary infection. The most common species causing clinical disease in humans is Legionella pneumophila (1). In addition to L. pneumophila, 19 species are documented as human pathogens on the basis of their isolation from clinical specimens (2). LD can affect people both in the community (3) and in the hospital and, in both settings, can occur in outbreaks (4, 5). The true incidence of LD is difficult to assess, because the bacterial etiology for community-acquired pneumonia (CAP) is generally not documented in clinical practice. LD cannot be differentiated clinically or radiographically from CAP caused by other bacterial pathogens (6). As Legionella spp. are obligatory intracellular bacteria, they are unaffected by beta-lactam antibiotics and require specific treatment with high-dose quinolones or macrolides (7). Treatment providing coverage against Legionella spp. has been shown to improve clinical success (8). Thus, early diagnosis of LD is important and can have an effect on both public health and management in hospitals (9, 10).Conventional methods for the diagnosis of LD ...

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

et al. 2016

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“…The mainstay of diagnosis at present should be culture (75,275,282). The sensitivity of culture is 50 to 80%, but the specificity is 100% and an isolate is then available for molecular analysis if epidemiological investigation is in order.…”

Section: Culturementioning

confidence: 99%

“…Even then, the diagnosis of sporadic cases by serology is not as firm as that from culture. Serological diagnosis has the additional disadvantage of being retrospective, although a seroconversion can be detected in many patients within the first week of illness (282).…”

Section: Culturementioning

confidence: 99%

Legionnaires disease: historical perspective

1988

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In the summer of 1976, a mysterious epidemic of fatal respiratory disease in Philadelphia launched an intensive investigation that resulted in the definition of a new family of pathogenic bacteria, the Legionellaceae. In retrospect, members of the family had been isolated from clinical specimens as early as 1943. Unsolved epidemics of acute respiratory disease dating to the 1950s were subsequently attributed to the newly described pathogens. In the intervening years, the Legionellaceae have been firmly established as important causes of sporadic and epidemic respiratory disease. The sources of the infecting bacteria are environmental, and geographic variation in the frequency of infection has been documented. Airborne dissemination of bacteria from cooling towers and evaporative condensers has been responsible for some epidemics, but potable water systems are perhaps more important sources. The mode of transmission from drinking water is unclear. The Legionellaceae are gram-negative, facultative, intracellular pathogens. The resident alveolar macrophage, usually an effective antibacterial defense, is the primary site of growth. Cell-mediated immunity appears to be the most important immunological defense; the role of humoral immunity is less clear. Erythromycin remains the antibiotic of choice for therapy of infected patients, but identification and eradication of environmental sources are also essential for the control of infection.

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“…7 Although rapid detection systems and serology may play a role, the backbone of the diagnostic effort should be culture of respiratory secretions. 8 Commercial media, including selective and differential agars, are now available.…”

Section: A Practical Approach To the Problemmentioning

confidence: 99%

The Problem of Environmental Legionella

Winn

1985

Infect. Control

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Diagnosis of Legionnaires' disease. An update of laboratory methods with new emphasis on isolation by culture

Cited by 44 publications

References 18 publications

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

Legionnaires disease: historical perspective

The Problem of Environmental Legionella

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