Molecular diagnosis of Legionella infections – Clinical utility of front-line screening as part of a pneumonia diagnostic algorithm

Summary Objectives Urinary antigen testing for Legionella pneumophila serogroup 1 is the leading rapid diagnostic test for Legionnaires' Disease (LD); however other Legionella species and serogroups can also cause LD. The aim was to determine the utility of front-line L. pneumophila and Legione...

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Bibliographic Details
Published in:	The Journal of infection 2016-02, Vol.72 (2), p.161-170
Main Authors:	Gadsby, Naomi J, Helgason, Kristjan O, Dickson, Elizabeth M, Mills, Jonathan M, Lindsay, Diane S.J, Edwards, Giles F, Hanson, Mary F, Templeton, Kate E
Format:	Article
Language:	eng
Subjects:	Adult Aged Algorithms Diagnostic Tests, Routine - methods Female Humans Infectious Disease Legionella anisa Legionella hackeliae Legionella longbeachae Legionella longbeachae - genetics Legionella longbeachae - immunology Legionella pneumophila Legionella pneumophila - genetics Legionella pneumophila - immunology Legionella species Legionellosis - diagnosis Legionnaires' Disease Male Mass Screening - methods Middle Aged Molecular Diagnostic Techniques - methods Molecular diagnostics PCR Pneumonia Polymerase Chain Reaction - methods United Kingdom
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Summary:	Summary Objectives Urinary antigen testing for Legionella pneumophila serogroup 1 is the leading rapid diagnostic test for Legionnaires' Disease (LD); however other Legionella species and serogroups can also cause LD. The aim was to determine the utility of front-line L. pneumophila and Legionella species PCR in a severe respiratory infection algorithm. Methods L. pneumophila and Legionella species duplex real-time PCR was carried out on 1944 specimens from hospitalised patients over a 4 year period in Edinburgh, UK. Results L. pneumophila was detected by PCR in 49 (2.7%) specimens from 36 patients. During a LD outbreak, combined L. pneumophila respiratory PCR and urinary antigen testing had optimal sensitivity and specificity (92.6% and 98.3% respectively) for the detection of confirmed cases. Legionella species was detected by PCR in 16 (0.9%) specimens from 10 patients. The 5 confirmed and 1 probable cases of Legionella longbeachae LD were both PCR and antibody positive. Conclusions Front-line L. pneumophila and Legionella species PCR is a valuable addition to urinary antigen testing as part of a well-defined algorithm. Cases of LD due to L. longbeachae might be considered laboratory-confirmed when there is a positive Legionella species PCR result and detection of L. longbeachae specific antibody response.
ISSN:	0163-4453 1532-2742