Materiały źródłowe

• #1 Legionnaires’ disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legionnaires-disease/diagnosis-treatment/drc-20351753

  Legionnaires’ disease is like other types of pneumonia. To find the legionella bacteria quickly, a healthcare professional might use a test that checks the urine for things that trigger the immune system, called antigens. Other tests might include: […] Blood tests. […] Chest X-ray. This doesn’t show the type of infection. But it can show how much infection is in the lungs. […] Tests on a sample of mucus from the lungs, called sputum, or lung tissue. […] Chest X-rays […] CT scan […] Lumbar puncture (spinal tap). […] What tests do I need? […] What is the best course of action?

• #2 Clinical manifestations and diagnosis of Legionella infection – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-legionella-infection

  Clinical manifestations and diagnosis of Legionella infection […] The clinical manifestations and diagnosis of Legionella infection will be reviewed here. […] LEGIONNAIRES’ DISEASE (LEGIONELLA PNEUMONIA) […] Although no clinical features reliably distinguish Legionnaires’ disease from other types of pneumonia, certain features may raise the index of suspicion.

• #3 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-and-treatment-of-Legionnaires-disease.aspx

  Legionnaires disease is caused by bacteria of the legionella species. […] Thus identification of the condition and early institution of therapy is vital to prevent death. […] All patients with pneumonia need to be screened and evaluated for legionella infection. The sputum, respiratory secretions, blood and urine samples are examined for the organism. […] Another test called the indirect immunofluorescent antibody test (IFAT) reveals L. pneumophillia infection by showing high rise of antibodies that the body prepares against the infective organism. […] Other tests like complete blood count reveals high white blood cell count, low sodium levels in blood, high blood levels of creatinine, low levels of enzyme Alkaline phosphatase etc. […] Drugs like Erythromycin, Azithromycin, Clarithromycin, and those like Ciprofloxacin, are often first line of drugs that are used in Legionnaires disease. […] Patients with risk factors like other long term illnesses like kidney or lung disease or diabetes are usually conditions that necessitate hospital admission.

• #4 Legionnaires’ disease – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legionnaires-disease/diagnosis-treatment/drc-20351753

  Legionnaires’ disease is like other types of pneumonia. To find the legionella bacteria quickly, a healthcare professional might use a test that checks the urine for things that trigger the immune system, called antigens. Other tests might include: […] Blood tests. […] Chest X-ray. This doesn’t show the type of infection. But it can show how much infection is in the lungs. […] Tests on a sample of mucus from the lungs, called sputum, or lung tissue. […] Chest X-rays […] CT scan […] Lumbar puncture (spinal tap). […] What tests do I need? […] What is the best course of action?

• #5 Legionella Tests: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/legionella-tests/

  Legionella tests look for these bacteria in urine or sputum. A blood test may be done to check if you have been exposed to the bacteria, but it cannot diagnose a Legionella infection. […] Legionella tests are used to find out whether you have Legionnaires’ disease. Other lung diseases have symptoms similar to Legionnaires’ disease. It’s important to get the right diagnosis and treatment to help prevent life-threatening complications. […] You may need this test if you have symptoms of Legionnaires’ disease. Symptoms usually show up two to 14 days after exposure to Legionella bacteria and may include: Cough, High fever, Chills, Headache, Chest pain, Shortness of breath, Fatigue, Nausea and vomiting, Diarrhea, Confusion. […] Legionella tests are usually done using urine or sputum. A blood test may be done to see if you have been exposed to the bacteria. […] If your results were positive, it probably means you have Legionnaires’ disease. […] Whether your results were positive or negative, your provider may do other tests to confirm or rule out a diagnosis of Legionnaires’ disease.

• #6 Legionnaires’ Disease: Risks, Symptoms, and Diagnosis

  https://www.healthline.com/health/legionnaires-disease

  Your doctor can diagnose Legionnaires disease by testing your blood or urine for the presence of Legionella antigens. Antigens are substances that your body recognizes as harmful. Your body produces an immune response to antigens to fight infection. Your doctor may also test a sample of sputum, or phlegm, for the Legionella bacteria. […] Your doctor might also perform a chest X-ray. While the X-ray cant be used to confirm Legionnaires disease, it can help determine the severity of your lung infection. […] Legionnaires disease is always treated with antibiotics. Treatment is usually started as soon as the disease is suspected, without waiting for confirmation. Prompt treatment significantly lowers the risk of complications.

• #7 Diagnosis of Legionnaires’ Disease | Mercury Legal

  https://www.legionnairesdiseasesolicitors.com/how-is-legionnaires-disease-diagnosed/

  Blood tests can help to illustrate the general health of a patient and also identify antibodies within the blood that are trying to fight off the infection. Not only that, but by monitoring the oxygenation of the blood, doctors can get an idea of how well the lungs are functioning and whether or not the patient will need mechanical assistance with breathing. […] A Chest X-ray will not confirm whether the cause of the infection is the Legionella bacteria, but it will help to identify if the lung is infected, and if so, the extent of the infection. […] A Computerised Tomography (CT) Scan combines a series of X-ray images taken from different angles to create clear images of the inside of bones, blood vessels and soft tissues. This can help to identify the extent of lung damage, but also to investigate any neurological symptoms such as confusion, or having trouble concentrating.

• #8 Laboratory Testing for Legionella | Legionella | CDC

  https://www.cdc.gov/legionella/php/laboratories/index.html

  Clinical laboratories can provide diagnostic testing for Legionella infections using culture, serology, or molecular methods. […] CDC recommends culture and Legionella urinary antigen testing (UAT) together for diagnosis of Legionnaires’ disease. […] The preferred diagnostic tests for Legionnaires’ disease are both of the following paired together: Culture of lower respiratory secretions and Legionella UAT. […] Culturing specimens is important to enable detection of all species and serogroups of Legionella. […] The UAT is the most commonly used laboratory test for diagnosis of Legionnaires disease. […] Best practice is to obtain both lower respiratory culture and urine concurrently. […] Laboratories shouldn’t reject lower respiratory specimens for these reasons when working-up Legionnaires’ disease because Legionella can often be recovered.

• #9 Legionellosis (Legionnaires’ Disease and Pontiac Fever) – Medical information | Occupational Safety and Health Administration

  http://www.osha.gov/legionnaires-disease/medical-Information

  CDC describes case classification for suspected and confirmed Legionellosis based on signs and symptoms of disease (i.e., clinical compatibility), travel history (for travel-associated cases), and laboratory testing. […] Employers, occupational safety and health professionals, and others involved in preventing and responding to Legionellosis outbreaks can use these definitions to help recognize and classify suspected and confirmed cases of disease. […] Diagnosing Legionnaires’ disease usually begins with a pneumonia diagnosis, confirmed by chest x-ray, and verified by one or more positive diagnostic tests for Legionella. […] The preferred diagnostic tests for Legionnaires’ disease are the Legionella urinary antigen test and lower respiratory secretion (i.e., sputum) culture. […] A urine or blood test may diagnose Pontiac Fever; however, a negative test does not definitively rule out disease.

• #10 Laboratory Testing for Legionella | Legionella | CDC

  https://www.cdc.gov/legionella/php/laboratories/index.html

  Clinical laboratories can provide diagnostic testing for Legionella infections using culture, serology, or molecular methods. […] CDC recommends culture and Legionella urinary antigen testing (UAT) together for diagnosis of Legionnaires’ disease. […] The preferred diagnostic tests for Legionnaires’ disease are both of the following paired together: Culture of lower respiratory secretions and Legionella UAT. […] Culturing specimens is important to enable detection of all species and serogroups of Legionella. […] The UAT is the most commonly used laboratory test for diagnosis of Legionnaires disease. […] Best practice is to obtain both lower respiratory culture and urine concurrently. […] Laboratories shouldn’t reject lower respiratory specimens for these reasons when working-up Legionnaires’ disease because Legionella can often be recovered.

• #11 Legionnaires’ Disease: Update on Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9124264/

  According to a 2019 European Centre for Disease Prevention and Control (ECDC) report, most cases in Europe (90%) are diagnosed using the urine antigen test (UAT) method. […] The introduction in the late 1990s of enzyme immunoassays for the detection of L. pneumophila antigen in urine made it possible to speed up the diagnosis of Legionnaires disease. […] The advantages of urinary antigen detection over other diagnostic methods are considerable. […] PCR is a method that has the potential to detect all known Legionella species. […] The literature on the association between the time of the onset of therapy and the prognosis in Legionnaires disease is scarce. […] These findings indicate that it is necessary to test for Legionella spp. at the time of hospital admission in severe CAP and to decide promptly whether to withdraw or continue antibiotic treatment according to the test results.

• #12

  https://link.springer.com/article/10.1007/s40121-022-00635-7

  According to a 2019 European Centre for Disease Prevention and Control (ECDC) report, most cases in Europe (90%) are diagnosed using the urine antigen test (UAT) method. […] Culture of respiratory samples is still considered the gold standard for diagnosis of legionellosis, but it is a very demanding test requiring considerable expertise and growth for several days on complex media. […] The introduction in the late 1990s of enzyme immunoassays for the detection of Legionella pneumophila antigen in urine made it possible to speed up the diagnosis of Legionnaires disease. […] The antigen detected is a bacterial lipopolysaccharide (LPS), on whose diversity of structure and antigenicity the identification of Legionella pneumophila serogroups is based. […] The advantages of urinary antigen detection over other diagnostic methods are considerable.

• #13 Legionella Infection Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/965492-workup

  General laboratory testing in patients with Legionnaires disease (LD) reveals several nonspecific abnormalities. […] Diagnosis cannot be excluded when one or more of the following results are negative (a combination of tests increases the probability of confirming the diagnosis): […] Urinary antigen test […] This is the preferred initial test for Legionnaires disease. […] The urine antigen test is a rapid, relatively inexpensive, and practical test for the detection of L pneumophila antigen excreted in the urine or present in pleural fluid. […] The primary disadvantage of urinary antigen testing is that it detects only L pneumophila serogroup 1. However, because this serogroup causes most cases of Legionnaires disease, the test is recommended strongly as part of the workup. […] Urine antigen testing has 70% sensitivity and approaches 100% specificity.

• #14 Legionnaires’ disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/legionnaires-disease/

  High specificity, high sensitivity, fast (results available within 15 minutes). […] PCR has high specificity, high sensitivity, fast (results typically available within hours). […] Microbiological studies include Legionella culture (gold standard) which requires buffered charcoal yeast extract agar with iron and cysteine. […] A four-fold rise in antibody titer confirms legionellosis.

• #15 Legionella Outbreak Toolbox

  https://legionnaires.ecdc.europa.eu/?pid=109

  An atypical pneumonia diagnosis of Legionnaires’ disease is not obvious. Initially the patient will have non-specific symptoms including fever, malaise, loss of appetite and headache. Gastrointestinal symptoms are also prominent, with diarrhoea occurring in about 20 – 40% of cases. If left undiagnosed and untreated, the patient could go on to suffer respiratory- and even multi-organ failure. A chest x-ray alone will be insufficient evidence for the observer to distinguish between legionellosis and other more usual causes of pneumonia, so specialised laboratory tests are required. However, due to the specific nutrient requirements of Legionella, it will not grow on more usual standard laboratory media but requires Buffered-Charcoal Yeast Extract Agar, BCYA. […] The gold standard test for Legionnaires’ disease is to culture the organism using sputum or bronchial lavage from a suspected patient. However, as the organism can take some time to grow, it is not always the most efficient method in an ongoing outbreak setting. Legionella urinary antigen tests are significantly quicker and have a high sensitivity and specificity, showing a positive detection of 90% of cases in under 15 minutes of incubation. The antigen can become present in the urine in as little as 1 to 3 days after symptomatic onset. The most significant problem with the urinary antigen test is that it is specific only to Legionella pneumophila serogroup 1, therefore a positive test indicates Legionnaires’ disease, but a negative test cannot rule it out. However, as previously mentioned, because most outbreaks are the result of serogroup 1, it is the most widely-used test in an epidemiological investigation and has become commercially available.

• #16 Legionella Infection Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/965492-workup

  Sensitivity improves if urine samples are concentrated by ultrafiltration and obtained within 7 days of the onset of pneumonia. […] Test results may remain positive for weeks, even after appropriate antibiotic therapy. […] Gram stains and cultures of sputum, lower respiratory tract secretions, tissue, or blood […] Culturing, considered the criterion standard, requires the use of special media (buffered charcoal yeast extract [BCYE] agar with L-cysteine and ferric ions to support growth, antibiotics to prevent overgrowth of other organisms, and dyes to impart a distinctive color to the organisms). […] Specialized techniques may require 2-7 days to isolate Legionella organisms. Routine sputum cultures provide 80% sensitivity and 100% specificity. Culture from BAL specimens has a sensitivity of 90% or greater.

• #17 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  Currently 97% of clinical diagnoses are obtained using a urinary antigen test. These tests use monoclonal antibodies that specifically recognize most L. pneumophila serogroup 1 lipopolysaccharide antigens; they however, fail to detect disease caused by other serogroups of L. pneumophila or other species of Legionella. L. pneumophila serogroup 1 causes from 50 to 80% of Legionnaires disease; so as many as 20-50% of cases of Legionnaires disease remain undiagnosed if the urine antigen is used as the sole test for diagnosis. […] Culturing of patient specimens remains the gold standard for diagnoses of Legionnaires disease. Culture can identify all of the known Legionella species and serogroups. All known serogroups and species can be identified with culture. We found that the sensitivity for culture on selective media was 81% if culture was used as the gold standard.

• #18 Diagnosis of Legionnaires’ Disease | IDR

  https://www.dovepress.com/diagnosis-of-legionnaires-disease-assisted-by-next-generation-sequenci-peer-reviewed-fulltext-article-IDR

  Although research has shown that L. pneumophila serogroup 1, which can be detected by urine antigen tests, is responsible for most cases of Legionnaires disease, 20-50% of cases of Legionnaires disease would remain undiagnosed if no additional testing methods are used. […] In these years, next-generation sequencing technique is crucial for us to detect such pathogen like Legionella. It can be used to detect pathogen quickly and accurately than conventional detection tools, and it can bring advantage for diagnosis and therapy in clinical setting. […] The current study demonstrated that metagenomic is a promising approach that facilitated the diagnosis of Legionnaires disease. In this case, the use of metagenomic analysis as a diagnostic tool for Legionnaires disease resulted in a change of antibiotics and improvement of patients clinical symptoms.

• #19 Legionnaires Disease Workup: Approach Considerations, Histologic Findings, Laboratory Studies

  https://emedicine.medscape.com/article/220163-workup

  The gold standard for diagnosing Legionella infection is isolating the organism in respiratory secretions using specialized media like buffered charcoal yeast extract agar. […] The recommended diagnostic tests for Legionnaires’ disease are lower respiratory secretion culture and the Legionella urinary antigen test, with serological tests generally discouraged. […] While pre-antibiotic sputum sampling is ideal, treatment initiation should not be delayed. […] The urinary antigen test can detect Legionella post-treatment, primarily targeting Legionella pneumophila serogroup 1. […] Legionella can be isolated from blood, but it shows a much lower sensitivity. […] Polymerase chain reaction assay of urine, serum, and BAL fluid is very specific for the detection of Legionella, but the sensitivity is not greater than that of culture.

• #20 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  Legionnaires disease is commonly diagnosed clinically using a urinary antigen test. The urinary antigen test is highly accurate for L. pneumophila serogroup 1, however other diagnostic tests should also be utilized in conjunction with the urinary antigen as many other Legionella species and serogroups are pathogenic. Culturing of patient specimens remains the gold standard for diagnosis of Legionnaires disease. Selective media, BYCE with the addition of antibiotics, allows for a high sensitivity and specificity. Culturing can identify all species and serogroups of Legionella. A major benefit of culturing is that it provides the recovery of a patient isolate, which can be used to find an environmental match. Other diagnostic tests, including DFA and molecular tests such as PCR and LAMP, are useful tests to supplement culturing. Molecular tests provide much more rapid results in comparison to culture, however these tests should not be a primary diagnostic tool given their lower sensitivity and specificity in comparison to culturing. It is recommended that all laboratories develop the ability to culture patient specimens in-house with the selective media.

• #21 Legionella Culture | Test Detail | Quest Diagnostics

  https://testdirectory.questdiagnostics.com/test/test-detail/688/legionella-culture?p=r&cc=MASTER

  Legionella Culture – Bacteria in the genus Legionella primarily cause respiratory illness, i.e. either Legionnaires’ disease, a systemic illness manifested primarily by pneumonia, or Pontiac fever, a nonpneumonic, influenza-like illness. Legionellae may also cause a variety of other illnesses. […] Preferred Specimen(s) 1 gram lung tissue, fresh (unfixed) tissue or3 mL bronchial lavage/wash, or sputum, or bronchial alveolar lavage, or pleural fluid, or nasopharyngeal lavage/wash, or tracheal lavage/wash […] Minimum Volume 2 mL for bronchial washings, sputum, bronchial alveolar lavage, pleural fluid, nasopharyngeal lavage/wash or tracheal lavage/wash […] Collection Instructions Lung biopsy: Place lung biopsy into sterile container. Sputum: Instruct patient to gargle with water and cough deeply to collect deep respiratory specimen in sterile container. Aspirate: Place aspirate or washing into sterile container. Tissue: Add small amount of sterile, non-bacteriostatic, distilled water to prevent drying, if necessary. Do not add saline because it may be inhibitory.

• #22 Legionellosis (Legionnaires’ Disease) Task Force Recommendations | Texas DSHS

  https://www.dshs.texas.gov/legionellosis-legionnaires-disease/legionellosis-legionnaires-disease-task-force-recommendations

  Legionellosis is characterized by fever, myalgias, cough, and pneumonia. It cannot be distinguished clinically or radiographically from pneumonia caused by other agents, and evidence of infection with other respiratory pathogens does not rule out the possibility of concomitant Legionella infection. […] Laboratory tests used to diagnose Legionella infection are summarized in Table 1. The definitive method for diagnosis is culture of the organism. Culture requires use of a specialized panel of differential and selective media. Respiratory specimens are plated onto these media (buffered charcoal yeast extract agar [BCYE], BCYE/PVA [contains polymixin B, vancomycin, and anisomycin], and BCYE/PAC [contains polymixin B, anisomycin, and cefamandole]) and incubated at 35-37oC (95-98.6oF) for up to 14 days. The ideal specimens for culture are bronchial washings, bronchial lavages, or bronchial brushings. If a sputum is the only specimen that can be obtained, results are improved if the sample is pretreated with 0.2 M KCl/HCl solution (pH=2.2) for 4 minutes to decrease numbers of endogenous bacteria that can grow on the BCYE agar. In experienced hands, culture results can usually be obtained in 3 to 5 days.

• #23 Legionella Infection Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/965492-workup

  Sensitivity improves if urine samples are concentrated by ultrafiltration and obtained within 7 days of the onset of pneumonia. […] Test results may remain positive for weeks, even after appropriate antibiotic therapy. […] Gram stains and cultures of sputum, lower respiratory tract secretions, tissue, or blood […] Culturing, considered the criterion standard, requires the use of special media (buffered charcoal yeast extract [BCYE] agar with L-cysteine and ferric ions to support growth, antibiotics to prevent overgrowth of other organisms, and dyes to impart a distinctive color to the organisms). […] Specialized techniques may require 2-7 days to isolate Legionella organisms. Routine sputum cultures provide 80% sensitivity and 100% specificity. Culture from BAL specimens has a sensitivity of 90% or greater.

• #24 Legionella Infections – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-negative-bacilli/legionella-infections

  Diagnosis requires specific growth media, serologic or urine antigen testing, or polymerase chain reaction analysis. […] Direct fluorescent antibody staining of sputum or bronchoalveolar lavage fluid is occasionally used but requires expertise. In addition, PCR testing with DNA probing is available and may help identify transmission pathways. […] A urinary antigen test is 60 to 95% sensitive and 98% specific 3 days after symptom onset but detects only L. pneumophila serogroup 1, which accounts for 65% to 90% of cases. […] Diagnosis of legionnaires’ disease is by culture of sputum or bronchoalveolar lavage fluid has a sensitivity of 20 to 95% depending on the severity of illness; blood cultures are unreliable. Specific growth media are required. Slow growth on laboratory media may delay identification for 3 to 5 days. […] Diagnose using direct fluorescent antibody staining or polymerase chain reaction testing; sputum or bronchoalveolar lavage fluid cultures are accurate but may take 3 to 5 days.

• #25 Diagnostic Testing for Legionnaires Disease and Pontiac Fever

  https://legionellacontrol.com/legionella/diagnostic-testing-legionnaires-disease-pontiac-fever/

  On the other hand, while the culture option is quite sensitive, it takes around five days to grow. This means there is a period of waiting involved before a definitive result can be obtained. […] There are occasions when accurate testing for Legionnaires disease and Pontiac fever can actually help identify the source of the outbreak. In a sense, the tests completed, and their results, will help investigators locate the source and hopefully prevent other cases from occurring. […] Such diagnostic tests are also likely to become more refined and more accurate over time, but as of now, we have several methods that can be used to diagnose patients so they can receive appropriate treatment for Legionnaires disease or Pontiac fever.

• #26

  https://link.springer.com/article/10.1007/s40121-022-00635-7

  According to a 2019 European Centre for Disease Prevention and Control (ECDC) report, most cases in Europe (90%) are diagnosed using the urine antigen test (UAT) method. […] Culture of respiratory samples is still considered the gold standard for diagnosis of legionellosis, but it is a very demanding test requiring considerable expertise and growth for several days on complex media. […] The introduction in the late 1990s of enzyme immunoassays for the detection of Legionella pneumophila antigen in urine made it possible to speed up the diagnosis of Legionnaires disease. […] The antigen detected is a bacterial lipopolysaccharide (LPS), on whose diversity of structure and antigenicity the identification of Legionella pneumophila serogroups is based. […] The advantages of urinary antigen detection over other diagnostic methods are considerable.

• #27 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  Legionnaires disease is commonly diagnosed clinically using a urinary antigen test. The urinary antigen test is highly accurate for L. pneumophila serogroup 1, however other diagnostic tests should also be utilized in conjunction with the urinary antigen as many other Legionella species and serogroups are pathogenic. Culturing of patient specimens remains the gold standard for diagnosis of Legionnaires disease. Selective media, BYCE with the addition of antibiotics, allows for a high sensitivity and specificity. Culturing can identify all species and serogroups of Legionella. A major benefit of culturing is that it provides the recovery of a patient isolate, which can be used to find an environmental match. Other diagnostic tests, including DFA and molecular tests such as PCR and LAMP, are useful tests to supplement culturing. Molecular tests provide much more rapid results in comparison to culture, however these tests should not be a primary diagnostic tool given their lower sensitivity and specificity in comparison to culturing. It is recommended that all laboratories develop the ability to culture patient specimens in-house with the selective media.

• #28 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  The direct fluorescent antibody (DFA) is a rapid test that requires expertise. The sensitivity of DFA is about 70% for detection of L. pneumophila serogroup 1 with specificity approaching 99%. DFA can be used as a confirmatory test for suspected Legionella colonies isolated from culture. […] PCR and in situ hybridization have provided commercially available tools for a rapid diagnosis. Commercially-available kits for PCR/RT-PCR for respiratory tract specimens have sensitivities ranging from 17 to 100% and specificities ranging from 95 to 100%. Genus probes and L. pneumophila probes have been developed, but results rarely identify specific species or serogroups. PCR can be performed in a few hours, but laboratory expertise is required. PCR assays for detection of Legionella in environmental water sources are commercially available. False positive results may exist when using PCR because molecular tests can detect non-culturable Legionella. […] Given the advantages of rapidity of results, LAMP assays might be a supplement to culture. The cost per sample for LAMP is low relative to PCR because prior DNA extraction and thermal cycling equipment are unnecessary.

• #29

  https://link.springer.com/article/10.1007/s40121-022-00635-7

  In 2019, approximately 90% of reported cases in Europe were diagnosed by urinary antigen. […] PCR is a method that has the potential to detect all known Legionella species. […] Compared with UAT, PCR offers higher sensitivity. […] In Europe, the use of PCR seems to have remained quite restricted (10%) despite its many advantages.

• #30 Clinical and Laboratory Diagnosis of Legionella Pneumonia

  https://www.mdpi.com/2075-4418/13/2/280

  Each method has its own distinct advantages and limitations. Choosing the correct samples and detection techniques at the appropriate time can significantly improve diagnostic efficiency. […] Cultural isolation of Legionella from lower respiratory tract specimens remains the gold standard for LP diagnosis. […] However, the sensitivity of cultural isolation (60–80%) is unsatisfactory, which is related to the fastidious nature of Legionella. […] The urinary antigen test, which mainly targets lipopolysaccharide in the cell wall of Legionella pneumophila, is now widely used as a first-line screening method. […] The popularity of the UAT is attributed to its speed, low cost, relatively simple procedure, and ease of sample collection. […] The efficacy of serological detection in the early diagnosis of LP patients will be affected by the patient’s immune status, disease course, and other factors.

• #31 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  The direct fluorescent antibody (DFA) is a rapid test that requires expertise. The sensitivity of DFA is about 70% for detection of L. pneumophila serogroup 1 with specificity approaching 99%. DFA can be used as a confirmatory test for suspected Legionella colonies isolated from culture. […] PCR and in situ hybridization have provided commercially available tools for a rapid diagnosis. Commercially-available kits for PCR/RT-PCR for respiratory tract specimens have sensitivities ranging from 17 to 100% and specificities ranging from 95 to 100%. Genus probes and L. pneumophila probes have been developed, but results rarely identify specific species or serogroups. PCR can be performed in a few hours, but laboratory expertise is required. PCR assays for detection of Legionella in environmental water sources are commercially available. False positive results may exist when using PCR because molecular tests can detect non-culturable Legionella. […] Given the advantages of rapidity of results, LAMP assays might be a supplement to culture. The cost per sample for LAMP is low relative to PCR because prior DNA extraction and thermal cycling equipment are unnecessary.

• #32 Clinical and Laboratory Diagnosis of Legionella Pneumonia

  https://www.mdpi.com/2075-4418/13/2/280

  Collectively, the efficacy of serological detection in the early diagnosis of LP patients will be affected by the patient’s immune status, disease course, and other factors. […] mNGS has several limitations in clinical practice, including high cost, lack of uniform experimental standards, and so on. […] The clinical value of the identified pathogens should be determined by a combination of clinical presentation, laboratories, and the response to antibiotic therapy.

• #33 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  Legionnaires disease is commonly diagnosed clinically using a urinary antigen test. The urinary antigen test is highly accurate for L. pneumophila serogroup 1, however other diagnostic tests should also be utilized in conjunction with the urinary antigen as many other Legionella species and serogroups are pathogenic. Culturing of patient specimens remains the gold standard for diagnosis of Legionnaires disease. Selective media, BYCE with the addition of antibiotics, allows for a high sensitivity and specificity. Culturing can identify all species and serogroups of Legionella. A major benefit of culturing is that it provides the recovery of a patient isolate, which can be used to find an environmental match. Other diagnostic tests, including DFA and molecular tests such as PCR and LAMP, are useful tests to supplement culturing. Molecular tests provide much more rapid results in comparison to culture, however these tests should not be a primary diagnostic tool given their lower sensitivity and specificity in comparison to culturing. It is recommended that all laboratories develop the ability to culture patient specimens in-house with the selective media.

• #34 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  The direct fluorescent antibody (DFA) is a rapid test that requires expertise. The sensitivity of DFA is about 70% for detection of L. pneumophila serogroup 1 with specificity approaching 99%. DFA can be used as a confirmatory test for suspected Legionella colonies isolated from culture. […] PCR and in situ hybridization have provided commercially available tools for a rapid diagnosis. Commercially-available kits for PCR/RT-PCR for respiratory tract specimens have sensitivities ranging from 17 to 100% and specificities ranging from 95 to 100%. Genus probes and L. pneumophila probes have been developed, but results rarely identify specific species or serogroups. PCR can be performed in a few hours, but laboratory expertise is required. PCR assays for detection of Legionella in environmental water sources are commercially available. False positive results may exist when using PCR because molecular tests can detect non-culturable Legionella. […] Given the advantages of rapidity of results, LAMP assays might be a supplement to culture. The cost per sample for LAMP is low relative to PCR because prior DNA extraction and thermal cycling equipment are unnecessary.

• #35 Diagnostic testing for Legionnaires’ disease | Annals of Clinical Microbiology and Antimicrobials | Full Text

  https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-017-0229-6

  The direct fluorescent antibody (DFA) is a rapid test that requires expertise. The sensitivity of DFA is about 70% for detection of L. pneumophila serogroup 1 with specificity approaching 99%. DFA can be used as a confirmatory test for suspected Legionella colonies isolated from culture. […] PCR and in situ hybridization have provided commercially available tools for a rapid diagnosis. Commercially-available kits for PCR/RT-PCR for respiratory tract specimens have sensitivities ranging from 17 to 100% and specificities ranging from 95 to 100%. Genus probes and L. pneumophila probes have been developed, but results rarely identify specific species or serogroups. PCR can be performed in a few hours, but laboratory expertise is required. PCR assays for detection of Legionella in environmental water sources are commercially available. False positive results may exist when using PCR because molecular tests can detect non-culturable Legionella. […] Given the advantages of rapidity of results, LAMP assays might be a supplement to culture. The cost per sample for LAMP is low relative to PCR because prior DNA extraction and thermal cycling equipment are unnecessary.

• #36 Legionella Infection Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/965492-workup

  Direct fluorescent antibody staining for Legionella species […] DFA staining has a low sensitivity of 33-70%. […] A negative DFA result does not exclude Legionella infection. […] Serologic tests for Legionella antibodies […] Confirmation of legionellosis requires a 4-fold or greater rise in antibody titer in paired acute and convalescent indirect fluorescent antibody (IFA) tests obtained 4-8 weeks apart. […] A single elevated titer greater than 1:256 does not confirm a diagnosis of Legionnaires disease; titers of 1:256 or more are found in 1-16% of healthy adults and children. […] Polymerase chain reaction (PCR) test […] Although commercial kits are available, the test is not widely used. […] In adults, these assays appear highly specific but are no more sensitive than culture.

• #37

  https://journals.lww.com/infectdis/fulltext/2002/03000/legionnaires_disease__a_guide_to_diagnosis_and.20.aspx

  The authors review Legionnaires disease and the following summarizes their observations with emphasis on the issues that are most clinically important and controversial: […] Urinary antigen assay detects only L. pneumophila serogroup 1, but this accounts for 90% of cases acquired in the community, the test takes only 13 hours and reagents are available from two commercial sources. The test remains positive for months after infection and is not influenced by antibiotic treatment. This test is recommended by the authors for all patients hospitalized with CAP. […] Sputum culture requires selective media that is not widely used by most laboratories, requires 37 days for growth, and does not require the standard cytologic criteria of laboratories for sputum purulence as a contingency for culture.

• #38 Legionellosis (Legionnaires’ disease) | health.vic.gov.au

  https://www.health.vic.gov.au/infectious-diseases/legionellosis-legionnaires-disease

  Diagnosis is made by the observation of a fourfold increase in antibody titre between sera taken in the acute phase and during convalescence, 36 weeks after the first specimen. The 2 samples should be tested concurrently (in parallel). […] Culture for Legionella must be specifically requested if the illness is suspected. […] Culture is the gold standard and the only method by which human specimens can be compared with environmental samples. […] Detection of Legionella bacteria DNA in respiratory specimens, sterile site fluid, or fresh biopsy specimens using polymerase chain reaction (PCR) techniques is available in some laboratories.

• #39

  https://journals.lww.com/infectdis/fulltext/2002/03000/legionnaires_disease__a_guide_to_diagnosis_and.20.aspx

  DFA testing requires substantial microbiology expertise, sensitivity is relatively low, the test becomes negative after 46 days of antibiotic treatment, and specificity for L. pneumophila is nearly 100%. […] Serology shows seroconversion for IgM at 16 months and for IgG at 36 months; a single titer of 1:256 is presumptive evidence and a four-fold rise to 1:256 is probably more specific.

• #40 Legionnaires Disease Workup: Approach Considerations, Histologic Findings, Laboratory Studies

  https://emedicine.medscape.com/article/220163-workup

  The most widely used tests include the IFA and enzyme-linked immunosorbent assay (ELISA) tests. […] A single increased antibody titer confirms LD if the IFA titer is greater than or equal to 1:256. […] The Legionella lipopolysaccharide antigen is detected with ELISA, radioimmunoassay (RIA), and the latex agglutination test. […] The urinary antigen assay can be used to detect only L pneumophila (serogroup 1). […] The advantages of urinary antigen testing include rapidity and simplicity. […] Legionella infection almost always produces an abnormal chest radiographic finding, with the abnormalities typically being unilateral and occurring in the lower lobes. […] Bronchoscopy with or without bronchoalveolar lavage (BAL) may be helpful in establishing or excluding the diagnosis if respiratory culture specimens are difficult to obtain. […] If a pleural effusion is present, fluid can be evaluated using DFA or LD culture.

• #41 Legionnaires Disease Workup: Approach Considerations, Histologic Findings, Laboratory Studies

  https://emedicine.medscape.com/article/220163-workup

  The most widely used tests include the IFA and enzyme-linked immunosorbent assay (ELISA) tests. […] A single increased antibody titer confirms LD if the IFA titer is greater than or equal to 1:256. […] The Legionella lipopolysaccharide antigen is detected with ELISA, radioimmunoassay (RIA), and the latex agglutination test. […] The urinary antigen assay can be used to detect only L pneumophila (serogroup 1). […] The advantages of urinary antigen testing include rapidity and simplicity. […] Legionella infection almost always produces an abnormal chest radiographic finding, with the abnormalities typically being unilateral and occurring in the lower lobes. […] Bronchoscopy with or without bronchoalveolar lavage (BAL) may be helpful in establishing or excluding the diagnosis if respiratory culture specimens are difficult to obtain. […] If a pleural effusion is present, fluid can be evaluated using DFA or LD culture.

• #42 Legionnaires Disease Workup: Approach Considerations, Histologic Findings, Laboratory Studies

  https://emedicine.medscape.com/article/220163-workup

  For patients with pneumonia, the following indications justify testing for Legionnaires’ disease: […] It is crucial to conduct testing for healthcare-associated Legionnaires disease (LD) if any of the following conditions are found within a healthcare facility: […] Although pneumonias caused by numerous pathogens share similar laboratory findings, hyponatremia (sodium 130 mEq/L) secondary to the syndrome of inappropriate antidiuretic hormone (SIADH) is more common in LD than in pneumonias secondary to other pathogens; however, this is not specific for LD. […] Other nonspecific laboratory findings in LD include the following: […] Severe disease is defined by respiratory failure, bilateral pneumonia, rapidly worsening pulmonary infiltrates, or the presence of at least 2 of the following 3 characteristics:

• #43 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-and-treatment-of-Legionnaires-disease.aspx

  Legionnaires disease is caused by bacteria of the legionella species. […] Thus identification of the condition and early institution of therapy is vital to prevent death. […] All patients with pneumonia need to be screened and evaluated for legionella infection. The sputum, respiratory secretions, blood and urine samples are examined for the organism. […] Another test called the indirect immunofluorescent antibody test (IFAT) reveals L. pneumophillia infection by showing high rise of antibodies that the body prepares against the infective organism. […] Other tests like complete blood count reveals high white blood cell count, low sodium levels in blood, high blood levels of creatinine, low levels of enzyme Alkaline phosphatase etc. […] Drugs like Erythromycin, Azithromycin, Clarithromycin, and those like Ciprofloxacin, are often first line of drugs that are used in Legionnaires disease. […] Patients with risk factors like other long term illnesses like kidney or lung disease or diabetes are usually conditions that necessitate hospital admission.

• #44 Legionnaires Disease Workup: Approach Considerations, Histologic Findings, Laboratory Studies

  https://emedicine.medscape.com/article/220163-workup

  For patients with pneumonia, the following indications justify testing for Legionnaires’ disease: […] It is crucial to conduct testing for healthcare-associated Legionnaires disease (LD) if any of the following conditions are found within a healthcare facility: […] Although pneumonias caused by numerous pathogens share similar laboratory findings, hyponatremia (sodium 130 mEq/L) secondary to the syndrome of inappropriate antidiuretic hormone (SIADH) is more common in LD than in pneumonias secondary to other pathogens; however, this is not specific for LD. […] Other nonspecific laboratory findings in LD include the following: […] Severe disease is defined by respiratory failure, bilateral pneumonia, rapidly worsening pulmonary infiltrates, or the presence of at least 2 of the following 3 characteristics:

• #45 Legionella – Pontiac Fever and Legionnaires Disease | Choose the Right Test

  https://arupconsult.com/content/legionella-pneumophila

  Legionella is a bacterial disease caused by Legionella that can present as either Legionnaires disease or Pontiac fever. Legionnaires disease is a severe form of pneumonia that often requires hospitalization. […] Laboratory testing such as polymerase chain reaction (PCR), culture, and urinary antigen testing is used to diagnosis legionellosis. […] Laboratory testing for Legionnaires disease should be considered in patients who have pneumonia (often initially confirmed with a chest x-ray) and meet one or more of the following conditions: Lack of response to outpatient antibiotic treatment for community-acquired pneumonia, Severe pneumonia (particularly if intensive care is required), Immunocompromised status, History of recent travel (within 10 days of disease onset), Risk for Legionnaires disease with healthcare-associated pneumonia, Exposure to a setting with a Legionnaires disease outbreak.

• #46 Legionella-Legionnaires’ Disease and Pontiac Fever : Health Care Provider Information : Programs : Programs & Services : Two Rivers Public Health Department

  https://www.trphd.ne.gov/programs-services/programs/health-care-provider-information/legionella-legionnaires-disease-and-pontiac-fever.html

  Pneumonia caused by Legionella is clinically and radiologically similar to pneumonia caused by other pathogens. Symptoms of Legionnaires’ disease develop 2-10 days after exposure to the bacteria occurs. Multiple sources denote that fever, fatigue, cough, and shortness of breath are the most predominant symptoms of disease. […] The CDC notes the following indications for further testing for Legionnaires’ disease: Failure of antibiotic therapy for community-acquired pneumonia, Severe pneumonia requiring ICU admission, Immunocompromised patients with pneumonia, Travel history within the last 10 days of symptom onset, During disease outbreak, Healthcare-associated pneumonia. […] According to the CDC, best practice is to obtain both sputum culture and a urinary antigen test concurrently.

• #47 Severe Legionnaires’ disease | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01252-y

  Legionnaires disease (LD) is a common but under-diagnosed cause of community-acquired pneumonia (CAP), although rapid detection of urine antigen testing (UAT) and advances in molecular testing have improved the diagnosis. […] LD diagnostic methods have improved due to the broad use of UAT and the development of molecular methods allowing the detection of all Lp serogroups. […] The Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS) recommend performing UAT for Legionella antigen only in adults with severe CAP (i.e., patients with septic shock, respiratory failure requiring mechanical ventilation, or with three minor severity criteria) or when CAP is associated with a Legionella outbreak or recent travel. […] Two methods are of major interest for the early diagnosis of LD: urine antigen detection and molecular study (polymerase chain reaction: PCR) in respiratory specimens. Urine antigen tests (UATs) account for 70-80% of cases diagnosed in Europe and the US, making them the first-line diagnostic test for LD. […] The detection of Legionella DNA by PCR from respiratory tract samples has been increasingly used over the last 10 years. […] Culture of lower respiratory tract specimens is considered the gold standard for LD diagnosis.

• #48 Laboratory Testing for Legionella | Legionella | CDC

  https://www.cdc.gov/legionella/php/laboratories/index.html

  Clinical laboratories can provide diagnostic testing for Legionella infections using culture, serology, or molecular methods. […] CDC recommends culture and Legionella urinary antigen testing (UAT) together for diagnosis of Legionnaires’ disease. […] The preferred diagnostic tests for Legionnaires’ disease are both of the following paired together: Culture of lower respiratory secretions and Legionella UAT. […] Culturing specimens is important to enable detection of all species and serogroups of Legionella. […] The UAT is the most commonly used laboratory test for diagnosis of Legionnaires disease. […] Best practice is to obtain both lower respiratory culture and urine concurrently. […] Laboratories shouldn’t reject lower respiratory specimens for these reasons when working-up Legionnaires’ disease because Legionella can often be recovered.

• #49 Legionella-Legionnaires’ Disease and Pontiac Fever : Health Care Provider Information : Programs : Programs & Services : Two Rivers Public Health Department

  https://www.trphd.ne.gov/programs-services/programs/health-care-provider-information/legionella-legionnaires-disease-and-pontiac-fever.html

  Pneumonia caused by Legionella is clinically and radiologically similar to pneumonia caused by other pathogens. Symptoms of Legionnaires’ disease develop 2-10 days after exposure to the bacteria occurs. Multiple sources denote that fever, fatigue, cough, and shortness of breath are the most predominant symptoms of disease. […] The CDC notes the following indications for further testing for Legionnaires’ disease: Failure of antibiotic therapy for community-acquired pneumonia, Severe pneumonia requiring ICU admission, Immunocompromised patients with pneumonia, Travel history within the last 10 days of symptom onset, During disease outbreak, Healthcare-associated pneumonia. […] According to the CDC, best practice is to obtain both sputum culture and a urinary antigen test concurrently.

• #50 Legionnaires Disease Workup: Approach Considerations, Histologic Findings, Laboratory Studies

  https://emedicine.medscape.com/article/220163-workup

  The gold standard for diagnosing Legionella infection is isolating the organism in respiratory secretions using specialized media like buffered charcoal yeast extract agar. […] The recommended diagnostic tests for Legionnaires’ disease are lower respiratory secretion culture and the Legionella urinary antigen test, with serological tests generally discouraged. […] While pre-antibiotic sputum sampling is ideal, treatment initiation should not be delayed. […] The urinary antigen test can detect Legionella post-treatment, primarily targeting Legionella pneumophila serogroup 1. […] Legionella can be isolated from blood, but it shows a much lower sensitivity. […] Polymerase chain reaction assay of urine, serum, and BAL fluid is very specific for the detection of Legionella, but the sensitivity is not greater than that of culture.

• #51 Legionella Outbreak Toolbox

  https://legionnaires.ecdc.europa.eu/?pid=109

  The true incidence of Legionnaires’ Disease in Europe is unknown, but it is believed to be a lot higher than the number of cases reported. There are several reasons why Legionnaires’ disease is underreported and underdiagnosed: […] Because Legionnaires’ disease is an uncommon form of pneumonia, with no particular clinical features that clearly distinguish it from other types of pneumonia, the identification of Legionnaires’ disease is reliant upon clinicians including Legionnaires’ disease in the differential diagnosis and requesting the appropriate investigations. […] When a patient is diagnosed with pneumonia, treatment is generally started immediately. If the patient is treated with antibiotics that are effective against Legionella, the patient usually recovers, without further need to establish the cause of the pneumonia. […] A small proportion of the diagnostic methods for Legionnaires’ disease lack sensitivity and may result in producing false negative results. […] The most commonly used method of diagnosis – urinary antigen detection, primarily detects Legionella pneumophila serogroup 1 infections. Infections due to other serogroups or other species, therefore, may not be detected by this method. […] Patients with a serious underlying disease involving immunosuppression are particularly at risk from Legionnaires’ disease. If these patients die, death may be attributed to their serious condition, without diagnosing the Legionella infection. […] Milder cases of Legionnaires’ disease may not be suspected and remain undiagnosed, since the disease is considered to be severe. […] Cases of travel-associated infection may be diagnosed in some countries but not forwarded to the national collaborator in the European surveillance scheme.

• #52 Legionnaires’ Disease: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/legionnaires-disease-pro

  LD must be in the differential diagnosis for any community-acquired pneumonia. Even with a high degree of watchfulness it is thought that up to 90% of cases are missed. […] The antibiotic of choice is erythromycin although gastrointestinal upset from the disease and the tendency of this drug to do the same may make it less attractive. Azithromycin, clarithromycin, levofloxacin, ciprofloxacin and doxycycline are excellent alternatives. […] Most patients with LD are admitted to hospital, as intensive treatment is usually needed.

• #53 Legionnaires’ Disease: Update on Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9124264/

  According to a 2019 European Centre for Disease Prevention and Control (ECDC) report, most cases in Europe (90%) are diagnosed using the urine antigen test (UAT) method. […] The introduction in the late 1990s of enzyme immunoassays for the detection of L. pneumophila antigen in urine made it possible to speed up the diagnosis of Legionnaires disease. […] The advantages of urinary antigen detection over other diagnostic methods are considerable. […] PCR is a method that has the potential to detect all known Legionella species. […] The literature on the association between the time of the onset of therapy and the prognosis in Legionnaires disease is scarce. […] These findings indicate that it is necessary to test for Legionella spp. at the time of hospital admission in severe CAP and to decide promptly whether to withdraw or continue antibiotic treatment according to the test results.

• #54 Legionnaires’ disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legionnaires-disease/symptoms-causes/syc-20351747

  Legionnaires’ disease is a severe form of a lung infection called pneumonia. It’s caused by a bacterium known as legionella. […] Diagnosing and treating Legionnaires’ disease as soon as possible can help shorten the time it takes to recover and prevent serious complications. […] Treating right away with antibiotics most often cures Legionnaires’ disease. But some people still have problems after treatment. […] Outbreaks of Legionnaires’ disease can be prevented by monitoring and cleaning water systems.

• #55

  https://www.who.int/news-room/fact-sheets/detail/legionellosis

  Legionnaires disease has an incubation period of 2 to 10 days (but up to 16 days has been recorded in some outbreaks). […] Treatments exist, but there is currently no vaccine available for Legionnaires’ disease. […] Delay in diagnosis and administration of appropriate antibiotic treatment, increasing age and presence of co-existing diseases are predictors of death from Legionnaires disease. […] Patients with Legionnaires disease always require antibiotic treatment following diagnosis.

• #56 Legionellosis (Legionnaires’ disease) | health.vic.gov.au

  https://www.health.vic.gov.au/infectious-diseases/legionellosis-legionnaires-disease

  Legionellosis is an urgent notifiable condition that must be notified immediately to the Department of Health by medical practitioners and pathology services. […] Legionellosis is an urgent notifiable condition and must be notified by medical practitioners and pathology services immediately by telephone upon initial diagnosis (presumptive or confirmed). Pathology services must follow up with written notification within 5 days. This is a Victorian statutory requirement. […] Methods of diagnosis for Legionella infection include urinary antigen testing, serology, culture and nucleic acid testing. […] Legionella urinary antigen testing is rapid and sensitive, but most tests in use only detect the most common serogroup, L. pneumophila serogroup 1. […] Positive Legionella antibody results (both IgG and IgM) are common in healthy adult populations.

• #57 Legionnaires’ Disease Factsheet for GPs – Health Protection Surveillance Centre

  https://www.hpsc.ie/a-z/respiratory/legionellosis/factsheet/legionnairesdiseasefactsheetforgps/

  Legionnaires disease is also diagnosed by undertaking culture or a PCR test on sputum samples. […] Please consult your local laboratory for information on sending specimens for Legionella investigations. […] Legionnaires disease is a statutorily notifiable disease. […] This suggests that under-diagnosis and thus, under-reporting of Legionnaires disease currently exists in Ireland. […] Delay of appropriate therapy can result in poor outcome and notification of a case can lead to detection of environmental sources and prevention of further cases.

• #58 Diagnosis of Legionnaires’ Disease | IDR

  https://www.dovepress.com/diagnosis-of-legionnaires-disease-assisted-by-next-generation-sequenci-peer-reviewed-fulltext-article-IDR

  Although research has shown that L. pneumophila serogroup 1, which can be detected by urine antigen tests, is responsible for most cases of Legionnaires disease, 20-50% of cases of Legionnaires disease would remain undiagnosed if no additional testing methods are used. […] In these years, next-generation sequencing technique is crucial for us to detect such pathogen like Legionella. It can be used to detect pathogen quickly and accurately than conventional detection tools, and it can bring advantage for diagnosis and therapy in clinical setting. […] The current study demonstrated that metagenomic is a promising approach that facilitated the diagnosis of Legionnaires disease. In this case, the use of metagenomic analysis as a diagnostic tool for Legionnaires disease resulted in a change of antibiotics and improvement of patients clinical symptoms.

• #59 Clinical and Laboratory Diagnosis of Legionella Pneumonia

  https://www.mdpi.com/2075-4418/13/2/280

  The diagnosis of LP relies on the integration of epidemiological features, clinical manifestations, radiological findings, and laboratory tests. Rapid clinical presumptions based on clinical assessment and epidemiological features will prevent missed diagnoses and reduce mortality. […] Considering that current diagnostic technologies are insufficient to meet the clinical needs of timeliness and accuracy, various methods have been developed to diagnose LP rapidly and accurately. […] In summary, when the above clinical and epidemiological features appear in the elderly, immunosuppressed individuals or those combined with multiple underlying diseases, clinicians should be highly vigilant and actively screen for LP. […] Pathogenetic testing is the most critical step for an accurate diagnosis and targeted treatment of LP. Various pathogenetic detection techniques based on different samples have been applied to confirm Legionella, including cultural isolation, serological assays, urinary antigen test (UAT), mass spectrometry (MS), polymerase chain reaction (PCR), Loop-mediated isothermal amplification (LAMP), and metagenomic next-generation sequencing (mNGS).

• #60 Legionellosis Diagnosis and Control in the Genomic Era

  https://www.caister.com/legionellosis

  Current diagnostic tools such as the urinary antigen test are biased towards detection of L. pneumophila serogroup 1 and increases the likelihood of cases caused by Legionella species being under or mis-diagnosed. […] Therefore, the true incidence of legionellosis cases caused by non-L. pneumophila species is probably under reported. […] This chapter discusses the typing of Legionella isolates and with emphasis on the new and advantageous genome-based methods.

• #61

  https://smw.ch/index.php/smw/article/view/3190

  BACKGROUND: The number of reported cases of Legionnaires’ disease has increased significantly over the last decade in Switzerland and abroad. […] Yet, while there are numerous guidelines and recommendations for the case management of community-acquired pneumonia, little is known about how physicians in Switzerland perceive and manage Legionnaires’ disease. […] The Legionella urine antigen test (UAT) was reported to be routinely performed in inpatients. […] The value of the diagnostic tests in general and the Legionella UAT in particular was considered to be dependent on the (preferred) antibiotic treatment approach. […] Improved diagnostic tools are needed to support physicians in reducing underestimation of Legionnaires’ disease and optimise antibiotic stewardship without compromising patient health outcomes.

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