Evaluation of Four Lateral Flow Assays for the Detection of Legionella Urinary Antigen

Wong, Alicia Yoke Wei; Johnsson, Alexander T A; Iversen, Aina; Athlin, Simon; Özenci, Volkan

doi:10.3390/microorganisms9030493

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…We previously reported various aspects of user friendliness of the BinaxNOW, Immu-View, Sofia, and STANDARD F Legionella UATs that are also applicable to this study [16]. Regarding the time to result of the assays, the immunochromatographic-based assays had longer time to result as compared to the immunofluorescent-based assays due to more assay setup procedures as well as longer incubation time.…”

Section: Discussionmentioning

confidence: 76%

Comparison of Four Streptococcus pneumoniae Urinary Antigen Tests Using Automated Readers

et al. 2021

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Streptococcus pneumoniae urinary antigen tests (UATs) may be interpreted using automatic readers to potentially automate sample incubation and provide standardized results reading. Here, we evaluated four UATs the BinaxNOW S. pneumoniae Antigen Card (Abbott, Chicago, USA), ImmuView S. pneumoniae and Legionella (SSI Diagnostica, Hillerød, Denmark), STANDARD F S. pneumoniae Ag FIA (SD Biosensor, Gyeonggi, South Korea), and Sofia S. pneumoniae FIA (Quidel Corporation, San Diego, USA) with their respective benchtop readers for their ability to detect S. pneumoniae urinary antigen. We found that these assays had a sensitivity of 76.9–86.5%, and specificity of 84.2–89.7%, with no significant difference found among the four UATs. The assays had a high level of agreement with each other, with 84.5% of samples testing consistently across all four assays. The automatically and visually read test results from the two immunochromatographic assays, BinaxNOW and ImmuView, were compared and showed excellent agreement between the two types of reading. Immunofluorescent-based assays, Sofia and STANDARD F, had significantly less time to detect compared to the two immunochromatographic assays due to having less assay setup procedures and shorter sample incubation times. In conclusion, the four UATs performed similarly in the detection of S. pneumoniae urinary antigen, and readers can bring increased flexibility to running UATs in the clinical routine.

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Section: Discussionmentioning

confidence: 76%

Comparison of Four Streptococcus pneumoniae Urinary Antigen Tests Using Automated Readers

et al. 2021

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“…Immunochromatography-based urinary antigen tests like the BinaxNOW Legionella Antigen Card (Abbott, USA) and ImmuView S. pneumoniae and L. pneumophila assays (SSD, Denmark) produce a visible result for interpretation, while fluorescent immunoassay (FIA)-based urinary antigen tests like the Sofia Legionella FIA (Quidel, San Diego) and STANDARD F Legionella FIA (SD Biosensor, South Korea) require an automated reader for interpretation. 63 All available Legionella UATs detect L. pneumophila serogroup 1 in urine samples of patients with Legionnaire’s disease. 18 This subtype is responsible for 80–95% of community-acquired legionellosis in the United States and Europe, but only approximately 50% of cases in Australia and New Zealand.…”

Section: Urinary Antigen Test For the Diagnosis Of Legionel...mentioning

confidence: 99%

“…The vast majority of Legionella UATs are only able to detect L. pneumophila serogroup 1. 63 , 70 While L. pneumophila serogroup 1 accounts for over 80–95% of legionellosis cases in most of the US and Europe, other species and serotypes predominate in certain areas like the southern and Pacific United States, New Zealand, and Australia. 29 , 64 , 71 Given that there are 58 different Legionella species and over 70 serogroups, the usefulness of Legionella UAT thus decreases as the prevalence of serogroup 1 decreases.…”

Section: Urinary Antigen Test For the Diagnosis Of Legionel...mentioning

confidence: 99%

“… 2 Comparisons between the different commercially available Legionella urinary antigen tests have shown that immunochromatography- and fluorescent immunoassay-based UATs perform very similarly to each other. 63 One meta-analysis of 30 studies yielded a pooled sensitivity of 74.0% (95% CI, 68–81%) and a specificity of 99.1% (95% CI, 98.4–99.7%). 73 The authors note that the poor quality of included studies and presence of publication bias may have led to an overestimation of the pooled estimates.…”

Section: Urinary Antigen Test For the Diagnosis Of Legionel...mentioning

confidence: 99%

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Urinary Antigen Testing for Respiratory Infections: Current Perspectives on Utility and Limitations

Kim¹,

Deshpande²,

Rothberg³

2022

IDR

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Pneumonia is a leading cause of hospitalization and death due to infection worldwide. Streptococcus pneumoniae and Legionella pneumophila remain among the most commonly identified bacterial pathogens. Unfortunately, more than half of all pneumonia cases today lack an etiologic diagnosis due to limitations in traditional microbiological methods like blood and sputum cultures, which are affected by poor sample collection, prior antibiotic administration, and delayed processing. Urinary antigen tests (UATs) for S. pneumoniae and L. pneumophila have emerged as powerful tools for improving the diagnosis of bacterial respiratory infections, enabling physicians to administer early directed therapy and improve antimicrobial stewardship. UATs are simple, rapid, and non-invasive diagnostic tests with high specificity (>90%) and moderate sensitivity (<80%). The potential impact of urinary antigen testing is especially significant for respiratory infections caused by Legionella . While all recommended community-acquired pneumonia (CAP) therapies are adequate for treating pneumococcal pneumonia, only certain antibiotics are effective against Legionella . Delayed therapy for Legionella is associated with worse clinical outcomes, which underscores the importance of rapid diagnostic methods like UATs. Despite their potential impact, current American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) guidelines argue against the routine use of urinary antigen testing for S. pneumoniae and L. pneumophila , except in patients with severe CAP and those with epidemiological risk factors for Legionella . Further research is necessary to evaluate the impact of early targeted treatment due to positive UAT results, as well as optimal strategies for UAT utilization. The purpose of this review is to summarize the UATs available for bacterial respiratory infections, describe current guidelines on their usage, and assess their impact on clinical outcomes and targeted therapy.

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“…The urinary antigen test (UAT) is a fast and non-invasive diagnostic method, but most of the commercial tests are highly specific only for Lp Sg1, and few of these tests show a cross-reactivity with the other serogroups (Helbig et al, 2001 ; Svarrer et al, 2012 ; Wong et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Use of Fourier-Transform Infrared Spectroscopy With IR Biotyper® System for Legionella pneumophila Serogroups Identification

et al. 2022

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Legionella spp. are Gram-negative bacteria that inhabit freshwater environments representing a serious risk for human health. Legionella pneumophila (Lp) is the species most frequently responsible for a severe pneumonia known as Legionnaires' disease. Lp consists of 15 serogroups (Sgs), usually identified by monoclonal or polyclonal antibodies. With regard to Lp serogrouping, it is well known that phenotyping methods do not have a sufficiently high discriminating power, while genotypic methods although very effective, are expensive and laborious. Recently, mass spectrometry and infrared spectroscopy have proved to be rapid and successful approaches for the microbial identification and typing. Different biomolecules (e.g., lipopolysaccharides) adsorb infrared radiation originating from a specific microbial fingerprint. The development of a classification system based on the intra-species identification features allows a rapid and reliable typing of strains for diagnostic and epidemiological purposes. The aim of the study was the evaluation of Fourier Transform Infrared Spectroscopy using the IR Biotyper® system (Bruker Daltonik, Germany) for the identification of Lp at the serogroup (Sg) level for diagnostic purposes as well as in outbreak events. A large dataset of Lp isolates (n = 133) and ATCC reference strains representing the 15 Lp serogroups were included. The discriminatory power of the instrument's classifier, was tested by Principal Component Analysis (PCA) and Linear Discriminant Analysis (LDA). All isolates were classified as follows: 12/133 (9.0%) as Lp Sg1 and 115/133 (86.5%) as Lp Sg 2–15 (including both ATCC and environmental Lp serogroup). Moreover, a mis-classification for 2/133 (1.5%) isolates of Lp Sg 2–15 that returned as Lp Sg1 was observed, and 4/133 (3.0%) isolates were not classified. An accuracy of 95.49% and an error rate of 4.51% were calculated. IR Biotyper® is able provide a quick and cost-effective reliable Lp classification with advantages compared with agglutination tests that show ambiguous and unspecific results. Further studies including a larger number of isolates could be useful to implement the classifier obtaining a robust and reliable tool for the routine Lp serogrouping. IR Biotyper® could be a powerful and easy-to-use tool to identify Lp Sgs, especially during cluster/outbreak investigations, to trace the source of the infection and promptly adopt preventive and control strategies.

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Evaluation of Four Lateral Flow Assays for the Detection of Legionella Urinary Antigen

Cited by 8 publications

References 14 publications

Comparison of Four Streptococcus pneumoniae Urinary Antigen Tests Using Automated Readers

Comparison of Four Streptococcus pneumoniae Urinary Antigen Tests Using Automated Readers

Urinary Antigen Testing for Respiratory Infections: Current Perspectives on Utility and Limitations

Use of Fourier-Transform Infrared Spectroscopy With IR Biotyper® System for Legionella pneumophila Serogroups Identification

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