Evaluation of sensitivity of two serological tests for diagnosing pneumonia caused by Legionella pneumophila serogroup 1.

Harrison, T G; Dournon, E; Taylor, A. G.

doi:10.1136/jcp.40.1.77

Cited by 29 publications

(11 citation statements)

References 8 publications

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“…The sensitivity of the RMAT was 63 % in a study evaluating sera from 119 patients with LD using a positive culture for L. pneumophila or its presence shown by direct fluorescence antibody as the gold standard (Harrison et al, 1987). The substantially higher sensitivity of the RMAT assay found in that study (63 versus 44 % in our study) is difficult to explain.…”

Section: Resultscontrasting

confidence: 50%

“…A different strain of L. pneumophila serogroup 1 was used, but the influence of different strains on RMAT sensitivity is unknown. There was a difference in the timing of the first serum sample (0-28 days after disease onset in the study of Harrison et al, 1987), but late sampling tends to underestimate the sensitivity. There were differences in study population: higher clinical severity, higher mortality, and over 50 % immunocompromised patients in the study of Harrison et al (1987).…”

Section: Resultsmentioning

confidence: 99%

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Sensitivity of three serum antibody tests in a large outbreak of Legionnaires' disease in the Netherlands

Yzerman

Boer

Lettinga

et al. 2006

Journal of Medical Microbiology

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In 1999, an outbreak involving 188 patients with Legionnaires' disease (LD) occurred at a flower show in the Netherlands. This large outbreak provided the opportunity to evaluate serum antibody tests to assay anti-Legionella pneumophila, since limited data are available on the sensitivity of these tests. The sensitivities of an indirect serotype 1-6 immunofluorescence antibody test (IFAT), a rapid micro-agglutination test (RMAT) IgM serotype 1 antibody assay, and an ELISA to detect IgM and IgG serotype 1-7 antibodies, were evaluated using serum samples from LD patients related to the 1999 outbreak. Sensitivity was calculated using positive culture and/or a positive urinary antigen test as the gold standard in outbreak-related patients with radiographically confirmed pneumonia who fulfilled the epidemiological criteria. The IFAT, RMAT and ELISA showed sensitivities of 61, 44 and 64 %, respectively. The sensitivity of the three tests combined was 67 %. In epidemic situations, however, high standing titres may be included in the laboratory evidence of LD cases. In the study population, high standing titres were found in 16 % of cases. If the presence of high standing antibody titres was added to the criteria of a positive test, the sensitivities of IFAT, RMAT and ELISA were 86, 48 and 75 %, respectively. The sensitivity was 91 % for all tests combined. The higher sensitivity for the combined use of tests is offset by a reduction in specificity to 97?6 %. The results of this study indicate that using a combination of serologic tests in pneumonia patients suspected to have LD does not substantially improve sensitivity. The results suggest that in the microbiological diagnosis of LD, both IFAT and ELISA are reasonably sensitive assays. In an epidemic situation, both tests are highly sensitive, the IFAT more so than the ELISA.

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Section: Resultscontrasting

confidence: 50%

Section: Resultsmentioning

confidence: 99%

Sensitivity of three serum antibody tests in a large outbreak of Legionnaires' disease in the Netherlands

Yzerman

Boer

Lettinga

et al. 2006

Journal of Medical Microbiology

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“…The IFA test used a swine anti-human pan-immunoglobulin, containing IgM and IgG (Nordic Immunologicals), to detect any Legionella-specific antibodies in serum. The negative cases may represent the small number of LD cases described previously in immunocompromised and immunocompetent patients where no antibody response was produced or detected (Harrison et al, 1987;McWhinney et al, 2000).…”

Section: Antibody Responsementioning

confidence: 99%

Laboratory diagnosis of legionnaires’ disease due to Legionella pneumophila serogroup 1: comparison of phenotypic and genotypic methods

Lindsay

Abraham

Findlay

et al. 2004

Journal of Medical Microbiology

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Laboratory results of 67 cases of legionnaires' disease caused by Legionella pneumophila 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 culturepositives 5-10 days after onset of disease. A Legionella-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 Legionella species causing infection requires to be verified by IFA serology and/or culture, but this could become unnecessary as new antigen and L. pneumophila Sg 1-specific PCR tests become available.

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“…These rapid urine antigen tests have sensitivities between 60% and 85% (5,6,11,14). Serological diagnosis is also commonly used, and a sensitivity of 80% has been reported (8). However, a diagnosis by a fourfold immunoglobulin G (IgG) titer increase can only be made retrospectively, and in 25% of patients no IgG titer increase is observed (8).…”

mentioning

confidence: 99%

Development and Clinical Evaluation of an Internally Controlled, Single-Tube Multiplex Real-Time PCR Assay for Detection of Legionella pneumophila and Other Legionella Species

Templeton

Scheltinga

Sillekens³

et al. 2003

J Clin Microbiol

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A multiplex real-time PCR assay for detection of Legionella pneumophila and Legionella spp. and including an internal control was designed. Legionella species, L. pneumophila, and the internal control were detected simultaneously by probes labeled with 6-carboxy-fluorescein, hexachlorofluorescein, and indodicarbocyanine, respectively. Therefore, no postamplification analysis was required in order to distinguish the targets. The sensitivity of both assays was 2.5 CFU/ml, and from analysis of 10 culture-positive and 74 culture-negative samples from patients investigated for legionellosis, 100% agreement was observed by both assays in comparison to culture. Four additional positives were found by the multiplex real-time PCR assay in the Legionella culture-negative samples.

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Evaluation of sensitivity of two serological tests for diagnosing pneumonia caused by Legionella pneumophila serogroup 1.

Cited by 29 publications

References 8 publications

Sensitivity of three serum antibody tests in a large outbreak of Legionnaires' disease in the Netherlands

Sensitivity of three serum antibody tests in a large outbreak of Legionnaires' disease in the Netherlands

Laboratory diagnosis of legionnaires’ disease due to Legionella pneumophila serogroup 1: comparison of phenotypic and genotypic methods

Development and Clinical Evaluation of an Internally Controlled, Single-Tube Multiplex Real-Time PCR Assay for Detection of Legionella pneumophila and Other Legionella Species

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