Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection.

Birtles, Richard J.; Harrison, T G; Samuel, Dhanraj; Taylor, A. G.

doi:10.1136/jcp.43.8.685

Cited by 67 publications

(46 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since then, numerous publications have followed that confirmed the value of urinary antigen detection for the diagnosis of Legionnaires' disease, regardless of the technical configuration of the test (1,3,7,8,(18)(19)(20). Based on prospective and retrospective studies using data from solitary cases, moderate to high urinary antigen test sensitivities have been described.…”

Section: Discussionmentioning

confidence: 99%

“…The reported sensitivities of both enzyme immunoassay (EIA) and immunochromatographic test (ICT) show great variation: 50 to 90% (3,7,8,19). These variations may be explained by differences in patient characteristics, the serogroup with which the patient is infected, the timing of collection the urine sample in the course of illness, and whether the urine is concentrated before testing.…”

Section: Legionnaires' Disease (Ld) Is An Acute Pneumonia Caused Bymentioning

confidence: 99%

See 1 more Smart Citation

Sensitivity of Three Urinary Antigen Tests Associated with Clinical Severity in a Large Outbreak of Legionnaires' Disease in The Netherlands

et al. 2002

View full text Add to dashboard Cite

In 1999 an outbreak involving 188 patients with Legionnaires' disease (LD) occurred among visitors to a flower show in the Netherlands. Two enzyme immunoassays (Binax and Biotest) and one immunochromatographic assay (Binax NOW) were tested, using urine samples from LD patients from the 1999 outbreak. Sensitivity was calculated using positive culture and/or seroconversion as the "gold standard" in outbreakrelated patients with radiographically confirmed pneumonia who fulfilled the epidemiological critera. The Binax EIA, Biotest EIA, and Binax NOW assay showed overall sensitivities of 69, 71, and 72%, respectively. When the tests were performed with concentrated urine samples, the overall sensitivities increased to 79, 74, and 81%, respectively. Using multiple logistic regression analysis with backward elimination, a statistically significant association was found between clinical severity and test sensitivity for all tests. For patients with mild LD, the test sensitivities ranged from 40 to 53%, whereas for patients with severe LD who needed immediate special medical care, the sensitivities reached 88 to 100%. These findings have major implications for the diagnostic process in patients with mild pneumonia and suggest that patients with mild pneumonia may go underdiagnosed if urine antigen tests alone are used. Legionnaires' disease (LD) is an acute pneumonia caused byLegionella, a rod-shaped gram-negative bacillus ubiquitous in (man-made) aquatic reservoirs. Currently 43 Legionella species and 65 serogroups have been described. In the United States, over 90% of Legionnaires' disease cases are caused by Legionella pneumophila, of which 70% of strains belong to serogroup type 1 (16). Legionella spp. are responsible for 1 to 5% of cases of community-acquired pneumonia (CAP) (5). Clinically and radiographically, LD cannot be distinguished from pneumonias caused by other microbial pathogens. Because of the high mortality rate in patients with LD requiring hospitalization, early diagnosis to enable adequate antimicrobial treatment is potentially life-saving. Diagnosis of LD in patients with symptomatic pneumonia is based on culture, serologic testing, or antigen detection in urine. Isolation of Legionella from respiratory secretions is not a very sensitive diagnostic test (25 to 75% sensitivity) (15) and has the disadvantage of delay, because a positive result is not available until at least 3 days of incubation. Seroconversion is a diagnostic test with a high sensitivity and a high (serogroup-dependant) specificity, but it is of limited clinical value since it may take up to 9 weeks for patients to develop detectable antibodies (10, 13).In contrast to the other tests mentioned above, urinary antigen tests combine reasonable sensitivity and high specificity with rapid results. The reported sensitivities of both enzyme immunoassay (EIA) and immunochromatographic test (ICT) show great variation: 50 to 90% (3,7,8,19). These variations may be explained by differences in patient characteristics, the serogroup with which th...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Legionnaires' Disease (Ld) Is An Acute Pneumonia Caused Bymentioning

confidence: 99%

Sensitivity of Three Urinary Antigen Tests Associated with Clinical Severity in a Large Outbreak of Legionnaires' Disease in The Netherlands

et al. 2002

View full text Add to dashboard Cite

show abstract

“…Based on prospective and retrospective studies with data from solitary cases, moderate to high urinary antigen test sensitivities have been described, ranging from 56 to 99% (2,5,6,8,13). This may be explained by differences in test and patient characteristics, the serogroup with which the patient is infected, the timing of specimen collection in the course of the illness, and whether the urine is concentrated before it is tested.…”

mentioning

confidence: 99%

Evaluation of Two New Immunochromatographic Assays (Rapid U Legionella Antigen Test and SD Bioline Legionella Antigen Test) for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine

Diederen

Peeters

2006

J Clin Microbiol

View full text Add to dashboard Cite

We evaluated two new immunochromatographic assays for their abilities to detect Legionella pneumophila serogroup 1 antigen in urine. The results were compared with those obtained by the Binax NOW urinary antigen test. The sensitivities and specificities were estimated to be 71.2% and 96.6%, respectively, for the Rapid U test; 31.5% and 98.9%, respectively, for the SD Bioline test; and 91.8% and 100%, respectively, for the Binax NOW test.Legionnaires' disease (LD) is a pneumonia responsible for 1 to 5% of cases of community-acquired pneumonia (CAP) requiring hospital admission (3,15). Legionella pneumophila causes 91% of all reported cases of LD, with serogroup 1 being the most predominant serogroup, causing approximately 80% of all culture-confirmed cases (12). However, this percentage is found to be lower in some European countries (10). Since antigen detection in urine has proved to be a sensitive and rapid method for the detection of L. pneumophila serogroup 1, this technique has become one of the most-used tools for the diagnosis of LD (10). An immunochromatographic (ICT) assay (the Binax NOW legionella urinary antigen test) that has a sensitivity and a specificity similar to those of enzyme immunoassays (EIAs) has been developed (4). ICT assays have important advantages over conventional EIAs: the tests are simple to perform, they do not require special laboratory equipment, and results can be obtained within 15 min.The aim of our study was to evaluate two newly developed ICT urine antigen tests, the Rapid U Legionella antigen test (Rapid U test; Diamondial, Sees, France) and the SD Bioline Legionella urinary antigen test (SD Bioline test; Standard Diagnostics, Inc., Kyonggi-do, Korea), for the detection of L. pneumophila serogroup 1 in urine. Neither test is yet commercially available.We evaluated the abilities of the new antigen tests to diagnose LD in a well-described sample of patients with and without LD using frozen urine samples. Urine samples were collected between 1997 and 2005 and were stored at Ϫ70°C until processing was performed. We included 73 urine samples from 73 patients with LD (cases). A case of LD was defined as a patient with pneumonia who had radiological signs of infiltration and who showed laboratory evidence of infection with L. pneumophila. One or more of the following criteria constituted laboratory evidence of infection with L. pneumophila: isolation of L. pneumophila from a lower respiratory tract (LRT) sample, a positive PCR result with an LRT sample by a 16S rRNAbased assay (16), or seroconversion to positivity for immunoglobulin M (IgM) and/or IgG antibodies to L. pneumophila in paired acute-phase and convalescent-phase sera by a commercial enzyme-linked immunosorbent assay

show abstract

“…Urinary antigen testing to detect Legionella antigen has proven the most powerful diagnostic method (4,5,15,16,18,22,24), and the commercially available tests have been widely used. However, the main drawback to the available urinary antigen tests is that they only detect the soluble antigen of L. pneumophila serogroup 1 but do not efficiently detect L. pneumophila non-serogroup 1 and other Legionella species (2,12).…”

Section: Discussionmentioning

confidence: 99%

“…Over the intervening years, Legionella urinary antigen detection methods using the techniques of enzyme immunoassay (EIA) and radioimmunoassay have been extensively studied and have proven to be the most powerful diagnostic methods (4,5,18,22,24). The specificity for these tests has been reported to be 100%, and the sensitivity has been shown to vary between 70 and 100% (15).…”

mentioning

confidence: 99%

Characterization of a Lipoprotein Common to Legionella Species as a Urinary Broad-Spectrum Antigen for Diagnosis of Legionnaires' Disease

Park¹,

Park²,

Chun

2003

J Clin Microbiol

View full text Add to dashboard Cite

We have previously identified the Legionella 19-kDa peptidoglycan-associated lipoprotein (PAL) as a speciescommon immunodominant antigen. We describe here for the first time the excretion and detection of the PAL antigen in infected urine specimens, which is useful for the diagnosis of Legionnaires' disease. Rabbit anti-PAL immunoglobulin G (IgG) antibody was produced by immunization with the purified, recombinant PAL of Legionella pneumophila serogroup 1 and used in the PAL antigen capture enzyme-linked immunosorbent assay (ELISA) to detect urinary PAL antigen. A soluble-antigen capture ELISA using rabbit IgG antibodies against Legionella soluble antigens was prepared independently and used as a broad-spectrum standard test to detect soluble antigens of several Legionella species. Urine samples were obtained from guinea pigs experimentally infected with each of L. pneumophila serogroups 1, 3, and 6, and other Legionella species. The absorbance values of the PAL antigen ELISA highly correlated with those of the soluble-antigen ELISA in infected urine samples, with a correlation coefficient of 0.84 (P < 0.01). When applied to 17 infected urine samples and 67 negative controls from guinea pigs, the sensitivity and specificity of the PAL antigen capture ELISA were 88.2 and 95.5%, respectively. Compared to the commercial Biotest enzyme immunoassay, the PAL antigen ELISA was more efficient for detecting pneumophila non-serogroup 1 and nonpneumophila species. None of the 161 control human urine specimens obtained from healthy adults and patients with either non-Legionella pneumonia or urinary tract infections tested positive in the PAL antigen ELISA. The present study shows that the Legionella PAL is a very useful broad-spectrum antigen for urinary diagnostic testing. Moreover, since recombinant PAL antigen can be produced more efficiently than the soluble antigens, the development of a broad-spectrum diagnostic immunoassay based on the detection of the PAL antigen appears to be warranted.

show abstract

Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection.

Abstract: The enzyme linked immunosorbent assay (ELISA) described was developed to detect a soluble antigen in the urine of

Cited by 67 publications

References 15 publications

Sensitivity of Three Urinary Antigen Tests Associated with Clinical Severity in a Large Outbreak of Legionnaires' Disease in The Netherlands

Sensitivity of Three Urinary Antigen Tests Associated with Clinical Severity in a Large Outbreak of Legionnaires' Disease in The Netherlands

Evaluation of Two New Immunochromatographic Assays (Rapid U Legionella Antigen Test and SD Bioline Legionella Antigen Test) for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine

Characterization of a Lipoprotein Common to Legionella Species as a Urinary Broad-Spectrum Antigen for Diagnosis of Legionnaires' Disease

Contact Info

Product

Resources

About