Nosocomial Legionella micdadei pneumonia: 10 years experience and a case-control study

Doebbeling, Bradley N.; Ishak, Magued; Wade, Barbara H.; Pasquale, Michael A.; Gerszten, Robert E.; Gröschel, D; Kadner, Robert J.; Wenzel, Richard P.

doi:10.1016/0195-6701(89)90010-8

Cited by 27 publications

(7 citation statements)

References 41 publications

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“…that causes LD in the United States and Europe but not in Asia and Australia (60). LD from non-pneumophila Legionella species is more common in immunocompromised patients, and L. pneumophila serogroups other than serogroup 1 can cause nosocomial outbreaks of LD (61,62). In such cases, the UA might provide false-negative results.…”

Section: Discussionmentioning

confidence: 97%

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

et al. 2016

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bThe diagnosis of Legionnaires' disease (LD) is based on the isolation of Legionella spp., a 4-fold rise in antibodies, a positive urinary antigen (UA), or direct immunofluorescence tests. PCR is not accepted as a diagnostic tool for LD. This systematic review assesses the diagnostic accuracy of PCR in various clinical samples with a direct comparison versus UA. We included prospective or retrospective cohort and case-control studies. Studies were included if they used the Centers for Disease Control and Prevention consensus definition criteria of LD or a similar one, assessed only patients with clinical pneumonia, and reported data for all true-positive, false-positive, true-negative, and false-negative results. Two reviewers abstracted data independently. Risk of bias was assessed using Quadas-2. Summary sensitivity and specificity values were estimated using a bivariate model and reported with a 95% confidence interval (CI). Thirty-eight studies were included. A total of 653 patients had confirmed LD, and 3,593 patients had pneumonia due to other pathogens. The methodological quality of the studies as assessed by the Quadas-2 tool was poor to fair. The summary sensitivity and specificity values for diagnosis of LD in respiratory samples were 97.4% (95% CI, 91.1% to 99.2%) and 98.6% (95% CI, 97.4% to 99.3%), respectively. These results were mainly unchanged by any covariates tested and subgroup analysis. The diagnostic performance of PCR in respiratory samples was much better than that of UA. Compared to UA, PCR in respiratory samples (especially in sputum samples or swabs) revealed a significant advantage in sensitivity and an additional diagnosis of 18% to 30% of LD cases. The diagnostic performance of PCR in respiratory samples was excellent and preferable to that of the UA. Results were independent on the covariate tested. PCR in respiratory samples should be regarded as a valid tool for the diagnosis of LD.) is a life-threatening pulmonary infection. The most common species causing clinical disease in humans is Legionella pneumophila (1). In addition to L. pneumophila, 19 species are documented as human pathogens on the basis of their isolation from clinical specimens (2). LD can affect people both in the community (3) and in the hospital and, in both settings, can occur in outbreaks (4, 5). The true incidence of LD is difficult to assess, because the bacterial etiology for community-acquired pneumonia (CAP) is generally not documented in clinical practice. LD cannot be differentiated clinically or radiographically from CAP caused by other bacterial pathogens (6). As Legionella spp. are obligatory intracellular bacteria, they are unaffected by beta-lactam antibiotics and require specific treatment with high-dose quinolones or macrolides (7). Treatment providing coverage against Legionella spp. has been shown to improve clinical success (8). Thus, early diagnosis of LD is important and can have an effect on both public health and management in hospitals (9, 10).Conventional methods for the diagnosis of LD ...

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Section: Discussionmentioning

confidence: 97%

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

et al. 2016

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“…1617 Hence, to link a particular environmental isolate with individual cases, clusters, or epidemics, microbiologists must evaluate the isolates further, using methods such as plasmid or chromosomal DNA analysis, monoclonal antibody typing, or lipopolysaccharide or membrane protein electrophoresis. [18][19][20][21][22] Pulsed-field gel electrophoresis (PFGE) of chromosomal DNA allows investigators to differentiate strains of various nosocomial pathogens. 2325 Investigators have used this tool to study Legionella infections, 2627 but no one has used PFGE to describe both the epidemiology of legionnaires' pneumonia in a hospital and the epidemiology of L pneumophila in the hospital's water supply over a long period of time.…”

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confidence: 99%

Persistence ofLegionella Pneumophilain a Hospital's Water System: A 13-Year Survey

Ms¹,

Rhomberg

et al. 1999

Infect. Control Hosp. Epidemiol.

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“…Among cases investigated by the U.S. CDC between 1980 and 1989 from which an isolate was recovered from a clinical specimen, approximately 10% were caused by species other than L. pneumophila (Marston et al, 1994). L. micdadei and L. bozemanii are frequently isolated during LD in immunocompromised patients (Doebbeling et al, 1989; Fang et al, 1989; Humphreys et al, 1992; Knirsch et al, 2000; McNally et al, 2000; Parry et al, 1985). L. longbeachae was the predominant Legionella species identified among patients with severe pneumonia in Thailand in 2004 (Phares et al, 2007) and is reported as a cause of LD as often as L. pneumophila in Australia (Group NARW, 2013; Yu et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Simultaneous detection of Legionella species and L. anisa , L. bozemanii , L. longbeachae and L. micdadei using conserved primers and multiple probes in a multiplex real-time PCR assay

Cross

Mercante

Benitez

et al. 2016

Diagnostic Microbiology and Infectious Disease

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Legionnaires’ disease is a severe respiratory disease that is estimated to cause between 8,000 and 18,000 hospitalizations each year, though the exact burden is unknown due to under-utilization of diagnostic testing. Although Legionella pneumophila is the most common species detected in clinical cases (80–90%), other species have also been reported to cause disease. However, little is known about Legionnaires’ disease caused by these non-pneumophila species. We designed a multiplex real-time PCR assay for detection of all Legionella spp. and simultaneous specific identification of four clinically-relevant Legionella species, L. anisa, L. bozemanii, L. longbeachae, and L. micdadei, using 5′-hydrolysis probe real-time PCR. The analytical sensitivity for detection of nucleic acid from each target species was ≤50 fg per reaction. We demonstrated the utility of this assay in spiked human sputum specimens. This assay could serve as a tool for understanding the scope and impact of non-pneumophila Legionella species in human disease.

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Nosocomial Legionella micdadei pneumonia: 10 years experience and a case-control study

Cited by 27 publications

References 41 publications

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review

Persistence ofLegionella Pneumophilain a Hospital's Water System: A 13-Year Survey

Simultaneous detection of Legionella species and L. anisa , L. bozemanii , L. longbeachae and L. micdadei using conserved primers and multiple probes in a multiplex real-time PCR assay

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