Prevalence and Diagnosis of Legionella Pneumonia: A 3-Year Prospective Study with Emphasis on Application of Urinary Antigen Detection

Ruf, B.; Schürmann, Dirk; Horbach, I; Fehrenbach, F. J.; Pohle, H. D.

doi:10.1093/infdis/162.6.1341

Cited by 88 publications

(52 citation statements)

References 37 publications

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“…Currently, there are several commercially available tests (the Binax Legionella urinary antigen enzyme immunoassay [EIA], the Biotest Legionella urine antigen EIA, and the Binax NOW Legionella urinary antigen immunochromatographic test [ICT]) for the detection of L. pneumophila antigen in urine. All of these tests have been previously evaluated, confirming their utility for the diagnosis of Legionnaires' disease (6,12). A wider range of sensitivity has been reported, however, although no research has demonstrated significant differences in sensitivity between these tests.…”

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confidence: 79%

Comparison of Diagnostic Sensitivities of Three Assays (Bartels Enzyme Immunoassay [EIA], Biotest EIA, and Binax NOW Immunochromatographic Test) for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine

et al. 2004

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The Bartels enzyme immunoassay (EIA), Biotest EIA, and Binax NOW immunochromatographic test (ICT) urinary antigen kits for the detection of Legionella pneumophila serogroup 1 were compared using 178 frozen urine samples. When nonconcentrated urine samples were used, the sensitivity levels of both enzyme EIAs were significantly higher than the sensitivity level of the ICT (Bartels EIA, 71.3%; Biotest EIA, 65.1%; Binax NOW ICT, 37% [P < 0.001]). After concentration of the urine samples, no significant differences in sensitivity were found among the three tests.Laboratory diagnosis of Legionella pneumophila infection is performed on the basis of the results of culture growth, direct immunofluorescence, serologic testing, and antigen detection in urine. Since antigen detection in urine has proved to be a sensitive and rapid method for detecting L. pneumophila serogroup 1, this technique has become one of the most used tools for the diagnosis of Legionnaires' disease. The urinary antigen test permits early diagnosis and initiation of appropriate antibiotic therapy (9), and it leads to the recognition of outbreaks of Legionnaires' disease, allowing a rapid epidemiological investigation (10, 11, 13). Currently, there are several commercially available tests (the Binax Legionella urinary antigen enzyme immunoassay [EIA], the Biotest Legionella urine antigen EIA, and the Binax NOW Legionella urinary antigen immunochromatographic test [ICT]) for the detection of L. pneumophila antigen in urine. All of these tests have been previously evaluated, confirming their utility for the diagnosis of Legionnaires' disease (6,12). A wider range of sensitivity has been reported, however, although no research has demonstrated significant differences in sensitivity between these tests. Recently a new EIA (Bartels Legionella Urinary Antigen) for the detection of L. pneumophila serogroup 1 antigen in urine has been developed. We evaluated this new test by comparing its sensitivity to that of two widely used tests: the Biotest EIA and the Binax NOW ICT.A total of 178 urine specimens (obtained from patients with Legionnaires' disease during an outbreak which occurred in Murcia, Spain, in July 2001) were included in the study. The samples were from patients who fulfilled the epidemiological criteria, suffered from symptoms compatible with pneumonia, and showed radiological signs of infiltration and for whom Legionnaires' disease was confirmed either by culture (defined as isolation of L. pneumophila serogroup 1 from respiratory specimens) or serology (defined as a fourfold increase in L. pneumophila serogroup 1 antibody titer in paired sera or, in patients with clinically compatible illness, a high [Ն 256] stationary titer value).During the outbreak, nonconcentrated urine samples were tested within a few hours after receipt by using Biotest EIA (182 were positive and 47 were negative); the samples were then frozen at Ϫ80°C. Samples were retested simultaneously using the Biotest Legionella urine antigen EIA (Biotest AG, Dreieich, Germany), Bi...

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confidence: 79%

Comparison of Diagnostic Sensitivities of Three Assays (Bartels Enzyme Immunoassay [EIA], Biotest EIA, and Binax NOW Immunochromatographic Test) for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine

et al. 2004

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“…These data emphasise the high speci®city of Legionella urinary antigen assays that was found with the Binax and Biotest EIA [9,18]. Published sensitivity data for Legionella urinary antigen assays have so far related only to cultureproven cases in general and have not discriminated between serogroups or MAb subgroups [2,6,18,19]. This is largely due to the fact that infections caused by L. pneumophila serogroups 2±15 and some MAb subgroups of serogroup 1 occur only very rarely [12, 20±22].…”

Section: Detection Of Legionella Antigens In Urine Samples From Patiementioning

confidence: 99%

“…The outcome of patients with Legionnaires' disease depends on the speed with which a diagnosis can be established and the initiation of appropriate therapy [1,2]. Urinary antigen detection for the diagnosis of Legionnaires' disease has several advantages compared with other methods.…”

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confidence: 99%

Detection of Legionella pneumophila antigen in urine samples by the BinaxNOW immunochromatographic assay and comparison with both Binax Legionella Urinary Enzyme Immunoassay (EIA) and Biotest Legionella Urin Antigen EIA

Helbig¹,

Uldum

Lück

et al. 2001

Journal of Medical Microbiology

144

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The new BinaxNOW Immunochromatographic (ICT) Assay for the detection of Legionella pneumophila antigens was used to test 535 urine specimens from patients with and without Legionnaires' disease. The speci®city, calculated by testing 112 samples from patients with pneumonia of aetiologies other than Legionella infection, and 167 urine specimens from urinary tract infections, was found to be 97.1% if the manufacturer's guidelines were followed. However, it was determined that the`false positive' results characterised by very weak bands could be discounted by reexamination of the results at 60 min, yielding a speci®city of 100%. With this minor modi®cation of the procedure applied to examination of urine samples from 117 patients with legionellosis con®rmed by isolation of L. pneumophila and 70 patients who had seroconverted to L. pneumophila serogroup 1, sensitivity was calculated to be 79.7%. In comparison, the sensitivities of the Binax Urinary Antigen Enzyme Immunoassay (EIA) and Biotest Urin Antigen EIA were estimated to be 79.1 and 83.4%, respectively. Eleven cases (5.9%) were positive by BinaxNOW assay but negative by Binax or Biotest EIA, or both. The sensitivities of all assays increased to c. 94% if only diagnosis of cases con®rmed by isolation of serogroup 1 L. pneumophila was considered, although the sensitivity for infections caused by L. pneumophila serogroup 1 monoclonal antibody (MAb) subgroup Bellingham was signi®cantly lower than for other MAb subgroups. The Biotest EIA recognised 10 (45%) of the 22 cases not caused by L. pneumophila serogroup 1, whereas the two Binax kits detected only three each. The ICT assay BinaxNOW can be recommended as a rapid speci®c test for the diagnosis of Legionnaires' diseases caused by L. pneumophila serogroup 1, although very weak bands should be interpreted cautiously.

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“…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.…”

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

et al. 2002

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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...

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Prevalence and Diagnosis of Legionella Pneumonia: A 3-Year Prospective Study with Emphasis on Application of Urinary Antigen Detection

Cited by 88 publications

References 37 publications

Comparison of Diagnostic Sensitivities of Three Assays (Bartels Enzyme Immunoassay [EIA], Biotest EIA, and Binax NOW Immunochromatographic Test) for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine

Comparison of Diagnostic Sensitivities of Three Assays (Bartels Enzyme Immunoassay [EIA], Biotest EIA, and Binax NOW Immunochromatographic Test) for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine

Detection of Legionella pneumophila antigen in urine samples by the BinaxNOW immunochromatographic assay and comparison with both Binax Legionella Urinary Enzyme Immunoassay (EIA) and Biotest Legionella Urin Antigen EIA

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

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