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

Yzerman, Ed P. F.; Boer, Jeroen W. Den; Lettinga, Kamilla D.; Schel, Arnoud J.; Schellekens, J. F. P.; Peeters, Marcel

doi:10.1099/jmm.0.46369-0

Cited by 11 publications

(11 citation statements)

References 19 publications

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“…However, the results were more similar for the high standing titre definition (73% vs. 86% in IFA and 68% vs. 75% in ELISA). Early sampling may lead to higher sensitivity; in our study, the mean time from disease onset to sampling of the acute-phase sera was 11 days (range 5 – 15) compared with 8 days (range 0 – 15) in the Dutch study [ 18 ]. This suggested that seroconversion may already have occurred, especially for IgM antibodies [ 31 ].…”

Section: Discussionmentioning

confidence: 64%

“…Evaluation of the serological assays (Table 1 ) demonstrated lower sensitivity than Yzerman et al [ 18 ] reported with LD patients from the large Dutch outbreak with the same assays, especially for the ≥4-fold IFA-titre rise (38% vs. 61%) and ELISA seroconversion (30% vs. 64%). However, the results were more similar for the high standing titre definition (73% vs. 86% in IFA and 68% vs. 75% in ELISA).…”

Section: Discussionmentioning

confidence: 83%

“…As the aim of that study was mainly to identify the source of the outbreak, probable cases were not included. In the present investigation, sera from the laboratory confirmed LD cases were used to evaluate two commercial serological assays against L. pneumophila, which previously had been evaluated in one study only [ 18 ]. Based on the sensitivities and specificities obtained in our evaluation, the tests were then employed to measure antibody levels in sera from all CAP patients, who were referred to the local hospital during the outbreak.…”

Section: Introductionmentioning

confidence: 99%

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Characterization of the extent of a large outbreak of Legionnaires’ disease by serological assays

et al. 2015

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Background: In May 2005, a long-distance outbreak of Legionnaires' disease (LD) caused by Legionella pneumophila serogroup 1 occurred in south-east Norway. The initial outbreak investigation without serology identified 56 laboratory-confirmed LD cases of whom 10 died. However, 116 patients with community-acquired pneumonia might belong to the outbreak based on epidemiological investigations, but acute laboratory tests other than serology were negative or not performed. To assess the true extent of the outbreak, we evaluated two serological assays in order to reclassify the 116 patients with indeterminate case status. Methods: Two polyvalent antibody tests, a serogroup 1-6 immunofluorescence assay (IFA) and a serogroup 1-7 enzyme-linked immunosorbent assay (ELISA) were used. They were evaluated with cases defined as culture-or urinary antigen positive LD patients (n = 40) and non-cases defined as confirmed non-LD patients (n = 39) and healthy control subjects (n = 62). The 116 patients, who were negative in culture, polymerase chain reaction and/or urinary antigen tests, were analysed by the same serological assays. Antibodies to the outbreak strain were determined by immunoblotting. Results: In the evaluation study, the sensitivity and specificity of a ≥4-fold IFA titre change was 38% and 100%, respectively, with corresponding values of 30% and 99% for seroconversion in ELISA. A single high positive IFA titre yielded sensitivity and specificity of 73% and 97%, respectively, with corresponding values of 68% and 96% for a single high immunoglobulin (Ig) G and/or IgM in ELISA. Based on this evaluation, the following serological testing identified 47 more LD cases, and the outbreak thus comprised 103 cases with a case fatality rate of 10%. About the same proportion (70%) of the urinary antigen positive and negative LD cases had antibodies to the serogroup-specific lipopolysaccharide of the outbreak strain. In addition to the 103 LD cases, Legionella infection could not be verified or excluded in 32 patients based on epidemiology and/or lack of microbiological sampling. Conclusions: The acute-phase tests (culture, polymerase chain reaction, and urinary antigen) identified less than 55% of the 103 patients in this outbreak. Serological testing thus remains an important supplement for diagnosis of LD and for determination of outbreak cases.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Characterization of the extent of a large outbreak of Legionnaires’ disease by serological assays

et al. 2015

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“…Legionella antibody tests have a sensitivity of 61-64% depending on the assay applied and also do not substantially improve the diagnosis of legionellosis (Yzerman et al, 2006). Serologic tests can never offer an early diagnosis and are therefore rather an epidemiological than a diagnostic tool.…”

Section: Reevaluation Of Serological Testsmentioning

confidence: 99%

Currently used nucleic acid amplification tests for the detection of viruses and atypicals in acute respiratory infections

Ieven

2007

Journal of Clinical Virology

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For the detection of respiratory viruses conventional culture techniques are still considered as the gold standard. However, results are mostly available too late to have an impact on patient management. The latest developments include appropriate DNA- and RNA-based amplification techniques (both NASBA and PCR) for the detection of an extended number of agents responsible for LRTI. Real time amplification, the latest technical progress, produces, within a considerable shorter time, results with a lower risk of false positives. As results can be obtained within the same day, patient management with appropriate therapy or reduction of unnecessary antibiotic therapy in LRTI will be possible. A number of technical aspects of these amplification assays, and their advantages are discussed. The availability and use of these new diagnostic tools in virology has contributed to a better understanding of the role of respiratory viruses in LRTI. The increasing importance of the viral agents, Mycoplasma pneumoniae and Chlamydophila pneumoniae in ARI is illustrated. A great proportion of ARI are caused by viruses, but their relative importance depends on the spectrum of agents covered by the diagnostic techniques and on the populations studied, the geographical location and the season. The discovery of new viruses is ongoing; examples are the hMPV and the increasing number of coronaviruses. Indications for the use of these rapid techniques in different clinical situations are discussed. Depending on the possibilities, the laboratory could optimize its diagnostic strategy by applying a combination of immunofluorescence for the detection of RSV an IFL, and a combination of real-time amplification tests for other respiratory viruses and the atypical agents. When implementing a strategy, a compromise between sensitivity, clinical utility, turn around time and cost will have to be found.

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“…4 Legionnaires' pneumonia is caused by Legionella species which are responsible for 2-55% of CAP. 5 Legionella pneumophila (92%) is the most common cause of Legionnaires' disease. Majority of clinical strains are serogroup1 isolates of L. Pneumophila.…”

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confidence: 99%

Prevalence of Atypical Bacterial Pneumonia in Patients Presenting With Lower Respiratory Tract Infections at a Tertiary Care Centre

K¹,

Sowjanya²,

P³

2017

jemds

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BACKGROUND A number of different viral, bacterial, fungal and protozoan organisms can cause atypical pneumonia; the three most common are Chlamydia pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae. Atypical pneumonias are by far the most underdiagnosed and underreported clinical entities, and very few studies have been reported in India. This study was conducted from March 2015 to September 2015 to determine the seroprevalence of M. pneumoniae, Chlamydia pneumoniae and Legionella pneumophila antibodies in patients with lower respiratory tract infections, and to compare IgM ELISA with that of the Sanger sequencing. Sequencing proved to be one of the rapid, sensitive and specific method of diagnosis in these cases. MATERIALS AND METHODS This cross sectional hospital based study was done at Government General and Chest Hospital, Erragadda, Hyderabad. The study population included 90 patients attending outpatient department and admitted as inpatients between March 2015 to September 2015 with a high probability of atypical pneumonia based on clinical symptoms and signs like fever, cough, dyspnoea, headache. Crepitations and presence of new pulmonary infiltrates on chest x-ray, in cases like COPD with acute exacerbation, bronchial asthma with acute exacerbation and Community-acquired pneumonia cases. Sputum and serum samples collected from each patient. 90 blood samples collected were subjected to ELISA to detect IgM antibody (EUROIMMUN) for Chlamydia pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae. The sputum samples showing no pathogenic organisms (NPO) were subjected to PCR for amplification of V3 region of 16 SMA followed by Sanger sequencing. RESULTS 17 cases were positive for IgM antibodies for atypical bacteria and 8 cases were positive by Sanger sequencing. The common presenting symptoms were cough, fever, chest pain, dyspnoea and headache. More number of cases were detected in Communityacquired pneumonia patients followed by COPD and bronchial asthma with acute exacerbation. CONCLUSION IgM ELISA having correlated clinically with reasonable sensitivity could be a useful tool in diagnosing atypical pneumonia caused by L. pneumophila, M. pneumoniae and C pneumoniae. Sanger sequencing in comparisons of low sensitivity although highly specific can be recommended for application in discriminating species and not for diagnosis from sputum samples.

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

Cited by 11 publications

References 19 publications

Characterization of the extent of a large outbreak of Legionnaires’ disease by serological assays

Characterization of the extent of a large outbreak of Legionnaires’ disease by serological assays

Currently used nucleic acid amplification tests for the detection of viruses and atypicals in acute respiratory infections

Prevalence of Atypical Bacterial Pneumonia in Patients Presenting With Lower Respiratory Tract Infections at a Tertiary Care Centre

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