What is the risk of missing legionellosis relying on urinary antigen testing solely? A retrospective Belgian multicenter study

Muyldermans, Astrid; Descheemaeker, Patrick; Boel, An; Desmet, Stefanie; Gasse, Natasja Van

doi:10.1007/s10096-019-03785-8

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…In Slovenia, the use of PCR testing has slightly increased in recent years; however, it is still low, which is probably due to the fact that Legionella patients hardly produce productive coughs. In a large retrospective Belgian (Flemish) multicenter study, the added value of PCR on a respiratory specimen was compared to UATs for the diagnosis of legionellosis: 37.5% (15/40) of infections of L. pneumophila were missed when UATs were performed as the sole diagnostic test [ 24 ]. Another factor that may also contribute to a more difficult diagnosis of LD by UATs is a higher prevalence of non- L. pneumophila in patients with nosocomial infection or in highly immunosuppressed patients [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Legionella pneumophila—Epidemiology and Characterization of Clinical Isolates, Slovenia, 2006–2020

et al. 2021

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Legionella pneumophila is the causative agent of severe Legionnaires’ disease (LD). Although an increasing number of LD cases have been observed, published data from Slovenia are very limited and data on molecular epidemiology are even scarcer. The present retrospective study (2006–2020) reports the results of the microbiological diagnosis of LD, as well as the epidemiology and characterization of the Legionella clinical isolates. We tested urine samples from 15,540 patients with pneumonia symptoms for L. pneumophila infection by urine antigen test, of which 717 (4.6%) tested positive. Isolation of L. pneumophila was successfully performed from 88 clinical specimens, with 82 (93.2%) being identified as L. pneumophila sg 1 and six (6.8%) as L. pneumophila sg 2–14. Sequence-based typing (SBT) identified 33 different sequence types (STs), the most frequent being ST1 and ST23. Sequence type 1 mainly comprised isolates belonging to the Philadelphia subgroup, and ST23 mostly to Allentown/France. The standard SBT scheme, as well as Dresden phenotyping for L. pneumophila, presented a high diversity among isolates.

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Section: Discussionmentioning

confidence: 99%

Legionella pneumophila—Epidemiology and Characterization of Clinical Isolates, Slovenia, 2006–2020

et al. 2021

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“…More than 80% of LD cases in Denmark are diagnosed by PCR [ 3 , 20 ], likely increasing the relative prevalence of non-SG1 cases, which makes comparison with other countries challenging as many countries rely on L. pneumophila urinary antigen tests that mainly detect SG1 and may underestimate the real disease burden of Legionella [ 59 , 60 , 61 ]. A combination of high DHW colonization rates, high test intensity (on average, 300 to 400 persons per 100,000 are investigated each year) and use of PCR as the main diagnostic method for LD might explain the high notification rate of LD in Denmark [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

A Tale of Four Danish Cities: Legionella pneumophila Diversity in Domestic Hot Water and Spatial Variations in Disease Incidence

Uldum

Schjoldager²,

Baig

et al. 2022

IJERPH

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Denmark has one of the highest Legionnaires’ disease notification rates within Europe, averaging 4.7 cases per 100,000 population annually (2017 to 2020). The relatively high incidence of disease is not uniform across the country, and approximately 70% of all domestically acquired cases in Denmark are caused by Legionella pneumophila (LP) strains that are considered less virulent. The aim of this study was to investigate if colonization rates, levels of colonization, and/or types of LP present in hot water systems were associated with geographic differences in Legionnaires’ disease incidence. Domestic water systems from four cities in Denmark were analyzed via culture and qPCR. Serogrouping and sequence typing was performed on randomly selected isolates. Single nucleotide polymorphism was used to identify clonal relationship among isolates from the four cities. The results revealed a high LP colonization rate from 68% to 87.5% among systems, composed primarily of non-serogroup 1. LP serogroup 1 reacting with the monoclonal antibody (MAb) 3/1 was not identified in any of the systems tested, while MAb 3/1 negative serogroup 1 strains were isolated from 10 systems (9.6%). We hypothesize that a combination of factors influences the incidence rate of LD in each city, including sequence type and serogroup distribution, colonization rate, concentration of Legionella in Pre-flush and Flush samples, and potentially building characteristics such as water temperature measured at the point of use.

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“…In fact, we wrongly ruled out legionellosis after the negative UAT and we were more concerned about resistant bacteria. Clinicians should be aware of the limitations of the Legionella UAT (it can miss a third of patients with a positive PCR from respiratory specimens [13] ) and consider using PCR on respiratory tract specimens in patients with atypical pneumonia and negative UAT. Also, in severe CAP there should always be empirical coverage for atypical bacteria with a macrolide, a quinolone or a tetracycline since a delay in appropriate treatment can worsen the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Septic shock due to co-infection with Legionella pneumophila and Saprochaete clavata

Caldas

Silva‐Pinto

Faustino

et al. 2022

IDCases

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Septic shock is the most dreaded presentation of an infection, carrying a reserved prognosis. Appropriate antimicrobial therapy is therefore the mainstay of treatment, alongside organ support as needed. Legionnaires’ disease is mainly due to Legionella pneumophila serogroup 1 but it can be caused by other serogroups and species not detected by the urinary antigen test. Anti-tumour necrosis factor α therapy may increase the risk of invasive fungal infection, which carry a poor prognosis. We present a challenging case of a septic shock due to Legionella pneumophila and Saprochaete clavata infections, with a review of the two infections presented.

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What is the risk of missing legionellosis relying on urinary antigen testing solely? A retrospective Belgian multicenter study

Cited by 14 publications

References 12 publications

Legionella pneumophila—Epidemiology and Characterization of Clinical Isolates, Slovenia, 2006–2020

Legionella pneumophila—Epidemiology and Characterization of Clinical Isolates, Slovenia, 2006–2020

A Tale of Four Danish Cities: Legionella pneumophila Diversity in Domestic Hot Water and Spatial Variations in Disease Incidence

Septic shock due to co-infection with Legionella pneumophila and Saprochaete clavata

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