Legionellosis and its diagnosis
Authors:
M. Kotrbancová 1; M. Špaleková 1; M. Fulová 1; K. Trnková 2; J. Perželová 1
Authors place of work:
Ústav epidemiológie LFUK, Bratislava, Slovenská republika
1; Katedra životného prostredia, Fakulta prírodných vied, Univerzita Mateja Bela, Banská Bystrica, Slovenská republika
2
Published in the journal:
Epidemiol. Mikrobiol. Imunol. 66, 2017, č. 3, s. 133-139
Category:
Review Article
Summary
The diagnosis of legionellosis, especially of its severe, life-threatening form, Legionnaires' disease, is complicated, primarily because of non-typical symptoms of the infection, not always dominating atypical pneumonia, and often a very dramatic septic course of the disease with multiorgan failures. The diagnosis of the acute phase of the disease can be established by the detection of Legionella antigen in urine and by PCR/real-time PCR detection of Legionella DNA in serum and lower respiratory tract and urine samples. Cultivation on specific media remains the gold standard, but this very demanding method is rarely used. Serological testing requires paired samples and thus is relevant to the diagnosis at a later stage of infection, although it is to be noted that about 20% of patients do not produce the antibodies. Great progress has been made in typing methods (RFLP, PFGE, or PCR based and sequence based methods) and rapid identification methods (MALDI-TOF).
KEYWORDS:
legionellae – Legionnaires’ disease – laboratory diagnosis
Zdroje
1. Diederen BMW. Legionella spp. and Legionnaires‘ disease. J Infect, 2008;56: 1–12.
2. Salavec M, Boštíková V, Prášil P, Sleha R, Špliňo M, Boštík P. Legionelové infekce – opomíjený problém. Epidemiol Mikrobiol Imunol, 2014;63(1): 43–49.
3.Trnková K, Kotrbancová M, Šimonyiová D, et al. Výskyt Legionella pneumophila a jej hostiteľov – voľne žijúcich meňaviek v distribučných systémoch vybraných nemocníc na Slovensku. In: Zborník prednášok a posterov, Mikrobiológia vody a životného prostredia 2015, Nový Smokovec, 2015: 55–63.
4. Bartram J, Chartier Y, Lee VJ, et al. Legionella and the preven-tion of legionellosis. Geneva, Switzerland: World Health Organization Press, 2007.
5. Currie SL, Beattie TK, Knapp CW, et al. Legionella spp. in UK composts – a potential public health issue? Clin Microbiol Infect, 2014;20: 224–229.
6. Cunha BA, Burillo A, Bouza E. Legionnaires´ disease. Lancet, 2016;387: 376–385.
7. Bajrai LH, Azhar EI, Yasir M, et al. Legionella saoudiensis sp. nov., isolated from a sewage water sample. Int J Syst Evol Microbiol, 2016;6(11): 4367–4371.
8. Campocasso A, Boughalmi M, Fournous G, et al. Legionella tunisiensis sp. nov. and Legionella massiliensis sp. nov., isolated from enironmental water samples. Int J Syst Evol Microbiol, 2012;62: 3003–3006.
9. Sakamoto R. Legionnaire´s disease, weather and climate. Bull World Health Organ, 2015;93: 435–436.
10. Brandsema PS, Euser SM, Karagiannis I, Den Boer JW. Summer increase of Legionnaires‘ disease 2010 in The Netherlands associated with weather conditions and implications for source finding. Epidemiol Infect, 2014;142(11): 2360–2371.
11. Hicks LA, Rose CE, Fields BS, et al. Increased rainfall is associated with increased risk for legionellosis. Epidemiol Infect, 2007;135: 811–817.
12. Phin N, Parry-Ford F, Harrison T, et al. Epidemiology and clinical management of Legionnaires´ disease. Lancet Infect Dis, 2014;14: 1011–1021.
13. Correia AM, Ferreira JS, Borges V, et al. Probable Person-to-Person Transmission of Legionnaires’ Disease. N Engl J Med, 2016;374: 497–498.
14. Tossa P, Deloge-Abarkan M, Zmirou-Navier D, et al. Pontiac fever: an operational definition for epidemiological studies. BMC Publ Health, 2006;6(112): 1–10.
15. Diederen BMW, De Jong CMA, et al. Detection and quantification of Legionella pneumophila DNA in serum: case reports and review of the literature. J Medical Microbiol, 2006;55: 639–642.
16. Fields BS et al. Legionella and Legionnaires’ Disease: 25 Years of Investigation. Clin Microbiol Rev, 2002;15:506-520.
17. Špaleková M. Legionelózy – klinický obraz, epidemiológia, diagnostika a liečba. Via practica, 2010;7:155-158.
18. Pedro-Botet ML, Yu VL. Treatment strategies for Legionella infec-tion. Expert Opin Pharmacother. 2009;10(7):1109-1121
19. European Centre for Disease Prevention and Control. Legionnaires’ disease in Europe, 2014. Stockholm: ECDC, 2016
20. Špaleková M. Výskyt a problematika legionelových infekcií v nemocničnom prostredí, Antibiotiká a rezistencia, 2011;10(1):24-28.
21. Dusserre E, Ginevra Ch, Hallier-Soulier S, et al. A PCR-Based Method for Monitoring Legionella pneumophila in Water Samples Detects Viable but Noncultivable Legionellae That Can Recover Their Cultivability. App Environ Microbiol, 2008;74(15):4817-4824.
22. Cunha BA. Legionnaires’ Disease: Clinical Differentiation from Typical and Other Atypical Pneumonias. Infect Dis Clin N Am, 2010;24: 73–105.
23. Descours G, Cassier P, Forey F, et al. Evaluation of BMPA, MWY, GVPC and BCYE media for the isolation of Legionella species from respiratory samples. Journal of Microbiological Methods, 2014;98: 119–121.
24. Waterer GW, Baselski VS, Wunderink RG. Legionella and community-acquired pneumonia: a review of current diagnostic tests from a clinician’s viewpoint. Am J Med, 2001;110: 41–48.
25. Helbig JH, Bernander S, Castellani Pastoris M, et al. Pan-European study on culture proven Legionnaires’ disease: distribution of Legionella pneumophila serogroups and monoclonal subgroups. Eur J Clin Microbiol Infect Dis, 2002;21: 710–716.
26. Murdoch DR. Diagnosis of Legionella infection. Clin Infect Dis, 2003;36(1): 64–69.
27. Cunha BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect, 2006;12: 12–24.
28. Lück PC. Diagnostics and Clinical Disease Treatment. In: Legionella: Molecular Microbiology, Caister Academic Press, 2008: 19–34.
29. Higa F, Fujita J, Koide M. Clinical features of two cases of legionnaires´disease with persistence of legionella urinary antigen excretion. Intern Med, 2008;47(3): 173–178.
30. Jiang L, Chen Y, Xia S, et al. The clinical value of urinary antigen detection of Legionella pneumonia. Zhongua Jie He He Hu Xi Za Zhi, 2015;38(1): 29–33.
31. Yzerman EP, Den Boer JW, Lettinga KD, et al. Sensitivity of three serum antibody tests in a large outbreak of legionnaires’ disease in the Netherlands. J Med Microbio, 2006;55: 561–566.
32. Blazquez RM, Espinosa FJ, Martinez-Toldos CM, et al. Sensitivity of urinary antigen test in relation to clinical severity in a large outbreak of Legionella pneumonia in Spain. Eur J Clin Microbiol Infect Dis, 2005;24: 488–491.
33. Lück PC, Von Baum H, Helbig JH, Marre R. The usefulness of microbiological diagnostic methods for the detection of Legionella infections. In Legionella – State of the art 30 years of its recognition. Washington DC:ASM Press, 2006: 15–21.
34. Ballard AL, Fry NK, Chan L, et al. Detection of Legionella pneumophila Using a Real-Time PCR Hybridization Assay. J Clin Microbiol, 2000;38(11): 4215–4218.
35. Yong SF, Tan SH, Wee J, et al. Molecular Detection of Legionella: Moving on From mip. Cellular and Infection Microbiology, 2010;1: 1–5.
36. Ratcliff RM. Rapid sequencing and analysis for pathogen confirmation. Microbiology Australia, 2010: 103–106.
37. Cloud JL, Carroll KC, Pixton P, et al. Detection of Legionella Species in Respiratory Specimens Using PCR with Sequencing Confirmation. J Clin Microbiol, 2000;38(5): 1709–1712.
38. Lindsay DSJ, Abraham WH, Findlay W, et al. Laboratory diagnosis of legionnaires’ disease due to Legionella pneumophila serogroup 1, comparison of phenotypic and genotypic methods. J Med Microbiol, 2004;53: 183–187.
39. Nazarian EJ, Bopp DJ, Saylors A, et al. Design and implementation of a protocol for the detection of Legionella in clinical and environmental samples. Diagn Microbiol Dis, 2008;62(2): 125–132.
40. Lindsay DSJ, Abraham WH, Fallon RJ. Detection of mip Gene by PCR for Diagnosis of Legionnaires´Disease. J Clin Microbiol, 1994;32(12): 3068–3069.
41. Yang G, Benson R, Pelish T, et al. Dual detection of Legionella pneumophila and Legionella species by real-time PCR targeting the 23S-5S rRNA gene spacer region. Clin Microbiol Infect, 2010;16 (3): 255–261.
42. Hayden RT, Uhl JR, Qian X, et al. Direct detection of Legionella species from bronchoalveolar lavage and open lung biopsy specimens: comparison of LightCycler PCR, in situ hybridization, direct fluo-rescence antigen detection, and culture. J Clin Microbiol, 2001; 39(7): 2618–2626.
43. Jaulhac B, Nowicki M, Bornstein N, et al. Detection of legionella spp. in bronchoalveolar lavage fluids by DNA amplification. J Clin Microbiol, 1992;30: 920–924.
44. Rantakokko-Jalava K, Jalava J. Development of conventional and real-time PCR assays for detection of Legionella DNA in respiratory specimens. J Clin Microbiol, 2001;39(8): 2904–2910.
45. Matsiota-Bernard P, Waser S, Vrioni G. Detection of Legionella pneumophila in urine and serum samples from patients with pneumonia. Clin Microb Infec, 2000;6: 223–225.
46. Bazovská S, Špaleková M. Problém špecificity sérologických diagnostických testov pri legionelóze. Epidemiol Mikrobiol Imunol, 1998;47(4): 141–144.
47. Helbig JH, Kurtz JB, Pastoris MC, et al. Antigenic lipopolysaccharide components of Legionella pneumophila recognized by monoclonal antibodies: possibilities and limitations for division of the species into serogroups. J Clin Microbiol, 1997;35(11): 2841–2845.
48. Jarraud S, Descours G, Ginevra C, et al. Identification of Legionella in clinical samples. Methods Mol Biol, 2013;954: 27–56.
49. Khodr A, Kay E, Gomez-Valero L, et al. Molecular epidemiology, phylogeny and evolution of Legionella. Infection Genetics and Evolution, 2016;43: 108–122.
50. Orsini M, Amore R, et al. Rapid pulsed-field gel electrophoresis protocol for Legionella pneumophila typing. JPH, 2008;5(2): 143–148.
51. Gaia V, Fry NK, Afshar B, et al. Consensus sequence-based scheme for epidemiological typing of clinical and environmental isolates of Legionella pneumophila. J Clin Microbiol, 2005;43: 2047–2052.
52. http://www.hpa-bioinformatics.org.uk/legionella/legionella_sbt/php/sbt_homepage.php
53. Moliner C, Ginevra C, Jarraud S, et al. Rapid identification of Legionella species by mass spectrometry. J Med Microbiol, 2010;59: 273–284.
54. Gaia V, Casati S, Tonolla M. Rapid identification of Legionella spp. by MALDI-TOF MS based protein mass fingerprinting. Syst Appl Microbiol, 2011;34: 40–44.
55. Dilger T, Melzl H, Gessner A. Rapid and reliable identification of waterborne Legionella species by MALDI-TOF mass spectrometry. Journal of Microbiological Methods, 2016;127: 154–159.
56. Fujinami Y, Kikkawa HS, Kurosaki Y, et al. Rapid discrimination of Legionella by matrix-assisted laser desorption ionization time-of--flight mass spectrometry. Microbiol Res, 2011;166: 77–86.
57. Wang YFW, Fu J. Rapid laboratory diagnosis for respiratory infectious diseases by using MALDI-TOF mass spectrometry. J Thorac Dis, 2014;6(5): 507–511.
Štítky
Hygiene and epidemiology Medical virology Clinical microbiologyČlánok vyšiel v časopise
Epidemiology, Microbiology, Immunology
2017 Číslo 3
Najčítanejšie v tomto čísle
- Hantavirus causing fatal haemorrhagic fever in the Czech Republic
- Serological diagnosis of whooping cough using immunoblot methods
- Possibilities for laboratory diagnosis of leptospiroses
- Legionellosis and its diagnosis