Legionellosis other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Sputum culture and urine antigen testing are the two preferred diagnostic studies. Serologic assays should be used if both culture and urine antigen test are negative in the presence of clinical or epidemiologic clues.
Other Diagnostic Studies
Sampling
Bronchoalveolar Lavage
Bronchoalveolar lavage (BAL) fluids can be submitted for cultures and PCR in pediatric patients.
Thoracocentesis
Thoracocentesis may be performed to obtain pleural fluid samples in the presence of significant effusion.
Assay
Culture
Expectorated sputum, endotracheal aspirates, pleural fluid, blood, or tissue samples may be sent for culture. Unlike serology and urine antigen testing, the yield of cultures is independent of serotype and may be positive in cases of non-Legionella pneumophila species.
Urinary antigen testing
Urine antigen testing is most sensitive for the detection of the Pontiac subtype of Legionella pneumophila serogroup 1.
Polymerase Chain Reaction
Polymerase chain reaction (PCR) is used to detect DNA of Legionella in sputum, pleural fluid, bronchoalveolar lavage samples, pulmonary tissues, urine, or environmental water. The detection rate by qualitative PCR is usually high, at > 90% of positive samples.
Serology
A four-fold or greater increase in antibody titer between the acute and convalescent sera is diagnostic.
Immunofluorescent microscopy
Detection of Legionella in respiratory tract tissues or fluids by immunofluorescent microscopy may be used.