1887

Abstract

Rapid and effective diagnosis of Legionnaires’ disease (LD) cases is extremely important so that timely and appropriate therapy can be provided, thereby lowering the morbidity and mortality rates and reducing the health and economic costs associated with this disease.

Diagnosis is established solely by microbiological tests. There are several methods available, each with different performance, sensitivity and specificity characteristics, and further understanding is required. Our objective was to assess the accuracy of urinary antigen detection, direct fluorescent antibody (DFA) staining, serological testing and the polymerase chain reaction (PCR) method versus culture analysis (the reference standard) in patients suspected of being infected with or patients with laboratory-confirmed LD. We performed a MEDLINE search in November 2014. Two authors independently assessed the trials and extracted data. Pooled analysis was performed through Meta-DiSc version 1.4.

The inclusion criteria were met by 11 studies. All the studies evaluated PCR and DFA tests to detect in clinical specimens, comparing them to culture techniques, and were included in the meta-analysis. The pooled sensitivity and specificity for PCR were 83 % [95 % confidence interval (CI): 79–87 %] and 90 % (95 % CI: 88–92 %), respectively. DFA was evaluated in one study and the sensitivity and specificity of this test were 67 % (95 % CI: 30–93 %) and 100 % (95 % CI: 91–100 %), respectively. PCR had high sensitivity and specificity for early diagnosis of LD.

Culture analysis is deemed necessary for epidemiological studies, molecular strain typing and antibiotic sensibility evaluations; however, the performance of PCR in recent studies calls for additional, well-designed studies in order to achieve the best standard test, which will enable optimization of the infection diagnostic.

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2017-04-01
2024-03-29
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References

  1. Zarogoulidis P, Alexandropoulou I, Romanidou G, Konstasntinidis TG, Terzi E et al. Community-acquired pneumonia due to Legionella pneumoplhila, the utility of PCR, and a review of the antibiotics used. Int J Med 2011; 4:15–19
    [Google Scholar]
  2. Fields BS, Benson RF, Besser RE. Legionella and legionnaires' disease: 25 years of investigation. Clin Microbiol Rev 2002; 15:506–526 [View Article][PubMed]
    [Google Scholar]
  3. Murdoch DR. Diagnosis of Legionella infection. Medical Microbiology 2003; 36:64–69
    [Google Scholar]
  4. Silva MT. Contribuição para o estudo do género Legionella e sua ocorrência em Portugal. PhD Dissertation 1996
    [Google Scholar]
  5. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155:529–536 [View Article][PubMed]
    [Google Scholar]
  6. Benitez AJ, Winchell JM. Clinical application of a multiplex real-time PCR assay for simultaneous detection of Legionella species, Legionella pneumophila, and Legionella pneumophila serogroup 1. J Clin Microbiol 2013; 51:348–351 [View Article][PubMed]
    [Google Scholar]
  7. Cloud JL, Carroll KC, Pixton P, Erali M, Hillyard DR. Detection of Legionella species in respiratory specimens using PCR with sequencing confirmation. J Clin Microbiol 2000; 38:1709–1712[PubMed]
    [Google Scholar]
  8. Edelstein PH, Bryan RN, Enns RK, Kohne DE, Kacian DL. Retrospective study of Gen-Probe rapid diagnostic system for detection of Legionellae in frozen clinical respiratory tract samples. J Clin Microbiol 1987; 25:1022–1026[PubMed]
    [Google Scholar]
  9. Fard SY, Nomanpour B, Fatolahzadeh B, Mobarez AM, Darban-Sarokhalil D et al. Hospital acquired pneumonia: comparison of culture and real-time PCR assays for detection of Legionella pneumophila from respiratory specimens at Tehran hospitals. Acta Microbiol Immunol Hung 2012; 59:355–365 [View Article][PubMed]
    [Google Scholar]
  10. Hayden RT, Uhl JR, Qian X, Hopkins MK, Aubry MC et al. Direct detection of Legionella species from bronchoalveolar lavage and open lung biopsy specimens: comparison of LightCycler PCR, in situ hybridization, direct fluorescence antigen detection, and culture. J Clin Microbiol 2001; 39:2618–2626 [View Article][PubMed]
    [Google Scholar]
  11. Lisby G, Dessau R. Construction of a DNA amplification assay for detection of Legionella species in clinical samples. Eur J Clin Microbiol Infect Dis 1994; 13:225–231 [View Article][PubMed]
    [Google Scholar]
  12. Mentasti M, Fry NK, Afshar B, Palepou-Foxley C, Naik FC et al. Application of Legionella pneumophila-specific quantitative real-time PCR combined with direct amplification and sequence-based typing in the diagnosis and epidemiological investigation of legionnaires' disease. Eur J Clin Microbiol Infect Dis 2012; 31:2017–2028 [View Article][PubMed]
    [Google Scholar]
  13. Pasculle AW, Veto GE, Krystofiak S, Mckelvey K, Vrsalovic K. Laboratory and clinical evaluation of a commercial DNA probe for the detection of Legionella spp. J Clin Microbiol 1989; 27:2350–2358[PubMed]
    [Google Scholar]
  14. Templeton KE, Scheltinga SA, Sillekens P, Crielaard JW, van Dam AP et al. Development and clinical evaluation of an internally controlled, single-tube multiplex real-time PCR assay for detection of Legionella pneumophila and other Legionella species. J Clin Microbiol 2003; 41:4016–4021 [View Article][PubMed]
    [Google Scholar]
  15. Wilson DA, Yen-Lieberman B, Reischl U, Gordon SM, Procop GW. Detection of Legionella pneumophila by real-time PCR for the mip gene. J Clin Microbiol 2003; 41:3327–3330 [View Article][PubMed]
    [Google Scholar]
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