Legionella
(Legionella pneumophila)
Material: | Pathogen detection (culture): Bronchoalveolar lavage fluid (BAL), pleura puncture specimen and pericardial puncture specimen as well as tissue samples Antigen detection: 10 ml urine (external service) DNA determination: 10 ml respiratory material (sputum, tracheal secretion, bronchoalveolar lavage fluid (BAL)) Antibody detection: 1 ml serum |
Methods: |
Amplifikationsverfahren → Real-time-PCR Kulturelle Untersuchungen → CO2 Atmosphäre Ligandenassays → Enzyme Linked Immunosorbent Assay (ELISA) | Reference range | IgG: < 50 U/ml – 70 U/ml |
Indication | Suspicion of Legionella pneumonia (fever, ague, thoracic pains, typically: non-productive cough) | Mandatory reporting | ja In accordance with § 7 IfSG, the laboratory has to inform the relevant health department, stating the patient’s name, in case of growth of legionella, legionella antigen detection in urine as well as a 4-fold antibody titer increase in a second serum sample. |
Please note | Infection by inhalation of contaminated water drops (air conditioning, shower, humidifier etc.). After a 2 day incubation period, flu-like illness with high fever, headaches, myalgia (especially in the thoracic region), non-productive cough, multilobular pulmonary infiltrations. Risk factors are immunosuppression (transplants), alcoholism and diabetes mellitus. Mainly men over the age of 50 are affected. On suspicion of an acute infection, antigen detection in urine, pathogen detection by culture and DNA demonstration is recommended. Please note that the DNA demonstration is not covered by the German medical insurances. For etiology clarification, antibody detection including titer course is suitable. The legionella antigen in the urine is latest seen on the third day after onset of symptoms. Excretion can last up to one year. Legionella antigen detection in urine has the highest sensitivity for serogroup 1, which is responsible for 50% – 60% of legionella pneumonias; the remaining serogroups have various sensitivities. In case of suspicion, direct pathogen detection by cultivation from bronchoalveolar lavage should always be sought. Incubation is for up to one week, if necessary, several samples should be sent. Antibodies may only be seen after a significant delay (4 – 6 weeks) after disease onset, thus serological acute diagnostics without pathogen demonstration (culture, antigen, DNA) is not recommended! Occasionally antibody development may even be omitted. Legionella serology captures serogroups 1 – 7. |
Accredited | ja |
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