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The majority of community epidemics of Legionnaire's disease (LD) are from -contaminated cooling towers or other aerosol-generating devices. Expectorated sputum and other lower respiratory specimens are the most common sources of spp. The identification techniques used by reference laboratories include serotyping using collections of antisera, biochemical characterization, and sequence-based identification. Typing of spp. is important for public health investigations to help link culture-positive environmental sites with clinical isolates during an epidemic of the disease. Sequence-based typing appears to be the most specific and precise molecular subtyping system for both and serogroup 1. A standardized pulsed-field gel electrophoresis method yields reproducible results and is used as a reference typing method by one national laboratory. The antimicrobial susceptibility of grown in broth or on agar can give results that have no clinical correlation. This is because of the intracellular location of the bacterium in human infection, to which not all antimicrobial agents gain access and retain activity. Multiple laboratory methods have to be used for optimal laboratory diagnosis of LD. Culture of bacteria from sputum, lung, or other respiratory sites is the most specific (100%) method for diagnosis of the disease, very sensitive in severe untreated disease, and insensitive in those with mild disease.

Citation: Edelstein P. 2011. , p 770-785. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch45

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Legionella pneumophila
Pulsed-Field Gel Electrophoresis
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Image of FIGURE 1

Photomicrographs of . (A) Gimenez stain of intracellular bacteria in lung infection. (B) Gram stain using basic fuchsin counterstain of colony taken from BCYEα plate. Note the dramatic size and shape differences between the intracellular and extracellular bacteria.

Citation: Edelstein P. 2011. , p 770-785. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch45
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Image of FIGURE 2

Photographs of colonies growing on BCYEα agar. Note the internal speckling and different colors that may be seen, sometimes in the same culture. (Reprinted from Fig. 2A and B , p. 814 of the eighth edition of this .)

Citation: Edelstein P. 2011. , p 770-785. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch45
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Image of FIGURE 3

Identification flow scheme for basic identification of spp. grown from a BCYEα plate. Abbreviations: BCYE, BCYEα; BCYE-, BCYEα made without l-cysteine; BAP, tryptic soy blood agar; UV light, colony fluorescence and color when illuminated with long-wave (360 nm) UV light; SG1, serogroup 1. Numbers refer to the amount of growth: 4+, good growth; 1+, poor growth; 0, no growth.

Citation: Edelstein P. 2011. , p 770-785. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch45
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Generic image for table

Selected characteristics of spp.

Abbreviations: Y, yes; N, no; Nk, not known; NC, no color; BW, bright blue-white; YG, pale yellow-green; BW/YG, some strains are BW and some YG; R, dark red; R/yg, majority of strains are red, with remainder YG.

All listed species, except “,” constitute validly published names. Several other species probably exist.

Severely immunosuppressed patients may acquire infections with spp. not previously isolated from humans.

AN, alternative name; while valid, the genus names and are not in widespread usage.

Citation: Edelstein P. 2011. , p 770-785. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch45
Generic image for table

Composition and selectivity of media used to grow spp. from clinical and environmental specimens

Antifungal, either anisomycin or natamycin antifungal compounds; normal respiratory microbiota, normal upper respiratory tract bacteria.

Selectivity scale range 0 to 4+: 0, does not inhibit these organisms; 1+, slight inhibition, allows about 75% growth; 2+, allows about 25 to 50% growth; 3+, allows about 10% growth; 4+, allows less than 1% growth.

Citation: Edelstein P. 2011. , p 770-785. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch45

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