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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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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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1. Adeleke, A. A.,, B. S. Fields,, R. F. Benson,, M. I. Daneshvar,, J. M. Pruckler,, R. M. Ratcliff,, T. G. Harrison,, R. S. Weyant,, R. J. Birtles,, D. Raoult,, and M. A. Halablab. 2001. Legionella drozanskii sp. nov., Legionella rowbothamii sp. nov. and Legionella fallonii sp. nov.: three unusual new Legionella species. Int. J. Syst. Evol. Microbiol. 51: 1151 1160.
2. Amer, A. O.,, and M. S. Swanson. 2002. A phagosome of one’s own: a microbial guide to life in the macrophage. Curr. Opin. Microbiol. 5: 56 61.
3. Aurell, H.,, J. Etienne,, F. Forey,, M. Reyrolle,, P. Girardo,, P. Farge,, B. Decludt,, C. Campese,, F. Vandenesch,, and S. Jarraud. 2003. Legionella pneumophila serogroup 1 strain Paris: endemic distribution throughout France. J. Clin. Microbiol. 41: 3320 3322.
4. Bencini, M. A.,, A. J. van den Brule,, E. C. Claas,, M. H. Hermans,, W. J. Melchers,, G. T. Noordhoek,, M. M. Salimans,, J. Schirm,, C. Vink,, Z. A. van der,, and R. Jansen. 2007. Multicenter comparison of molecular methods for detection of Legionella spp. in sputum samples. J. Clin. Microbiol. 45: 3390 3392.
5. Benin, A. L.,, R. F. Benson,, and R. E. Besser. 2002. Trends in legionnaires disease, 1980-1998: declining mortality and new patterns of diagnosis. Clin. Infect. Dis. 35: 1039 1046.
6. Benson, R. F.,, W. L. Thacker,, J. A. Lanser,, N. Sangster,, W. R. Mayberry,, and D. J. Brenner. 1991. Legionella adelaidensis, a new species isolated from cooling tower water. J. Clin. Microbiol. 29: 1004 1006.
7. Benson, R. F.,, W. L. Thacker,, B. B. Plikaytis,, and H. W. Wilkinson. 1987. Cross-reactions in Legionella antisera with Bordetella pertussis strains. J. Clin. Microbiol. 25: 594 596.
8. Bentz, J. S.,, K. Carroll,, J. H. Ward,, M. Elstad,, and C. J. Marshall. 2000. Acid-fast-positive Legionella pneumophila: a possible pitfall in the cytologic diagnosis of mycobacterial infection in pulmonary specimens. Diagn. Cytopathol. 22: 45 48.
9. Brenner, D. J. 1987. Classification of the legionellae. Semin. Respir. Infect. 2: 190 205.
10. Brenner, D. J.,, A. G. Steigerwalt,, P. Epple,, W. F. Bibb,, R. M. McKinney,, R. W. Starnes,, J. M. Colville,, R. K. Selander,, P. H. Edelstein,, and C. W. Moss. 1988. Legionella pneumophila serogroup Lansing 3 isolated from a patient with fatal pneumonia, and descriptions of L. pneumophila subsp. pneumophila subsp. nov., L. pneumophila subsp. fraseri subsp. nov., and L. pneumophila subsp. pascullei subsp. nov. J. Clin. Microbiol. 26: 1695 1703.
11. Cazalet, C.,, S. Jarraud,, Y. Ghavi-Helm,, F. Kunst,, P. Glaser,, J. Etienne,, and C. Buchrieser. 2008. Multigenome analysis identifies a worldwide distributed epidemic Legionella pneumophila clone that emerged within a highly diverse species. Genome Res. 18: 431 441.
12. Cazalet, C.,, C. Rusniok,, H. Bruggemann,, N. Zidane,, A. Magnier,, L. Ma,, M. Tichit,, S. Jarraud,, C. Bouchier,, F. Vandenesch,, F. Kunst,, J. Etienne,, P. Glaser,, and C. Buchrieser. 2004. Evidence in the Legionella pneumophila genome for exploitation of host cell functions and high genome plasticity. Nat. Genet. 36: 1165 1173.
13. Cercenado, E.,, P. H. Edelstein,, L. H. Gosting,, and J. C. Sturge. 1987. Legionella micdadei and Legionella dumoffii monoclonal antibodies for laboratory diagnosis of Legionella infections. J. Clin. Microbiol. 25: 2163 2167.
14. Chen, S.,, L. Hicks,, M. Yuen,, D. Mitchell,, and G. L. Gilbert. 1994. Serological cross-reaction between Legionella spp. and Capnocytophaga ochracea by using latex agglutination test. J. Clin. Microbiol. 32: 3054 3055.
15. Collins, M. T.,, F. Espersen,, N. Høiby,, S. N. Cho,, A. Friss-Møller,, and J. S. Reif. 1983. Cross-reactions between Legionella pneumophila (serogroup 1) and twenty-eight other bacterial species, including other members of the family Legionellaceae. Infect. Immun. 39: 1441 1456.
16. den Boer, J. W.,, E. P. Yzerman,, J. Schellekens,, K. D. Lettinga,, H. C. Boshuizen,, J. E. Van Steenbergen,, A. Bosman,, H. S. Van den,, H. A. Van Vliet,, M. F. Peeters,, R. J. van Ketel,, P. Speelman,, J. L. Kool,, and M. A. Conyn-van Spaendonck. 2002. A large outbreak of Legionnaires’ disease at a flower show, the Netherlands, 1999. Emerg. Infect. Dis. 8: 37 43.
17. Dennis, P. J.,, J. A. Taylor,, and G. I. Barrow. 1981. Phosphate buffered, low sodium chloride blood agar medium for Legionella pneumophila. Lancet ii: 636.
18. Diederen, B. M.,, J. A. Kluytmans,, C. M. Vandenbroucke-Grauls,, and M. F. Peeters. 2008. Utility of real-time PCR for diagnosis of Legionnaires’ disease in routine clinical practice. J. Clin. Microbiol. 46: 671 677.
19. Diederen, B. M.,, and M. F. Peeters. 2007. Evaluation of the SAS Legionella Test, a new immunochromatographic assay for the detection of Legionella pneumophila serogroup 1 antigen in urine. Clin. Microbiol. Infect. 13: 86 88.
20. Doleans, A.,, H. Aurell,, M. Reyrolle,, G. Lina,, J. Freney,, F. Vandenesch,, J. Etienne,, and S. Jarraud. 2004. Clinical and environmental distributions of Legionella strains in France are different. J. Clin. Microbiol. 42: 458 460.
21. Domínguez, J. A.,, J. M. Manterola,, R. Blavia,, N. Sopena,, F. J. Belda,, E. Padilla,, M. Gimenez,, M. Sabria,, J. Morera,, and V. Ausina. 1996. Detection of Legionella pneumophila serogroup-1 antigen in nonconcentrated urine and urine concentrated by selective ultrafiltration. J. Clin. Microbiol. 34: 2334 2336.
22. Drenning, S. D.,, J. E. Stout,, J. R. Joly,, and V. L. Yu. 2001. Unexpected similarity of pulsed-field gel electrophoresis patterns of unrelated clinical isolates of Legionella pneumophila, serogroup 1. J. Infect. Dis. 183: 628 632.
23. Edelstein, P. H. 1995. Antimicrobial chemotherapy for legionnaires’ disease: a review. Clin. Infect. Dis. 21: S265 S276.
24. Edelstein, P. H., 1999. The guinea-pig model of Legionnaires’ disease, p. 303 314. In O. Zak, and M. A. Sande (ed.), Handbook of Animal Models of Infection. Academic Press, London, United kingdom.
25. Edelstein, P. H., 2004. Detection of Legionella antigen by direct immunofluorescence, p. 11.3.1 11.3.7. In H. D. Isenberg (ed. in chief), Clinical Microbiology Procedures Handbook, 2nd ed. ASM Press, Washington, DC.
26. Edelstein, P. H., 2006. Detection of antibodies to Legionella, p. 468 476. In B. Detrick,, R. G. Hamilton,, and J. D. Folds (ed.), Manual of Molecular and Clinical Laboratory Immunology, 7th ed. ASM Press, Washington, DC.
27. Edelstein, P. H., Urinary antigen detection for Legionella spp, p. 11.4.1 11.4.7. In L. S. Garcia (ed. in chief), Clinical Microbiology Procedures Handbook, 3rd ed., vol. 3. ASM Press, Washington, DC.
28. Edelstein, P. H.,, K. B. Beer,, J. C. Sturge,, A. J. Watson,, and L. C. Goldstein. 1985. Clinical utility of a monoclonal direct fluorescent reagent specific for Legionella pneumophila: comparative study with other reagents. J. Clin. Microbiol. 22: 419 421.
29. Edelstein, P. H.,, and N. P. Cianciotto,. 2001. Legionella species and Legionnaires’ disease. In M. Dworkin,, S. Falkow,, E. Rosenberg,, K. H. Schleifer,, and E. Stackebrandt (ed.), The Prokaryotes: an Evolving Electronic Resource for the Microbiological Community. Springer-Verlag, New York, NY.
30. Edelstein, P. H.,, and N. P. Cianciotto,. 2010. Legionella. In G. L. Mandell,, J. E. Bennett,, and R. Dolin (ed.), Principles and Practice of Infectious Diseases, 7th ed. Elsevier, Philadelphia, PA.
31. Edelstein, P. H.,, and M. A. C. Edelstein. 1989. Evaluation of the Merifluor- Legionella immunofluorescent reagent for identifying and detecting 21 Legionella species. J. Clin. Microbiol. 27: 2455 2458.
32. Edelstein, P. H.,, and S. M. Finegold. 1979. Use of a semiselective medium to culture Legionella pneumophila from contaminated lung specimens. J. Clin. Microbiol. 10: 141 143.
33. Edelstein, P. H.,, R. M. McKinney,, R. D. Meyer,, M. A. C. Edelstein,, C. J. Krause,, and S. M. Finegold. 1980. Immunologic diagnosis of Legionnaires’ disease: cross-reactions with anaerobic and microaerophilic organisms and infections caused by them. J. Infect. Dis. 141: 652 655.
34. Edelstein, P. H.,, R. D. Meyer,, and S. M. Finegold. 1980. Laboratory diagnosis of Legionnaires’ disease. Am. Rev. Respir. Dis. 121: 317 327.
35. Evans, G. E.,, D. R. Murdoch,, T. P. Anderson,, H. C. Potter,, P. M. George,, and S. T. Chambers. 2003. Contamination of Qiagen DNA extraction kits with Legionella DNA. J. Clin. Microbiol. 41: 3452 3453.
36. Ezaki, T.,, Y. Hashimoto,, H. Yamamoto,, M. L. Lucida,, S. L. Liu,, S. Kusunoki,, K. Asano,, and E. Yabuuchi. 1990. Evaluation of the microplate hybridization method for rapid identification of Legionella species. Eur. J. Clin. Microbiol. Infect. Dis. 9: 213 217.
37. Faine, S.,, P. Edelstein,, B. D. Kirby,, and S. M. Finegold. 1979. Rapid presumptive bacteriological diagnosis of Legionnaires disease. J. Clin. Microbiol. 10: 104 105.
38. Fang, G.-D.,, V. L. Yu,, and R. M. Vickers. 1989. Disease due to the Legionellaceae (other than Legionella pneumophila). Historical, microbiological, clinical, and epidemiological review. Medicine (Baltimore) 68: 116 132.
39. Ferrer, A.,, P. Bellver,, and P. Royo. 1995. Screening quality of respiratory samples and Legionella pneumoniae [sic]. J. Clin. Microbiol. 33: 1971.
40. Fields, B. S.,, T. Haupt,, J. P. Davis,, M. J. Arduino,, P. H. Miller,, and J. C. Butler. 2001. Pontiac fever due to Legionella micdadei from a whirlpool spa: possible role of bacterial endotoxin. J. Infect. Dis. 184: 1289 1292.
41. Fraser, D. W.,, T. R. Tsai,, W. Orenstein,, W. E. Parkin,, H. J. Beecham,, R. G. Sharrar,, J. Harris,, G. F. Mallison,, S. M. Martin,, J. E. McDade,, C. C. Shepard,, and P. S. Brachman. 1977. Legionnaires’ disease: description of an epidemic of pneumonia. N. Engl. J. Med. 297: 1189 1197.
42. Fry, N. K.,, J. M. Bangsborg,, S. Bernander,, J. Etienne,, B. Forsblom,, V. Gaia,, P. Hasenberger,, D. Lindsay,, A. Papoutsi,, C. Pelaz,, M. Struelens,, S. A. Uldum,, P. Visca,, and T. G. Harrison. 2000. Assessment of intercentre reproducibility and epidemiological concordance of Legionella pneumophila serogroup 1 genotyping by amplified fragment length polymorphism analysis. Eur. J. Clin. Microbiol. Infect. Dis. 19: 773 780.
43. Fry, N. K.,, T. J. Rowbotham,, N. A. Saunders,, and T. M. Embley. 1991. Direct amplification and sequencing of the 16S ribosomal DNA of an intracellular Legionella species recovered by amoebal enrichment from the sputum of a patient with pneumonia. FEMS Microbiol. Lett. 67: 165 168.
44. Fry, N. K.,, S. Warwick,, N. A. Saunders,, and T. M. Embley. 1991. The use of 16S ribosomal RNA analyses to investigate the phylogeny of the family Legionellaceae. J. Gen. Microbiol. 137: 1215 1222.
45. Gaia, V.,, N. K. Fry,, B. Afshar,, P. C. Luck,, H. Meugnier,, J. Etienne,, R. Peduzzi,, and T. G. Harrison. 2005. Consensus sequence-based scheme for epidemiological typing of clinical and environmental isolates of Legionella pneumophila. J. Clin. Microbiol. 43: 2047 2052.
46. Garduño, R. A.,, E. Garduño,, M. Hiltz,, and P. S. Hoffman. 2002. Intracellular growth of Legionella pneumophila gives rise to a differentiated form dissimilar to stationary-phase forms. Infect. Immun. 70: 6273 6283.
47. Garrity, G. M.,, A. Brown,, and R. M. Vickers. 1980. Tatlockia and Fluoribacter: two new genera of organisms resembling Legionella pneumophila. Int. J. Syst. Bacteriol. 30: 609 614.
48. Ginevra, C.,, C. Barranger,, A. Ros,, O. Mory,, J. L. Stephan,, F. Freymuth,, M. Joannes,, B. Pozzetto,, and F. Grattard. 2005. Development and evaluation of Chlamylege, a new commercial test allowing simultaneous detection and identification of Legionella, Chlamydophila pneumoniae, and Mycoplasma pneumoniae in clinical respiratory specimens by multiplex PCR. J. Clin. Microbiol. 43: 3247 3254.
49. Ginevra, C.,, F. Forey,, C. Campese,, M. Reyrolle,, D. Che,, J. Etienne,, and S. Jarraud. 2008. Lorraine strain of Legionella pneumophila serogroup 1, France. Emerg. Infect. Dis. 14: 673 675.
50. Glupczynski, Y.,, M. Labbe,, and E. Yourassowsky. 1984. Cross-reactivity of environmental bacteria with fluorescent-antibody conjugates for Legionella pneumophila. Eur. J. Clin. Microbiol. Infect. Dis. 3: 215.
51. Gotz, H. M.,, A. Tegnell,, J. De,, K. A. Broholm,, M. Kuusi,, I. Kallings,, and K. Ekdahl. 2001. A whirlpool associated outbreak of Pontiac fever at a hotel in Northern Sweden. Epidemiol. Infect. 126: 241 247.
52. Grau, S.,, J. M. Antonio,, E. Ribes,, M. Salvado,, J. M. Garces,, and J. Garau. 2006. Impact of rifampicin addition to clarithromycin in Legionella pneumophila pneumonia. Int. J. Antimicrob. Agents 28: 249 252.
53. Greer, P. W.,, F. W. Chandler,, and M. D. Hicklin. 1980. Rapid demonstration of Legionella pneumophila in unembedded tissue. An adaptation of the Gimenez stain. Am. J. Clin. Pathol. 73: 788 790.
54. Guerrero, C.,, C. M. Toldos,, G. Yagüe,, C. Ramírez,, T. Rodríguez,, and M. Segovia. 2004. Comparison of diagnostic sensitivities of three assays (Bartels enzyme immunoassay [EIA], Biotest EIA, and Binax NOW immunochromatographic test) for detection of Legionella pneumophila serogroup 1 antigen in urine. J. Clin. Microbiol. 42: 467 468.
55. Harrison, T. G.,, B. Afshar,, N. Doshi,, N. K. Fry,, and J. V. Lee. 2009. Distribution of Legionella pneumophila serogroups, monoclonal antibody subgroups and DNA sequence types in recent clinical and environmental isolates from England and Wales (2000-2008). Eur. J Clin. Microbiol. Infect. Dis. 28: 781 791.
56. Harrison, T. G.,, N. A. Saunders,, A. Haththotuwa,, N. Doshi,, and A. G. Taylor. 1992. Further evidence that genotypically closely related strains of Legionella pneumophila can express different serogroup specific antigens. J. Med. Microbiol. 37: 155 161.
57. Heath, T. C.,, C. Roberts,, B. Jalaludin,, I. Goldthrope,, and A. G. Capon. 1998. Environmental investigation of a legionellosis outbreak in western Sydney: the role of molecular profiling. Aust. N. Z. J. Public Health 22: 428 431.
58. Helbig, J. H.,, P. C. Luck,, and W. Witzleb. 1994. Serogroupspecific and serogroup-cross-reactive epitopes of Legionella pneumophila. Int. J. Med. Microbiol. Virol. Parasitol. Infect. Dis. 281: 16 23.
59. Helbig, J. H.,, S. A. Uldum,, S. Bernander,, P. C. Luck,, G. Wewalka,, B. Abraham,, V. Gaia,, and T. G. Harrison. 2003. Clinical utility of urinary antigen detection for diagnosis of community-acquired, travel-associated, and nosocomial legionnaires’ disease. J. Clin. Microbiol. 41: 838 840.
60. Helbig, J. H.,, S. A. Uldum,, P. C. Luck,, and T. G. Harrison. 2001. Detection of Legionella pneumophila antigen in urine samples by the Binax NOW immunochromatographic assay and comparison with both Binax Legionella Urinary Enzyme Immunoassay (EIA) and Biotest Legionella Urin Antigen EIA. J. Med. Microbiol. 50: 509 516.
61. Helbig, J. H.,, S. A. Uldum,, P. C. Lück,, and T. G. Harrison,. 2002. Detection of Legionella pneumophila antigen in urine samples: recognition of serogroups and monoclonal serogroups, p. 204 206. In R. Marre,, Y. Abu Kwaik,, C. Bartlett,, N. P. Cianciotto,, B. S. Fields,, M. Frosch,, J. Hacker,, and P. C. Lück (ed.), Legionella. ASM Press, Washington, DC.
62. Herpers, B. L.,, B. M. de Jongh,, K. van der Zwaluw,, and E. J. van Hannen. 2003. Real-time PCR assay targets the 23S-5S spacer for direct detection and differentiation of Legionella spp. and Legionella pneumophila. J. Clin. Microbiol. 41: 4815 4816.
63. Hilton, E.,, R. A. Freedman,, F. Cintron,, H. D. Isenberg,, and C. Singer. 1986. Acid-fast bacilli in sputum: a case of Legionella micdadei pneumonia. J. Clin. Microbiol. 24: 1102 1103.
64. Horn, J., 2002. Comparison of non-serogroup 1 detection by Biotest and Binax Legionella urinary antigen enzyme immunoassays, p. 207 210. In R. Marre,, Y. Abu kwaik,, C. Bartlett,, N. P. Cianciotto,, B. S. Fields,, M. Frosch,, J. Hacker,, and P. C. Lück (ed.), Legionella. ASM Press, Washington, DC.
65. Huang, B.,, B. A. Heron,, B. R. Gray,, S. Eglezos,, J. R. Bates,, and J. Savill. 2004. A predominant and virulent Legionella pneumophila serogroup 1 strain detected in isolates from patients and water in Queensland, Australia, by an amplified fragment length polymorphism protocol and virulence gene-based PCR assays. J. Clin. Microbiol. 42: 4164 4168.
66. Ingram, J. G.,, and J. F. Plouffe. 1994. Danger of sputum purulence screens in culture of Legionella species. J. Clin. Microbiol. 32: 209 210.
67. Isberg, R. R.,, T. J. O’Connor,, and M. Heidtman. 2009. The Legionella pneumophila replication vacuole: making a cosy niche inside host cells. Nat. Rev. Microbiol. 7: 13 24.
68. Jimenez-Lucho, V.,, M. Shulman,, and J. Johnson. 1994. Bordetella bronchiseptica in an AIDS patient cross-reacts with Legionella antisera. J. Clin. Microbiol. 32: 3095 3096.
69. Kerr, E.,, H. Snell,, B. L. Black,, M. Storey,, and W. D. Colby. 1992. Isolation of Nocardia asteroides from respiratory specimens by using selective buffered charcoal-yeast extract agar. J. Clin. Microbiol. 30: 1320 1322.
70. Khanna, M.,, J. Fan,, K. Pehler-Harrington,, C. Waters,, P. Douglass,, J. Stallock,, S. Kehl,, and K. J. Henrickson. 2005. The pneumoplex assays, a multiplex PCR-enzyme hybridization assay that allows simultaneous detection of five organisms, Mycoplasma pneumoniae, Chlamydia (Chlamydophila) pneumoniae, Legionella pneumophila, Legionella micdadei, and Bordetella pertussis, and its real-time counterpart. J. Clin. Microbiol. 43: 565 571.
71. Klein, G. C. 1980. Cross-reaction to Legionella pneumophila antigen in sera with elevated titers to Pseudomonas pseudomallei. J. Clin. Microbiol. 11: 27 29.
72. Ko, K. S.,, H. K. Lee,, M. Y. Park,, K. H. Lee,, Y. J. Yun,, S. Y. Woo,, H. Miyamoto,, and Y. H. Kook. 2002. Application of RNA polymerase beta-subunit gene (rpoB) sequences for the molecular differentiation of Legionella species. J. Clin. Microbiol. 40: 2653 2658.
73. Kool, J. L.,, U. Buchholz,, C. Peterson,, E. W. Brown,, R. F. Benson,, J. M. Pruckler,, B. S. Fields,, J. Sturgeon,, E. Lehnkering,, R. Cordova,, L. M. Mascola,, and J. C. Butler. 2000. Strengths and limitations of molecular subtyping in a community outbreak of Legionnaires’ disease. Epidemiol. Infect. 125: 599 608.
74. Kozak, N. A.,, R. F. Benson,, E. Brown,, N. T. Alexander,, T. H. Taylor, Jr.,, B. G. Shelton,, and B. S. Fields. 2009. Distribution of lag1 alleles and sequence-based types among Legionella pneumophila serogroup 1 clinical and environmental isolates in the United States. J. Clin. Microbiol. 47: 2525 2535.
75. Lambert, M. A.,, and C. W. Moss. 1989. Cellular fatty acid compositions and isoprenoid quinone contents of 23 Legionella species. J. Clin. Microbiol. 27: 465 473.
76. La Scola, B.,, R. J. Birtles,, G. Greub,, T. J. Harrison,, R. M. Ratcliff,, and D. Raoult. 2004. Legionella drancourtii sp. nov., a strictly intracellular amoebal pathogen. Int. J. Syst. Evol. Microbiol. 54: 699 703.
77. Lawrence, C.,, M. Reyrolle,, S. Dubrou,, F. Forey,, B. Decludt,, C. Goulvestre,, P. Matsiota-Bernard,, J. Etienne,, and C. Nauciel. 1999. Single clonal origin of a high proportion of Legionella pneumophila serogroup 1 isolates from patients and the environment in the area of Paris, France, over a 10-year period. J. Clin. Microbiol. 37: 2652 2655.
78. Liu, H.,, Y. Li,, X. Huang,, Y. Kawamura,, and T. Ezaki. 2003. Use of the dnaJ gene for the detection and identification of all Legionella pneumophila serogroups and description of the primers used to detect 16S rDNA gene sequences of major members of the genus Legionella. Microbiol. Immunol. 47: 859 869.
79. Loens, K.,, T. Beck,, D. Ursi,, M. Overdijk,, P. Sillekens,, H. Goossens,, and M. Ieven. 2008. Evaluation of different nucleic acid amplification techniques for the detection of M. pneumoniae, C. pneumoniae and Legionella spp. in respiratory specimens from patients with community-acquired pneumonia. J. Microbiol. Methods 73: 257 262.
80. LoPresti, F.,, S. Riffard,, H. Meugnier,, M. Reyrolle,, Y. Lasne,, P. A. Grimont,, F. Grimont,, F. Vandenesch,, J. Etienne,, J. Fleurette,, and J. Freney. 1999. Legionella taurinensis sp. nov., a new species antigenically similar to Legionella spiritensis. Int. J. Syst. Bacteriol. 49: 397 403.
81. Luck, P. C.,, R. J. Birtles,, and J. H. Helbig. 1995. Correlation of MAb subgroups with genotype in closely related Legionella pneumophila serogroup 1 strains from a cooling tower. J. Med. Microbiol. 43: 50 54.
82. Marston, B. J.,, J. F. Plouffe,, T. M. File, Jr.,, B. A. Hackman,, S. J. Salstrom,, H. B. Lipman,, M. S. Kolczak,, R. F. Breiman, et al. 1997. Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. Arch. Intern. Med. 157: 1709 1718.
83. McDade, J. E.,, C. C. Shepard,, D. W. Fraser,, T. R. Tsai,, M. A. Redus,, and W. R. Dowdle. 1977. Legionnaires’ disease: isolation of a bacterium and demonstration of its role in other respiratory disease. N. Engl. J. Med. 297: 1197 1203.
84. Morrill, W. E.,, J. M. Barbaree,, B. S. Fields,, G. N. Sanden,, and W. T. Martin. 1990. Increased recovery of Legionella micdadei and Legionella bozemanii on buffered charcoal yeast extract agar supplemented with albumin. J. Clin. Microbiol. 28: 616 618.
85. Muder, R. R.,, and V. L. Yu. 2002. Infection due to Legionella species other than L. pneumophila. Clin. Infect. Dis. 35: 990 998.
86. Murdoch, D. R. 2003. Diagnosis of Legionella infection. Clin. Infect. Dis. 36: 64 69.
87. Mykietiuk, A.,, J. Carratalà,, N. Fernández-Sabé,, J. Dorca,, R. Verdaguer,, F. Manresa,, and F. Gudiol. 2005. Clinical outcomes for hospitalized patients with Legionella pneumonia in the antigenuria era: the influence of levofloxacin therapy. Clin. Infect. Dis. 40: 794 799.
88. Nagington, J.,, T. G. Wreghitt,, J. O. Tobin,, and A. D. Macrae. 1979. The antibody response in Legionnaires’ disease. J. Hyg. Lond. 83: 377 381.
89. Nazarian, E. J.,, D. J. Bopp,, A. Saylors,, R. J. Limberger,, and K. A. Musser. 2008. Design and implementation of a protocol for the detection of Legionella in clinical and environmental samples. Diagn. Microbiol. Infect. Dis. 62: 125 132.
90. Ng, V.,, L. Weir,, M. K. York,, and W. K. Hadley. 1992. Bordetella pertussis versus non- L. pneumophila Legionella spp.: a continuing diagnostic challenge. J. Clin. Microbiol. 30: 3300 3301.
91. Ogawa, M.,, A. Takade,, H. Miyamoto,, H. Taniguchi,, and S. Yoshida. 2001. Morphological variety of intracellular microcolonies of Legionella species in Vero cells. Microbiol. Immunol. 45: 557 562.
92. Osterholm, M. T.,, T. D. Chin,, D. O. Osborne,, H. B. Dull,, A. G. Dean,, D. W. Fraser,, P. S. Hayes,, and W. N. Hall. 1983. A 1957 outbreak of Legionnaires’ disease associated with a meat packing plant. Am. J. Epidemiol. 117: 60 67.
93. Park, M. Y.,, K. S. Ko,, H. K. Lee,, M. S. Park,, and Y. H. Kook. 2003. Legionella busanensis sp. nov., isolated from cooling tower water in korea. Int. J. Syst. Evol. Microbiol. 53: 77 80.
94. Pasculle, A. W.,, and D. McDevitt,. 2004. Legionella cultures, p. In H. D. Isenberg (ed. in chief), Clinical Microbiology Procedures Handbook, 2nd ed. ASM Press, Washington, DC.
95. Pelaz, C.,, L. García Albert,, and C. M. Bourgon. 1987. Cross-reactivity among Legionella species and serogroups. Epidemiol. Infect. 99: 641 646.
96. Pruckler, J. M.,, L. A. Mermel,, R. F. Benson,, C. Giorgio,, P. K. Cassiday,, R. F. Breiman,, C. G. Whitney,, and B. S. Fields. 1995. Comparison of Legionella pneumophila isolates by arbitrarily primed PCR and pulsed-field gel electrophoresis: analysis from seven epidemic investigations. J. Clin. Microbiol. 33: 2872 2875.
97. Ratcliff, R. M.,, J. A. Lanser,, P. A. Manning,, and M. W. Heuzenroeder. 1998. Sequence-based classification scheme for the genus Legionella targeting the mip gene. J. Clin. Microbiol. 36: 1560 1567.
98. Ratzow, S.,, V. Gaia,, J. H. Helbig,, N. K. Fry,, and P. C. Luck. 2007. Addition of neuA, the gene encoding N-acylneuraminate cytidylyl transferase, increases the discriminatory ability of the consensus sequence-based scheme for typing Legionella pneumophila serogroup 1 strains. J. Clin. Microbiol. 45: 1965 1968.
99. Richardson, I. R.,, and N. F. Lightfoot. 1992. Legionella pneumophila species identification using a commercial latex agglutination kit: a potential cross-reaction problem with serogroup 12. Med. Lab. Sci. 49: 144 146.
100. Riffard, S.,, F. LoPresti,, P. Normand,, F. Forey,, M. Reyrolle,, J. Etienne,, and F. Vandenesch. 1998. Species identification of Legionella via intergenic 16S-23S ribosomal spacer PCR analysis. Int. J. Syst. Bacteriol. 48: 723 730.
101. Riffard, S.,, F. Vandenesch,, M. Reyrolle,, and J. Etienne. 1996. Distribution of mip-related sequences in 39 species (48 serogroups) of Legionellaceae. Epidemiol. Infect. 117: 501 506.
102. Rowbotham, T. J. 1986. Current views on the relationships between amoebae, legionellae and man. Isr. J. Med. Sci. 22: 678 689.
103. She, R. C.,, E. Billetdeaux,, A. R. Phansalkar,, and C. A. Petti. 2007. Limited applicability of direct fluorescent-antibody testing for Bordetella sp. and Legionella sp. specimens for the clinical microbiology laboratory. J. Clin. Microbiol. 45: 2212 2214.
104. Shen, H.,, S. Rogelj,, and T. L. Kieft. 2006. Sensitive, real-time PCR detects low-levels of contamination by Legionella pneumophila in commercial reagents. Mol. Cell. Probes 20: 147 153.
105. Steele, T. W.,, J. Lanser,, and N. Sangster. 1990. Isolation of Legionella longbeachae serogroup 1 from potting mixes. Appl. Environ. Microbiol. 56: 49 53.
106. Tateyama, M. 3. 1992. Misleading serological identification of Legionella anisa as Legionella bozemanii. Kansenshogaku Zasshi 66: 149 155.
107. Templeton, K. E.,, S. A. Scheltinga,, P. Sillekens,, J. W. Crielaard,, A. P. van Dam,, H. Goossens,, and E. C. Claas. 2003. 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. 41: 4016 4021.
108. Tenover, F. C.,, P. H. Edelstein,, L. C. Goldstein,, J. C. Sturge,, and J. J. Plorde. 1986. Comparison of cross-staining reactions by Pseudomonas spp. and fluorescein-labeled poly-clonal and monoclonal antibodies directed against Legionella pneumophila. J. Clin. Microbiol. 23: 647 649.
109. Thacker, L.,, R. M. McKinney,, C. W. Moss,, H. M. Sommers,, M. L. Spivack,, and T. F. O’Brien. 1981. Thermophilic sporeforming bacilli that mimic fastidious growth characteristics and colonial morphology of legionella. J. Clin. Microbiol. 13: 794 797.
110. Thacker, W. L.,, R. F. Benson,, R. B. Schifman,, E. Pugh,, A. G. Steigerwalt,, W. R. Mayberry,, D. J. Brenner,, and H. W. Wilkinson. 1989. Legionella tucsonensis sp. nov. isolated from a renal transplant recipient. J. Clin. Microbiol. 27: 1831 1834.
111. Thacker, W. L.,, R. F. Benson,, H. W. Wilkinson,, N. M. Ampel,, E. J. Wing,, A. G. Steigerwalt,, and D. J. Brenner. 1986. 11th serogroup of Legionella pneumophila isolated from a patient with fatal pneumonia. J. Clin. Microbiol. 23: 1146 1147.
112. Thacker, W. L.,, J. W. Dyke,, R. F. Benson,, D. H. Havlichek, Jr.,, B. Robinson-Dunn,, H. Stiefel,, W. Schneider,, C. W. Moss,, W. R. Mayberry,, and D. J. Brenner. 1992. Legionella lansingensis sp. nov. isolated from a patient with pneumonia and underlying chronic lymphocytic leukemia. J. Clin. Microbiol. 30: 2398 2401.
113. Thacker, W. L.,, H. W. Wilkinson,, and R. F. Benson. 1983. Comparison of slide agglutination test and direct immunofluorescence assay for identification of Legionella isolates. J. Clin. Microbiol. 18: 1113 1118.
114. van der Zee, A.,, M. Peeters,, C. de Jong,, H. Verbakel,, J. W. Crielaard,, E. C. Claas,, and K. E. Templeton. 2002. Qiagen DNA extraction kits for sample preparation for legionella PCR are not suitable for diagnostic purposes. J. Clin. Microbiol. 40: 1126.
115. Vesey, G.,, P. J. Dennis,, J. V. Lee,, and A. A. West. 1988. Further development of simple tests to differentiate the legionellas. J. Appl. Bacteriol. 65: 339 345.
116. Vickers, R. M.,, J. D. Rihs,, and V. L. Yu. 1992. Clinical demonstration of isolation of Nocardia asteroides on buffered charcoal-yeast extract media. J. Clin. Microbiol. 30: 227 228.
117. von Baum, H.,, S. Ewig,, R. Marre,, N. Suttorp,, S. Gonschior,, T. Welte,, and C. Lück. 2008. Community-acquired Legionella pneumonia: new insights from the German competence network for community acquired pneumonia. Clin. Infect. Dis. 46: 1356 1364.
118. Westerman, E. L.,, and J. McDonald. 1983. Tularemia pneumonia mimicking legionnaires’ disease: isolation of organism on CYE agar and successful treatment with erythromycin. South. Med. J. 76: 1169 1170.
119. Wilkinson, H. W.,, W. L. Thacker,, A. G. Steigerwalt,, D. J. Brenner,, N. M. Ampel,, and E. J. Wing. 1985. Second serogroup of Legionella hackeliae isolated from a patient with pneumonia. J. Clin. Microbiol. 22: 488 489.
120. Wilson, D. A.,, U. Reischl,, G. S. Hall,, and G. W. Procop. 2007. Use of partial 16S rRNA gene sequencing for identification of Legionella pneumophila and non- pneumophila Legionella spp. J. Clin. Microbiol. 45: 257 258.
121. Winn, W. C., Jr. 1985. Legionella and Legionnaires’ disease: a review with emphasis on environmental studies and laboratory diagnosis. Crit. Rev. Clin. Lab. Sci. 21: 323 381.
122. Zusman, T.,, G. Yerushalmi,, and G. Segal. 2003. Functional similarities between the icm/dot pathogenesis systems of Coxiella burnetii and Legionella pneumophila. Infect. Immun. 71: 3714 3723.


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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