Chapter 49 : Legionella

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Legionnaires’ disease (LD) is a type of pneumonia caused by the spp. is the most common cause of the disease and, along with , causes disease in both immunocompetent and immunosuppressed people. The >50 other named spp. rarely cause LD and do so exclusively in immunocompromised patients. The spp. are aerobic Gram-negative bacilli that are found mainly in aqueous environments. Humans are accidental hosts of these bacteria, acquiring LD by inhalation or aspiration of environmental bacteria. The bacteria can be grown on buffered yeast extract medium. Bacterial identification can be difficult because of the nonreactivity of the bacteria in biochemical tests. Laboratory diagnosis of LD is based on the use of selective culture media, detection of urinary antigen, antibody detection, and molecular amplification methods, such as PCR. Culture diagnosis is insensitive but very specific, having the highest yield in severely ill and immunosuppressed patients. Urine antigen testing is fast, easy, and relatively sensitive, especially for community-acquired LD, but around 30% of LD patients have negative urine tests. Molecular-amplification diagnosis, such as PCR, appears to be more sensitive than other methods, but the lack of FDA-cleared assays limits its use to large reference laboratories in the United States. Strain typing is mainly sequence based, with monoclonal antibody reactivity being a useful, quick screening test.

Citation: Edelstein P, LÜCK C. 2015. Legionella, p 887-904. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch49
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Image of FIGURE 1

Photomicrographs of . (A) Gimenez stain of intracellular bacteria from a patient with lung infection. (B) Gram stain using a basic fuchsin counterstain of a colony taken from a BCYEα plate. Note the dramatic size and shape differences between the intracellular and extracellular bacteria. (C) Direct immunofluorescent staining of in lung. doi:10.1128/9781555817381.ch49.f1

Citation: Edelstein P, LÜCK C. 2015. Legionella, p 887-904. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch49
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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. doi:10.1128/9781555817381.ch49.f2

Citation: Edelstein P, LÜCK C. 2015. Legionella, p 887-904. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch49
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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-L, BCYEα made without -cysteine; BAP, tryptic soy blood agar; UV light, colony fluorescence and color when illuminated with long-wave (360-nm) UV light. doi:10.1128/9781555817381.ch49.f3

Citation: Edelstein P, LÜCK C. 2015. Legionella, p 887-904. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch49
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Selected characteristics of the spp.

Citation: Edelstein P, LÜCK C. 2015. Legionella, p 887-904. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch49
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Composition and selectivity of media used to grow spp. from clinical and environmental specimens

Citation: Edelstein P, LÜCK C. 2015. Legionella, p 887-904. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch49

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