Chapter 11.3 : Detection of Antigen by Direct Immunofluorescence

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Legionnaires' disease is a type of bacterial pneumonia caused by spp. ( ). It is estimated that about 1 to 4% of adults with pneumonia requiring hospitalization have Legionnaires' disease and that about 20,000 to 100,000 adults with community-acquired pneumonia have this disease in the United States each year. About 5 to 20% of patients with Legionnaires' disease die of the disease, with major dependence on promptness of specific antibiotic therapy and underlying health of the patient. Legionnaires' disease occurs worldwide, in both epidemic and sporadic form, with sporadic cases being far more common. The disease is more prevalent in some geographic regions than others, for unclear reasons. The primary host risk factors for the disease include immunosuppression, cigarette smoking, and travel. is the cause of more than 90% of cases of community-acquired Legionnaires' disease, with serogroup 1 being by far the most common causative agent of the disease. Immunosuppressed patients, and those with nosocomial pneumonia, may have infections caused by other serogroups and other spp., in particular , and . Distribution of the common serogroups and species causing infection may be quite different in various geographic regions. bacteria are commonly found in the aqueous environment, including tap water and sometimes even distilled water. The preponderance of as the cause of Legionnaires' disease has resulted in the development of reagents optimized for detection of this species; detection of other species can be problematic, for reasons of both test sensitivity and specificity. Rarely, organs other than the lungs and pleural space may be infected by the bacterium, causing such diseases as prosthetic heart valve endocarditis, assorted soft tissue abscesses, and systemic infection.

Citation: Garcia L. 2010. Detection of Antigen by Direct Immunofluorescence, p 146-152. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.3
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1. Cherry, W. B.,, B. Pittman,, P. P. Harris,, G. A. Hebert,, B. M. Thomason,, L. Thacker,, and R. E. Weaver. 1978. Detection of Legionnaires disease bacteria by direct immunofluorescent staining. J. Clin. Microbiol. 8: 329 338.
2. Edelstein, P. H. 1993. Legionnaires’ disease. Clin. Infect. Dis. 16: 741 749.
3. 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.
4. 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.
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8. Johnson, D. A.,, K. F. Wagner,, J. Blanks,, and J. Slater. 1985. False-positive direct fluorescent antibody testing for Legionella. JAMA 253: 40 41. (Letter.)
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11. Roy, T. M.,, D. Fleming,, and W. H. Anderson. 1989. Tularemic pneumonia mimicking Legionnaires’ disease with false-positive direct fluorescent antibody stains for Legionella. South. Med. J. 82: 1429 1431.
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13. 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.
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15. 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 polyclonal and monoclonal antibodies directed against Legionella pneumophila. J. Clin. Microbiol. 23: 647 649.
16. Winn, W. C., Jr.,, W. B. Cherry,, R. O. Frank,, C. A. Casey,, and C. V. Broome. 1980. Direct immunofluorescent detection of Legionella pneumophila in respiratory specimens. J. Clin. Microbiol. 11: 59 64.
17. Zuravleff, J. J.,, V. L. Yu,, J. W. Shonnard,, B. K. Davis,, and, J. D. Rihs. 1983. Diagnosis of Legionnaires’disease. An update of laboratory methods with new emphasis on isolation by culture. JAMA 250: 1981 1985.


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Table 11.3-1

Suitable specimen types for DFA testing

Citation: Garcia L. 2010. Detection of Antigen by Direct Immunofluorescence, p 146-152. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.3
Generic image for table
Table 11.3-2

Commercial DFA reagents

Citation: Garcia L. 2010. Detection of Antigen by Direct Immunofluorescence, p 146-152. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch11.3

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