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Rello J, Allam C, Ruiz-Spinelli A, Jarraud S. Severe Legionnaires' disease. Ann Intensive Care 2024; 14:51. [PMID: 38565811 PMCID: PMC10987467 DOI: 10.1186/s13613-024-01252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Legionnaires' disease (LD) is a common but under-diagnosed cause of community-acquired pneumonia (CAP), although rapid detection of urine antigen testing (UAT) and advances in molecular testing have improved the diagnosis. LD entails intensive care unit (ICU) admission in almost one-third of cases, and the mortality rate ranges from 4% to 40%. This review aims to discuss recent advances in the study of this condition and to provide an update on the diagnosis, pathogenesis and management of severe LD. RESULTS The overall incidence of LD has increased worldwide in recent years due to the higher number of patients with risk factors, especially immunosuppression, and to improvements in diagnostic methods. Although LD is responsible for only around 5% of all-cause CAP, it is one of the three most common causes of CAP requiring ICU admission. Mortality in ICU patients, immunocompromised patients or patients with a nosocomial source of LD can reach 40% despite appropriate antimicrobial therapy. Regarding pathogenesis, no Legionella-specific virulence factors have been associated with severity; however, recent reports have found high pulmonary Legionella DNA loads, and impairments in immune response and lung microbiome in the most severe cases. The clinical picture includes severe lung injury requiring respiratory and/or hemodynamic support, extrapulmonary symptoms and non-specific laboratory findings. LD diagnostic methods have improved due to the broad use of UAT and the development of molecular methods allowing the detection of all Lp serogroups. Therapy is currently based on macrolides, quinolones, or a combination of the two, with prolonged treatment in severe cases. CONCLUSIONS Numerous factors influence the mortality rate of LD, such as ICU admission, the underlying immune status, and the nosocomial source of the infection. The host immune response (hyperinflammation and/or immunoparalysis) may also be associated with increased severity. Given that the incidence of LD is rising, studies on specific biomarkers of severity may be of great interest. Further assessments comparing different regimens and/or evaluating host-directed therapies are nowadays needed.
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Affiliation(s)
- Jordi Rello
- Global Health ECore, Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
- Formation Recherche Evaluation (FOREVA) Research Group, CHU Nîmes, Nîmes, France
| | - Camille Allam
- Institut des Agents Infectieux, Centre National de Référence des Légionelles, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Équipe Pathogenèse des Légionelles, Université Lyon, Inserm, U1111,Université Claude Bernard Lyon 1, CNRS, UMR5308,École Normale Supérieure de Lyon, Lyon, France
| | | | - Sophie Jarraud
- Institut des Agents Infectieux, Centre National de Référence des Légionelles, Hospices Civils de Lyon, Lyon, France.
- Centre International de Recherche en Infectiologie (CIRI), Équipe Pathogenèse des Légionelles, Université Lyon, Inserm, U1111,Université Claude Bernard Lyon 1, CNRS, UMR5308,École Normale Supérieure de Lyon, Lyon, France.
- Centre National de Reference des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, 103 Grande rue de la Croix Rousse, 69317, Lyon Cedex 04, France.
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Gentry Z, Zhao L, Faust RA, David RE, Norton J, Xagoraraki I. Wastewater surveillance beyond COVID-19: a ranking system for communicable disease testing in the tri-county Detroit area, Michigan, USA. Front Public Health 2023; 11:1178515. [PMID: 37333521 PMCID: PMC10272568 DOI: 10.3389/fpubh.2023.1178515] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Throughout the coronavirus disease 2019 (COVID-19) pandemic, wastewater surveillance has been utilized to monitor the disease in the United States through routine national, statewide, and regional monitoring projects. A significant canon of evidence was produced showing that wastewater surveillance is a credible and effective tool for disease monitoring. Hence, the application of wastewater surveillance can extend beyond monitoring SARS-CoV-2 to encompass a diverse range of emerging diseases. This article proposed a ranking system for prioritizing reportable communicable diseases (CDs) in the Tri-County Detroit Area (TCDA), Michigan, for future wastewater surveillance applications at the Great Lakes Water Authority's Water Reclamation Plant (GLWA's WRP). Methods The comprehensive CD wastewater surveillance ranking system (CDWSRank) was developed based on 6 binary and 6 quantitative parameters. The final ranking scores of CDs were computed by summing the multiplication products of weighting factors for each parameter, and then were sorted based on decreasing priority. Disease incidence data from 2014 to 2021 were collected for the TCDA. Disease incidence trends in the TCDA were endowed with higher weights, prioritizing the TCDA over the state of Michigan. Results Disparities in incidences of CDs were identified between the TCDA and state of Michigan, indicating epidemiological differences. Among 96 ranked CDs, some top ranked CDs did not present relatively high incidences but were prioritized, suggesting that such CDs require significant attention by wastewater surveillance practitioners, despite their relatively low incidences in the geographic area of interest. Appropriate wastewater sample concentration methods are summarized for the application of wastewater surveillance as per viral, bacterial, parasitic, and fungal pathogens. Discussion The CDWSRank system is one of the first of its kind to provide an empirical approach to prioritize CDs for wastewater surveillance, specifically in geographies served by centralized wastewater collection in the area of interest. The CDWSRank system provides a methodological tool and critical information that can help public health officials and policymakers allocate resources. It can be used to prioritize disease surveillance efforts and ensure that public health interventions are targeted at the most potentially urgent threats. The CDWSRank system can be easily adopted to geographical locations beyond the TCDA.
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Affiliation(s)
- Zachary Gentry
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, United States
| | - Liang Zhao
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, United States
| | | | - Randy E. David
- Wayne State University School of Medicine, Detroit, MI, United States
| | - John Norton
- Great Lakes Water Authority, Detroit, MI, United States
| | - Irene Xagoraraki
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, United States
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Fraz MSA, Dahle G, Skaug KM, Jarraud S, Frye S, Bjørnholt JV, Nordøy I. Case report: A prosthetic valve endocarditis caused by Legionella bozemanae in an immunocompetent patient. Front Med (Lausanne) 2022; 9:1055465. [DOI: 10.3389/fmed.2022.1055465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Extrapulmonary infections with Legionella species are rare, but important to acknowledge. We report a case of infective endocarditis (IE) with Legionella bozemanae in a 66-year-old immunocompetent man with an aortic homograft. The diagnosis was made by direct 16S rRNA gene amplification from valve material, confirmed by a targeted Legionella-PCR in serum and the detection of L. bozemanae specific antibodies. To our knowledge, this is the first confirmed case of IE with L. bozemanae as causative pathogen. The infected aortic prosthesis was replaced by a homograft, and the patient was successfully treated with levofloxacin and azithromycin for 6 weeks.
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Legionnaires' Disease: Update on Diagnosis and Treatment. Infect Dis Ther 2022; 11:973-986. [PMID: 35505000 PMCID: PMC9124264 DOI: 10.1007/s40121-022-00635-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Legionellosis is the infection caused by bacteria of the genus Legionella, including a non-pneumonic influenza-like syndrome, and Legionnaires’ disease is a more serious illness characterized by pneumonia. Legionellosis is becoming increasingly important as a public health problem throughout the world; although it is an underreported disease, studies have consistently documented a high incidence. In addition, health costs associated with the disease are high. Diagnosis of Legionnaires’ disease is based mainly on the detection of Legionella pneumophila serogroup 1 antigen in urine. However, there have been advances in detection tests for patients with legionellosis. New methodologies show greater sensitivity and specificity, detect more species and serogroups of Legionella spp., and have the potential for use in epidemiological studies. Testing for Legionella spp. is recommended at hospital admission for severe community-acquired pneumonia, and antibiotics directed against Legionella spp. should be included early as empirical therapy. Inadequate or delayed antibiotic treatment in Legionella pneumonia has been associated with a worse prognosis. Either a fluoroquinolone (levofloxacin or moxifloxacin) or a macrolide (azithromycin preferred) is the recommended first-line therapy for Legionnaires’ disease; however, little information is available regarding adverse events or complications, or about the duration of antibiotic therapy and its association with clinical outcomes. Most published studies evaluating antibiotic treatment for Legionnaires’ disease are observational and consequently susceptible to bias and confounding. Well-designed studies are needed to assess the usefulness of diagnostic tests regarding clinical outcomes, as well as randomized trials comparing fluoroquinolones and macrolides or combination therapy that evaluate outcomes and adverse events.
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Fida M, Wolf MJ, Hamdi A, Vijayvargiya P, Esquer Garrigos Z, Khalil S, Greenwood-Quaintance KE, Thoendel MJ, Patel R. Detection of Pathogenic Bacteria From Septic Patients Using 16S Ribosomal RNA Gene-Targeted Metagenomic Sequencing. Clin Infect Dis 2021; 73:1165-1172. [PMID: 33893492 PMCID: PMC8492209 DOI: 10.1093/cid/ciab349] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Conventional blood cultures were compared to plasma cell-free DNA-based 16S ribosomal RNA (rRNA) gene polymerase chain reaction (PCR)/next-generation sequencing (NGS) for detection and identification of potential pathogens in patients with sepsis. METHODS Plasma was prospectively collected from 60 adult patients with sepsis presenting to the Mayo Clinic (Minnesota) Emergency Department from March through August 2019. Results of routine clinical blood cultures were compared to those of 16S rRNA gene NGS. RESULTS Nineteen (32%) subjects had positive blood cultures, of which 13 yielded gram-negative bacilli, 5 gram-positive cocci, and 1 both gram-negative bacilli and gram-positive cocci. 16S rRNA gene NGS findings were concordant in 11. For the remaining 8, 16S rRNA gene NGS results yielded discordant detections (n = 5) or were negative (n = 3). Interestingly, Clostridium species were additionally detected by 16S rRNA gene NGS in 3 of the 6 subjects with gastrointestinal sources of gram-negative bacteremia and none of the 3 subjects with urinary sources of gram-negative bacteremia. In the 41 remaining subjects, 16S rRNA gene NGS detected at least 1 potentially pathogenic organism in 17. In 15, the detected microorganism clinically correlated with the patient's syndrome. In 17 subjects with a clinically defined infectious syndrome, neither test was positive; in the remaining 7 subjects, a noninfectious cause of clinical presentation was identified. CONCLUSIONS 16S rRNA gene NGS may be useful for detecting bacteria in plasma of septic patients. In some cases of gram-negative sepsis, it may be possible to pinpoint a gastrointestinal or urinary source of sepsis based on the profile of bacteria detected in plasma.
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Affiliation(s)
- Madiha Fida
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J Wolf
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed Hamdi
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prakhar Vijayvargiya
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississipi, USA
| | - Zerelda Esquer Garrigos
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississipi, USA
| | - Sarwat Khalil
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Matthew J Thoendel
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
The clinical presentation of brucellosis in humans is variable and unspecific, and thus, laboratory corroboration of the diagnosis is essential for the patient's proper treatment. The diagnosis of brucellar infections can be made by culture, serological tests, and nucleic acid amplification assays. Modern automated blood culture systems enable detection of acute cases of brucellosis within the routine 5- to 7-day incubation protocol employed in clinical microbiology laboratories, although a longer incubation and performance of blind subcultures may be needed for protracted cases. Serological tests, though they lack specificity and provide results that may be difficult to interpret in individuals repeatedly exposed to Brucella organisms, nevertheless remain a diagnostic cornerstone in resource-poor countries. Nucleic acid amplification assays combine exquisite sensitivity, specificity, and safety and enable rapid diagnosis of the disease. However, long-term persistence of positive molecular test results in patients that have apparently fully recovered is common and has unclear clinical significance and therapeutic implications. Therefore, as long as there are no sufficiently validated commercial tests or studies that demonstrate an adequate interlaboratory reproducibility of the different homemade PCR assays, cultures and serological methods will remain the primary tools for the diagnosis and posttherapeutic follow-up of human brucellosis.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Pilar Morata
- Biochemistry and Molecular Biology Department, Faculty of Medicine, University of Málaga, Málaga, Spain
- IBIMA, Málaga, Spain
| | - Juan D Colmenero
- Infectious Diseases Service, University Regional Hospital, Málaga, Spain
- IBIMA, Málaga, Spain
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7
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Buhmann MT, Abt D, Nolte O, Neu TR, Strempel S, Albrich WC, Betschart P, Zumstein V, Neels A, Maniura-Weber K, Ren Q. Encrustations on ureteral stents from patients without urinary tract infection reveal distinct urotypes and a low bacterial load. MICROBIOME 2019; 7:60. [PMID: 30981280 PMCID: PMC6462311 DOI: 10.1186/s40168-019-0674-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/28/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Current knowledge of the urinary tract microbiome is limited to urine analysis and analysis of biofilms formed on Foley catheters. Bacterial biofilms on ureteral stents have rarely been investigated, and no cultivation-independent data are available on the microbiome of the encrustations on the stents. RESULTS The typical encrustations of organic and inorganic urine-derived material, including microbial biofilms formed during 3-6 weeks on ureteral stents in patients treated for kidney and ureteral stones, and without reported urinary tract infection at the time of stent insertion, were analysed. Next-generation sequencing of the 16S rRNA gene V3-V4 region revealed presence of different urotypes, distinct bacterial communities. Analysis of bacterial load was performed by combining quantification of 16S rRNA gene copy numbers by qPCR with microscopy and cultivation-dependent analysis methods, which revealed that ureteral stent biofilms mostly contain low numbers of bacteria. Fluorescence microscopy indicates the presence of extracellular DNA. Bacteria identified in biofilms by microscopy had mostly morphogenic similarities to gram-positive bacteria, in few cases to Lactobacillus and Corynebacterium, while sequencing showed many additional bacterial genera. Weddellite crystals were absent in biofilms of patients with Enterobacterales and Corynebacterium-dominated microbiomes. CONCLUSIONS This study provides novel insights into the bacterial burden in ureteral stent encrustations and the urinary tract microbiome. Short-term (3-6 weeks) ureteral stenting is associated with a low load of viable and visible bacteria in ureteral stent encrustations, which may be different from long-term stenting. Patients could be classified according to different urotypes, some of which were dominated by potentially pathogenic species. Facultative pathogens however appear to be a common feature in patients without clinically manifested urinary tract infection. TRIAL REGISTRATION ClinicalTrials.gov, NCT02845726 . Registered on 30 June 2016-retrospectively registered.
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Affiliation(s)
- Matthias T. Buhmann
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Oliver Nolte
- Zentrum für Labormedizin, Frohbergstrasse 3, 9001 St. Gallen, Switzerland
| | - Thomas R. Neu
- Microbiology of Interfaces, Department River Ecology, Helmholtz Centre for Environmental Research – UFZ, Brueckstrasse 3A, 39114 Magdeburg, Germany
| | | | - Werner C. Albrich
- Division of Infectious Diseases/Hospital Epidemiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
| | - Antonia Neels
- Center for X-ray Analytics, Empa, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Katharina Maniura-Weber
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Qun Ren
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
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Abstract
Urine is a major repository of biometabolites, some proteins, and DNA. Within the past few decades, it has become increasingly apparent that certain infectious, neoplastic, and congenital diseases can be investigated using urine samples for diagnostic and prognostic purposes. In this chapter, a number of pertinent urine analytes and methods of banking urine samples for future analyses are discussed.
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Bioassays: The best alternative for conventional methods in detection of Legionella pneumophila. Int J Biol Macromol 2018; 121:1295-1307. [PMID: 30219511 DOI: 10.1016/j.ijbiomac.2018.09.074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022]
Abstract
Fastidious bacteria are group of bacteria that not only grow slowly but also have complex nutritional needs. In this review, recent progress made on development of biosensing strategies towards quantification of Legionella pneumophila as fastidious bacteria in microbiology was investigated. In coincidence with medical bacteriology, it is the most widely used bio-monitoring, biosensors based on DNA and antibody. Also, all of legionella pneumophila genosensors and immunosensors that developed in recent years were collected analyzed. This review is meant to provide an overview of the various types of bioassays have been developed for determination of Legionella Legionella, along with significant advances over the last several years in related technologies. In addition, this review described: i) Most frequently applied principles in bioassay/biosensing of Legionellaii) The aspects of fabrication in the perspective of bioassay/biosensing applications iii) The potential of various electrochemical and optical bioassay/biosensing for the determination of Legionella and the circumvention of the most serious problem in immunosensing/immunoassay was discussed. iv) Some of bioassay/biosensing has been discussed with and without labels. v) We also summarize the latest developments in the applications of bioassay/biosensing methods for detection of Legionella. vi) The development trends of optical and electrochemical based bioassay/biosensing are also introduced.
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Murdoch DR. How recent advances in molecular tests could impact the diagnosis of pneumonia. Expert Rev Mol Diagn 2016; 16:533-40. [PMID: 26891612 PMCID: PMC7103682 DOI: 10.1586/14737159.2016.1156536] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/17/2016] [Indexed: 12/21/2022]
Abstract
Molecular diagnostic tests have been the single major development in pneumonia diagnostics over recent years. Nucleic acid detection tests (NATs) have greatly improved the ability to detect respiratory viruses and bacterial pathogens that do not normally colonize the respiratory tract. In contrast, NATs do not yet have an established role for diagnosing pneumonia caused by bacteria that commonly colonize the nasopharynx due to difficulties discriminating between pathogens and coincidental carriage strains. New approaches are needed to distinguish infection from colonization, such as through use of quantitative methods and identification of discriminating cut-off levels. The recent realization that the lung microbiome exists has provided new insights into the pathogenesis of pneumonia involving the interaction between multiple microorganisms. New developments in molecular diagnostics must account for this new paradigm.
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Affiliation(s)
- David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, and Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
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11
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Avni T, Bieber A, Green H, Steinmetz T, Leibovici L, Paul M. Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.: a Systematic Review. J Clin Microbiol 2016; 54:401-11. [PMID: 26659202 PMCID: PMC4733173 DOI: 10.1128/jcm.02675-15] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of Legionnaires' disease (LD) is based on the isolation of Legionella spp., a 4-fold rise in antibodies, a positive urinary antigen (UA), or direct immunofluorescence tests. PCR is not accepted as a diagnostic tool for LD. This systematic review assesses the diagnostic accuracy of PCR in various clinical samples with a direct comparison versus UA. We included prospective or retrospective cohort and case-control studies. Studies were included if they used the Centers for Disease Control and Prevention consensus definition criteria of LD or a similar one, assessed only patients with clinical pneumonia, and reported data for all true-positive, false-positive, true-negative, and false-negative results. Two reviewers abstracted data independently. Risk of bias was assessed using Quadas-2. Summary sensitivity and specificity values were estimated using a bivariate model and reported with a 95% confidence interval (CI). Thirty-eight studies were included. A total of 653 patients had confirmed LD, and 3,593 patients had pneumonia due to other pathogens. The methodological quality of the studies as assessed by the Quadas-2 tool was poor to fair. The summary sensitivity and specificity values for diagnosis of LD in respiratory samples were 97.4% (95% CI, 91.1% to 99.2%) and 98.6% (95% CI, 97.4% to 99.3%), respectively. These results were mainly unchanged by any covariates tested and subgroup analysis. The diagnostic performance of PCR in respiratory samples was much better than that of UA. Compared to UA, PCR in respiratory samples (especially in sputum samples or swabs) revealed a significant advantage in sensitivity and an additional diagnosis of 18% to 30% of LD cases. The diagnostic performance of PCR in respiratory samples was excellent and preferable to that of the UA. Results were independent on the covariate tested. PCR in respiratory samples should be regarded as a valid tool for the diagnosis of LD.
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Affiliation(s)
- Tomer Avni
- Medicine E, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Amir Bieber
- Medicine E, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Hefziba Green
- Medicine E, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Tali Steinmetz
- Medicine E, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Leonard Leibovici
- Medicine E, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Mical Paul
- Infectious Diseases Unit, Rambam Medical Center and Rappaport Faculty of Medicine, Tehnion, Israel Institute of Technology, Haifa, Israel
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12
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Using Nucleic Acid Amplification Techniques in a Syndrome-Oriented Approach: Detection of Respiratory Agents. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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13
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Microbiologic Diagnosis of Lung Infection. MURRAY AND NADEL'S TEXTBOOK OF RESPIRATORY MEDICINE 2016. [PMCID: PMC7152380 DOI: 10.1016/b978-1-4557-3383-5.00017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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14
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Mercante JW, Winchell JM. Current and emerging Legionella diagnostics for laboratory and outbreak investigations. Clin Microbiol Rev 2015; 28:95-133. [PMID: 25567224 PMCID: PMC4284297 DOI: 10.1128/cmr.00029-14] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Legionnaires' disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic "blind spot" for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.
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Affiliation(s)
- Jeffrey W Mercante
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Pneumonia Response and Surveillance Laboratory, Respiratory Diseases Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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15
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Ximenes C, Brandão E, Oliveira P, Rocha A, Rego T, Medeiros R, Aguiar-Santos A, Ferraz J, Reis C, Araujo P, Carvalho L, Melo FL. Detection of Wuchereria bancrofti DNA in paired serum and urine samples using polymerase chain reaction-based systems. Mem Inst Oswaldo Cruz 2014; 109:978-83. [PMID: 25424447 PMCID: PMC4325614 DOI: 10.1590/0074-0276140155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/31/2014] [Indexed: 11/23/2022] Open
Abstract
The Global Program for the Elimination of Lymphatic Filariasis (GPELF) aims to
eliminate this disease by the year 2020. However, the development of more specific
and sensitive tests is important for the success of the GPELF. The present study
aimed to standardise polymerase chain reaction (PCR)-based systems for the diagnosis
of filariasis in serum and urine. Twenty paired biological urine and serum samples
from individuals already known to be positive for Wuchereria bancrofti
were collected during the day. Conventional PCR and semi-nested PCR assays
were optimised. The detection limit of the technique for purified W.
bancrofti DNA extracted from adult worms was 10 fg for the internal
systems (WbF/Wb2) and 0.1 fg by using semi-nested PCR. The specificity of the primers
was confirmed experimentally by amplification of 1 ng of purified genomic DNA from
other species of parasites. Evaluation of the paired urine and serum samples by the
semi-nested PCR technique indicated only two of the 20 tested individuals were
positive, whereas the simple internal PCR system (WbF/Wb2), which has highly
promising performance, revealed that all the patients were positive using both
samples. This study successfully demonstrated the possibility of using the PCR
technique on urine for the diagnosis of W. bancrofti infection.
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Affiliation(s)
- Camila Ximenes
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Eduardo Brandão
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Paula Oliveira
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Abraham Rocha
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Tamisa Rego
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Rafael Medeiros
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Ana Aguiar-Santos
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - João Ferraz
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Christian Reis
- Departamento de Microbiologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Paulo Araujo
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
| | - Luiz Carvalho
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - Fabio L Melo
- Serviço de Referência Nacional em Filarioses, Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-Fiocruz, Recife, PE, Brasil
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16
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Lamoth F, Greub G. Fastidious intracellular bacteria as causal agents of community-acquired pneumonia. Expert Rev Anti Infect Ther 2014; 8:775-90. [DOI: 10.1586/eri.10.52] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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Garcia-Vidal C, Carratalà J. Current clinical management of Legionnaires’ disease. Expert Rev Anti Infect Ther 2014; 4:995-1004. [PMID: 17181416 DOI: 10.1586/14787210.4.6.995] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Legionella pneumophila is increasingly recognized as a cause of both sporadic and epidemic community-acquired pneumonia. Clinical manifestations of Legionnaires' disease are not specific and current diagnostic scores are of limited use. Urinary antigen detection is an effective test for rapid diagnosis of infection caused by L. pneumophila serogroup 1. Improved outcomes regarding the time to defervescence, development of complications and length of stay, have been recently observed for patients treated with levofloxacin monotherapy. Current case-fatality rates for hospitalized patients with community-acquired Legionella pneumonia are lower than those traditionally reported for this infection. Effective preventive strategies are needed.
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Affiliation(s)
- Carolina Garcia-Vidal
- Infectious Disease Service, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de llobregat, Barcelona, Spain.
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18
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Murdoch DR, Podmore RG, Anderson TP, Barratt K, Maze MJ, French KE, Young SA, Chambers ST, Werno AM. Impact of Routine Systematic Polymerase Chain Reaction Testing on Case Finding for Legionnaires’ Disease: A Pre–Post Comparison Study. Clin Infect Dis 2013; 57:1275-81. [DOI: 10.1093/cid/cit504] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Legionellosis and lung abscesses: contribution of legionella quantitative real-time PCR to an adapted followup. Case Rep Infect Dis 2013; 2013:190183. [PMID: 23862082 PMCID: PMC3686064 DOI: 10.1155/2013/190183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/19/2013] [Indexed: 11/17/2022] Open
Abstract
We report a case of severe Legionnaires' disease (LD) complicated by a lung abscess in an immunocompetent patient who required ECMO therapy and thoracic surgery. The results of repeated Legionella quantitative real-time PCR performed on both sera and respiratory samples correlated with the LD severity and the poor clinical outcome. Moreover, the PCR allowed for the detection of Legionella DNA in the lung abscess specimen, which was negative when cultured for Legionella. This case report provides a logical basis for further investigations to examine whether the Legionella quantitative PCR could improve the assessment of LD severity and constitute a prognostic marker.
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20
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Jarraud S, Descours G, Ginevra C, Lina G, Etienne J. Identification of legionella in clinical samples. Methods Mol Biol 2013; 954:27-56. [PMID: 23150388 DOI: 10.1007/978-1-62703-161-5_2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Currently, several methods are used for the detection of Legionella in clinical samples, and these methods constitute part of the criteria for defining legionellosis cases. Urinary antigen detection is the first-line diagnostic test, although this test is limited to L. pneumophila serogroup 1 (Lp1) (Helbig et al., J Clin Microbiol 41:838-840, 2003). The use of molecular techniques can improve Legionaire's disease (LD) diagnosis by detecting other serogroups and species (Diederen et al., J Clin Microbiol 46:671-677, 2008). The isolation of Legionella strains from pulmonary samples by axenic culture is still required to perform further epidemiological investigations (Blyth et al., N S W Public Health Bull 20:157-161, 2009; Fields et al., Clin Microbiol Rev 15:506-526, 2002) but demonstrates various sensitivities. Amoebic coculture has been described as a method to recover Legionella from clinical culture-negative specimens (La Scola et al., J Clin Microbiol 39:365-366, 2001; Rowbotham, J Clin Pathol 36:978-986, 1983) and can be proposed for optimizing Legionella strain isolation from samples contaminated by oropharyngeal flora. Identification of Legionella isolates is based on serological characterization, genotypic methods (with sequencing of the mip gene as the standard method) and, more recently, the Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) method.This chapter is limited to the identification of Legionella in clinical samples; antibody detection in human serum will not be discussed.
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Affiliation(s)
- Sophie Jarraud
- National Reference Center of Legionella, Centre de Biologie Est, Hospices Civils de Lyon, Lyon, France.
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21
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Taha SA, Al-Ayed TM, Al-Haider SA, Frayha HH. Lethal Legionella infection in an immunocompromised child: first reported case in the Middle East. Ann Saudi Med 2012; 32:430-2. [PMID: 22705619 PMCID: PMC6081022 DOI: 10.5144/0256-4947.2012.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Legionnaires disease continues to be underreported in the Middle East--a reflection of underdiagnosis, both clinically and by laboratory investigations. We draw the attention to this unusual cause of occasionally fatal, yet severe, pneumonia by reporting an immunocompromised infant who succumbed to Legionella pneumophila pneumonia. The urinary test for Legionella antigen was positive, and this was then confirmed by a bronchoalveolar fluid culture. Moreover we have reviewed the incidence, pathophysiology, association with immunodeficiency, diagnostic tools, and treatment in this case report.
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Affiliation(s)
- Sami A Taha
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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22
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Mentasti M, Fry NK, Afshar B, Palepou-Foxley C, Naik FC, Harrison TG. Application of Legionella pneumophila-specific quantitative real-time PCR combined with direct amplification and sequence-based typing in the diagnosis and epidemiological investigation of Legionnaires’ disease. Eur J Clin Microbiol Infect Dis 2012; 31:2017-28. [DOI: 10.1007/s10096-011-1535-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 12/16/2011] [Indexed: 11/25/2022]
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23
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Update on the Detection and Characterization of Bacterial Pathogens by Nucleic Acid Amplification. Mol Microbiol 2011. [DOI: 10.1128/9781555816834.ch23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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te Witt R, van Leeuwen WB, van Belkum A. Specific Diagnostic Tests for Atypical Respiratory Tract Pathogens. Infect Dis Clin North Am 2010. [DOI: 10.1016/j.idc.2009.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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25
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Two-step scheme for rapid identification and differentiation of Legionella pneumophila and non-Legionella pneumophila species. J Clin Microbiol 2009; 48:433-9. [PMID: 20007397 DOI: 10.1128/jcm.01778-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A rapid two-step scheme based on PCR amplification and enzymatic digestion analysis of a 226-bp fragment of the 16S rRNA gene was developed to identify the Legionella genus by PCR amplification and to differentiate the Legionella pneumophila and non-Legionella pneumophila species by enzymatic digestion analysis. Among 42 ATCC strains (16 strains of L. pneumophila and 26 strains of non-L. pneumophila) and 200 Legionella isolates from environmental water samples, including pools, rivers, lakes, and cooling towers in Guangdong province, 99.59% of L. pneumophila and non-L. pneumophila strains were correctly identified and differentiated by this scheme. The procedure of this two-step identification and differentiation scheme is simple and takes only about 4 h. These results suggest that this two-step scheme provides a simple and convenient method for the rapid identification and differentiation of L. pneumophila and non-L. pneumophila species.
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26
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Implications of storing urinary DNA from different populations for molecular analyses. PLoS One 2009; 4:e6985. [PMID: 19746164 PMCID: PMC2735781 DOI: 10.1371/journal.pone.0006985] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 08/19/2009] [Indexed: 02/04/2023] Open
Abstract
Background Molecular diagnosis using urine is established for many sexually transmitted diseases and is increasingly used to diagnose tumours and other infectious diseases. Storage of urine prior to analysis, whether due to home collection or bio-banking, is increasingly advocated yet no best practice has emerged. Here, we examined the stability of DNA in stored urine in two populations over 28 days. Methodology Urine from 40 (20 male) healthy volunteers from two populations, Italy and Zambia, was stored at four different temperatures (RT, 4°C, −20°C & −80°C) with and without EDTA preservative solution. Urines were extracted at days 0, 1, 3, 7 and 28 after storage. Human DNA content was measured using multi-copy (ALU J) and single copy (TLR2) targets by quantitative real-time PCR. Zambian and Italian samples contained comparable DNA quantity at time zero. Generally, two trends were observed during storage; no degradation, or rapid degradation from days 0 to 7 followed by little further degradation to 28 days. The biphasic degradation was always observed in Zambia regardless of storage conditions, but only twice in Italy. Conclusion Site-specific differences in urine composition significantly affect the stability of DNA during storage. Assessing the quality of stored urine for molecular analysis, by using the type of strategy described here, is paramount before these samples are used for molecular prognostic monitoring, genetic analyses and disease diagnosis.
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27
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Yang G, Benson R, Pelish T, Brown E, Winchell JM, Fields B. Dual detection of Legionella pneumophila and Legionella species by real-time PCR targeting the 23S-5S rRNA gene spacer region. Clin Microbiol Infect 2009; 16:255-61. [PMID: 19438641 PMCID: PMC7129662 DOI: 10.1111/j.1469-0691.2009.02766.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although the majority of cases of Legionnaires’ disease (LD) are caused by Legionella pneumophila, an increasing number of other Legionella species have been reported to cause human disease. There are no clinical presentations unique to LD and hence accurate laboratory tests are required for early diagnosis. Therefore, we designed a real-time PCR assay that targets the 23S-5S rRNA intergenic spacer region (23S-5S PCR) and allows for detection of all Legionella species and discrimination of L. pneumophila from other Legionella species. In total, 271 isolates representing 50 Legionella species were tested and the assay was validated using 39 culture-positive and 110 culture-negative patient specimens collected between 1989 and 2006. PCR-positive results were obtained with all 39 culture-positive samples (100% sensitivity). Specimens that tested positive according to 23S-5S PCR, but were culture-negative, were further analysed by DNA sequencing of the amplicon or the macrophage infectivity potentiator (mip) gene. In addition to L. pneumophila, Legionella longbeachae, Legionella cincinnatiensis and Legionella micdadei were identified in the specimens. The assay showed a 7-log dynamic range displaying a sensitivity of 7.5 CFU/mL or three genome equivalents per reaction. Sixty-one specimens containing viruses or bacteria other than Legionellae were negative according to 23S-5S PCR, demonstrating its specificity. Use of this assay should contribute to the earlier detection of respiratory disease caused by Legionella species, as well as to increased rates of detection.
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Affiliation(s)
- G Yang
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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28
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Legionella pneumophila DNA in serum samples during Legionnaires’ disease in relation to C-reactive protein levels. Eur J Clin Microbiol Infect Dis 2008; 28:371-6. [DOI: 10.1007/s10096-008-0638-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 09/13/2008] [Indexed: 11/26/2022]
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29
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Qasem JA, Mustafa AS, Khan ZU. Legionella in clinical specimens and hospital water supply facilities: molecular detection and genotyping of the isolates. Med Princ Pract 2008; 17:49-55. [PMID: 18059101 DOI: 10.1159/000109590] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate genus- and species-specific polymerase chain reactions (PCRs) for the detection of the genus Legionella and the species Legionella pneumophila in clinical specimens and hospital water supplies, and to establish a simple and reproducible random amplification of polymorphic DNA (RAPD)-PCR technique for genotyping of Legionella. MATERIALS AND METHODS A total of 70 respiratory tract specimens(bronchoalveolar lavage: n = 46; endotracheal secretions: n = 9; sputum: n = 15) from patients with atypical pneumonia, and 283 environmental samples (water: 20; swabs: 263) collected from water storage and supply facilities of the Mubarak Al-Kabeer Hospital, Kuwait, were tested by culture and genus-specific PCR for the detection of Legionella. The L. pneumophila isolates were subsequently typed by serology and RAPD-PCR using serotype-specific sera and arbitrary primers, respectively. RESULTS Of the 70 clinical samples, culture yielded 2 (2.9%) whereas genus-specific PCR detected Legionella in 20 (28.6%) samples. The 2 culture-positive specimens were also positive for L.-pneumophila-specific PCR. Testing of swab and water samples by culture and genus-specific PCR yielded 61 (21.6%) and 67 (23.7%) positive samples, respectively. All of the 61 culture-positive samples were also positive by genus-specific PCR and 45 of them were positive for L.-pneumophila-specific PCR. Serological typing of 43 L. pneumophila isolates showed that 8 of these belonged to serotype 1 and 35 to serotype 3; however, RAPD-PCR analyses demonstrated polymorphisms among the isolates of both serotypes. CONCLUSION A higher association between PCR and culture was observed for the environmental samples than for the clinical samples. The application of genus- and species-specific PCRs and RAPD is useful in the detection and typing of Legionella in clinical and environmental samples.
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Affiliation(s)
- J A Qasem
- Department of Applied Medical Sciences, College of Health Sciences, The Public Authority for Applied Education and Training, Kuwait University, Kuwait.
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30
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Utility of real-time PCR for diagnosis of Legionnaires' disease in routine clinical practice. J Clin Microbiol 2007; 46:671-7. [PMID: 18094136 DOI: 10.1128/jcm.01196-07] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The main aim of our study was to determine the added value of PCR for the diagnosis of Legionnaires' disease (LD) in routine clinical practice. The specimens were samples submitted for routine diagnosis of pneumonia from December 2002 to November 2005. Patients were evaluated if, in addition to PCR, the results of at least one of the following diagnostic tests were available: (i) culture for Legionella spp. on buffered charcoal yeast extract agar or (ii) detection of Legionella pneumophila antigen in urine specimens. Of the 151 evaluated patients, 37 (25%) fulfilled the European Working Group on Legionella Infections criteria for a confirmed case of LD (the "gold standard"). An estimated sensitivity, specificity, and overall percent agreement of 86% (32 of 37; 95% confidence interval [CI] = 72 to 95%), 95% (107 of 112; 95% CI = 90 to 98%), and 93% (139 of 149), respectively, were found for 16S rRNA-based PCR, and corresponding values of 92% (34 of 37; 95% CI = 78 to 98%), 98% (110 of 112; 95% CI = 93 to 100%), and 97% (144 of 149), respectively, were found for the mip gene-based PCR. A total of 35 patients were diagnosed by using the urinary antigen test, and 34 were diagnosed by the 16S rRNA-based PCR. With the mip gene PCR one more case of LD (n = 36; not significant) was detected. By combining urinary antigen test and the mip gene PCR, LD was diagnosed in an additional 4 (11%) patients versus the use of the urinary antigen test alone. The addition of a L. pneumophila-specific mip gene PCR to a urinary antigen test is useful in patients with suspected LD who produce sputum and might allow the early detection of a significant number of additional patients.
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31
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Diederen BMW. Legionella spp. and Legionnaires' disease. J Infect 2007; 56:1-12. [PMID: 17980914 DOI: 10.1016/j.jinf.2007.09.010] [Citation(s) in RCA: 262] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 09/18/2007] [Accepted: 09/19/2007] [Indexed: 11/24/2022]
Abstract
Infection with Legionella spp. is an important cause of community- and hospital-acquired pneumonia, occurring both sporadically and in outbreaks. Infection with Legionella spp. ranks among the three most common causes of severe pneumonia in the community setting, and is isolated in 1-40% of cases of hospital-acquired pneumonia. There are no clinical features unique to Legionnaires' disease. Macrolides and fluoroquinolones are the most widely used drugs in treatment. The availability of a good diagnostic repertoire, suitable for accurately diagnosing LD, constitutes the basis for the early recognition and treatment of the individual patient as well as for effective measures for prevention and control. This review summarizes the available information regarding the microbiology, clinical presentation, diagnosis and treatment of LD, with an emphasis on the laboratory diagnosis of infection with Legionella spp.
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Affiliation(s)
- B M W Diederen
- Regional Laboratory of Public Health Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands.
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32
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Diederen BMW, de Jong CMA, Marmouk F, Kluytmans JAJW, Peeters MF, Van der Zee A. Evaluation of real-time PCR for the early detection of Legionella pneumophila DNA in serum samples. J Med Microbiol 2007; 56:94-101. [PMID: 17172523 DOI: 10.1099/jmm.0.46714-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Legionella pneumonia can be difficult to diagnose. Existing laboratory tests all have shortcomings, especially in the ability to diagnose Legionnaires' disease (LD) at an early stage of the disease in a specimen that is readily obtainable. The aim of this study was to assess the performance of PCR as a rapid diagnostic method and to compare the results of different PCR assays of serum samples from patients with LD. Samples included 151 serum samples from 68 patients with proven LD and 60 serum samples from 36 patients with respiratory tract infections other than Legionella. PCR assays were based on the 5S rRNA gene, 16S rRNA gene and the mip gene. The samples from patients with infections caused by pathogens other than Legionella all tested negative in PCR. Among the patients with proven LD 54.4 % (37/68) tested positive in 5S rRNA PCR, 52.9 % (36/68) in mip gene PCR and 30.9 % (21/68) in 16S rRNA PCR in the first available serum sample. The association between threshold cycle value in 5S PCR positive serum samples (n=49) and C-reactive protein value was determined, and showed a strong negative correlation (Pearson correlation coefficient r=−0.63, P<0.0001). In addition to existing tests for the diagnosis of LD, detection of Legionella DNA in serum could be a useful tool for early diagnosis of LD caused by any Legionella species and serogroup, and has the potential to provide a diagnosis in a time frame that could affect initial infection management.
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Affiliation(s)
- Bram M W Diederen
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
| | - Caroline M A de Jong
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
| | - Faïçal Marmouk
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
| | - Jan A J W Kluytmans
- Laboratory of Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK Breda, The Netherlands
| | - Marcel F Peeters
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
| | - Anneke Van der Zee
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
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Legionnaires’ Disease. INFECTIOUS DISEASES IN CRITICAL CARE 2007. [PMCID: PMC7122631 DOI: 10.1007/978-3-540-34406-3_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The incidence of legionnaires’ disease (LD) seems to increase with age, particularly in males [36]. It was considered an infrequent cause of pneumonia in the past, but it currently ranks second to pneumococcus in the list of etiologic agents of severe community-acquired pneumonia (CAP) of bacterial origin [2, 24, 60, 89]. Considering less severe cases, in a series of 145 pneumonias in which BCYE culture, serology and the Legionella urinary antigen (LUA) test were systematically applied, Vergis et al. [91] reported a prevalence of LD of 13.7%. In another series of 392 adult patients with CAP treated in a university hospital, Sopena et al. found a prevalence of 12.5%, and LD was the second cause of pneumonia [83].
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34
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Korosec P, Silar M, Erzen R, Kosnik M. The influence of antimicrobial therapy on the sensitivity of Legionella PCR. ACTA ACUST UNITED AC 2006; 38:925-8. [PMID: 17008241 DOI: 10.1080/00365540600561777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of our study was to establish the sensitivity of Legionella DNA detection in lower respiratory tract samples in 3 cases of Legionnaires' disease after initiation of specific antibiotic therapy. The results showed that Legionella amplicon intensity was highest in the sputum or bronchial aspirates collected at or before the start of appropriate therapy and decreased markedly within 3 days of therapy. PCR testing was negative within 4 to 6 days of therapy. These data suggest that within a few days specific antimicrobial therapy induces a significant drop of bacterial concentration in respiratory secretions reaching the detection limit of PCR assay. Respiratory samples for Legionella PCR should be obtained before or early after initiating antimicrobial therapy.
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Affiliation(s)
- Peter Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.
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35
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Philippart F. [Managing lower respiratory tract infections in immunocompetent patients. Definitions, epidemiology, and diagnostic features]. Med Mal Infect 2006; 36:784-802. [PMID: 17092676 PMCID: PMC7131155 DOI: 10.1016/j.medmal.2006.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 11/13/2022]
Abstract
Les infections respiratoires basses sont une des principales cause de mortalité dans le monde et les pneumopathies représentent en France la première cause de décès d'origine infectieuse. Trois entités nosologiques distinctes sont habituellement isolées en fonction de la localisation infectieuse : la bronchite aiguë, la pneumopathie et la bronchopneumopathie (atteignant les bronches et le parenchyme pulmonaire). En cas d'infections de l'arbre bronchique dans le cadre d'une bronchopathie chronique on parle de décompensation infectieuse de la maladie bronchique. Les deux principales difficultés diagnostiques de ces infections sont de déterminer la présence d'une participation alvéolaire au processus infectieux et de définir l'agent (ou les agents) pathogènes. Ces deux éléments vont conditionner la prise en charge thérapeutique. En dehors de l'examen physique, indispensable dans ce contexte, seule la radiographie thoracique pourra, en cas de persistance d'un doute, permettre de confirmer la présence d'une participation alvéolaire. Le diagnostic microbiologique pose la question de sa nécessité systématique et celui de sa valeur. Il n'est pas indispensable de réaliser un diagnostic microbiologique de certitude dans tous les cas. La décision de documentation doit répondre à deux impératifs : faisabilité et valeur diagnostique. La valeur d'un prélèvement dépend de son aptitude à mettre en évidence l'agent pathogène et dans certains cas de la possibilité d'en déterminer le profil de sensibilité (qui reste une indication majeure à la réalisation de ces prélèvements).
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Affiliation(s)
- F Philippart
- Service de réanimation polyvalente, fondation-hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
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36
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Abstract
Transrenal DNA (Tr-DNA) is a recently discovered class of extracellular urinary DNA that originates from cells dying throughout the body. Postapoptotic DNA is known to appear in the circulating plasma, but it is now recognized that a portion of these fragments cross the kidney barrier and appear in urine in the form of 150-200-bp fragments. Tr-DNA containing fetal sequences has been isolated from the urine of pregnant women, tumor-specific mutations have been detected in Tr-DNA from patients with colon and pancreatic tumors, and donor DNA has been found in Tr-DNA isolated from recipient urine. Furthermore, proviral HIV DNA, bacterial and parasite DNA sequences have been detected in Tr-DNA from infected patients. Potential applications of Tr-DNA-based tests cover a very broad area of molecular diagnostics and genetic testing, including prenatal detection of inherited diseases, tumor diagnostics and therapeutic monitoring and detection of infectious agents. The Tr-DNA test is expected to have utility in treatment monitoring, transplantation monitoring, drug development and broad public health screening, where a noninvasive, common-platform diagnostic technology has particular value. This review describes some of the highlights of Tr-DNA technology applications, advantages over existing technologies and potential problems anticipated in test development.
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Horng YT, Soo PC, Shen BJ, Hung YL, Lo KY, Su HP, Wei JR, Hsieh SC, Hsueh PR, Lai HC. Development of an improved PCR-ICT hybrid assay for direct detection of Legionellae and Legionella pneumophila from cooling tower water specimens. WATER RESEARCH 2006; 40:2221-9. [PMID: 16713613 DOI: 10.1016/j.watres.2006.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 03/23/2006] [Accepted: 03/29/2006] [Indexed: 05/09/2023]
Abstract
A novelly improved polymerase chian reaction and immunochromatography test (PCR-ICT) hybrid assay comprising traditional multiplex-nested PCR and ICT, (a lateral-flow device) was developed for direct detection of Legionella bacteria from environmental cooling tower samples. The partial 16S rDNA (specific for Legionella spp.) and dnaJ (specific for Legionella pneumophila) genes from Legionella chromosome were first specifically amplified by multiplex-nested PCR, respectively, followed by detection using ICT strip. Reading of results was based on presence or absence of the two test lines on the strips. Presence of test line 1 indicated existence of Legionella spp. specific 16S rDNA and identified Legionella spp. Presence of test line 2 further indicated existence of dnaJ and thus specifically identified L. pneumophila. In contrast, for non-Legionellae bacteria no test line formation was observed. Results of direct detection of Legionella bacteria and L. pneumophila from water tower specimens by this assay showed 100% sensitivity, and 96.6% and 100% specificity, respectively compared with traditional culture, biochemical and serological identification methods. The PCR-ICT hybrid assay does not require sophisticated equipment and was proved to be practically useful in rapid and direct Legionellae detection from environmental water samples.
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Affiliation(s)
- Yu-Tze Horng
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, No. 1. Chan-Dar Street 100, Taipei, Taiwan, ROC
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Diederen BMW, de Jong CMA, Kluytmans JAJW, van der Zee A, Peeters MF. Detection and quantification of Legionella pneumophila DNA in serum: case reports and review of the literature. J Med Microbiol 2006; 55:639-642. [PMID: 16585654 DOI: 10.1099/jmm.0.46453-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Legionella pneumonia can be difficult to diagnose. Existing laboratory tests all have shortcomings, especially the ability to diagnose all Legionella spp. at an early stage. Detection of Legionella DNA in serum can be a valuable tool for the diagnosis of Legionnaires' disease (LD). This report describes two patients with LD diagnosed by PCR using serum samples. In addition, quantification of L. pneumophila DNA using real-time PCR during the course of illness was carried out. The results obtained mirrored both the clinical condition and C-reactive protein values during the course of the illness. Quantification of Legionella DNA in serum using real-time PCR could be a valuable tool to monitor the effects of antimicrobial therapy in patients with LD.
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Affiliation(s)
- Bram M W Diederen
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
| | - Caroline M A de Jong
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
| | - Jan A J W Kluytmans
- Laboratory of Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK Breda, The Netherlands
| | - Anneke van der Zee
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
| | - Marcel F Peeters
- Laboratory of Medical Microbiology and Immunology, St Elisabeth Hospital, PO Box 747, 5000 AS Tilburg, The Netherlands
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Lück PC, Steinert M. Pathogenese, Diagnostik und Therapie der Legionella-Infektion. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:439-49. [PMID: 16596363 DOI: 10.1007/s00103-006-1254-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Legionella species are ubiquitous in aquatic environments. About 50 years ago they entered the engineered (technical) environment, i.e. warm water systems with zones of stagnation. Since that time they represent a hygienic problem. After transmission to humans via aerosols legionellae might cause Legionella pneumonia (legionnaires' disease) or influenza-like respiratory infections (Pontiac fever). Epidemiological data suggest that Legionella strains might differ substantially in their virulence properties. Although the molecular basis is not understood L. pneumophila serogroup 1 especially MAb 3/1-positive strains cause the majority of infections. The main virulence feature is the ability to multiply intracellularly. After uptake into macrophages legionellae multiply in a specialized vacuole and finally lyse their host cells. Several bacterial factors like surface components, secretion systems and iron uptake systems are involved in this process. Since the clinical picture of Legionella pneumonia does not allow differentiation from pneumoniae caused by other pathogens, microbiological diagnostic methods are needed to establish the diagnosis. Cultivation of legionellae from clinical specimens, detection of antigens and DNA in patients' samples and detection of antibodies in serum samples are suitable methods. However, none of the diagnostic tests presently available offers the desired quality with respect to sensitivity and specificity. Therefore, the standard technique is to use several diagnostic tests in parallel. Advantages and disadvantages of the diagnostic procedures are discussed. Therapeutic options for Legionella infections are newer macrolides like azithromycin and chinolones (ciprofloxacin, levofloxacin and moxifloxacin).
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Affiliation(s)
- P C Lück
- Institut für Medizinische Mikrobiologie, Nationales Konsiliarlabor für Legionellen, TU-Dresden, Fiedlerstrasse 42, 01307 Dresden.
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40
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Elfaki MG, Uz-Zaman T, Al-Hokail AA, Nakeeb SM. Detection of Brucella DNA in sera from patients with brucellosis by polymerase chain reaction. Diagn Microbiol Infect Dis 2006; 53:1-7. [PMID: 16054326 DOI: 10.1016/j.diagmicrobio.2005.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 03/25/2005] [Indexed: 11/22/2022]
Abstract
To overcome the limitations of current diagnostic methods for brucellosis, accurate and simple methods must be sought. In this study, sera of patients diagnosed with brucellosis were examined by polymerase chain reaction (PCR) for the detection of Brucella DNA. Results showed that an amplicon of 223 bp was obtained in 96% (24/25) of tested sera using primers derived from the nucleotide sequence of a gene encoding the 31-kDa Brucella abortus antigen. However, when serum DNA templates were examined by another PCR, an amplicon of 731 bp was obtained in 60% (15/25) of the tested samples using Brucella melitensis-specific primers derived from a polymorphic locus adjacent to the 3' end of IS711. The specificity of each PCR was demonstrated by inclusion of reference Brucella DNA strains and by DNA sequence analysis of PCR products. These results suggest that serum analysis by PCR is a convenient and safe method for rapid and accurate diagnosis of brucellosis and that B. melitensis is the leading cause of brucellosis in Saudi Arabia.
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Affiliation(s)
- Mohamed G Elfaki
- Zoonotic Diseases Unit, Department of Comparative Medicine, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Kingdom of Saudi Arabia.
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41
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Den Boer JW, Yzerman EPF. Diagnosis of Legionella infection in Legionnaires' disease. Eur J Clin Microbiol Infect Dis 2005; 23:871-8. [PMID: 15599647 DOI: 10.1007/s10096-004-1248-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since 1977, the diagnostic tools for Legionnaires' disease have been culture and serological investigation. Both methods require considerable time to produce results and have low to reasonable sensitivity. Since the introduction of urinary antigen tests in the mid 1990s, underdiagnosis has diminished and mortality has declined, thanks to early diagnosis. To obtain the most accurate diagnosis, culture, serological investigation, and urinary antigen testing should all be performed. In the last decade, much effort has been directed toward the development of assays detecting Legionella nucleic acid. Thus far, only widely varying results with small patient series have been reported. Furthermore, these assays are labour intensive and complicated. As a result, these assays are not yet suitable for the average medical microbiological laboratory.
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Affiliation(s)
- J W Den Boer
- Municipal Health Service Kennemerland, Haarlem, The Netherlands
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42
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Abstract
Molecular diagnostic techniques, such as PCR, have become useful tools for the rapid etiological diagnosis of lower respiratory tract infections. Nucleic acid amplification tests (NAATs) have been evaluated for detecting most respiratory pathogens, and commercial assays are available for some pathogens. However, standardized protocols are needed before these assays are introduced into routine diagnostic use. For pneumonia, NAATs offer advantages over conventional tests for the detection of Mycoplasma pneumoniae, Legionella spp. and Chlamydia pneumoniae. For pneumococcal pneumonia in adults, PCR adds little to existing diagnostic tests, and is unable to distinguish pneumococcal colonization from infection when testing respiratory samples. Although less sensitive than culture-based methods, several commercial molecular diagnostic assays have been developed for tuberculosis and are useful rapid tests for selected patients. PCR can now be considered the rapid diagnostic test of choice for pertussis and some respiratory virus infections. Further work is required to better characterize the role of molecular diagnostic tests for diagnosing lower respiratory tract infections, and to develop standard assays that can be readily adopted by routine diagnostic laboratories.
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Affiliation(s)
- David R Murdoch
- Department of Pathology, Christchurch School of Medicine and Health Sciences, and Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
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Lindsay DSJ, Abraham WH, Findlay W, Christie P, Johnston F, Edwards GFS. Laboratory diagnosis of legionnaires’ disease due to Legionella pneumophila serogroup 1: comparison of phenotypic and genotypic methods. J Med Microbiol 2004; 53:183-187. [PMID: 14970242 DOI: 10.1099/jmm.0.05464-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Laboratory results of 67 cases of legionnaires' disease caused by Legionella pneumophila serogroup (Sg) 1 spanning a 6-year period were analysed by both phenotypic and genotypic methods. The methods compared were urinary antigen enzyme immunoassay (EIA), an immunofluorescent antibody (IFA) test, direct fluorescent antibody (DFA), culture and a 5S rRNA PCR with Southern blotting confirmation. Urine was available in 53 cases, of which 35 (66%) were positive, with an antigen peak observed at 5-10 days after onset of disease symptoms. The IFA test was positive in 62 (92.5%) cases, with 56 (90.3%) cases producing a greater than fourfold rise in titre and 6 (9.7%) giving presumptive high titres of > or =1:128. There were two antibody peaks, one at 10-15 days and another at >25 days after onset. In 23 cases where samples were available, DFA and culture were respectively positive in 5 (22%) and 10 (48%) cases. There was a peak in culture-positives 5-10 days after onset of disease. A Legionella-specific 5S rRNA PCR on patient serum was positive in 54 (80.5%) cases, with a peak in PCR positivity at 6-10 days after disease onset. In 22 of the 67 cases, the full panel of diagnostic methods was available for comparison. The relative sensitivity and specificity of the urinary antigen EIA and the serum PCR was 100%. The IFA gave relative sensitivity and specificity values of 93.8 and 95%. DFA and culture, although 100% specific, produced only low sensitivities, of 19 and 42.8%, respectively. This study has shown that urinary antigen and serum PCR are valuable tests in the acute phase of disease, with excellent sensitivity and specificity values. At present, the Legionella species causing infection requires to be verified by IFA serology and/or culture, but this could become unnecessary as new antigen and L. pneumophila Sg 1-specific PCR tests become available.
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Affiliation(s)
- Diane S J Lindsay
- Scottish Legionella Reference Laboratory, Department of Microbiology, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, Scotland, UK 2Scottish Centre for Infection and Environmental Health, Clifton House, Clifton Place, Glasgow G3 7LN, Scotland, UK
| | - William H Abraham
- Scottish Legionella Reference Laboratory, Department of Microbiology, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, Scotland, UK 2Scottish Centre for Infection and Environmental Health, Clifton House, Clifton Place, Glasgow G3 7LN, Scotland, UK
| | - William Findlay
- Scottish Legionella Reference Laboratory, Department of Microbiology, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, Scotland, UK 2Scottish Centre for Infection and Environmental Health, Clifton House, Clifton Place, Glasgow G3 7LN, Scotland, UK
| | - Peter Christie
- Scottish Legionella Reference Laboratory, Department of Microbiology, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, Scotland, UK 2Scottish Centre for Infection and Environmental Health, Clifton House, Clifton Place, Glasgow G3 7LN, Scotland, UK
| | - Fiona Johnston
- Scottish Legionella Reference Laboratory, Department of Microbiology, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, Scotland, UK 2Scottish Centre for Infection and Environmental Health, Clifton House, Clifton Place, Glasgow G3 7LN, Scotland, UK
| | - Giles F S Edwards
- Scottish Legionella Reference Laboratory, Department of Microbiology, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, Scotland, UK 2Scottish Centre for Infection and Environmental Health, Clifton House, Clifton Place, Glasgow G3 7LN, Scotland, UK
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Templeton KE, Scheltinga SA, Sillekens P, Crielaard JW, van Dam AP, Goossens H, Claas ECJ. 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 2003; 41:4016-21. [PMID: 12958219 PMCID: PMC193800 DOI: 10.1128/jcm.41.9.4016-4021.2003] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2003] [Revised: 04/14/2003] [Accepted: 05/27/2003] [Indexed: 11/20/2022] Open
Abstract
A multiplex real-time PCR assay for detection of Legionella pneumophila and Legionella spp. and including an internal control was designed. Legionella species, L. pneumophila, and the internal control were detected simultaneously by probes labeled with 6-carboxy-fluorescein, hexachlorofluorescein, and indodicarbocyanine, respectively. Therefore, no postamplification analysis was required in order to distinguish the targets. The sensitivity of both assays was 2.5 CFU/ml, and from analysis of 10 culture-positive and 74 culture-negative samples from patients investigated for legionellosis, 100% agreement was observed by both assays in comparison to culture. Four additional positives were found by the multiplex real-time PCR assay in the Legionella culture-negative samples.
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Affiliation(s)
- Kate E Templeton
- Department of Medical Microbiology, Center of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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45
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Evans GE, Murdoch DR, Anderson TP, Potter HC, George PM, Chambers ST. Contamination of Qiagen DNA extraction kits with Legionella DNA. J Clin Microbiol 2003; 41:3452-3. [PMID: 12843121 PMCID: PMC165320 DOI: 10.1128/jcm.41.7.3452-3453.2003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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46
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Wilson DA, Yen-Lieberman B, Reischl U, Gordon SM, Procop GW. Detection of Legionella pneumophila by real-time PCR for the mip gene. J Clin Microbiol 2003; 41:3327-30. [PMID: 12843084 PMCID: PMC165371 DOI: 10.1128/jcm.41.7.3327-3330.2003] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2002] [Revised: 01/28/2003] [Accepted: 04/03/2003] [Indexed: 11/20/2022] Open
Abstract
A real-time PCR assay for the mip gene of Legionella pneumophila was tested with 27 isolates of L. pneumophila, 20 isolates of 14 other Legionella species, and 103 non-Legionella bacteria. Eight culture-positive and 40 culture-negative clinical specimens were tested. This assay was 100% sensitive and 100% specific for L. pneumophila.
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47
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Murdoch DR. Nucleic acid amplification tests for the diagnosis of pneumonia. Clin Infect Dis 2003; 36:1162-70. [PMID: 12715312 DOI: 10.1086/374559] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2002] [Accepted: 01/22/2003] [Indexed: 11/03/2022] Open
Abstract
Molecular diagnostic techniques, such as polymerase chain reaction (PCR), are promising tools for the rapid etiological diagnosis of pneumonia. PCR offers potential advantages over conventional tests for the detection of Mycoplasma pneumoniae, Legionella species, and Chlamydia pneumoniae. For pneumococcal pneumonia in adults, PCR adds little to existing diagnostic tests and is unable to distinguish pneumococcal colonization from infection when testing respiratory samples. Although PCR is probably more sensitive than are conventional microscopy-based methods for diagnosing Pneumocystis carinii pneumonia, the specificity is uncertain, because P. carinii can occasionally be detected in the absence of clinical symptoms. PCR is useful for the diagnosis of viral pneumonia in immunocompromised patients. Further work is required to better characterize the role of PCR versus the role of other tests for diagnosing pneumonia and to develop standard PCR assays that can be readily adopted by routine diagnostic laboratories.
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Affiliation(s)
- David R Murdoch
- Microbiology Unit, Canterbury Health Laboratories, and Department of Pathology, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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48
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Aoki S, Hirakata Y, Miyazaki Y, Izumikawa K, Yanagihara K, Tomono K, Yamada Y, Tashiro T, Kohno S, Kamihira S. Detection of Legionella DNA by PCR of whole-blood samples in a mouse model. J Med Microbiol 2003; 52:325-329. [PMID: 12676871 DOI: 10.1099/jmm.0.04999-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A detection system for Legionella DNA in blood samples based on the PCR was developed and evaluated in A/J mice with experimentally induced Legionella pneumonia. Primers were designed to amplify a 106 bp DNA fragment of the 16S rRNA gene specific to Legionella species. The PCR system could detect clinically relevant Legionella species including Legionella pneumophila, Legionella micdadei, Legionella bozemanae, Legionella dumoffii, Legionella longbeachae, Legionella gormanii and Legionella jordanis. The sensitivity of the PCR system was 20 fg extracted DNA. In the mouse model, the blood PCR was compared with results obtained by PCR on bronchoalveolar lavage fluid (BALF) samples, cultures of blood and BALF and detection of Legionella urinary antigen. Blood PCR was positive until 8 days after infection, while BALF PCR became negative on day 4. These results indicate that PCR using blood samples may be a useful, convenient and non-invasive method for the diagnosis of Legionella pneumonia.
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Affiliation(s)
- S Aoki
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - Y Hirakata
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - Y Miyazaki
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - K Izumikawa
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - K Yanagihara
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - K Tomono
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - Y Yamada
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - T Tashiro
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - S Kohno
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
| | - S Kamihira
- Department of Laboratory Medicine1 and Second Department of Internal Medicine2, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan
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Murdoch DR, Anderson TP, Beynon KA, Chua A, Fleming AM, Laing RTR, Town GI, Mills GD, Chambers ST, Jennings LC. Evaluation of a PCR assay for detection of Streptococcus pneumoniae in respiratory and nonrespiratory samples from adults with community-acquired pneumonia. J Clin Microbiol 2003; 41:63-6. [PMID: 12517826 PMCID: PMC149569 DOI: 10.1128/jcm.41.1.63-66.2003] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, but it is undoubtedly underdiagnosed. We used a nested PCR assay (targeting the pneumolysin gene) to detect S. pneumoniae DNA in multiple sample types from 474 adults with community-acquired pneumonia and 183 control patients who did not have pneumonia. Plasma or buffy coat samples were PCR positive in only 6 of the 21 patients with positive blood cultures for S. pneumoniae and in 12 other patients (4 of whom had no other laboratory evidence of S. pneumoniae infection). Buffy coat samples from two control patients (neither having evidence of S. pneumoniae infection), but no control plasma samples, were PCR positive. Although pneumococcal antigen was detected in the urine from 120 of 420 (29%) patients, only 4 of 227 (2%) urine samples tested were PCR positive. Overall, 256 of 318 (81%) patients had PCR-positive sputum samples, including 58 of 59 samples from which S. pneumoniae was cultured. Throat swab samples from 229 of 417 (55%) patients were PCR positive and, in those who produced sputum, 96% also had positive PCR results from sputum. Throat swabs from 73 of 126 (58%) control patients were also PCR positive. We conclude that the pneumolysin PCR assay adds little to existing diagnostic tests for S. pneumoniae and is unable to distinguish colonization from infection when respiratory samples are tested.
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Affiliation(s)
- David R Murdoch
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand.
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50
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Murdoch DR. Diagnosis of Legionella infection. Clin Infect Dis 2003; 36:64-9. [PMID: 12491204 DOI: 10.1086/345529] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2002] [Accepted: 10/08/2002] [Indexed: 11/03/2022] Open
Abstract
Legionellae, which are important causes of pneumonia in humans, continue to be incorrectly labeled as exotic pathogens. The ability to diagnose Legionella infection is limited by the nonspecific nature of clinical features and the shortcomings of diagnostic tests. Despite recent improvements, existing diagnostic tests for Legionella infection either lack sensitivity for detecting all clinically important legionellae or are unable to provide results within a clinically useful time frame. Understanding local Legionella epidemiology is important for making decisions about whether to test for Legionella infection and which diagnostic tests to use. In most situations, the use of both the urinary antigen test plus sputum culture is the best diagnostic combination. Polymerase chain reaction (PCR) is a promising tool, but standardized assays are not commercially available. Further work needs to focus on the development of urinary antigen tests assays that detect a wider range of pathogenic legionellae and on the development of standardized PCR assays.
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Affiliation(s)
- David R Murdoch
- Department of Pathology, Christchurch School of Medicine and Health Sciences, Canterbury Health Laboratories, Christchurch, New Zealand.
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