A high molecular weight antigen in Legionnaires' disease bacterium: isolation and partial characterization

Common epitope on urinary antigen derived from different Legionella pneumophila serogroup 1 strains recognized by a monoclonal antibody

Guinea pigs were infected intraperitoneally with 4 subgroup reference strains (Knoxville 1, Philadelphia 1, Bellingham 1, OLDA) and 2 clinical isolates of Legionella pneumophila serogroup 1. Antigenuria was demonstrated by the enzyme-linked immunosorbent assay using polyclonal antibodies and monoclonal antibody (mab) F8/5. Mab F8/5 recognizes a hitherto undetected common epitope on urinary antigen of the investigated strains.

Immunologic diversity among serogroup 1 Legionella pneumophila urinary antigens demonstrated by monoclonal antibody enzyme-linked immunosorbent assays

We tested urine specimens from 222 patients with serogroup 1 Legionella pneumophila pneumonia in two enzyme-linked immunosorbent assays (ELISAs) which used different monoclonal antibodies (A and B) as detector antibodies. Of 171 specimens which contained enough antigen to be detected in the ELISAs, 169 reacted in only one of the two assays. A total of 25 patients whose infections were acquired in any of three Indianapolis hospitals excreted antigen reactive with monoclonal antibody B, but 18 patients who were treated for infections acquired elsewhere reacted with monoclonal antibody A. The urinary antigen ELISA reactivity patterns correlated with the reactivity patterns of L. pneumophila isolates when a separate panel of seven monoclonal antibodies was used. The isolate patterns, in turn, correlated well with environmental isolate patterns from two of the hospitals with nosocomial cases. We conclude that at least two different epitopes exist on the antigen molecules in urine from patients with serogroup 1 L. pneumophila pneumonia and that the subtyping of urinary antigens can be useful epidemiologically.

Legionnaires disease: historical perspective

In the summer of 1976, a mysterious epidemic of fatal respiratory disease in Philadelphia launched an intensive investigation that resulted in the definition of a new family of pathogenic bacteria, the Legionellaceae. In retrospect, members of the family had been isolated from clinical specimens as early as 1943. Unsolved epidemics of acute respiratory disease dating to the 1950s were subsequently attributed to the newly described pathogens. In the intervening years, the Legionellaceae have been firmly established as important causes of sporadic and epidemic respiratory disease. The sources of the infecting bacteria are environmental, and geographic variation in the frequency of infection has been documented. Airborne dissemination of bacteria from cooling towers and evaporative condensers has been responsible for some epidemics, but potable water systems are perhaps more important sources. The mode of transmission from drinking water is unclear. The Legionellaceae are gram-negative, facultative, intracellular pathogens. The resident alveolar macrophage, usually an effective antibacterial defense, is the primary site of growth. Cell-mediated immunity appears to be the most important immunological defense; the role of humoral immunity is less clear. Erythromycin remains the antibiotic of choice for therapy of infected patients, but identification and eradication of environmental sources are also essential for the control of infection.

Abundance and distribution of Legionellaceae in Puerto Rican waters

Waters in marine and freshwater areas of Puerto Rico were analyzed for the presence of Legionella spp. by direct fluorescent antibody assay with guinea pig confirmation. Several species, including L. bozemanii, L. dumoffii, L. gormanii, L. longbeachae, L. micdadei, and L. pneumophila, were widely distributed among all sites. Legionellaceae, including L. pneumophila, were found in high densities in water collected in the rain forest from epiphytes in trees 30 ft. (about 9.25 m) above the ground. Both interspecific and intersite variations were significant. L. pneumophila was the most abundant species at all sites, with average densities of 10(4) cells ml-1, very close to the range which is potentially pathogenic for humans. Densities of L. pneumophila were highest in sewage-contaminated coastal waters. These are the highest densities of Legionella spp. ever reported for marine habitats. Densities of L. pneumophila were positively correlated with concentrations of sulfates, phosphates, and pH. A survey of 88 fatal atypical pneumonia cases at a Puerto Rico hospital showed that 15% of the patients had L. pneumophila infections. This study establishes L. pneumophila as a relatively common cause of atypical pneumonia in Puerto Rico and suggests natural aquatic habitats as possible sources or reservoirs of pathogenic Legionella spp. in the tropics.

Induction of interleukin 1 by Legionella pneumophila antigens in mouse macrophage and human mononuclear leukocyte cultures

Exposure to Legionella pneumophila antigens has been reported to result in both an adjuvant effect and pathophysiological changes such as fever, headache, myalgia and arthralgias. Immunoenhancement and inflammatory changes have been associated with the production of interleukin 1, and we, therefore, sought an involvement of interleukin production in the alteration of biological responsiveness following exposure to Legionella pneumophila antigens. Killed Legionella pneumophila cells, incubated with mouse splenocytes, induced the formation of a soluble substance which enhanced splenocyte antibody production to heterologous antigen. The immunoenhancing substance was also produced by mouse peritoneal macrophages and supernatants from these cultures were demonstrated to also contain thymocyte co-mitogenic activity. Following gel filtration, this co-mitogenic activity eluted in the 15,000 molecular weight range suggesting an involvement of interleukin 1. Experiments with Legionella pneumophila cells, and cell extracts containing endotoxin, and purified endotoxin suggested that the interleukin 1 activity was induced by both endotoxin and non-endotoxin antigens. The Legionella pneumophila antigens were also found to be potent inducers of interleukin 1 activity in human peripheral blood mononuclear cell cultures. These results suggest that Legionella pneumophila antigens are potent inducers of interleukin 1 in both mouse and human cells. The induction of this monokine may partially account for both the immunoenhancing property of this bacterial species and the associated pathophysiological changes following infection with this microorganism.

Serospecific antigens of Legionella pneumophila

Serospecific antigens isolated by EDTA extraction from four serogroups of Legionella pneumophila were analyzed for their chemical composition, molecular heterogeneity by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and immunological properties. The antigens were shown to be lipopolysaccharides and to differ from the lipopolysaccharides of other gram-negative bacteria. The serospecific antigens contained rhamnose, mannose, glucosamine, and two unidentified sugars together with 2-keto-3-deoxyoctonate, phosphate, and fatty acids. The fatty acid composition was predominantly branched-chain acids with smaller amounts of 3-hydroxymyristic acid. The antigens contain periodate-sensitive groups; mannosyl residues were completely cleaved by periodate oxidation. Hydrolysis of the total lipopolysaccharide by acetic acid resulted in the separation of a lipid A-like material that cross-reacted with the antiserum to lipid A from Salmonella minnesota but did not comigrate with it on sodium dodecyl sulfate gels. None of the four antigens contained heptose. All of the antigen preparations showed endotoxicity when tested by the Limulus amebocyte lysate assay. The results of this study indicate that the serogroup-specific antigens of L. pneumophila are lipopolysaccharides containing an unusual lipid A and core structure and different from those of other gram-negative bacteria.

Antigenic specificity of the antibody response in humans during legionellosis

The antigenic specificity of the human immune response during legionellosis was studied. Twenty-two sera obtained from 12 individuals were studied using the Western-blot technique with antigens from various legionella. In five of six patients, the reactivity of their sera obtained at different times during legionellosis was qualitatively constant. In one patient, a new IgG antibody to a 50 Kdal bacterial antigen appeared between the 14th and 22nd day after infection. In every patient, the IgG and IgM responses differed. When the patient's serum was reacted with antigen prepared from the isolate obtained from that patient or from a closely related isolate, the antibody response appeared to be directed against broad antigenic bands.

The relationship between the serogroup antigen and lipopolysaccharide of Legionella pneumophila

Serogroup-specific antigen was extracted from a number of Legionella pneumophila strains and compared with phenol-water extracted lipopolysaccharide on the basis of gel filtration, chemical analysis, SDS-PAGE and reaction with serogroup-specific antibody in immunoblots. Serogroup specificity is apparently borne by the O side-chains of the lipopolysaccharide, which, although smooth in type, partitions in the phenol phase. For four serogroup 1 strains tested, there was no qualitative correlation between O side-chain length and pulmonary virulence for guinea-pigs.

Serogroup specificity of Legionella pneumophila is related to lipopolysaccharide characteristics

We studied the lipopolysaccharide (LPS) of Legionella pneumophila and six other Legionella species to determine whether strain differences were apparent. The LPS was purified by a cold ethanol extraction procedure, and total carbohydrates represented 10 to 20% of LPS weight. 2-keto-3-deoxyoctonate represented 1 to 13% of the total carbohydrate present in the LPS. By sodium dodecyl sulfate-polyacrylamide gel electrophoresis, all strains except L. dumoffi showed smooth-type LPS with multiple high-molecular-weight complexes. Proteinase K-treated, whole-cell lysates showed profiles similar to those of purified LPS. Each serogroup of L. pneumophila and each Legionella species had a distinct sodium dodecyl sulfate-polyacrylamide gel electrophoresis profile. L. pneumophila lipid A is antigenically related to the lipid A of Enterobacteriaceae. In immunoblot assays with the LPS of L. pneumophila serogroups 1 to 6 as antigens, serogroup-specific immune monkey sera recognized homologous purified LPS, but not the LPS of the five heterologous serogroups. These studies indicate that LPS composition may be a determinant of serogroup specificity as defined by the immunofluorescence-based serogrouping schema for L. pneumophila and other Legionella species.

Outer membrane proteins from Legionella pneumophila serogroups and other Legionella species

Outer membranes were isolated from eight serogroups of L. pneumophila and five other Legionella species. The protein composition of the membranes was characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. A single, disulfide stabilized protein with a molecular size of 29,000 to 30,000 daltons was found to be the major outer membrane protein (MOMP) of all the serogroups. The equivalent of the L. pneumophila MOMP was not observed in any of the other Legionella species examined. Silver staining of sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels revealed distinctive patterns for each serogroup and other Legionella species that were not observed by staining with Coomassie blue and may result from the presence of lipopolysaccharide in the membrane preparations. The MOMP from serogroup 1 was isolated by exposing crude peptidoglycan to detergent in the presence of heat and reducing agent and was found to be tightly associated with lipopolysaccharide. Antibodies to this complex were used to probe the outer membranes of the remaining, L. pneumophila serogroups and other Legionella species by Western blotting. Serogroup 1 anti-MOMP antibodies were found to react with the MOMP from the remaining seven serogroups examined, whereas antibodies directed against the lipopolysaccharide of serogroup 1 only reacted with lipopolysaccharide from two of the remaining seven serogroups.

Immunologic response of patients with legionellosis against major protein-containing antigens of Legionella pneumophila serogroup 1 as shown by immunoblot analysis

Major protein-containing antigens of Legionella pneumophila serogroup 1 were were identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblot analysis with rabbit antisera to 14 different Legionella species or serogroups. Fourteen bands were observed in immunoelectropherograms of whole-cell, sonicated cell, and heated cell preparations, seven of which appeared in the supernatant fluid from the heated cells and three of which were shown in an outer membrane fraction. Immunoblots of whole-cell antigen preparations of 14 Legionella species or serogroups revealed seven major Legionella proteins: antigens with molecular weights of 58,000, 79,000, and 154,000 were present in all Legionella sp. strains, antigens with molecular weights of 44,000 and 97,000 occurred in multiple species, and antigens with molecular weights of 14,000 and 25,000 were present only in L. pneumophila strains. All sera from 15 patients with culture-confirmed L. pneumophila serogroup 1 disease and 14 of 18 (78%) sera from serologically diagnosed patients reacted with the 58-kilodalton (kDa) common antigen. In contrast, less than one-half of the sera reacted with the L. pneumophila-specific proteins (14 and 25 kDa). Absorption of sera with Escherichia coli cells had no effect on their reactivity with the 58-kDa antigen, whereas absorption with L. pneumophila serogroup 1 cells removed reactivity. These data suggest that the 58-kDa antigen may prove useful in serodiagnostic tests for legionellosis.

Opsonic requirements for phagocytosis of Legionella micdadei by polymorphonuclear leukocytes

The roles of the classical and alternative pathways of complement activation and of antibody in the phagocytosis of Legionella micdadei by polymorphonuclear leukocytes were studied. Normal serum was treated with the appropriate chelators or with heat to inactivate the classical, alternate, or both pathways of complement activation. Normal and complement-depleted sera with or without antibody were employed as opsonins for L. micdadei in phagocytosis assays. There was no difference in the phagocytosis of L. micdadei promoted by normal serum and either C4-deficient serum or serum in which the classical pathway had been inactivated. Both normal and classical pathway-deficient sera promoted significantly greater phagocytosis than did sera in which the alternate pathway or both the alternate and classical pathways had been inactivated. Thus, polymorphonuclear leukocyte phagocytosis of L. micdadei in the absence of antibody required an intact alternate pathway. Specific antibody partially restored opsonization to sera deficient in the alternate or both complement pathways, but phagocytosis was still significantly less than that with the alternate pathway intact.

Production of monoclonal antibodies against Legionella pneumophila serogroup 1

Four monoclonal antibodies to Legionella pneumophila Philadelphia 1 were produced by the fusion of immunized BALB/c lymphocytes to a murine myeloma cell line. Two (Lp1-1 and Lp1-3) of the four monoclonal antibodies reacted with 14 L. pneumophila serogroup 1 strains, and the other (Lp1-2 and Lp1-4) reacted with only three out of 20 strains tested. These four monoclonal antibodies did not bind to any strains of L. pneumophila serogroup 2-7 and other Legionella species. In addition, it has been shown that these monoclonal antibodies may be useful not only for subserotyping of L. pneumophila but also for retrospective diagnosis using immunopathological methods.

Isolation and characterization of the cytoplasmic and outer membranes of the Legionnaires' disease bacterium (Legionella pneumophila)

Legionella pneumophila, the etiologic agent of Legionnaires' disease, is phagocytized in an unusual way and multiplies in human mononuclear phagocytes in a novel phagosome. As a first step toward understanding these L. pneumophila-phagocyte interactions, we have studied the envelope of L. pneumophila Philadelphia 1 strain. We isolated cell envelopes by treating whole bacterial cells with lysozyme and EDTA to convert them to spheroplasts, then lysing the spheroplasts osmotically or sonically. We resolved the cell envelopes into two membrane fractions by isopycnic centrifugation. We localized NADH oxidase to the fraction of buoyant density 1.145, which we designated cytoplasmic membrane, and lipopolysaccharide (LPS) to the fraction of density 1.222, which we designated outer membrane. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) revealed that the L. pneumophila outer membrane contains a single major protein species migrating at 28,000 mol wt; this is the major protein of the bacterium. The cytoplasmic membrane also contains a single major protein species migrating at 65,000 mol wt. Surface iodination of the bacteria and agglutination and immunofluorescence studies with rabbit antibody produced against the purified major outer membrane protein (MOMP) revealed that this protein is exposed at the cell surface. We isolated LPS from L. pneumophila membranes by SDS-EDTA treatment. The pattern obtained by subjecting the LPS to SDS-PAGE and staining the gel with silver nitrate suggests that L. pneumophila LPS might be atypical. We studied patient serologic responses to cell envelope components of L. pneumophila Philadelphia 1, a serogroup 1 organism. Sera from patients with evidence of infection with serogroup 1 L. pneumophila contained large amounts of antibody to this strain. Few of these antibodies recognized the MOMP of L. pneumophila. In contrast, greater than 98% of these antibodies were directed against the LPS. This indicates that LPS is the dominant serogroup antigen and the major antigen responsible for the reactivity of patient sera in the indirect fluorescent antibody assay, currently the principal diagnostic assay for Legionella infection.

Legionella and Legionnaires' disease: a review with emphasis on environmental studies and laboratory diagnosis

Legionella pneumophila and related species are important causes of epidemic bacterial pneumonia and nosocomial infection. This review will discuss this new family of bacteria and the diseases they produce. The classification, general microbiologic characteristics, and ecology of the bacteria will be reviewed and the epidemiology and clinical aspects of the infection will be discussed. More emphasis will be given to issues that are more directly related to laboratory workers and with which the author has had more direct experience: pathology, laboratory diagnosis of human infection, pathogenesis of the infection, and virulence mechanisms of the bacterium. Therapy and prevention of the infection will be discussed more briefly.

Isolation and characterization of the Legionella pneumophila outer membrane

A whole cell lysate of Legionella pneumophila was fractionated into five membrane fractions by sucrose gradient centrifugation. Membranes were characterized by enzymatic, chemical, and sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis. Two forms of cytoplasmic membrane (CM-1, CM-2), a band of intermediate density (IM), and two forms of outer membrane (OM-1, OM-2) were detected. The CM-1 fraction was the purest form of cytoplasmic membrane, and fraction CM-2 was primarily cytoplasmic membrane associated with small amounts of peptidoglycan. The IM, CM-1, and CM-2 fractions were enriched in peptidoglycan, and the amount of carbohydrate and 2-keto-3-deoxyoctonic acid was not appreciably greater in outer membrane relative to cytoplasmic membrane. Phosphatidylethanolamine and phosphatidylcholine were found to be the major phospholipids in the membrane fractions. The major outer membrane proteins had molecular sizes of 29,000 and 33,000 daltons and were both modified by heating. The 29,000-dalton protein was tightly associated with the peptidoglycan and was equally distributed in the IM, OM-1, and OM-2.

Lymphoid cell blastogenesis as an in vitro indicator of cellular immunity to Legionella pneumophila antigens

The lymphocyte blastogenic transformation assay was adapted to study responsiveness of lymphoid cells from animals and humans to Legionella pneumophila antigens in vitro. Spleen cells from guinea pigs after active immunization with Legionella vaccine, but not from normal animals, responded by blast cell transformation when stimulated in vitro with killed Legionella whole-cell vaccine, sonic extracts thereof, or a purified somatic antigen. The response was dose dependent. Similar lymphocyte blastogenesis occurred with spleen cells from mice sensitized to Legionella by sublethal infection with the bacteria. In addition, blastogenesis occurred with peripheral blood leukocytes from human volunteers tested in vitro with whole-cell vaccine, sonic extracts, or purified somatic antigen. Maximum responsiveness generally occurred 4 to 5 days after stimulation of human peripheral blood leukocytes, but a day or two earlier with spleen cells from normal or sensitized mice. Guinea pig spleen cells generally showed peak responses at the same time as human peripheral blood leukocytes after stimulation in vitro. Blastogenic responses with purified antigen were comparable to those with the whole-cell vaccine or sonic extract. Such antigens from Legionella provide a useful material for inducing responses in vitro as a correlate of cellular immunity to these bacteria.

Legionella pneumophila-induced blastogenesis of murine lymphoid cells in vitro

Legionella pneumophilia antigen preparations, either killed whole cell vaccine, a soluble sonic extract, or a purified large-molecular-weight somatic antigen, stimulated blastogenic responses by splenocytes from both normal and Legionella-sensitized mice. Graded amounts of the bacterial preparations, when added to cultures of normal spleen cells, resulted in increased uptake of thymidine into cellular DNA, indicating that the preparations were mitogenic for normal mouse splenocytes. Spleen cells from mice injected with graded numbers of living bacteria showed blastogenic responsiveness to Legionella preparations generally at a higher level than spleen cells from normal animals. The heightened blastogenic response was mainly evident with spleen cells obtained from mice injected with living bacteria 2 to 3 weeks earlier. Splenocytes from mice infected with legionella less than 1 to 2 weeks or for more than 4 to 5 weeks responded generally similar to those obtained from uninjected mice, indicating that sensitization with living organisms had a relatively short duration. Spleen cell suspensions responding to the L. pneumophila antigens appeared to be mainly B-lymphocytes since cell suspensions from athymic nude mice deficient in T-cells responded as well as cells from conventional mice. Furthermore, passage of splenocytes over nylon wool columns to obtain B-cell-enriched preparations resulted in cell populations capable of responding to Legionella antigen. The cell fractions rich in T-cells were much less capable of responding to the Legionella antigens. In addition, treatment of spleen cell populations with antitheta serum plus complement failed to inhibit the blastogenic response, whereas the same spleen cell preparations treated with anti-mouse immunoglobulin serum plus complement markedly diminished blastogenic responsiveness, again consistent with the likelihood that B-lymphocytes were the major cell class responding to the Legionella preparations.

Immunostimulation by Legionella pneumophila antigen preparations in vivo and in vitro

Injection of Legionella pneumophila antigen, either killed vaccine or soluble sonicate thereof, resulted in an enhanced antibody response by mouse spleen cells to sheep erythrocytes as determined by the hemolytic plaque assay. Enhancement was dose dependent and reached a peak response at a concentration of 10(7) bacteria or 50 micrograms of sonicate per animal. Larger doses of antigen were less stimulatory or even depressed the antibody response. Similar enhancement of antibody formation by normal spleen cell cultures to sheep erythrocytes in vitro occurred in the presence of graded amounts of L. pneumophila vaccine or sonicate. In addition, the L. pneumophila antigen stimulated enhanced background antibody formation in vitro in the absence of sheep erythrocytes or specific antigen. It appeared likely that the immunoenhancing activity of the L. pneumophila extract may be unrelated to the presence of lipopolysaccharide since boiling the antigen preparation eliminated much of the antibody-enhancing properties of the extract. A large-molecular-weight surface component from L. pneumophila was also immunomodulatory in vitro. Immunostimulation appeared to be related to effects on macrophages since adherent spleen cell populations rich in macrophages, when derived from spleen cell suspensions incubated with L. pneumophila antigen in vitro, stimulated enhanced antibody formation by normal mouse spleen cells in coculture experiments. Further investigations concerning the mechanism of immunomodulation by L. pneumophila antigen in vivo and in vitro appear to be warranted.

Characterization of surfaces involved in adherence of Legionella pneumophila to Fischerella species

Legionella pneumophila adheres to the slime coat of Fischerella spp. This was shown by microscopic examination and by a decline in L. pneumophila CFU in samples removed from coincubation mixtures of both organisms. Binding of partially purified Fischerella slime by L. pneumophila was most efficient by young, less hydrophobic L. pneumophila cells than by older, more hydrophobic cells. Uptake of crystal violet and partitioning into hexadecane were used to measure hydrophobicity of L. pneumophila. Purified soluble Legionella antigen also bound to Fischerella slime, as shown by indirect immunofluorescence. Adherence was not specific for L. pneumophila, since a variety of gram-negative, gram-positive, and acid-fast bacteria also bound to Fischerella slime.

Hybridoma-derived monoclonal immunoglobulin M antibodies to Legionella pneumophila serogroup 1 with diagnostic potential

Mouse hybridomas were isolated by fusing P3-X63-Ag 8.653 myeloma cells with spleen cells from mice that had been repeatedly immunized with Legionella pneumophila serogroup 1 organisms. In one fusion, three independent hybridoma cultures which secreted antibodies that reacted with the immunizing strain in the indirect immunofluorescent-antibody test were selected for cloning. Representative continuously growing clones, one of each hybridoma, which remained stable in producing high-titer antibodies were examined in detail. Extensive specificity tests revealed that these hybridoma-derived monoclonal antibodies were specifically directed against L. pneumophila serogroup 1 organisms and showed no cross-reactions in the indirect immunofluorescent-antibody test either with the other known serogroups of L. pneumophila or with other unrelated bacterial species. The three monoclonal antibodies F4/CB5/K18, F/4CB5/K104, and F4/JD3.8/K101 belonged to the immunoglobulin M class and were capable of agglutinating serogroup 1 organisms of L. pneumophila exquisitely. These monoclonal antibodies against L. pneumophila with defined fine specificity should enable purification and subsequent analysis of the corresponding antigenic determinant(s) and can also be used for the preparation of unlimited supplies of standard diagnostic reagents for the identification of L. pneumophila in the tissues and body fluids.

Counterimmunoelectrophoresis in the serodiagnosis of Legionnaires' disease

Counterimmunoelectrophoresis (CIE) was found to be a rapid, specific method for detecting circulating antibodies to Legionella pneumophila, using a simple ultrasonically disrupted antigen. The diagnostic specificity of the technique was 93% and the diagnostic sensitivity was 86.3%. Both IgM and IgG classes of antibody can be detected. There is some cross-reactivity between serogroup 1 and serogroup 6 but none between serogroup 1 and serogroups 3, 4, and 5. It is suggested that CIE may provide a simple, reproducible screening test for Legionnaires' disease.

Detection ofLegionella antibodies by enzyme-linked immunosorbent assay (ELISA) using whole cell and carbohydrate antigens

The systematic study ofLegionella as a human pathogen and a bacterium widely disseminated in the environment requires simplification of present methodology. We describe a highly sensitive enzyme-linked immunosorbent assay (ELISA) for the detection of serum antibodies that can also be used for the detection of antigen.Legionella pneumophila serogroups 1 and 3 (Philadelphia 2 and Bloomington 2),L. bozemanii (WIGA), andL. micdadei (TATLOCK) were grown in diphasic medium consisting of charcoal yeast extract agar (CYE) overlayed with yeast extract medium (YEM) for the production of whole cell antigen and CYE for the extraction of carbohydrate antigen. The whole cells were inactivated with 0.5% formalin. The carbohydrate was obtained from the supernatant of cells resuspended twice in phosphate buffered saline (PBS). The antigen was sterilized and concentrated by filtration and purified by chromatography through a Sepharose 4B column. The highest molecular weight fractions were used for chemical characterization, which confirmed the carbohydrate nature of the antigen, and for micro-ELISA. Titers ranging from 5×10(3) to 3×10(5) (inverse of serum dilutions) were obtained from rabbit sera collected after 1, 2, or 3 injections of whole cells. The titers were somewhat higher and more consistent with the higher of 2 antigen concentrations used (5 or 15μg/ml protein or dry weight), and with the carbohydrate rather than the whole cell antigen. The reactions were serogroup and species specific and only low titers were obtained with some of the heterologous antigens. The sensitivity and specificity of the reactions were not diminished when as many as 4 antigens were mixed in the same well. Thus, the micro-ELISA can be used as a test of highly specific antigens as well as a screening test with mixtures of antigens. A preliminary test withLegionella containing water specimen concentrates and high-titer rabbit sera indicated that the micro-ELISA can also be used for the detection of antigen. This investigation appears to have paved the way for the simplification of the serological methodology for the study ofLegionella.

Antigenic analysis of Legionella pneumophila and Tatlockia micdadei (Legionella micdadei) by two-dimensional (crossed) immunoelectrophoresis

The antigens of the six serogroups of Legionella pneumophila were compared by two-dimensional (crossed) immunoelectrophoresis by using rabbit antisera to serogroups 1, 2, 3 and 4. The close relationship among the serogroups was shown by the fact that 27 of the 31 antigens demonstrated so far were common. However, distinctive group-specific antigens with slow electrophoretic mobility were observed for serogroups 1, 2, 3, and 4. When intact serogroup 1 organisms were extracted with EDTA, the group-specific antigen was recovered in a virtually pure form. The group-specific antigen was pronase resistant, heat stable, and amphiphilic and had a surface location, all of which are properties suggestive of lipopolysaccharide. L. pneumophila shared four to five antigens with Tatlockia micdadei (Legionella micdadei). The large number of common antigens in the serogroups of L. pneumophila has important implications for the specific detection of antigens and antibodies by fluorescent and other tagged antibody methods.

Immunological and biochemical relationships among flagella isolated from Legionella pneumophila serogroups 1, 2, and 3

Flagella were isolated from virulent Legionella pneumophila serogroups 1, 2, and 3. Antiserum made against purified serogroups 1 flagellin agglutinated live, flagellated serogroups 1, 2, and 3 but not heat-killed or nonflagellated bacteria. A single line of identity was seen in immunodiffusion slides between the flagella isolated from the three serogroups and antibody to flagellin isolated from serogroups 1, 2, and 3. Indirect immunoperoxidase staining showed that antibody to flagellin isolated from serogroup 1 organisms reacted with flagella on serogroup 1, 2, and 3 bacteria. Indirect immunoperoxidase staining was also showed that antibody to flagellin isolated from serogroup 1 L. pneumophila did not react with the serogroup-specific cell surface antigen, thus demonstrating that the flagella- and the serogroup-specific antigen are separate antigens. The amino acid content of the flagella from the three serogroups was essentially the same, with aspartate, glutamate, alanine, and threonine comprising 41% of the total. Thirty-five percent of the amino acids were hydrophobic, and there were not detectable amounts of cysteine, tryptophan, or tyrosine.

Detection of Legionella pneumophila capsular-like envelope antigens by counterimmunoelectrophoresis

The capsular-like envelope of Legionella pneumophila strains Togus 1 (serotype 2) and Philadelphia 1 (serotype 1) was isolated and purified by column chromatography on Sepharose 6B. Antibody raised in rabbits to these two antigenic materials did not cross-react in gel diffusion. Upon electrophoresis followed by gel diffusion, the majority of both envelope materials was found to migrate towards the cathode. A minor antigenic component of each envelope only migrated slightly towards the anode. Using the envelope antigens and the two anti-envelope sera in a counterimmunoelectrophoresis (CIE) assay, positive results were only obtained when the antigenic materials were placed in the cathodal well. The Togus 1 and Philadelphia 1 antigens did not cross-react in CIE. The sensitivity of the CIE assay was poor (15.6 micrograms/ml by carbohydrate content) compared to its sensitivity in other microbial systems. Although CIE may not be a useful diagnostic aid in identifying Legionella species due to its low sensitivity, it may be of value in serotyping the microorganism since we did not see cross-reactivity between the two strains when anti-envelope sera were used.

Ultrastructural localization and protective activity of a high-molecular-weight antigen isolated from Legionella pneumophila

Immunoperoxidase labeling showed that the F-1 antigen of Legionella pneumophila is located on the bacterial cell surface. Protection against lethal intraperitoneal challenge with serogroup 1 L. pneumophila was induced in guinea pigs by heat-killed cells and F-1 antigen from serogroup 1, but not by heat-killed cells or F-1 antigens from serogroup 2, 3, or 4.

Legionnaires' disease among pneumonias in Iowa (FY 1972-1978) II. Epidemiologic and clinical features of 30 sporadic cases of L. pneumophila infection

We reviewed retrospectively the clinical records of 30 cases of sporadic Legionella pneumophila infection that occurred in Iowa between FY 1972 and 1978. Cases occurred throughout the year, most between May and December. Twenty-one male patients and 9 female patients ranging in age from 5-80 years were infected. Half the patients smoked or had an underlying illness; five were receiving corticosteroids or immunosuppressive therapy. Occupations and exposures related to hospitals, construction and travel were common; four patients had been exposed to birds. In addition to L. pneumophila infection, six patients had evidence of infection with a viral, mycoplasmal, bacterial, mycobacterial or fungal pathogen; three had had preceding dental infections. Twenty-seven cases were pneumonias visible on radiographs. Fever, cough, chills, myalgia and rales occurred inover half the cases. Headache, gastrointestinal symptoms and encephalopathy also were seen. Upper respiratory symptoms were uncommon. Urinalysis and blood studies often suggested renal and hepatic involvement, but other routine laboratory diagnostic tests were not helpful. All but two patients were hospitalized; seven required intensive care. The median duration of hospitalization was 12 days. Two patients who did not receive erythromycin or tetracycline therapy died.

Legionnaires' disease

Described here is a unique case of Legionnaires' disease in a previously healthy 46 year old man in whom disseminated disease was demonstrated in the kidneys, bone marrow, spleen and multiple peripheral lymph nodes at autopsy. The pathologic distribution of the lesions suggests that dissemination occurred by both hematogenous and lymphatic pathways. Pancytopenia associated with bone marrow destruction and fibrosis suggests that substances toxic to hematopoietic cells were present. It is likely that many of the unusual systemic manifestations of this disease are related to dissemination of the bacterium. The findings presented extend the spectrum of the clinical and pathologic manifestations of Legionnaires' disease from a mild and self-limited illness to a severe and fatal disseminated form of the disease.