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Characterization of the extent of a large outbreak of Legionnaires' disease by serological assays.
BMC Infect Dis. 2015 Mar 28; 15:163.BI

Abstract

BACKGROUND

In May 2005, a long-distance outbreak of Legionnaires' disease (LD) caused by Legionella pneumophila serogroup 1 occurred in south-east Norway. The initial outbreak investigation without serology identified 56 laboratory-confirmed LD cases of whom 10 died. However, 116 patients with community-acquired pneumonia might belong to the outbreak based on epidemiological investigations, but acute laboratory tests other than serology were negative or not performed. To assess the true extent of the outbreak, we evaluated two serological assays in order to reclassify the 116 patients with indeterminate case status.

METHODS

Two polyvalent antibody tests, a serogroup 1-6 immunofluorescence assay (IFA) and a serogroup 1-7 enzyme-linked immunosorbent assay (ELISA) were used. They were evaluated with cases defined as culture- or urinary antigen positive LD patients (n=40) and non-cases defined as confirmed non-LD patients (n=39) and healthy control subjects (n=62). The 116 patients, who were negative in culture, polymerase chain reaction and/or urinary antigen tests, were analysed by the same serological assays. Antibodies to the outbreak strain were determined by immunoblotting.

RESULTS

In the evaluation study, the sensitivity and specificity of a ≥4-fold IFA titre change was 38% and 100%, respectively, with corresponding values of 30% and 99% for seroconversion in ELISA. A single high positive IFA titre yielded sensitivity and specificity of 73% and 97%, respectively, with corresponding values of 68% and 96% for a single high immunoglobulin (Ig) G and/or IgM in ELISA. Based on this evaluation, the following serological testing identified 47 more LD cases, and the outbreak thus comprised 103 cases with a case fatality rate of 10%. About the same proportion (70%) of the urinary antigen positive and negative LD cases had antibodies to the serogroup-specific lipopolysaccharide of the outbreak strain. In addition to the 103 LD cases, Legionella infection could not be verified or excluded in 32 patients based on epidemiology and/or lack of microbiological sampling.

CONCLUSIONS

The acute-phase tests (culture, polymerase chain reaction, and urinary antigen) identified less than 55% of the 103 patients in this outbreak. Serological testing thus remains an important supplement for diagnosis of LD and for determination of outbreak cases.

Authors+Show Affiliations

Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway. oystein.simonsen@so-hf.no.Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. elisabeth.wedege@fhi.no.Department of Clinical Microbiology, Østfold Hospital Trust, Fredrikstad, Norway. anita.kanestrom@so-hf.no.Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. karin.bolstad@fhi.no.Department of Bacteriology and Immunology, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. ingeborg.aaberge@fhi.no.Department of Clinical Microbiology, Østfold Hospital Trust, Fredrikstad, Norway. eivin-ra@online.no.Department of Medicine, Østfold Hospital Trust, Fredrikstad, Norway. jetmund.ringstad@so-hf.no.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25887275

Citation

Simonsen, Øystein, et al. "Characterization of the Extent of a Large Outbreak of Legionnaires' Disease By Serological Assays." BMC Infectious Diseases, vol. 15, 2015, p. 163.
Simonsen Ø, Wedege E, Kanestrøm A, et al. Characterization of the extent of a large outbreak of Legionnaires' disease by serological assays. BMC Infect Dis. 2015;15:163.
Simonsen, Ø., Wedege, E., Kanestrøm, A., Bolstad, K., Aaberge, I. S., Ragnhildstveit, E., & Ringstad, J. (2015). Characterization of the extent of a large outbreak of Legionnaires' disease by serological assays. BMC Infectious Diseases, 15, 163. https://doi.org/10.1186/s12879-015-0903-2
Simonsen Ø, et al. Characterization of the Extent of a Large Outbreak of Legionnaires' Disease By Serological Assays. BMC Infect Dis. 2015 Mar 28;15:163. PubMed PMID: 25887275.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of the extent of a large outbreak of Legionnaires' disease by serological assays. AU - Simonsen,Øystein, AU - Wedege,Elisabeth, AU - Kanestrøm,Anita, AU - Bolstad,Karin, AU - Aaberge,Ingeborg S, AU - Ragnhildstveit,Eivind, AU - Ringstad,Jetmund, Y1 - 2015/03/28/ PY - 2014/07/09/received PY - 2015/03/13/accepted PY - 2015/4/19/entrez PY - 2015/4/19/pubmed PY - 2016/2/24/medline SP - 163 EP - 163 JF - BMC infectious diseases JO - BMC Infect Dis VL - 15 N2 - BACKGROUND: In May 2005, a long-distance outbreak of Legionnaires' disease (LD) caused by Legionella pneumophila serogroup 1 occurred in south-east Norway. The initial outbreak investigation without serology identified 56 laboratory-confirmed LD cases of whom 10 died. However, 116 patients with community-acquired pneumonia might belong to the outbreak based on epidemiological investigations, but acute laboratory tests other than serology were negative or not performed. To assess the true extent of the outbreak, we evaluated two serological assays in order to reclassify the 116 patients with indeterminate case status. METHODS: Two polyvalent antibody tests, a serogroup 1-6 immunofluorescence assay (IFA) and a serogroup 1-7 enzyme-linked immunosorbent assay (ELISA) were used. They were evaluated with cases defined as culture- or urinary antigen positive LD patients (n=40) and non-cases defined as confirmed non-LD patients (n=39) and healthy control subjects (n=62). The 116 patients, who were negative in culture, polymerase chain reaction and/or urinary antigen tests, were analysed by the same serological assays. Antibodies to the outbreak strain were determined by immunoblotting. RESULTS: In the evaluation study, the sensitivity and specificity of a ≥4-fold IFA titre change was 38% and 100%, respectively, with corresponding values of 30% and 99% for seroconversion in ELISA. A single high positive IFA titre yielded sensitivity and specificity of 73% and 97%, respectively, with corresponding values of 68% and 96% for a single high immunoglobulin (Ig) G and/or IgM in ELISA. Based on this evaluation, the following serological testing identified 47 more LD cases, and the outbreak thus comprised 103 cases with a case fatality rate of 10%. About the same proportion (70%) of the urinary antigen positive and negative LD cases had antibodies to the serogroup-specific lipopolysaccharide of the outbreak strain. In addition to the 103 LD cases, Legionella infection could not be verified or excluded in 32 patients based on epidemiology and/or lack of microbiological sampling. CONCLUSIONS: The acute-phase tests (culture, polymerase chain reaction, and urinary antigen) identified less than 55% of the 103 patients in this outbreak. Serological testing thus remains an important supplement for diagnosis of LD and for determination of outbreak cases. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/25887275/Characterization_of_the_extent_of_a_large_outbreak_of_Legionnaires'_disease_by_serological_assays_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-015-0903-2 DB - PRIME DP - Unbound Medicine ER -