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|In House Availability||Daily, day and evening shifts|
|Container type||Clean container, urine cup|
|Sample type||BAL, Sputum, Unfixed tissue|
|Critical value||Positive culture|
|Synonyms||Bacterial culture; Legionnaires disease|
|Stability||Refrigerated 24 hours|
|Turn around times||2-7 days|
|Additional information||Routinely set up on all bronchial lavage and lung biopsy specimens, at additional charge.
Diagnosis of L. pneumophila can be challenging, particularly since existing tests lack good sensitivity. While this disease is usually considered in an otherwise healthy individual presenting with atypical pneumonia (possibly in an outbreak setting), our patient population often has significant comorbidities that make the diagnosis even more difficult.
1) Culture is the gold standard and 100% specific, but sensitivity can vary by lab from 25-75%. Inadequate specimens, poor growth characteristics and prior antibiotic use will decrease culture yield.
2) DFA is highly specific, but has relatively poor sensitivity (approx 50%), again, inadequate specimens and few organisms can be present in samples. Additionally, samples from the upper respiratory tract may contain cross reacting bacterial species.
3) Urine Ag can be more sensitive for L. pneumophilia, Serotype 1, however at UCSF only 28% of Legionella infections are due to this serotype.
Overall, diagnosis of Legionella pneumonia is first entertained and treated clinically, proper specimen collection is critical to the laboratory diagnosis, with culture and DFA being a reasonable first pass where there is moderate to high clinical suspicion that Legionella is the causative organism. Unfortunately, no test is adequate for ruling out the disease, and most testing is designed to identify outbreak
|Last Updated||10/24/2013 10:46:23 AM|