Key words: Legionella, urinary antigen, enzymeimmunoassay (EIA), rapid diagnosis

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Key words: Legionella, urinary antigen, enzymeimmunoassay (EIA), rapid diagnosis

lymerase chain reaction(pcr) EIA kit Table1 @ Reference strains used in this study Table2 @ Comparison between Biotest and Binax

Table3 @ Positive cases for urinary antigen detection test Table4 @ Comparison between culture method and urinary antigen EIA Sensitivity: 100%(5/5) Specificity: 93%(67/72) Overall agreement to culture: 93.5%(72/77)

Table5 @ Comparison between IFA and urinary antigeneia Sensitivity: 50.0%(3/6) Specificity: 90.0%(63/70) Overall agreement to IFA: 86.8%(66/76) Table6 @ Comparison between PCR and urinary antigen Sensitivity: 100%(7/7) Specificity: 97.1%(67/69) Overall agreement to PCR: 97.4%(74/76)

Fig.1 @ Clinical course of Legionella pneumonia: case7

Table7 @ Urinary antigen detection as a function of days after onset The average day of first positive specimen after onset: day13 Table8 @ Urinary antigen detection as a function of days after admission The average day of first positive specimen after admission: day8.1 1) Yu VL: Legionella pneumonia (Legionnaires' disease) Principles and practice of infectious disease. 4th ed., 1995; 2087-2097, Mandell GL, Bennet JE, Dolin R eds. Churchill Livingstone, New York, 1995. 2) Kashuba AD, Ballow CH: Legionella urinary an- testing: Potential impact on diagnosis and tigen antibiotic therapy. Diagn Microbiol Infect Dis

576-582. 14) Hackman BA, Plouffe JF, Benson RF, Fields BS, Breiman RF: Comparison of Binax Legionella urinary antigen EIA kit with Binax RIA urinary antigen kit for detection of Legionella pneumophila 5) Koide M, Saito A: Diagnosis of Legionella pneumophila infection by polymerase chain reaction. Clin Infect Dis1995; 21: 199-201. 6) Plouffe JF, File TM Jr, Breiman RF: Reevaluation of the definition of Legionnaires' disease: use of the urinary antigen assay. Clin Infect Dis 1995; 20: 1286-1291. 7) Tilton RC : Legionnaires' disease antigen detected by enzyme-linked immunoassay. Ann Int Med1979; 90: 697-698. 8) Berdal BP, Farcy CE, Feeley JC: Detection of Legionella pneumophila antigen in urine by enzymelinked immunospecific assay. J Clin Microbiol 1979; 9: 575-578. 9) Kohler RB, Zimmerman SE, Wilson E et al.: Rapid diagnosis of Legionnaires' disease; detection and partial characterization of urinary antigen. Ann Intern Med. 1981; 94: 601-605. 10) Kohler RB, Winn WC, Wheat LJ: Onset and duration of urinary antigen excretion in Legionnaires' disease. J Infect Dis. 1984; 20: 605-607. 11) Edelstein ME, Edeldtein PH : Retrospective evaluation of the Du Pont Radioimmunoassay Kit for detection of Legionella pneumophila serogroup1. J Clin Microbiol. 1988; 26: 1775-1778. 12) Centers for Disease Controle and Prevention: Guilines for prevention of nosocomial pneumonia. MMWR1997; 46: 1-79. 13) Sathapatayavongs B, Kohler RB, Wheat LJ, White A: Rapid diagnosis of legionnaires' disaese by urinary antigen detection; comparison of ELISA and radioimmunoassay. Am J Med1982; 72: serogroup1antigen. J Clin Microbiol. 1996; 34: 1579-1580. 15) Dominguez JA, Matas L, Manterola JM et al.: Comparison of radioimmunoassay and enzymeimmunoassay kit for detection of Legionella pneumophila serogroup1antigen in both cocentrated and nonconcentrated urine samples. J Clin Microbiol. 1997; 135: 1627-1629. 16) Sonneborn HH, Backes M, Hartlaub A, Horn J, Jurgens D, Fehrenbach F: EIA assay for the detection of Legionella antigen in urine. 8 th European Congress of clinical microbiology and infectious disease. 1997. 17) Dominguez JA, Gali N, Pedroso P et al.: Comparison of the Binax Legionella urinary antigen enzyme immunoassay (EIA) with the Biotest Legionella urin antigen EIA for detection of Legionella antigen in both concentrated ans nonconcentrated urine samples. J Clin Pathol1998; 36: 2718-2722. 18) Birtles RJ, Harrison TG, Samuel D et al.: Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup1infection. Pathol1990; 43: 685-690. J Clin

Evaluation of Urinary Antigen Detection Methods for Rapid Diagnosis of Legionella pneumonia Noriko ARAKAKI1), Futoshi HIGA1), Michio KOIDE", Masao TAKEYAMA1), Takashi SHINZATO1), Nobuchika KUSANO2), Eiko YABUUCHI3) and Atushi SAITO1) We have evaluated urine specimens of presumptive cases of legionnaires' disease (110cases, 173 sample), collected in the past eight years (April, 1990August, 1998) with the Binax EIA kit which detects the soluble antigen of Legionella pneumophila serogroup (SG) 1, and the Biotest EIA kit which detects Legionella species. Seven cases (19specimens) were positive for the Binax EIA kit, and nine cases (22specimens) were positive for the Biotest EIA kit. The sensitivity for culture, PCR, IFA method were100%, 100 %, and50%, the specificity for these method were 93%, 97.1%, and90% respectively. Overall agreements for these method were93.5%, 97.4%, 86.8%, these results suggested that the urinary antigen detection test had high sensitivity and specificity. Our study indicated that concentrated urine samples increase sensitivity. We also evaluated the capabilities of both EIAs to detect soluble antigens were extracted from bacterial suspension of18strains of5legionella species by heating. Both assays detected L. pneumophila serogroups1to14, L. bozemanii. The Binax EIA proved to be useful as the Biotest EIA for diagnosis of legionellosis caused by Legionella species and serogroups other than L. pneumophila serogroup 1. Some cases have been shown to excrete antigen for prolonged period of times despite recovery from infection, so that the patient's history should be sought. The urine antigen detection EIA methods proved to be rapid and easy to use, detect antigen in the early stage of the desease with high sensitivity and specificity. Its use for the definition of legionellosis should be considered in Japan.

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