Nosocomial Legionnaires' disease--advances in diagnosis and typing

The impact of new methodologies on the routine diagnosis of legionella pneumonia has been limited but the potential for advance is considerable. Antigen detection immunoassays have not yet reached the stage where they are used in routine practice. Monoclonal antibodies have been successfully used for direct fluorescence of bronchial aspirates. Nucleic acid hybridization techniques have yet to find a role in diagnosis. Serology remains the most commonly used method in the diagnosis of Legionnaires' disease. Methods of typing Legionella pneumophila include monoclonal antibodies and isoenzyme, plasmid and nucleic acid analysis. Biotyping methods have not been found to be of value. The use of monoclonal antibodies has permitted the comparison of clinical and environmental isolates and allowed the separation of serogroup 1 into subgroups of differing virulence. The subgroup of serogroup 1 called Pontiac is responsible for the majority of sporadic and epidemic legionella pneumonia in the UK. An internationally accepted panel of monoclonal antibodies is used to define these strains. The extent to which other subgroups of serogroup 1 and other serogroups of L. pneumophila cause disease appear to reflect their environmental prevalence.