Improvement of legionnaires’ disease diagnosis using real-time PCR assay: A retrospective analysis, Italy, 2010 to 2015

Maria Luisa Ricci, Antonella Grottola, Giulia Fregni Serpini, Antonino Bella, Maria Cristina Rota, Francesca Frascaro, Emanuela Pegoraro, Marisa Meacci, Anna Fabio, Elena Vecchi, Antonietta Girolamo, Fabio Rumpianesi, Monica Pecorari, Maria Scaturro

Research output: Contribution to journalArticle

Abstract

Aim: To evaluate real-time PCR as a diagnostic method for Legionnaires’ disease (LD). Detection of Legionella DNA is among the laboratory criteria of a probable LD case, according to the European Centre for Disease Prevention and Control, although the utility and advantages, as compared to culture, are widely recognised. Methods: Two independent laboratories, one using an in-house and the other a commercial real-time PCR assay, analysed 354 respiratory samples from 311 patients hospitalised with pneumonia between 2010–15. The real-time PCR reliability was compared with that of culture and urinary antigen tests (UAT). Concordance, specificity, sensitivity and positive and negative predictive values (PPV and NPV, respectively) were calculated. Results: Overall PCR detected eight additional LD cases, six of which were due to Legionella pneumophila (Lp) non-serogroup 1. The two real-time PCR assays were concordant in 99.4% of the samples. Considering in-house real-time PCR as the reference method, specificity of culture and UAT was 100% and 97.9% (95% CI: 96.2–99.6), while the sensitivity was 63.6% (95%CI: 58.6–68.6) and 77.8% (95% CI: 72.9–82.7). PPV and NPV for culture were 100% and 93.7% (95% CI: 91.2-96.3). PPV and NPV for UAT were 87.5% (95% CI: 83.6-91.4) and 95.8% (95% CI: 93.5-98.2). Conclusion: Regardless of the real-time PCR assay used, it was possible to diagnose LD cases with higher sensitivity than using culture or UAT. These data encourage the adoption of PCR as routine laboratory testing to diagnose LD and such methods should be eligible to define a confirmed LD case.

Original languageEnglish
Article number1800032
JournalEurosurveillance
Volume23
Issue number50
DOIs
Publication statusPublished - Dec 13 2018

    Fingerprint

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Virology

Cite this

Ricci, M. L., Grottola, A., Serpini, G. F., Bella, A., Rota, M. C., Frascaro, F., Pegoraro, E., Meacci, M., Fabio, A., Vecchi, E., Girolamo, A., Rumpianesi, F., Pecorari, M., & Scaturro, M. (2018). Improvement of legionnaires’ disease diagnosis using real-time PCR assay: A retrospective analysis, Italy, 2010 to 2015. Eurosurveillance, 23(50), [1800032]. https://doi.org/10.2807/1560-7917.ES.2018.23.50.1800032