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Should urine antigen testing for Legionella pneumophila be ordered for all hospitalized patients with community-acquired pneumonia?

Anna Cheek, MD, Ian Jackson, MD, Manasa Velagapudi, MBBS and Shraddha Narechania, MD, FCCP
Cleveland Clinic Journal of Medicine June 2023, 90 (6) 345-347; DOI: https://doi.org/10.3949/ccjm.90a.22039

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Tables

  • TABLE 1

    Advantages and disadvantages of tests for Legionella pneumophila

    TestSensitivitySpecificityAdvantagesDisadvantages
    Culture10%–80%100%Detects all serogroupsResults take several days, difficult technique
    Urine antigen70%–80%> 99%Results in less than 1 hourDetects only Legionella pneumophila serogroup 1
    Polymerase chain reaction95%–99%> 99%Results in hours, detects all serogroupsAvailability may be limited in some areas
    Direct fluorescent antibody stain25%–75%> 95%Results in hours, detects all serogroupsDifficult technique
    Serology80%–90%> 99%Detects all serogroupsMust test acute-phase and convalescent-phase sera, results take several weeks

    • Adapted from reference 13.

  • TABLE 2

    Indications for Legionella testing

    Atypical symptoms including but not limited to altered mentation, pleuritic chest pain, and diarrhea
    Admission to intensive care unit
    High-risk patient features including immunosuppression, chronic lung disease, history of smoking, and age older than 50
    Hypoxemia and increasing oxygen requirements
    Recent travel (ie, within 2 weeks of initial presentation)
    Concern for community or nosocomial pneumonia outbreak
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