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J Med Microbiol 55 (2006), 561-566; DOI: 10.1099/jmm.0.46369-0
© 2006 Society for General Microbiology
ISSN 1473-5644

Sensitivity of three serum antibody tests in a large outbreak of Legionnaires' disease in the Netherlands

Ed P. F. Yzerman1,2, Jeroen W. den Boer3, Kamilla D. Lettinga2, Arnoud J. Schel2, Joop Schellekens4 and Marcel Peeters5

1 Regional Laboratory of Public Health Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands

2 Academic Medical Center, Amsterdam, The Netherlands

3 Municipal Health Service Kennemerland, Haarlem, The Netherlands

4 National Institute for Public Health and the Environment, Bilthoven, The Netherlands

5 Regional Laboratory of Public Health Tilburg, Tilburg, The Netherlands

Correspondence
Ed P. F. Yzerman
e.yzerman{at}streeklabhaarlem.nl

Received 11 October 2005
Accepted 26 January 2006

In 1999, an outbreak involving 188 patients with Legionnaires' disease (LD) occurred at a flower show in the Netherlands. This large outbreak provided the opportunity to evaluate serum antibody tests to assay anti-Legionella pneumophila, since limited data are available on the sensitivity of these tests. The sensitivities of an indirect serotype 1-6 immunofluorescence antibody test (IFAT), a rapid micro-agglutination test (RMAT) IgM serotype 1 antibody assay, and an ELISA to detect IgM and IgG serotype 1-7 antibodies, were evaluated using serum samples from LD patients related to the 1999 outbreak. Sensitivity was calculated using positive culture and/or a positive urinary antigen test as the gold standard in outbreak-related patients with radiographically confirmed pneumonia who fulfilled the epidemiological criteria. The IFAT, RMAT and ELISA showed sensitivities of 61, 44 and 64 %, respectively. The sensitivity of the three tests combined was 67 %. In epidemic situations, however, high standing titres may be included in the laboratory evidence of LD cases. In the study population, high standing titres were found in 16 % of cases. If the presence of high standing antibody titres was added to the criteria of a positive test, the sensitivities of IFAT, RMAT and ELISA were 86, 48 and 75 %, respectively. The sensitivity was 91 % for all tests combined. The higher sensitivity for the combined use of tests is offset by a reduction in specificity to 97·6 %. The results of this study indicate that using a combination of serologic tests in pneumonia patients suspected to have LD does not substantially improve sensitivity. The results suggest that in the microbiological diagnosis of LD, both IFAT and ELISA are reasonably sensitive assays. In an epidemic situation, both tests are highly sensitive, the IFAT more so than the ELISA.

Abbreviations: CAP, community-acquired pneumonia; EWGLI, European Working Group on Legionella Infections; IFAT, immunofluorescence antibody test; LD, Legionnaires' disease; RMAT, rapid micro-agglutination test.




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