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Potential false-positive urine Legionella enzyme immunoassay test results

  • James ComoEmail author
  • Matthew A. Moffa
  • Nitin Bhanot
  • Zaw Min
  • Kelly Stefano Cole
  • James Kuzyck
  • Thomas L. Walsh
Original Article

Abstract

The objective of this study was to identify potential false-positive urine Legionella pneumophila (Legionella) enzyme immunoassay test results. A total of 107 consecutive patients with positive EIA tests were retrospectively analyzed over a 34-month period. Concurrent blood, urine, and sputum cultures, as well as chest radiographic findings, were reviewed in these patients. Twenty patients (19%) had no radiographic evidence of pulmonary disease despite a positive EIA test. In those 20 patients, 14 also had growth of non-Legionella bacteria. Of patients with an infiltrate or opacity on chest imaging, only 27 had Legionella sputum cultures obtained, with Legionella culture growth occurring in 7 (26%). Nine other patients had negative Legionella sputum cultures but the growth of another pathogenic organism in blood, sputum, and/or urine cultures. Pseudomonas aeruginosa was the most common organism isolated, found in 20% of patients in the entire cohort. Twenty-five patients (23%) were characterized as having probable false-positive Legionella urinary antigen EIA testing, and an additional 17 patients (16%) were characterized as having possible false-positive Legionella EIA tests. Our findings suggest that urine Legionella EIA tests may lead to a substantial number of cases being misdiagnosed as Legionaries’ disease in patients with non-Legionella bacterial colonization or infection.

Keywords

Legionella Enzyme immunoassay EIA Urine antigen testing Urine alone 

Notes

Acknowledgments

The authors would like to thank Lori Vandiver for assistance with electronic data capture.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine and Division of Infectious DiseasesAllegheny General HospitalPittsburghUSA
  2. 2.Department of Medicine and Division of Infectious DiseasesWest Penn HospitalPittsburghUSA
  3. 3.Department of Pathology, Clinical Microbiology LaboratoryAllegheny Health NetworkPittsburghUSA

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