The laboratory diagnosis of legionellosis is based on cultural isolation of the organisms, serologic conversion, and direct detection by fluorescent antibody techniques or DNA probes. Cultural isolation of the organism provides definitive diagnosis and has been successfully performed with BAL specimens. Isolation, however, may be somewhat problematic since the saline solution used for lavage may inhibit Legionella growth (personal experience). Fluorescent antibody staining may be used, although the method is generally considered less sensitive than culture. Cheap Diskus Advair
Stains may be performed using monoclonal or polyclonal L pneumophila specific reagents, but for detecting all species a more broadly reactive polyclonal reagent may be preferred. With either reagent, occasional false-positive reactions may be seen due to other crossreacting bacteria, particularly Bacteroides and Pseudomonas species. Highly specific DNA probe tests (Gen Probe) for direct detection of Legionella species in respiratory samples with a sensitivity equivalent to fluorescent antibody staining having recently become available. Although the use of DNA probe tests has not been evaluated with BAL specimens, it is likely that the test will become a useful adjunctive procedure.
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