17
Views
12
CrossRef citations to date
0
Altmetric
Original Article

Legionella and Legionnaires' Disease: A Review with Emphasis on Environmental Studies and Laboratory Diagnosis

Pages 323-381 | Published online: 02 Jul 2009

References

  • Kirby B. D., Snyder K. M., Meyer R. D., Finegold S. M. Legionnaires' disease. Report of sixty-five nosocomially acquired cases and review of the literature. Medicine 1980; 59: 188
  • Muder R. R., Yu V. L., Zuravleff J. J. Pneumonia due to the Pittsburgh pneumonia agent, New clinical perspective with a review of the literature. Medicine 1983; 62: 120
  • Broome C. V., Fraser D. W. Epidemiologic aspects of legionellosis. Epidemiol. Rev. 1979; 1: 1
  • Winn W. C., Jr., Myerowitz R. L. The pathology of the Legionella pneumonias, A review of 74 cases and the literature. Hum. Pathol. 1981; 12: 401
  • Winn W. C., Jr., Pasculle A. W. Laboratory diagnosis of infections caused by Legionella species. Clin. Lab. Med. 1982; 2: 343
  • Jones G. L., Herbert G. A. “Legionnaires”, the Disease, the Bacterium and Methodology. U.S. Department of Health, Education and Welfare, Atlanta 1979, HEW Publ. No. (CDC) 79–8375
  • Edelstein P. H. Legionnaires' disease laboratory manual. National Technical Information Service, Springfield, Va 1983, U.S. Dept. of Commerce, #PB83–213751
  • Balows A., Fraser D. W. International symposium on Legionnaires' disease. Ann. Intern. Med. 1979; 90: 491
  • Feeley J. C., Thornsberry C., Jakubowski W., Balows A. Legionella: Proceedings of the Second International Symposium. American Society for Microbiology, Washington 1984
  • Brenner D. J., Steigerwalt A. G., McDade J. E. Classification of the Legionnaires' disease bacterium, Legionella pneumophila, genus novum, species nova, of the family Legionellaceae, family nova. Ann. Intern. Med. 1979; 90: 656
  • Moss C. W., Weaver R. E., Dees S. B., Cherry W. B. Cellular fatty acid composition of isolates from Legionnaires' disease. J. Clin. Microbiol. 1977; 6: 140
  • Fliermans C. B., Cherry W. B., Orrison L. H., Smith S. J., Tison D. L., Pope D. H. Ecological distribution of Legionella pneumophila. Appl. Environ. Microbiol. 1981; 41: 9
  • Morris G. K., Steigerwalt A., Feeley J. C., Wong E. S., Martin W. T., Patton C. M., Brenner D. J. Legionella gormanii sp. nov. J. Clin. Microbiol. 1980; 12: 718
  • Cherry W. B., Gorman G. W., Orrison L. H., Moss C. W., Steigerwalt A. G., Wilkinson H. W., Johnson S. E., McKinney R. M., Brenner D. J. Legionella jordanis, a new species of Legionella isolated from water and sewage. J. Clin. Microbiol. 1982; 15: 290
  • Pine L., George J. R., Reeves M. W., Harrell W. K. Development of a chemically defined liquid medium for growth of Legionella pneumophila. J. Clin. Microbiol. 1979; 9: 615
  • Warren W. J., Miller R. D. Growth of Legionnaires disease bacterium (Legionella pneumophila) in chemically defined medium. J. Clin. Microbiol. 1979; 10: 50
  • George J. R., Pine L., Reeves M. W., Harrell W. K. Amino acid requirements of Legionella pneumophila. J. Clin. Microbiol. 1980; 11: 286
  • Baine W. B., Rasheed J. K., Feeley J. C., Gorman G. W., Cassida L. E., Jr. Effect of supplemental L-tyrosine on pigment production in cultures of the Legionnaires' disease bacterium. Curr. Microbiol. 1978; 1: 93
  • Moss C. W., Karr D. E., Dees S. B. Cellular fatty acid composition of Legionella longbeachae sp. nov. J. Clin. Microbiol. 1981; 14: 692
  • Garrity G. M., Brown A., Vickers R. M. Tatlockia, Fluoribacter, Two new genera of organisms resembling Legionella pneumophila. Int. J. Syst. Bacteriol. 1980; 30: 609
  • McKinney R. M., Thomason B. M., Harris P. P., Thacker L., Lewallen K. R., Wilkinson H. W., Hebert G. A., Moss C. W. Recognition of a new serogroup of legionnaires' disease bacterium. J. Clin. Microbiol. 1979; 9: 103
  • Politi B. D., Fraser D. W., Mallison G. F., Mohatt J. V., Morris G. K., Patton C. M., Feeley J. C., Telle R. D., Bennett J. V. A major focus of legionnaires' disease in Bloomington, Indiana. Ann. Intern. Med. 1979; 90: 587
  • Edelstein P. H., Meyer R. D., Finegold S. M. Isolation of a new serotype of Legionnaires' disease bacterium. Lancet 1978; ii: 1172
  • McKinney R. M., Thacker L., Harris P. P., Lewallen K. R., Hebert G. A., Edelstein P. H., Thomason B. M. Four serogroups of Legionnaires' disease bacteria defined by direct immunofluorescence. Ann. Intern. Med. 1979; 90: 621
  • England A. C., III, McKinney R. M., Skaliy P., Gorman G. W. A fifth serogroup of Legionella pneumophila. Ann. Intern. Med. 1980; 93: 58
  • McKinney R. M., Wilkinson H. W., Sommers H. M., Fikes B. J., Sasseville K. R., Yungbluth M. M., Wolf J. S. Legionella pneumophila serogroup six. Isolation from cases of legionellosis, identification by immunofluorescence staining, and immunological response to infection. J. Clin. Microbiol. 1980; 12: 395
  • Bibb W. F., Arnow P. M., Dellinger D. L., Perryman S. R. Isolation and characterization of a seventh serogroup of Legionella pneumophila. J. Clin. Microbiol. 1983; 17: 346
  • Bissett M. L., Lee J. O., Lindquist D. S. New serogroup of Legionella pneumophila, serogroup 8. J. Clin. Microbiol. 1983; 17: 887
  • Bibb W. F., Sorg R. J., Thomason B. M., Hicklin M. D., Steigerwalt A. G., Benner D. J., Wulf M. R. Recognition of a second serogroup of Legionella longbeachae. J. Clin. Microbiol. 1981; 14: 674
  • Porschen R. K. Legionnaires' disease, more on staining and isolation of Legionella pneumophila. N. Engl. J. Med. 1979; 300: 369
  • Pasculle A. W., Myerowitz R. L., Rinaldo C. R., Jr. New bacterial agent of pneumonia isolated from renal-transplant recipients. Lancet 1979; ii: 58
  • Rogers B. H., Donowitz G. R., Walker G. K., Harding S. A., Sande M. A. Opportunistic pneumonia. A clinicopathological study of five cases caused by an unidentified acid-fast bacterium. N. Engl. J. Med. 1979; 301: 959
  • Wing E. J., Schafer F. J., Pastille A. W. Successful treatment of Legionella micdadei (Pittsburgh pneumonia agent) pneumonia with erythromycin. Am. J. Med. 1981; 71: 836
  • Cordes L. G., Myerowtiz R. L., Pasculle A. W., Corcoran L., Thompson T. A., Gorman G. W., Patton C. M. Legionella micdadei (Pittsburgh pnuemonia agent). Direct fluorescent-antibody examination of infected human lung tissue and characterization of clinical isolates. J. Clin. Microbiol. 1981; 13: 720
  • Myerowitz R. L., Pasculle A. W., Dowling J. N., Pazin G. J., Puerzer M., Yee R. B., Rinaldo C. R., Jr., Hakala T. R. Opportunistic lung infection due to “Pittsburgh pneumonia agent”. N. Engl. J. Med. 1979; 301: 53
  • Chandler F. W., Blackmon J. A., Hicklin M. D., Cole R. M., Callaway C. S. infrastructure of the agent of legionnaires' disease in the human lung. Am. J. Pathol. 1979; 71: 43
  • Rodgers F. G., Davey M. R. Ultrastructure of the cell envelope layers and surface details of Legionella pneumophila. J. Gen. Microbiol. 1982; 128: 1547
  • Flesher A. R., Ito S., Mansheim B. J., Kasper D. L. The cell envelope of the legionnaires' disease bacterium. Ann. Intern. Med. 1979; 90: 628
  • Weaver R. E., Feeley J. C. Cultural and biochemical characterization of the legionnaires' disease bacterium. “Legionnaires”. the Disease, the Bacterium and Methodology, G. L. Jones, G. A. Herbert. U.S. Department of Health, Education and Welfare, Atlanta 1979, HEW Publ. No. (CDC) 79–8375
  • Chandler F. W., Thomason B. M., Herbert G. A. Flagella on legionnaires' disease bacteria in the human lung. Ann. Intern. Med. 1980; 93: 715
  • Chandler F. W., Roth I. L., Callaway C. S., Bump J. L., Thomason B. M., Weaver R. E. Flagella on legionnaires' disease bacteria. Ultrastructural observations. Ann. Intern. Med. 1980; 93: 711
  • Rodgers F. G., Greaves P. W., Macrae A., Lewis M. J. Electron microscopic evidence of flagella and pili on Legionella pneumophila. J. Clin. Pathol. 1980; 33: 1184
  • Orrison L. H., Cherry W. B., Tyndall R. L., Fliermans C. B., Gough S. B., Lambert M. A., McDougal L. K., Bibb W. F., Brenner D. J. Legionella oakridgensis, Unusual new species isolated from cooling tower water. Appl. Environ. Microbiol. 1983; 45: 536
  • Glavin F. L., Winn W. C., Jr., Craighead J. E. Ultrastructure of lung in legionnaires' disease. Observations of three biopsies done during the Vermont epidemic. Ann. Intern. Med. 1979; 90: 555
  • Winn W., Jr., Davis G. Interaction of Legionella pneumophila and human alveolar macrophages. Current Chemotherapy and Infectious Disease, J. D. Nelson, C. Grassi. American Society for Microbiology, Washington 1980; 1001
  • Johnson W., Elliott J. A., Helms C. M., Renner E. D. A high molecular weight antigen in legionnaires' disease bacterium, isolation and partial characterization. Ann. Intern. Med. 1979; 90: 638
  • Rodgers F. G. Ultrastructure of Legionella pneumophila. J. Clin. Pathol. 1979; 32: 1195
  • Neblett T. R., Riddle J. M., Dumoff M. Surface topography and fine structure of the legionnaires' disease bacterium. A study of six isolates from hospitalized patients. Ann. Intern. Med. 1979; 90: 645
  • Gress F. M., Myerowitz R. L., Pasculle A. W., Rinaldo C. R., Jr., Dowling J. N. The ultrastructural morphologic features of Pittsburgh pneumonia agent. Am. J. Pathol. 1980; 101: 63
  • Joly J. R., Kenny G. E. Antigenic analysis of Legionella pneumophila, Tatlockia micdadei (Legionella micdadei) by two-dimensional (crossed) Immunoelectrophoresis. Infect. Immun. 1982; 35: 721
  • Collins M. T., Cho S., Hoiby N., Espersen F., Baek L., Reif J. S. Crossed immunoelectrophoretic analysis of Legionella pneumophila serogroup 1 antigens. Infect. Immun. 1983; 39: 1428
  • Collins M. T., Espersen F., Hoiby N., Cho S., Friis-Moller A., Reif J. S. Cross-reactions between Legionella pneumophila (serogroup 1) and twenty-eight other bacterial species, including other members of the family Legionellaceae. Infect. Immun. 1983; 39: 1441
  • Wong K. H., Schalla W. O., Arko R. J., Bullard J. C., Feeley J. C. Immunochemical, serologic, and immunologic properties of major antigens isolated from the legionnaires' disease bacterium. Observations bearing on the feasibility of a vaccine. Ann. Intern. Med. 1979; 90: 634
  • Johnson W., Pesanti E., Elliott J. Serospecificity and opsonic activity of antisera to Legionella pneumophila. Infect. Immun. 1979; 26: 698
  • Elliott J. A., Johnson W., Helms C. M. Ultrastructural localization and protective activity of a high-molecular-weight antigen isolated from Legionella pneumophila. Infect. Immun. 1981; 31: 822
  • Flesher A. R., Jennings H. J., Lugowski C., Kasper D. L. Isolation of a serogroup 1-specific antigen from Legionella pneumophila. J. Infect. Dis. 1982; 145: 224
  • Taylor A. G., Harrison T. G. Legionnaires' disease caused by Legionella pneumophila serogroup 3. Lancet 1979; ii: 47
  • Fallon R. J. Legionnaires' disease, serogroup 6 (letter). Lancet 1980; ii: 857
  • Garrity G. M., Elder E. M., Davis B., Vickers R. M., Brown A. Serological and genotypic diversity among serogroup 5-reacting environmental Legionella isolates. J. Clin. Microbiol. 1982; 15: 646
  • Elliott J. A., Johnson W. Immunological and biochemical relationships among flagella isolated from Legionella pneumophila serogroups 1, 2, and 3. Infect. Immun. 1981; 33: 602
  • Joly J. R., Chen Y., Ramsay D. Serogrouping and subtyping of Legionella pneumophila with monoclonal antibodies. J. Clin. Microbiol. 1983; 18: 1040
  • Feeley J. C., Gorman G. W., Weaver R. E., Mackel D. C., Smith H. W. Primary isolation media for legionnaires' disease bacterium. J. Clin. Microbiol. 1978; 8: 320
  • Tesh M. J., Miller R. D. Amino acid requirements for Legionella pneumophila growth. J. Clin. Microbiol. 1981; 13: 865
  • Ristroph J. D., Hedlund K. W., Gowda S. Chemically defined medium for Legionella pneumophila growth. J. Clin. Microbiol. 1981; 13: 115
  • Edelstein P. H. Improved semiselective medium for isolation of Legionella pneumophila from contaminated clinical and environmental specimens. J. Clin. Microbiol. 1981; 14: 298
  • Keathley J. D., Winn W. C., Jr. Comparison of media for recovery of clinical isolates of Legionella pneumophila. Legionella: Proceedings of the Second International Symposium, C. Thomsberry, J. C. Feeley, W. Jakubowski, A. Balows. American Society for Microbiology, Washington 1984; 19
  • Tesh M. J., Miller R. D. Growth of Legionella pneumophila in defined media, requirement for magnesium and potassium. Can. J. Microbiol. 1982; 28: 1055
  • Reeves M. W., Pine L., Hunter S. H., George J. R., Harrell W. K. Metal requirements of Legionella pneumophila. J. Clin. Microbiol. 1981; 13: 688
  • Feeley J. C., Gibson R. J., Gorman G. W., Langford N. C., Rasheed K., Mackel D. C., Baine W. B. Charcoal-yeast extract agar, Primary isolation medium for Legionella pneumophila. J. Clin. Microbiol. 1979; 10: 437
  • Smalley D. L., Jaquess P. A., Layne J. S. Selenium-enriched medium for Legionella pneumophila. J. Clin. Microbiol. 1980; 12: 32
  • Dumoff M. Direct in-vitro isolation of the legionnaires' disease bacterium in two fatal cases. Ann. Intern. Med. 1979; 90: 694
  • Pasculle A. W., Feeley J. C., Gibson R. J., Cordes L. G., Myerowitz R. L., Patton C. M., Gorman G. W., Carmack C. L., Ezzell J. W., Dowling J. N. Pittsburgh pneumonia agent, Direct isolation from human lung tissue. J. Infect. Dis. 1980; 141: 727
  • Greaves P. W. New methods for the isolation of Legionella pneumophila. J. Clin. Pathol. 1980; 33: 581
  • Dennis P. J., Taylor J. A., Barrow G. I. Phosphate buffered, low sodium chloride blood agar medium for Legionella pneumophila. Lancet 1981; ii: 636
  • McDade J. E., Shepard C. C. Virulent to avirulent conversion of legionnaires' disease bacterium (Legionella pneumophila)—its effect on isolation techniques. J. Infect. Dis. 1979; 139: 707
  • Elliott J. A., Johnson W. Virulence conversion of Legionella pneumophila serogroup I by passage in guinea pigs and embryonated eggs. Infect. Immun. 1982; 35: 943
  • Hoffman P. S., Pine L., Bell S. Production of superoxide and hydrogen peroxide in medium used to culture Legionella pneumophila, Catalytic decomposition by charcoal. Appl. Environ. Microbiol. 1983; 45: 784
  • Ristroph J. D., Hedlund K. W., Allen R. G. Liquid medium for growth of Legionella pneumophila. J. Clin. Microbiol. 1980; 11: 19
  • Winn W. C., Jr., Davis G. S., Gump D. W., Craighead J. E., Beaty H. N. Legionnaires' pneumonia after intratracheal inoculation of guinea pigs and rats. Lab. Invest. 1982; 47: 568
  • Horwitz M. A., Silverstein S. C. Legionnaires' disease bacterium (Legionella pneumophila) multiplies intracellularly in human monocytes. J. Clin. Invest. 1980; 66: 441
  • Elliott J. A., Winn W. C., Jr. Differences in the interaction of guinea pig and rat alveolar macrophages with Legionella pneumophila in vitro. Legionella: Proceedings of the Second International Symposium, C. Thomsberry, J. C. Feeley, W. Jakubowski, A. Balows. American Society for Microbiology, Washington 1984; 167
  • Davis G. S., Winn W. C., Jr., Gump D. W., Craighead J. E., Beaty H. N. Legionnaires' pneumonia after aerosol exposure in guinea pigs and rats. Am. Rev. Resp. Dis. 1982; 126: 1050
  • Skaliy P., McEachern H. V. Survival of the legionnaires' disease bacterium in water. Ann. Intern. Med. 1979; 90: 662
  • Yee R. B., Wadowsky R. M. Multiplication of Legionella pneumophila in unsterilized tap water. Appl. Environ. Microbiol. 1982; 43: 1330
  • Berendt R. F. Survival of Legionella pneumophila in aerosols. Effect of relative humidity. J. Infect. Dis. 1980; 141: 689
  • Hambleton P., Broster M. G., Dennis P. J., Henstridge R., Fitzgeorge R., Conlan J. W. Survival of virulent Legionella pneumophila in aerosols. J. Hyg. Camb. 1983; 90: 451
  • Berendt R. F. Influence of blue-green algae (Cyanobacteria) on survival of Legionella pneumophila in aerosols. Infect. Immun. 1981; 32: 690
  • Adams A. P., Spendlove J. C., Rengers E. C., Garbett M. Emission of microbial aerosols from vents of cooling towers. I. Particle size. Source strength and downwind travel. Dev. Ind. Microbiol. 1979; 20: 769
  • Fraser D. W., Tsai T., Orenstein W., Parkin W. E., Beecham H. J., Sharrar R. G., Harris J., Mallison G. F., Martin S. M., McDade J. E., Shepard C. C., Brachman, P. S., and the Field Investigation Team. Legionnaires' disease—description of an epidemic of pneumonia. N. Engl. J. Med. 1977; 297: 1189
  • Glick T. H., Gregg M. B., Berman B., Mallison G., Rhodes W. W., Jr., Kassanoff I. Pontiac Fever. An epidemic of unknown etiology in a health department. I. Clinical and epidemiologic aspects. Am. J. Epidemiol. 1978; 107: 149
  • Beaty H. N., Miller A. A., Broome C. V., Goings S., Phillips C. A. Legionnaires' disease in Vermont, May to October 1977. JAMA 1978; 240: 127
  • Kirby B. D., Snyder K. M., Meyer R. D., Finegold S. M. Legionnaires' disease. Clinical features of 24 cases. Ann. Intern. Med. 1978; 89: 297
  • Dietrich P. A., Johnson R. D., Fairbank J. T., Walke J. S. The chest radiograph in legionnaires' disease. Radiology 1978; 127: 577
  • Fairbank J. T., Mamourian A. C., Dietrich P. A., Girod J. C. The chest radiograph in legionnaires' disease. Radiology 1983; 147: 33
  • Storch G. A., Sagel S. S., Baine W. B. The chest roentgenogram in sporadic cases of legionnaires' disease. JAMA 1981; 245: 587
  • Friedman H. M. Legionnaires' disease in non-Legionnaires. A report of five cases. Ann. Intern. Med. 1978; 88: 294
  • Posner M. R., Caudill M. A., Brass R., Ellis E. Legionnaires' disease associated with rhabdomyolysis and myoglobinuria. Arch. Intern. Med. 1980; 140: 848
  • Gartenberg G., Weinstein M. P., Fernando N. K., Dodelson R., Ribot S. Rhabdomyolysis with acute renal failure in legionnaire's disease. J. Med. Soc. N. J. 1981; 78: 119
  • Urso F. P. Deceived but described. Legionellosis masquerading as rickettsia pneumonia. Am. J. Clin. Pathol. 1980; 74: 364
  • Urso F. P. The pathologic findings in rickettsial pneumonia. Am. J. Clin. Pathol. 1975; 64: 335
  • Evans C. P., Winn W. C., Jr. Extrathoracic localization of Legionella pneumophila in legionnaires' pneumonia. Am. J. Clin. Pathol. 1981; 76: 813
  • Weisenburger D. D., Rappaport H., Ahluwalia M. S., Melvani R., Renner E. D. Legionnaires' disease. Am. J. Med. 1980; 69: 476
  • Edelstein P. H., Meyer R. D., Finegold S. M. Isolation of Legionella pneumophila from blood. Lancet 1979; 1: 750
  • Macrae A. D., Greaves P. W., Plaits P. Isolation of Legionella pneumophila from blood culture. Br. Med. J. 1979; 2: 1189
  • Chester B., Poulos E. G., Demaray M. J., Albin E., Prilucik T. Isolation of Legionella pneumophila serogroup 1 from blood with nonsupplemented blood culture bottles. J. Clin. Microbiol. 1983; 17: 195
  • Miller A. C. Early clinical differentiation between legionnaires' disease and other sporadic pneumonias. Ann. Intern. Med. 1979; 90: 526
  • Sharrar R. G., Friedman H. M., Miller W. T., Yanak M. J., Arbutyn E. Summertime pneumonias in Philadelphia in 1976. An epidemiologic study. Ann. intern. Med. 1979; 90: 577
  • Yu V. L., Kroboth F. J., Shonnard J., Brown A., McDearman S., Magnussen M. Legionnaires' disease. New clinical perspective from a prospective pneumonia study. Am. J. Med. 1982; 73: 357
  • Helms C. M., Viner J. P., Sturm R. H., Renner E. D., Johnson W. Comparative features of pneumococcal, mycoplasmal, and legionnaires' disease pneumonias. Ann. Intern. Med. 1979; 90: 543
  • Dowling J. N. Clinical aspects of Pittsburgh pneumonia. Microbiology 1981, D. Schlessinger. American Society for Microbiology, Washington 1981; 161
  • Pope T. L., Jr., Armstrong P., Thompson R., Donowitz G. R. Pittsburgh pneumonia agent: chest film manifestations. Am. J. Radiol. 1982; 138: 237
  • Winn W. C., Jr., Glavin F. L., Perl D. P., Craighead J. E. Macroscopic pathology of the lungs in legionnaires' disease. Ann. Intern. Med. 1979; 90: 548
  • Kirby B. D., Peck H., Meyer R. D. Radiographic features of legionnaires' disease. Chest. 1979; 76: 562
  • Winn W. C., Jr., Glavin F. L., Perl D. P., Keller J. L., Andres T. L., Brown T. M., Coffin C. M., Sensecqua J. E., Roman L. M., Craighead J. E. The pathology of legionnaires' disease. Fourteen fatal cases from the 1977 outbreak in Vermont. Arch. Pathol. Lab. Med. 1978; 103: 344
  • Hernandez F. J., Kirby B. D., Stanley T. M., Edelstein P. H. Legionnaires' disease. Postmortem pathologic findings of 20 cases. Am. J. Clin. Pathol. 1980; 73: 488
  • Blackmon J. A., Hicklin M. D., Chandler F. W., and The Special Expert Pathology Panel. Legionnaires' disease. Pathologic and historical aspects of a “new” disease. Arch. Pathol. Lab. Med. 1978; 102: 337
  • Lewin S., Brettman L. R., Goldstein E. J. C., Holzman R. S., Devila H., Taubman F., Sierra M. F., Edelstein P. H. Legionnaires' disease. A cause of severe abscess-forming pneumonia. Am. J. Med. 1979; 67: 339
  • Leder L. D. Uber die selektive ferment cytochemische Darstellung von neutrophilen myeloische Zellen und Gewabsmastzellen im Paraffinschnitt. Klinisch. Wochenschr. 1964; 42: 553
  • Weisenburger D. D., Helms C. M., Renner E. D. Sporadic legionnaires' disease. A pathologic study of 23 fatal cases. Arch. Pathol. Lab. Med. 1981; 105: 130
  • Pennington J. E., Mark E. J. Case Records of the Massachusetts General Hospital, Case 28–1980. N. Engl. J. Med. 1980; 303: 145
  • Randolph K. A., Beekman J. F. Legionnaires' disease presenting with empyema. Chest 1979; 75: 404
  • Chandler F. W., Hicklin M. D., Blackmon J. A. Demonstration of the agent of legionnaires' disease in tissue. N. Engl. J. Med. 1977; 297: 1218
  • Van Orden A. E., Greer P. W. Modification of the Dieterle spirochete stain. J. Histotechnol. 1977; 1: 51
  • Pounder D. J. Staining methods for Legionella. Hum. Pathol. 1982; 13: 185
  • Faine S., Edelstein P., Kirby B. D., Finegold S. M. Rapid presumptive bacteriological diagnosis of legionnaires' disease. J. Clin. Microbiol. 1979; 10: 104
  • Tseng C. H., Renner E. D. A new method for Legionella pneumophila. Am. J. Clin. Pathol. 1983; 79: 377
  • Engbaek K., Johansen K. S., Jensen M. E. A new technique for Gram staining paraffin-embedded tissue. J. Clin. Pathol. 1979; 32: 187
  • Frenkel J. K., Baker L. H., Chonko A. M. Autopsy diagnosis of legionnaires' disease in immunosuppressed patients. A paleodiagnosis using Giemsa stain (Wohlbach modification). Ann. Intern. Med. 1979; 90: 559
  • Janssen W. A., Hedlund K. W. Giemsa stain for Legionella pneumophila and TATLOCK bacterium. Ann. Intern. Med. 1981; 94: 413
  • Greer P. W., Chandler F. W., Hicklin M. D. Rapid demonstration of Legionella pneumophila in unembedded tissue. An Actaptation of the Gimenez stain. Am. J. Clin. Pathol. 1980; 73: 788
  • Fliermans C. B., Cherry W. B., Orrison L. H., Thacker L. Isolation of Legionella pneumophila from nonepidemic-related aquatic habitats. Appl. Environ. Microbiol. 1979; 37: 1239
  • England A. C., III, Fraser D. W., Plikaytis B. D., Tsai T. F., Storch G., Broome C. V. Sporadic legionellosis in the U.S., The first thousand cases. Ann. Intern. Med. 1981; 94: 164
  • Stout J., Yu V. L., Vickers R. M., Zuravleff J., Best M., Brown A., Yee R. B., Wadowsky R. Ubiquitousness of Legionella pneumophila in the water supply of a hospital with endemic legionnaires' disease. N. Engl. J. Med. 1980; 306: 466
  • Wadowsky R. M., Yee R. B., Mezmar L., Wing E. J., Dowling J. N. Hot water systems as sources of Legionella pneumophila in hospital and nonhospital plumbing fixtures. Appl. Environ. Microbiol. 1982; 43: 1104
  • Tison D. L., Pope D. H., Cherry W. B., Fliermans C. B. Growth of Legionella pneumophila in association with blue-green algae (Cyanobacteria). Appl. Environ. Microbiol. 1980; 39: 456
  • Rowbotham T. J. Preliminary report on the pathogenicity of Legionella pneumophila for freshwater and soil ameobae. J. Clin. Pathol. 1980; 33: 1179
  • Tyndall R. L., Domingue E. L. Cocultivation of Legionella pneumophila and free-living amoebae. Appl. Environ. Microbiol. 1982; 44: 954
  • Blackmon J. A., Chandler F. W., Cherry W. B., England A. C., III, Feeley J. C., Hicklin M. D., McKinney R. M., Wilkinson H. W. Legionellosis. Am. J. Pathol. 1981; 103: 429
  • Meyer R. D. Legionella infections, a review of five years of research. Rev. Infect. Dis. 1983; 5: 258
  • England A. C., III, Fraser D. W. Sporadic and epidemic nosocomial legionellosis in the U.S. Epidemiologic features. Am. J. Med. 1981; 70: 707
  • Terranova W., Cohen M. L., Fraser D. W. 1974 outbreak of legionnaires' disease diagnosed in 1977. Clinical and epidemiological features. Lancet 1978; ii: 122
  • Haley C. E., Cohen M. L., Halter J., Meyer R. D. Nosocomial legionnaires' disease, A continuing common-source epidemic at Wadsworth Medical Center. Ann. Intern. Med. 1979; 90: 583
  • Marks J. S., Tsai T. F., Martone W. J., Baron R. C., Kennicott J., Holtzhauer F. J., Baird I., Fay D., Feeley J. C., Mallison G. F., Fraser D. W., Halpin T. J. Nosocomial legionnaires' disease in Columbus, Ohio. Ann. Intern. Med. 1979; 90: 565
  • Dondero T. J., Jr., Clegg H. W., Tsai T. F., Weeks M., Duncan E., Strickler J., Chapman C., Mallison G. F., Politi B., Potter M. E., Schaflher W. Legionnaires' disease in Kingsport, Tennessee. Ann. Intern. Med. 1979; 90: 569
  • Broome C. V., Goings S. A. J., Thacker S. B., Vogt R. L., Beaty H. N., Fraser, D. W., and the Field Investigation Team. The Vermont epidemic of legionnaires' disease. Ann. Inter. Med. 1979; 90: 573
  • Dondero T. J., Jr., Rendtorff R. C., Mallison G. F., Weeks R. M., Levy J. S., Wong E. W., Schaffner W. An outbreak of legionnaires' disease associated with a contaminated air-conditioning cooling tower. N. Engl. J. Med. 1980; 302: 365
  • Cordes L. G., Fraser D. W., Skaliy P., Perlino C. A., Elsea W. R., Mallison G. F., Hayes P. S. Legionnaires' disease outbreak at an Atlanta, Georgia, country club: evidence for spread from an evaporative condenser. Am. J. Epidemiol. 1980; 111: 425
  • Band J. D., LaVenture M., Davis J. P., Mallison G. F., Skaliy P., Hayes P. S., Schell W. L., Weiss H., Greenberg J., Fraser D. W. Epidemic legionnaires' disease. Airborne transmission down a chimney. JAMA 1981; 245: 2404
  • Girod J. C., Reichman R. C., Winn W. C., Jr., Klaucke D. N., Vogt R. L., Dolin R. Pneumonic and nonpneumonic forms of legionellosis. The result of a common-source exposure to Legionella pneumophila. Arch. Intern. Med. 1982; 142: 545
  • Klaucke D. N., Vogt R. L., Larue D., Withered L. E., Orciari L. A., Spitalny K. C., Pelletier R., Cherry W. B., Novick L. F. Legionnaires' disease. The epidemiology of two outbreaks in Burlington, Vermont. Am. J. Epidemiol. 1980; 119: 382
  • Kaufmann A. F., McDade J. E., Patton C. M., Bennett J. V., Skaliy P., Feeley J. C., Anderson D. C., Potter M. E., Newhouse V. F., Gregg M. B., Brachman P. S. Pontiac fever. Isolation of the etiologic agent (Legionella pneumophila) and demonstration of its mode of transmission. Am. J. Epidemiol. 1981; 114: 337
  • Tobin J. O'H., Beare J., Dunnill M. S., Fisher-Hoch S., French M., Mitchell R. G., Morris P. J., Muers M. F. Legionnaires' disease in a transplant unit, isolation of the causative agent from shower baths. Lancet 1980; ii: 118
  • Cordes L. G., Wiesenthal A. M., Gorman G. W., Phair J. P., Sommers H. M., Brown A., Yu V. L., Magnussen M. H., Meyer R. D., Wolf J. S., Shands K. N., Fraser D. W. Isolation of Legionella pneumophila from hospital shower heads. Ann. Intern. Med. 1981; 94: 195
  • Dennis P. J., Taylor J. A., Fitzgeorge R. B., Bartlett C. L. R., Barrow G. I. Legionella pneumophila in water plumbing systems. Lancet 1982; i: 949
  • Fisher-Hoch S. P., Smith M. G., Colbourne J. S. Legionella pneumophila in hospital hot water cylinders. Lancet 1982; i: 1073
  • Waterborne Legionella. Lancet 1983; ii: 381, Anon.
  • Stout J., Yu V. L., Vickers R. M., Shonnard J. Potable water supply as the hospital reservoir for Pittsburgh pneumonia agent. Lancet 1982; i: 471
  • Dowling J. N., Kroboth F. J., Karpf M., Yee R. B., Pasculle A. W. Pneumonia and multiple lung abscesses caused by dual infection with Legionella micdadei and Legionella pneumophila. Am. Rev Respir. Dis. 1983; 127: 121
  • Muder R. R., Yu V. L., Vickers R. M., Rihs J., Shonnard J. Simultaneous infection with Legionella pneumophila and Pittsburgh pneumonia agent. Clinical features and epidemiologic implications. Am. J. Med. 1983; 74: 609
  • Gorman G. W., Yu V. L., Brown A., Hall J. A., Martin W. T., Bibb W. F., Morris G. K., Magnussen M. H., Fraser D. W. Isolation of Pittsburgh pneumonia agent from nebulizers used in respiratory therapy. Ann. Intern. Med. 1980; 93: 572
  • Brown A., Yu V. L., Magnussen M. H., Vickers R. M., Garrity G. M., Elder E. M. Isolation of Pittsburgh pneumonia agent from a hospital shower. Appl. Environ. Microbiol. 1982; 43: 725
  • Muder R. R., Yu V. L., McClure J. K., Kroboth F. J., Kominos S. D., Lumish R. M. Nosocomial legionnaires' disease uncovered in a prospective pneumonia study. Implications for underdiagnosis. JAMA 1983; 249: 3184
  • Edelstein P. H. What to do about Legionella?. JAMA 1983; 249: 3214
  • Brown A., Yu V. L., Elder E. M., Magnussen M. H., Kroboth F. Nosocomial outbreak of legionnaires' disease at the Pittsburgh Veterans Administration Medical Center. Trans. Am. Assoc. Phys. 1982; 93: 52
  • Brown A., Vickers R. M., Elder E. M., Lema M., Garrity G. M. Plasmid and surface antigen markers of endemic and epidemic Legionella pneumophila strains. J. Clin. Microbiol. 1982; 16: 230
  • Best M., Yu V. L., Stout J., Goetz A., Muder R. R., Taylor F. Legionellaceae in the hospital water-supply. Epidemiological link with disease and evaluation of a method for control of nosocomial legionnaires' disease and Pittsburgh pneumonia. Lancet 1983; ii: 307
  • Shands K. N., Ho J. L., Gorman G. W., Meyer R. D., Edelstein P. H., Finegold S. M., Fraser D. W. Potable water as a source of legionnaires' disease. Clin. Res. 1981; 29: 260A
  • Arnow P. M., Chou T., Weil D., Shaprio E. N., Kretzschmar C. Nosocomial legionnaires' disease caused by aerosolized tap water from respiratory devices. J. Infect. Dis. 1982; 146: 460
  • Hanrahan J., Morse D. L., Scharf G., Debbie J., Shayegani M. Community hospital legionellosis outbreak linked to hot water showers. Legionella: Proceedings of the Second International Symposium, C. Thomsberry, J. C. Feeley, W. Jakubowski, A. Balows. American Society for Microbiology, Washington 1984; 224
  • Plouffe J. F., Para M. F., Maher W. E., Hackman B., Webster L. Subtypes of Legionella pneumophila serogroup 1 associated with different attack rates. Lancet 1983; ii: 649
  • Joly J. R., Winn W. C., Jr. Classification of strains of Legionella pneumophila as sporadic or epidemic by monoclonal antibody typing. J. Infect. Dis., in press
  • Remis R. S., Jones E. E., Tait K. A., McGee H. B., Wentworth B. B., Gorman G. W., Brake B. J., Wilkinson H. W., Hightower A. W., Broome C. V. An outbreak of Pontiac fever related to whirlpool use, Michigan 1982. Presented at Sec. Int. Symp. on Legionella, Atlanta, Ga, 1983
  • Spitalny K., Vogt R., Witherell L., Orciari L., Orrison L., Etkind P., Novick L. Legionnaires' disease and Pontiac Fever associated with a whirlpool. Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami Beach, 1982, Paper #87
  • Herwaldt L. A., Gorman G., Hightower A. W., Brake B., Wilkinson H., Boxer P. A., McGrath T., Brenner D., Moss C. W., Broome C. V. Pontiac fever in an engine assembly plant. Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami Beach, 1982, Paper #100
  • Wang W. L. L., Blaser M. J., Cravens J., Johnson M. A. Growth, survival, and resistance of the legionnaires' disease bacterium. Ann. Intern. Med. 1979; 90: 614
  • Bopp C. A., Sumner J. W., Morris G. K., Wells J. G. Isolation of Legionella spp. from environmental water samples by low-pH treatment and use of a selective medium. J. Clin. Microbiol. 1981; 13: 714
  • Buesching W. J., Brust R. A., Ayers L. W. Enhanced primary isolation of Legionella pneumophila from clinical specimens by low-pH treatment. J. Clin. Microbiol. 1983; 17: 1153
  • Skaliy P., Thompson T. A., Gorman G. W., Morris G. K., McEachern H. V., Mackel D. C. Laboratory studies of disinfectants against Legionella pneumophila. Appl. Environ. Microbiol. 1980; 40: 697
  • Grace R. D., Dewar N. E., Barnes W. G., Hodges G. R. Susceptibility of Legionella pneumophila to three cooling tower microbicides. Appl. Environ. Microbiol. 1981; 41: 233
  • Soracco R. J., Gill H. K., Fliermans C. B., Pope D. H. Susceptibilities of algae and Legionella pneumophila to cooling water biocides. Appl. Environ. Microbiol. 1983; 45: 1254
  • Soracco R. J., Pope D. H. Bacteriostatic and bactericidal modes of action of bis(tributyltin)oxide on Legionella pneumophila. Appl. Environ. Microbiol. 1983; 45: 48
  • Antopol S. C., Ellner P. D. Susceptibility of Legionella pneumophila to ultraviolet radiation. Appl. Environ. Microbiol. 1979; 38: 347
  • Edelstein P. H., Whittaker R. E., Kreiling R. L., Howell C. L. Efficacy of ozone in eradication of Legionella pneumophila from hospital plumbing fixtures. Appl. Environ. Microbiol. 1982; 44: 1330
  • Locksley R. M., Jacobs R. F., Wilson C. B., Weaver W. M., Klebanoff S. J. Susceptibility of Legionella pneumophila to oxygen-dependent microbicidal systems. J. Immunol. 1982; 129: 2192
  • Friedman R. L., Lochner J. E., Bigley R. H., Iglewski B. H. The effects of Legionella pneumophila toxin on oxidative processes and bacterial killing of polymorphonuclear leukocytes. J. Infect. Dis. 1982; 146: 328
  • Winn W. C., Jr., Davis G. S., Weinberg D. N., Beaty H. N. Survival of Legionella pneumophila after decontamination with paraformaldehyde gas. J. Infect. Dis. 1982; 146: 291
  • England A. C., III, Fraser D. W., Mallison G. F., Mackel D. C., Skaliy P., Gorman G. W. Failure of Legionella pneumophila sensitivities to predict culture results from disinfectant-treated air-conditioning cooling towers. Appl. Envion. Microbiol. 1982; 43: 240
  • Marshall E. Hospitals harbor a built-in disease source. Science 1980; 210: 745
  • Dychdala G. R. Chlorine and chlorine compounds. Disinfection, Sterilization, and Preservation, 3rd ed., S. S. Block. Lea & Febiger, Philadelphia 1983
  • Baird I. M., Potts W., Smiley J., Click N., Schleich S., Connole C., Davison K. Control of endemic nosocomial legionellosis by hyperchlorination of potable water. Legionella: Proceedings of the Second International Symposium, C. Thornsberry, J. C. Feeley, W. Jakubowski, A. Balows. American Society for Microbiology, Washington 1984; 333
  • Fisher-Hoch S. P., Bartlett C. L. R., Tobin J. O'H., Gillett M. B., Nelson A. M., Pritchard J. E., Smith M. G., Swann R. A., Talbot J. M., Thomas J. A. Investigation and control of an outbreak of legionnaires' disease in a district general hospital. Lancet 1981; i: 932
  • Helms C. M., Massanari R. M., Zeitler R., Street S., Gilchrist M. J., Hall N., Hausler W. J., Jr., Sywassink J., Johnson W., Wintermeyer L., Hierholzer W. J., Jr. Legionnaires' disease associated with a hospital water system. A cluster of 24 nosocomial cases. Ann. Intern. Med. 1983; 99: 172
  • Foy H. M., Broome C. V., Hayes P. S., Allan I., Cooney M. K., Tobe R. Legionnaires' disease in a prepaid medical-care group in Seattle 1963—75. Lancet 1979; i: 767
  • Renner E. D., Helms C. M., Hierholzer W. J., Jr., Hall N., Wong Y. W., Viner J. P., Johnson W., Hausler W. J., Jr. Legionnaires' disease in pneumonia patients in Iowa. A retrospective seroepidemiologic study, 1972—1977. Ann. Intern. Med. 1979; 90: 603
  • Cohen M. L., Broome C. V., Paris A. L., Martin W. T., Allen J. R. Fatal nosocomial legionnaires' disease. Clinical and epidemiologic characteristics. Ann. Intern. Med. 1979; 90: 611
  • Fay D., Baird I. M., Aguirre A., Haegren V., Werling K., Bell T. W. Unrecognized legionnaires' disease as a cause of fatal illness. JAMA 1980; 243: 2311
  • Gerber J. E., Casey C. A., Martin P., Winn W. C., Jr. Legionnaires' disease in Vermont 1972—1976. Am. J. Clin. Pathol. 1981; 76: 816
  • Sutherland G. E., Tsai C. C., Routburg M., Eldridge J. E., Laskowski L. F. Prevalence of pneumonias caused by Legionella species among patients on whom autopsies were performed. Arch. Pathol. Lab. Med. 1983; 107: 358
  • Saravolatz L. D., Fisher E. J., Arking L., Levin N. Legionnaires' disease in the nephrology patient. Current Chemotherapy and Infectious Disease, J. D. Nelson, C. Grassi. American Society for Microbiology, Washington 1980; 1005
  • Marshall W., Foster R. S., Jr., Winn W. Legionnaires' disease in renal transplant patients. Am. J. Surg. 1981; 141: 423
  • Bock B. V., Kirby B. D., Edelstein P. H., George W. L., Snyder K. M., Owens M. L., Hatayama C. M., Haley C. E., Lewis R. P., Meyer R. D., Finegold S. M. Legionnaires' disease in renal-transplant recipients. Lancet 1978; i: 410
  • Goldstein J. D., Keller J. L., Winn W. C., Jr., Myerowitz R. L. Sporadic legionellaceae pneumonia in renal transplant recipients. Arch. Pathol. Lab. Med. 1982; 106: 108
  • Macfarlane J. T., Finch R. G., Ward M. J., Macrae A. D. Hospital study of adult community-acquired pneumonia. Lancet 1982; ii: 255
  • Marrie T. J., Haldane E. V., Noble M. A., Faulkner R. S., Martin R. S., Lee S. H. S. Causes of atypical pneumonia. Results of a 1-year prospective study. Can. Med. Assoc. J. 1981; 125: 1118
  • White R. J., Blainey A. D., Harrison K. J., Clarke S. K. R. Causes of pneumonia presenting to a district general hospital. Thorax 1981; 36: 566
  • Kennedy D. H., Borland W. How common is legionnaires' disease?. Lancet 1983; i: 360
  • Andersen R. D., Lauer B. A., Fraser D. W., Hayes P. S., McIntosh K. Infections with Legionella pneumophila in children. J. Infect. Dis. 1981; 143: 386
  • Thacker S. B., Bennett J. V., Tsai T. F., Fraser D. W., McDade J. E., Shepard C. C., Williams K. H., Jr., Stuart W. H., Dull H. B., Eickhoff T. C. An outbreak in 1965 of severe respiratory illness caused by the legionnaires' disease bacterium. J. Infect. Dis. 1978; 138: 512
  • Snowman W. J. The role of indoor and outdoor occupations in the seroepidemiology of Legionella pneumophila. J. Infect. Dis. 1982; 145: 275
  • Saravolatz L., Arking L., Wentworth B., Quinn E. Prevalence of antibody to the legionnaires' disease bacterium in hospital employees. Ann. Intern. Med. 1979; 90: 601
  • Yu V. L., Zuravleff J. J., Gavlik L., Magnussen M. H. Lack of evidence for person-to-person transmission of legionnaires' disease. J. Infect. Dis. 1983; 147: 362
  • Katz S. M., Habib W. A., Hammel J. M., Nash P. Lack of airborne spread of infection by Legionella pneumophila among guinea pigs, 1A1, 38: 620, 182
  • Horwitz M. A. Cell-mediated immunity in legionnaires' disease. J. Clin. Invest. 1983; 71: 1686
  • Davis G. S., Winn W. C., Jr., Gump D. W., Beaty H. N. The kinetics of early inflammatory events during experimental pneumonia due to Legionella pneumophila in guinea pigs. J. Infect. Dis. 1983; 148: 823
  • Richards S. W., Peterson P. K., Niewoehner D. E., Hoidal J. R. The interaction of immunosupression, cigarette smoking and legionnaires' disease. Legionella: Proceedings of the Second International Symposium, C. Thornsberry, J. C. Feeley, W. Jakubowski, A. Balows. American Society for Microbiology, Washington 1984
  • Guthrie T. H., Jr., Mahizhnan P. Brief communication, Legionnaire's disease successfully treated in acute myelocytic leukemia during severe neutropenia. Med. Ped. Oncol. 1983; 11: 180
  • Berlin G., Fryden A., Maller R., Malm C., Vikrot O. Legionnaires' disease in leukaemic reticuloendotheliosis. Scand. J. Haematol. 1980; 25: 171
  • Kornfeld H., Vande Stouwe R. A., Lange M., Reddy M. M., Grieco M. H. T-lymphocyte subpopulations in homosexual men. N. Engl. J. Med. 1982; 307: 729
  • Lane H. C., Masur H., Edgar L. C., Whalen G., Rook A. H., Fauci A. S. Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome. N. Engl. J. Med. 1983; 309: 453
  • Centers for Disease Control Taskforce on Kaposi's Sarcoma and Opportunistic Infection. Epidemiologic aspects of the current outbreak of Kaposi's sarcoma and opportunistic infections. N. Engl. J. Med. 1982; 306: 248
  • Aronson M. D., Komanoff A. L., Pasculle A. W., Myerowitz R. L. Legionella micdadei (Pittsburgh pneumonia agent) infection in nonimmunosupressed patients with pneumonia. Ann. Intern. Med. 1981; 94: 485
  • Ackley A. M., Jr. Community-acquired Legionella micdadei pneumonia. Lancet 1981; i: 2211
  • Wadowsky R. M., Yee R. B. Glycine-containing selective medium for isolation of Legionellaceae from environmental specimens. Appl. Environ. Microbiol. 1981; 42: 768
  • Thorpe T. C., Miller R. D. Negative enrichment procedure for isolation of Legionella pneumophila from seeded cooling tower water. Appl. Environ. Microbiol. 1980; 40: 849
  • Orrison L. H., Cherry W. B., Milan D. Isolation of Legionella pneumophila from cooling tower water by filtration. Appl. Environ. Microbiol. 1981; 41: 1202
  • Fitzgeorge R. B., Baskerville A., Broster M., Hambleton P., Dennis P. J. Aerosol infection of animals with strains of Legionella pneumophila of different virulence, comparison with intraperitoneal and intranasal routes of infection. J. Hyg. Camb. 1983; 90: 81
  • McDade J. E. Primary isolation using guinea pigs and embryonated eggs. “Legionnaires” the disease, the bacterium and methodology, G. L. Jones, G. A. Hebert, 1979; 69, Center for Disease Controll, Atlanta, Health Education and Welfare Publication No. (CDC) 79–8375
  • Leinbach E. D., Winkler H. H., Wood D. O., Coggin J. H., Jr. Improved facility and sensitivity in the use of guinea pigs for the isolation of Legionella pneumophila from cooling tower water. Appl. Environ. Microbiol. 1983; 45: 1119
  • Edelstein P. H. Comparative study of selective media for isolation of Legionella pneumophila from potable water. J. Clin. Microbiol. 1982; 16: 697
  • Edelstein P. H., Snitzer J. B., Finegold S. M. Isolation of Legionella pneumophila from hospital potable water specimens. Comparison of direct plating with guinea pig inoculation. J. Clin. Microbiol. 1982; 15: 1092
  • McDade J. E., Shepard C. C., Fraser D. W., Tsai T. R., Redus M. A., Dowdle W. R., and The Laboratory Investigation Team, Legionnaires' disease. Isolation of a bacterium and demonstration of its role in other respiratory disease. N. Engl. J. Med. 1977; 297: 1197
  • Fallon R. J., Abraham W. H. Scottish experience with the serologic diagnosis of legionnaires' disease. Ann. Intern. Med. 1979; 90: 684
  • Edelstein P. H., Meyer R. D., Finegold S. M. Laboratory diagnosis of legionnaires' disease. Am. Rev. Respir. Dis. 1980; 121: 317
  • Wilkinson H. W., Cruce D. D., Fikes B. J., Yealy L. P., Farshy C. E. Indirect immunofluorescence test for legionnaires' disease. “Legionnaires'” the Disease, the Bacterium and Methodology, G. L. Jones, G. A. Herbert, 1979; 111, Center for Disease Control, Atlanta, Health Education and Welfare Publication No. (CDC) 79–8375
  • Taylor A. G., Harrison T. G., Dighero M. W., Bradstreet C. M. False positive reactions in the indirect fluorescent antibody test for legionnaires' disease eliminated by use of formolised yolk-sac antigen. Ann. Intern. Med. 1979; 90: 686
  • Harrison T. G., Taylor A. G. Diagnosis of Legionella pneumophila infections by means of formolised yolk sac antigens. J. Clin. Pathol. 1982; 35: 211
  • Lattimer G. L., Cepil B. A. Legionnaires' disease serology. Effect of antigen preparation on specificity and sensitivity of the indirect fluorescent antibody test. J. Clin. Pathol. 1980; 33: 585
  • Wilkinson H. W., Brake B. J. Formalin-killed versus heat-killed Legionella pneumophila serogroup 1 antigen in the indirect immunofluorescence assay for legionellosis. J. Clin. Microbiol. 1982; 16: 979
  • Benson R. F., Malcolm G. B., Pine L., Harrell W. K. Factors influencing the reactivity of Legionella antigens in immunofluorescence tests. J. Clin. Microbiol. 1983; 17: 909
  • Fallon R. J., Abraham W. H. Polyvalent heat-killed antigen for the diagnosis of infection with Legionella pneumophila. J. Clin. Pathol. 1982; 35: 434
  • Wilkinson H. W., Reingold A. L., Brake B. J., McGiboney D. L., Gorman G. W., Broome C. V. Reactivity of serum from patients with suspected Legionellosis against 29 antigens of legionellaceae and Legionella-like organisms by indirect immunofluorescence assay. J. Infect. Dis. 1983; 147: 23
  • Wilkinson H. W., Cruce D. D., Broome C. V. Validation of Legionella pneumophila indirect immunofluorescence assay with epidemic sera. J. Clin. Microbiol. 1981; 13: 139
  • Wilkinson H. W., Farshy C. E., Fikes B. J., Cruce D. D., Yealy L. P. Measure of immunoglobulin G-, M-, and A-specific titers against Legionella pneumophila and inhibition of titers against nonspecific, gram-negative bacterial antigens in the indirect immunofluorescence test for Legionellosis. J. Clin. Microbiol. 1979; 10: 685
  • Edelstein P. H., McKinney R. M., Meyer R. D., Edelstein M. A. C., Krause C. J., Finegold S. M. Immunologic diagnosis of legionnaires' disease. Cross-reactions with anaerobic and microaerophilic organisms and infections caused by them. J. Infect. Dis. 1980; 141: 652
  • Ormsbee R. A., Peacock M. G., Lattimer G. L., Page L. A., Fiset P. Legionnaires' disease. Antigenic peculiarities, strain differences, and antibiotic sensitivities of the agent. J. Infect. Dis. 1978; 138: 260
  • Lattimer G. L., Ormsbee R. A., Peacock M. G., Rhodes L. V. Diagnostic specificity of immunoglobulin M (IgM) response in differentiating legionnaires' disease from psittacosis. Scand. J. Infect. Dis. 1979; 11: 271
  • Kallings I., Nystrom-Rosander C., Forsgren A., Ahlfors K. Serologic differentiation of legionnaires' disease and psittacosis. J. Infect. Dis. 1981; 144: 92
  • Wentworth B. B., Stiefel H. E. Studies of the specificity of Legionella serology. J. Clin. Microbiol. 1982; 15: 961
  • Grady G. F., Gilfillan R. F. Relation of Mycoplasma pneumoniae seroreactivity, immunosuppression, and chronic disease to legionnaires' disease. Ann. Intern. Med. 1979; 90: 607
  • Taylor A. G., Harrison T. G., Andrews B. E., Sillis M. Serological differentiation of legionnaires' disease and mycoplasma pneumoniae pneumonia. Lancet 1980; i: 764
  • Renner E. D., Helms C. M., Hall N. H., Johnson W., Wong Y. W., Lattimer G. L. Seroreactivity to Mycoplasma pneumoniae, Legionella pneumophila, Lack of a statistically significant
  • Berdal B. P., Eng J. Coreactivity of Legionella pneumophila immune sera in the Mycoplasma pneumoniae complement fixation test. J. Clin. Microbiol. 1982; 16: 794
  • McMaster P. R. B., Tsang V. C. W., Wong K. H., Feeley J. C., Gann D. S. Adjuvant properties of Legionella pneumophila. Fed. Proc. 1982; 41: 695
  • Klein G. C. Cross-reaction to Legionella pneumophila antigen in sera with elevated titers to Pseudomonas pseudomallei. J. Clin. Microbiol. 1980; 11: 27
  • Cherry W. B., McKinney R. M. Detection of legionnaires' disease bacteria in clinical specimens by direct immunofluorescence. “Legionnaires'” the Disease, the Bacterium and Methodology, G. L. Jones, G. A. Hebert, 1979; 91, Center for Disease Control, Atlanta, Health Education and Welfare Publication No. (CDC) 79–8375
  • Tsai T. F., Fraser D. W. The diagnosis of legionnaires' disease. Ann. Intern. Med. 1978; 89: 413
  • Zimmerman S. E., French M. L., Allen S. D., Wilson E., Kohler R. B. Immunoglobulin M antibody titers in the diagnosis of legionnaires' disease. J. Clin. Microbiol. 1982; 16: 1007
  • Nagington J., Wreghitt T. G., Tobin J. O'H., Macrae A. D. The antibody response in legionnaires' disease. J. Hyg. Camb. 1979; 83: 377
  • Elder E. M., Brown A., Remington J. S., Shonnard J., Naot Y. Microenzyme-linked immunosorbent assay for detection of immunoglobulin G and immunoglobulin M antibodies to Legionella pneumophila. J. Clin. Microbiol. 1983; 17: 112
  • Taylor A. G., Harrison T. G. Timing of antibody response in legionnaires' disease. Lancet 1979; ii: 697
  • Taylor A. G. Formalized yolk sac antigen in early diagnosis of legionnaires' disease caused by Legionella pneumophila serogroup 1. Lancet 1981; ii: 591
  • Fallon R. J., Abraham W. H. Formalized yolk sac antigen in early diagnosis of legionnaires' disease caused by Legionella pneumophila serogroup 1. J. Clin. Pathol. 1982; 35: 791
  • Dournon E., Brunod M., Meyoh M. C. Formalized yolk sac antigen in early diagnosis of legionnaires' disease. Lancet 1981; ii: 750
  • Farshy C. E., Klein G. C., Feeley J. C. Detection of antibodies to legionnaires disease organism by microagglutination and microenzyme-linked immunosorbent assay tests. J. Clin. Microbiol. 1978; 7: 327
  • Farshy C. E., Cruce D. D., Klein G. C., Wilkinson H. W., Feeley J. C. Immunoglobulin specificity of the microagglutination test for the legionnaires' disease bacterium. Ann. Intern. Med. 1979; 90: 690
  • Klein G. C., Jones W. L., Feeley J. C. Upper limit of normal titer for detection of antibodies to Legionella pneumophila by the microagglutination test. J. Clin. Microbiol. 1979; 10: 754
  • Helms C. M., Johnson W., Renner E. D., Hierholyer W. J., Jr., Wintermeyer L. A., Viner J. P. Background prevalence of microagglutination antibodies to Legionella pneumophila serogroups 1, 2, 3, and 4. Infect, lmmun. 1980; 30: 612
  • Harrison T. G., Taylor A. G. A rapid microagglutination test for the diagnosis of Legionella pneumophila (serogroup 1) infection. J. Clin. Pathol. 1982; 35: 1028
  • Wreghitt T. G., Nagington J., Gray J. An ELISA test for the detection of antibodies to Legionella pneumophila. J. Clin. Pathol. 1982; 35: 657
  • Wreghitt T. G., Nagington J. Variability in EIA plates used in ELISA tests for the detection of antibodies to Legionella pneumophila. J. Clin. Pathol. 1983; 36: 238
  • Soriano F., Aguilar L., Garces J. L. G. Simple immunodiffusion test for detecting antibodies against Legionella pneumophila serotype 1. J. Clin. Microbiol. 1982; 15: 330
  • Holliday M. G. The diagnosis of legionnaires' disease by counterimmunoelectrophoresis. J. Clin. Pathol. 1980; 33: 1174
  • Holliday M. G. Counterimmunoelectrophoresis in the serodiagnosis of legionnaires' disease. J. Clin. Pathol. 1983; 36: 466
  • Yonke C. A., Stiefel H. E., Wentworth B. B., Wilson D. L. Prevalence of antibody to serogroups 1—4 of Legionella pneumophila. A seroepidemiologic study using the indirect hemagglutination test. Am. J. Epidemiol. 1982; 115: 633
  • Lennette D. A., Lennette E. T., Wentworth B. B., French M. L., Lattimer G. L. Serology of legionnaires' disease. Comparison of indirect fluorescent antibody, immune adherence hemagglutination, and indirect hemagglutination tests. J. Clin. Microbiol. 1979; 10: 876
  • Black C. M., Pine L., Reimer C. B., Benson R. F., Wells T. W. Characterization of antibody responses in legionellosis with an immunofluorometric assay. J. Clin. Microbiol. 1982; 15: 1077
  • Vogel F. R., Klein T. W., Specter S. C., Hitchings M., Friedman H. Detection of antibodies to Legionella pneumophila in immune guinea pig serum by solid-phase immunofluorescence. J. Clin. Microbiol. 1981; 13: 726
  • Thompson T. A., Wilkinson H. W. Evaluation of a solid-phase immunofluorescence assay for detection of antibodies to Legionella pneumophila. J. Clin. Microbiol. 1982; 16: 202
  • Wong K. H., McMaster P. R., Feeley J. C., Arko R. J., Schalla W. O., Chandler F. W. Detection of hypersensitivity to Legionella pneumophila in guinea pigs by skin test. Curr. Microbiol. 1980; 4: 105
  • Friedman H., Widen R., Lee I., Klein T. Cellular immunity to Legionella pneumophila in guinea pigs assessed by direct and indirect migration inhibition reactions in vitro. Infect. Immun. 1983; 41: 1132
  • Widen R., Klein T., Lee I., Friedman H. Agar microdroplet assay for delayed hypersensitivity to Legionella pneumophila serogroup 1. J. Clin. Microbiol. 1983; 17: 819
  • Plouffe J. F., Baird I. M. Lymphocyte transformation to Legionella pneumophila. J. Clin. Lab. Immunol. 1981; 5: 149
  • Plouffe J. F., Baird I. M. Lymphocyte blastogenic responses to L. pneumophila in acute legionellosis. J. Clin. Lab. Immunol. 1982; 7: 43
  • Plouffe J. F., Baird I. M. Cord blood lymphocyte transformation resonses to Legionella pneumophila. J. Clin. Lab. Immunol. 1983; 9: 119
  • Cherry W. B., Pittman B., Harrison P. P. Detection of legionnaires' disease bacteria by direct immunofluorescent staining. J. Clin. Microbiol. 1978; 8: 329
  • Hebert G. A., Pittman B., McKinney R. M. Optimal fluorescein-to-protein ratios of bacterial direct fluorescent-antibody reagents. J. Clin. Microbiol. 1981; 13: 498
  • Durham T. M., Hale C. T., Harrell W. K., Colvin H. M. The status of commercially available Legionella direct and indirect immunofluorescence reagents. Legionella: Proceedings of the Second International Symposium, C. Thornsberry, J. C. Feeley, W. Jakubowski, A. Balows. American Society for Microbiology, Washington 1984; 27
  • Lowry B. S., Vega F. G., Hedlund K. W. Localization of Legionella pneumophila in tissue using FITC-conjugated specific antibody and a background stain. Am. J. Clin. Pathol. 1982; 77: 601
  • Thomason B. M., van Orden A., Chandler F. W., Hicklin M. D. Effect of various histological fixatives on fluorescent antibody detection of legionnaires disease bacteria. J. Clin. Microbiol. 1979; 10: 106
  • Skinner A. R., Swann A. The demonstration, by immunofluorescence, of Legionella pneumophila organisms in human lung tissue embedded in epoxy resins. Histochemistry 1981; 71: 581
  • Edelstein P. H., Deboynton E., Bridge J., Cox N. Laboratory sources of false-positive direct FA tests for L. pneumophila. Paper C43, Annual Meeting of the American Society for Microbiology, Atlanta, 1982
  • Thomason B. M., Harris P. P., Lewallen K. R., McKinney R. M. Preparation and testing of a polyvalent conjugate for direct fluorescent-antibody detection of Legionella pneumophila. Curr. Microbiol. 1979; 2: 357
  • Broome C. V., Cherry W. B., Winn W. C., Jr., MacPherson B. R. Rapid diagnosis of legionnaires' disease by direct immunofluorescent staining. Ann. Intern. Med. 1979; 90: 1
  • Winn W. C., Jr., Cherry W. B., Frank R. O., Casey C. A., Broome C. V. Direct immunofluorescent detection of Legionella pneumophila in respiratory specimens. J. Clin. Microbiol. 1980; 11: 59
  • Saravolatz L. D., Russell G., Cvitkovich D. Direct immunofluorescence in the diagnosis of legionnaires' disease. Chest 1981; 79: 566
  • Winn W. C., Girod J. C., Pelletier R., Reichman R. C., Dolin R. The laboratory diagnosis of legionnaires' disease. Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, 1981, Paper #296
  • Zuravleff J. J., Yu V. L., Shonnard J. W., Davis B. K., Rihs J. D. Diagnosis of legionnaires' disease. An update of laboratory methods with new emphasis on isolation by culture. JAMA 1983; 250: 1981
  • Thomas P., Lang A. P., Fong I. W. Diagnosis of legionnaires' disease from transbronchial lung biopsy using the fiberoptic bronchoscope. Can. Med. Assoc. J. 1980; 122: 794
  • Orrison L. H., Bibb W. F., Cherry W. B., Thacker L. Determination of antigenic relationships among legionellae and non-legionellae by direct fluorescent-antibody and immunodiffusion tests. J. Clin. Microbiol. 1983; 17: 332
  • Bushbaum P. A., Cleary T., Saldana M., Castro M. Immunoperoxidase staining for the serotype-specific demonstration of Legionella pneumophila. N. Engl. J. Med. 1981; 304: 613
  • Suffin S. C., Kaufmann A. F., Whitaker B., Muck K. B., Prince G. A., Porter D. D. Legionella pneumophila. Identification in tissue sections by a new immunoenzymatic procedure. Arch. Pathol. Lab. Med. 1980; 104: 283
  • Tilton R. C. Legionnaires' disease antigen detected by enzyme-linked immunosorbent assay. Ann. Intern. Med. 1979; 90: 697
  • Berdal B. P., Farshy C. E., Feeley J. C. Detection of Legionella pneumophila antigen in urine by enzyme-linked immunospecific assay. J. Clin. Microbiol. 1979; 9: 575
  • Kohler R. B., Zimmerman S. E., Wilson E., Allen S. D., Edelstein P. H., Wheat L. J., White A. Rapid radioimmunoassay diagnosis of legionnaires' disease. Detection and partial characterization of urinary antigen. Ann. Intern. Med. 1981; 94: 601
  • Kohler R. B., Winn W. C., Jr., Girod J. C., Wheat L. J. Rapid diagnosis of pneumonia due to Legionella pneumophila serogroup 1. J. Infect. Dis. 1982; 146: 444
  • Sathapatayavongs B., Kohler R. B., Wheat L. J., White A., Winn W. C., Jr., Girod J. C., Edelstein P. H. Rapid diagnosis of legionnaires' disease by urinary antigen detection. Am. J. Med. 1982; 72: 576
  • Sathapatayavongs B., Kohler R. B., Wheat L. J., White A., Winn W. C., Jr. Rapid diagnosis of legionnaires' disease by latex agglutination. Am. Rev. Respir. Dis. 1983; 127: 559
  • Johnson S. R., Schalla W. O., Wong K. H., Perkins G. H. Simple, transparent medium for study of legionellae. J. Clin. Microbiol. 1982; 15: 342
  • Flesher A. R., Kasper D. L., Modern P. A., Mason E. O. Legionella pneumophila, Growth inhibition by human pharyngeal flora. J. Infect. Dis. 1980; 142: 313
  • Edelstein P. H., Finegold S. M. Use of a semiselective medium to culture Legionella pneumophila from contaminated lung specimens. J. Clin. Microbiol. 1979; 10: 141
  • Edelstein P. H., Snitzer J. B., Bridge J. A. Enhancement of recovery of Legionella pneumophila from contaminated respiratory tract specimens by heat. J. Clin. Microbiol. 1982; 16: 1061
  • Holmes R. L. Aniline blue-containing buffered charcoal-yeast extract medium for presumptive identification of Legionella species. J. Clin. Microbiol. 1982; 15: 723
  • Vickers R. M., Brown A., Garrity G. M. Dye-containing buffered charcoal-yeast extract medium for differentiation of members of the family Legionellaceae. J. Clin. Microbiol. 1981; 13: 380
  • Dorn G. L., Barnes W. R. Rapid isolation of Legionella pneumophila from seeded donor blood. J. Clin. Microbiol. 1979; 10: 114
  • Bridge J. A., Edelstein P. H. Oropharyngeal colonization with Legionella pneumophila. J. Clin. Microbiol. 1983; 18: 1108
  • Hebert G. A. Hippurate hydrolysis by Legionella pneumophila. J. Clin. Microbiol. 1981; 13: 240
  • Smith M. G. A simple disc technique for the presumptive identification of Legionella pneumophila. J. Clin. Pathol. 1982; 35: 1353
  • Cherry W. B., Pittman B., Harris P. P., Hebert G. A., Thomason B. M., Thacker L., Weaver R. E. Detection of legionnaires' disease bacteria by direct immunofluorescent staining. J. Clin. Microbiol. 1978; 8: 329
  • Sedgwick A. K., Tilton R. C. Identification of Legionella pneumophila by latex agglutination. J. Clin. Microbiol. 1983; 17: 365
  • Wilkinson H. W., Fikes B. J. Detection of cell-associated or soluble antigens of Legionella pneumophila serogroups 1 to 6, Legionella bozemanii, Legionella dumoffii, Legionella gormanii, Legionella micdadei by staphylococcal coagglutination tests. J. Clin. Microbiol. 1981; 14: 322
  • Wilkinson H. W., Fikes B. J. Slide agglutination test for serogrouping Legionella pneumophila and atypical Legionella-like organisms. J. Clin. Microbiol. 1980; 11: 99
  • Thacker W. L., Wilkinson H. W., Benson R. F. Comparison of slide agglutination test and direct immunofluorescence assay for identification of Legionella isolates. J. Clin. Microbiol. 1983; 18: 1113
  • Fisher-Hoch S., Hudson M. J., Thompson M. H. Identification of a clinical isolate as Legionella pneumophila by gas chromatography and mass spectrometry of cellular fatty acids. Lancet 1979; ii: 323
  • Janssen W. A., Hedlund K. W. Antiserum-agar plate method for simultaneous detection and direct isolation of Legionella species in clinical and environmental specimens. J. Clin. Microbiol. 1982; 15: 1176
  • Fraser D. W., Wachsmuth I. K., Bopp C., Feeley J. C., Tsai T. S. Antibiotic treatment of guinea-pigs infected with agent of legionnaires' disease. Lancet 1978; i: 175
  • Pasculle A. W., Dowling J. N. Antimicrobial therapy of experimental Legionella micdadei pneumonia in guinea pigs. Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami Beach, 1982, Paper #95
  • Edelstein P. H., Meyer R. D. Susceptibility of Legionella pneumophila to twenty antimicrobial agents. Antimicrob. Agents Chemother. 1980; 18: 403
  • Pasculle A. W., Dowling J. N., Weyant R. S., Sniffen J. M., Cordes L. G., Gorman G. M., Feeley J. C. Susceptibility of Pittsburgh pneumonia agent (Legionella micdadei) and other newly recognized members of the genus Legionella to nineteen antimicrobial agents. Antimicrob. Agents Chemother. 1981; 20: 793
  • Dowling J. N., Weyant R. S., Pasculle A. W. Bactericidal activity of antibiotics against Legionella micdadei (Pittsburgh pneumonia agent). Antimicrob. Agents Chemother. 1982; 22: 272
  • Hebert G. A., Steigerwalt A. G., Brenner D. J. Legionella micdadei species nova: Classification of a third species of Legionella associated with human pneumonia. Curr. Microbiol. 1980; 3: 255
  • Brenner D. J., Steigerwalt A. G., Gorman G. W., Weaver R. E., Feeley J. C., Cordes L. G., Wilkinson H. W., Patton C., Thomason B. M., Sasseville K. R. L. Legionella bozemanii sp. nov. and Legionella dumoffii sp. no v.: classification of two additional species of Legionella associated with human pneumonia. Curr. Microbiol. 1980; 4: 111
  • McKinney R. M., Porschen R. K., Edelstein P. H., Bissett M. L., Harris P. P., Bondell S. P., Steigerwalt A. G., Weaver R. E., Ein M. E., Lindquist D. S., Kops R. S., Brenner D. J. Legionella longbeachae species nova, another etiologic agent of human pneumonia. Ann. Intern. Med. 1981; 94: 739
  • Edelstein P. H., Brenner D. J., Moss C. W., Steigerwalt A. G., Francis E. M., George W. L. Legionella wadsworthii species nova: a cause of human pneumonia. Ann. Intern. Med. 1982; 97: 809
  • Moss C. W., Bibb W. F., Karr D. E., Guerrant G. O., Lambert M. A. Cellular fatty acid composition and ubiquinone content of Legionella feeleii sp. nov. J. Clin. Microbiol. 1983; 18: 917
  • White H. J., Felton W. W., Sun C. N. Extrapulmonary histopathologic manifestations of legionnaires' disease. Evidence for myocarditis and bacteremia. Arch. Pathol. Lab. Med. 1980; 104: 287
  • Mayock R., Skale B., Kohler R. B. Legionella pneumophila pericarditis proved by culture of pericardial fluid. Am. J. Med. 1983; 75: 534
  • Cutz E., Thorner P. S., Rao C. P., Toma S., Gold R., Gelfand E. W. Disseminated Legionella pneumophila infection in an infant with severe combined immunodeficiency. J. Pediatr. 1982; 100: 760
  • Dournon E., Bure A., Kemeny J. L., Pourrait J. L., Valeyre D. Legionella pneumophila peritonitis. Lancet 1982; i: 1363
  • Arnow P. M., Boyko E. J., Friedman E. L. Perirectal abscess caused by Legionella pneumophila and mixed anaerobic bacteria. Ann. Intern. Med. 1983; 98: 184
  • Kalweit W. H., Winn W. C., Jr., Rocco T. A., Girod J. C. Hemodialysis fistula infections caused by Legionella pneumophila. Ann. Intern. Med. 1982; 96: 173
  • Dorman S. A., Hardin N. J., Winn W. C., Jr. Pyelonephritis associated with Legionella pneumophila, serogroup 4. Ann. Intern. Med. 1980; 93: 835
  • Storch G., Baine W. B., Fraser D. W., Broome C. V., Clegg H. W., II, Cohen M. L., Goings S. A. J., Politi B. D., Terranova W. A., Tsai T. F., Plikaytis B. D., Shepard C. C., Bennett J. V. Sporadic community-acquired legionnaires' disease in the United States. A case-control study. Ann. Intern. Med. 1979; 90: 596

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.