Diagnosis of Legionnaires' disease. An update of laboratory methods with new emphasis on isolation by culture.

A prospective clinical study of 40 cases of legionnaires' disease combined with serial laboratory examinations enabled us to present an update as well as new recommendations concerning the use of diagnostic tests for legionnaires' disease. Transtracheal aspirate specimens are the optimal specimen for recovery of Legionella pneumophila by culture as well as the most sensitive method for early diagnosis. In addition, with recent improvements in culture media and methodology, L pneumophila can now be readily isolated from sputum. Examination of respiratory specimens by direct immunofluorescence (DFA) is useful, but the sensitivity is much less than that of culture. The yield from DFA examination directly correlates with the number of L pneumophila recoverable by cultural methods; thus, the DFA test result may be negative in an early or mild case of legionnaires' disease. Antibody titers were elevated in 27% of cases within one week of onset of pneumonia and may, therefore, be useful in early diagnosis in selected patients.