Legionnaires' disease: further evidence to implicate water storage and distribution systems as sources.
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Biomedical subjects
Publications and source records attributed to A D Macrae.
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Twenty-one strains of Legionella pneumophila, representing the six known serotypes of the organism, cultured on various bacteriological media and in the yolk sacs of fertile hens' eggs were examined by negative stain electron microscopy for flagella and pili. These appendages were usually observed after cultivation on media capable of inducing an early profuse growth of the organisms.
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From 22 patients with Legionnaires' disease, 86 sera were examined for specific serotype 1 IgM and IgG antibodies by the indirect immunofluorescence technique. No antibody was detectable until 8 days or more from the onset of symptoms. When produced the amount was widely variable and remained detectable for periods from less than 34 days to more than 1 year. Intially IgM antibody predominated, ten patients produced only IgM in the first 21 days, six produced only IgM in the first 28 days and three did not produce IgG at any time. One patient, and possibly a second, produced only IgG antibody. Since IgM antibody was still present in one patient after a year it is important not to accept the presence of this as evidence of very recent infection. It is advisable that any type of serological test for L. pneumophila infection should detect the production of both IgM and IgG antibodies.
Legionnaires' disease bacterium was identified as the cause of severe pneumonia in some Nottingham, England, patients in 1977. Laboratory studies were not restricted to Nottingham but included several other areas in England. The 41 cases identified were evenly divided between areas; they also accounted for about one half of all cases for the entire country. No source of infection has been identified in these sporadic cases. There was no contact between patients, and only a few had travelled abroad before their illnesses. Serologic sampling of populations in Nottingham did not reveal a large background of infection. Only 31 of 2023 sera tested had low titer antibody to the Pontiac antigen used. Guinea-pig antisera to two positive lung extracts showed an antigenic relation to the Pontiac but not to the Togus strain,suggesting strain variation.
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Radial haemolysis (RH) for assaying rubella antibody was studied in parallel tests with haemagglutination-inhibition (HAI) on 1102 sera from adult women. Simple to perform and economical in reagents, the RH test is as sensitive as the HAI test and is a useful method of screening antenatal and other sera for rubella immunity. It detects IgG but not IgM antibody.
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