Identification of Legionella pneumophila by latex agglutination.

A latex agglutination test for the identification of Legionella pneumophila serogroups 1 through 6 is described. The reagent is specific for L. pneumophila and enables the ready identification of L. pneumophila colonies on agar plates. Preliminary evidence suggests that latex agglutination enables the detection of soluble L. pneumophila antigens in respiratory secretions of patients suspected of having legionellosis.     

Cross-reactions in Legionella antisera with Bordetella pertussis strains.

While preparing slide agglutination test antisera and immunofluorescence conjugates for the identification of Legionella species and serogroups, we found that several of the reagents cross-reacted with Bordetella pertussis strains. To determine the extent of this problem and to estimate the specificity of Legionella reagents, we tested slide agglutination test antisera against 22 species and 35 serogroups with 92 bacterial strains representing 19 genera. The only cross-reactions observed were with Legionella pneumophila serogroup 10, L. maceachernii, L. gormanii, and L. feeleii serogroup 1 antisera and 4 of 10 B. pertussis strains. Nineteen conjugates, previously available from the Centers for Disease Control but no longer distributed as reference reagents, were tested with the four cross-reactive B. pertussis strains. Two conjugates, L. micdadei and L. wadsworthii, stained three of the B. pertussis strains at a fluorescence intensity of greater than or equal to 3+. All cross-reactions were removed from the antisera and conjugates by absorption with the cross-reacting strain without diminishing the homologous reaction. Special emphasis should be placed on the identification and removal of cross-reactions in Legionella reagents with strains that have similar morphologic and growth characteristics.     

Electron microscopic evidence of flagella and pili on Legionella pneumophila.

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.     

Detection of typhus antibodies by latex agglutination.

A latex test for assay of antibodies to endemic and epidemic typhus rickettsiae is simple, group-specific, sensitive, and reproducible. Cross-reactivity within the typhus group was extensive.     

Detection of Legionella antigenuria by reverse passive agglutination.

A reverse passive agglutination method was developed to detect soluble antigens of Legionella spp. By this method Legionella antigens were detected in urine specimens from 14 of 15 antigenuric patients with clinically diagnosed Legionnaires disease and in none of 263 urine samples from healthy subjects or patients with urinary tract infections. Intra-genus cross-reactivity was observed only between L. pneumophila serogroups 2, 3, and 6. The Legionella reverse passive agglutination method was also evaluated with reference to reagent concentrations, test conditions, and subjectivity of reading test results. The method is rapid and does not require special equipment.     

Detection of cytomegalovirus antibody with latex agglutination.

Transfusion-acquired cytomegalovirus (CMV) infections should be prevented in seronegative immunocompromised patients by providing blood products from donors who are also seronegative. Latex agglutination was investigated as a simple and rapid method for detecting antibody against CMV. Latex beads were coated with CMV antigen, incubated for 8 min at room temperature with 25 microliter of sera, and examined for agglutination. The sensitivity and specificity of latex agglutination was compared with that of indirect hemagglutination (IHA, Cetus Corp., Emeryville, Calif.) and enzyme immunoassay (EIA) with sera from 604 random blood donors or patients. Of 327 serum samples shown to be seronegative by EIA and IHA, 327 had a latex agglutination titer of less than 1:4 (specificity, 100%). Of 236 serum samples with detectable antibody by EIA and IHA, 228 had a latex agglutination titer of 1:4 or greater (sensitivity, 97%). Plasma collected with EDTA, heparin, or citrate was satisfactory for latex agglutination. Latex agglutination results correlated quantitatively with those of EIA, and the test also detected fourfold or greater rises in antibody with paired sera from six patients with posttransfusion CMV infections. Latex agglutination is a sensitive and specific assay that is rapid and simple to perform and should be effective in selecting seronegative blood donors to prevent posttransfusion CMV infections in seronegative recipients.     

Serological cross-reaction between Legionella spp. and Capnocytophaga ochracea by using latex agglutination test.

Cross-reactivity between Legionella spp. and Capnocytophaga ochracea was noted by latex agglutination tests (Serobact Legionella; Disposable Products, Adelaide, Australia). Four of 11 (36%) C. ochracea isolates agglutinated with latex reagents designed to identify Legionella pneumophila serogroups. C. ochracea isolated on buffered charcoal yeast extract media may give false-positive results in this Legionella latex agglutination assay.     

Detection of Legionella pneumophila capsular-like envelope antigens by counterimmunoelectrophoresis.

The capsular-like envelope of Legionella pneumophila strains Togus 1 (serotype 2) and Philadelphia 1 (serotype 1) was isolated and purified by column chromatography on Sepharose 6B. Antibody raised in rabbits to these two antigenic materials did not cross-react in gel diffusion. Upon electrophoresis followed by gel diffusion, the majority of both envelope materials was found to migrate towards the cathode. A minor antigenic component of each envelope only migrated slightly towards the anode. Using the envelope antigens and the two anti-envelope sera in a counterimmunoelectrophoresis (CIE) assay, positive results were only obtained when the antigenic materials were placed in the cathodal well. The Togus 1 and Philadelphia 1 antigens did not cross-react in CIE. The sensitivity of the CIE assay was poor (15.6 micrograms/ml by carbohydrate content) compared to its sensitivity in other microbial systems. Although CIE may not be a useful diagnostic aid in identifying Legionella species due to its low sensitivity, it may be of value in serotyping the microorganism since we did not see cross-reactivity between the two strains when anti-envelope sera were used.     

Typing of Legionella pneumophila strains by polymerase chain reaction-mediated DNA fingerprinting.

Well-defined Legionella pneumophila strains were analyzed by amplification of variable genomic regions with arbitrary and repeat sequence primers. Clinical and environmental outbreak-related isolates showed closely related amplicon patterns. Eleven strains of unrelated origins displayed 10 distinct patterns. Fingerprinting of L. pneumophila by polymerase chain reaction appeared to have the potential of being as epidemiologically useful as other genotypic methods.     

Detection of Legionella spp. in bronchoalveolar lavage fluids by DNA amplification.

By using Taq polymerase, DNA amplification of a specific fragment of the macrophage infectivity potentiator (mip) gene from Legionella pneumophila was used to detect Legionella spp. in bronchoalveolar lavage (BAL) fluid specimens. We were able to detect DNAs from all 30 L. pneumophila strains tested (serogroups 1 to 14), L. micdadei, and L. bozemanii serogroup 1. DNA from bacteria of other species tested and DNA from human leukocytes were not amplified by this procedure. After optimization of the conditions for DNA extraction from BAL fluid, a 2-ml sample of BAL fluid seeded with 25 CFU/ml tested positive after DNA amplification. A total of 68 frozen BAL fluid specimens sent to the laboratory because of suspected legionellosis were tested in a retrospective study. The eight culture-positive samples were all positive after specific DNA amplification. Among 60 culture-negative samples, 7 were positive after amplification. Of these seven samples, four were from patients who had presented a typical clinical history of legionellosis; the samples had antibody titer increases of 2 dilutions. For the three remaining samples, serological diagnosis of legionellosis in the patients from whom the samples were obtained could not be documented, and although the causative agent of these pulmonary infections was not determined, the clinical features of the patients were in accordance with legionellosis.     

Detection of staphylococcal exfoliative toxin by slide latex agglutination.

A simple and rapid method in which slide latex agglutination was used was developed to detect the exfoliative toxin (ET) elaborated by clinical isolates. ET types A and B (ET-A and ET-B) were purified by plate gel isoelectrofocusing, and anti-ET sera were obtained by immunizing rabbits. A specific immunoglobulin G antitoxin was then prepared from the immunized rabbit sera by fast protein liquid chromatography, and latex particles were coated with the antitoxin. Of 74 staphylococcal strains isolated from patients with staphylococcal scalded skin syndrome, 61 strains were found to produce ET by the newborn mouse bioassay. All 61 strains were shown to be positive for ET-A and ET-B production by the slide latex agglutination method. The lowest concentration of ETs detected by the latex agglutination method was 0.5 microgram/ml, which was much lower than that detected by the double immunodiffusion method, with a sensitivity of 50 micrograms/ml. It is crucial to prove ET production by clinical isolates for the diagnosis and surveillance of staphylococcal scalded skin syndrome. The latex agglutination method is a sensitive, simple, and rapid test which can be used as an alternative to the newborn mouse bioassay.     

Detection of Legionella pneumonophila antigen in urine by enzyme-linked immunospecific assay.

An enzyme-linked immunospecific assay "sandwich" technique was developed for detecting soluble antigen from the Legionnaires disease bacterium (Legionella pneumophila). With this technique, antigen was detected in urine specimens from guinea pigs inoculated intraperitoneally with heat-killed Legionnaires disease bacteria and in urine specimens from three of four patients who attended the American Legion Convention in Philadelphia in 1976. Urine from a fifth pneumonia patient who attended the Eucharistic Congress (but who was a dubious seroconverter) was negative. Presumably, the test could also be used for detecting antigen in sputum or respiratory aspirates, but this has not been tried to date.     

Detection of rotavirus in faeces by latex agglutination

Human rotavirus (HRV) in faeces of patients may be readily detected with high sensitivity and specificity using latex agglutination (LA) on a glass slide by making use of the cross-reactivity of anti-calf rotavirus (CRV) antibody. Latex particles were coated with anti-CRV immunoglobin. The antibody coated particles (AC-L) are specifically agglutinated by both CRV and HRV, and the agglutination is evident macroscopically within a minute. To examine the sensitivity and reliability of the LA method compared to other methods, HRV in faecal extracts of 48 infants with acute gastroenteritis was sought by the LA, reversed passive haemagglutination (RPHA) and electron microscope (EM) methods. Samples positive by the EM method were all positive by the LA method, and samples negative by EM were all negative by LA. The LA method is suitable for application as a simple clinical diagnostic test.     

Molecular typing of nosocomial strains of Legionella pneumophila by arbitrarily primed PCR.

Arbitrarily primed PCR with two different primers was compared with ribotyping and monoclonal antibody analysis for typing Legionella strains. Applied to 11 epidemiologically unrelated strains, arbitrarily primed PCR resulted in an index of discrimination of 100% with both primers. It was found able to identify an epidemic clone of Legionella pneumophila serogroup 1 that was isolated from both patients and a hot water circuit of the same hospital.     

Detection of antibodies to human immunodeficiency virus by latex agglutination with recombinant antigen.

Recombinant human immunodeficiency virus (HIV) env antigen was attached to polystyrene particles, and these complexes were used to develop the first latex agglutination assay for antibodies to HIV. A total of 95 positive and 116 negative human serum samples were assayed for antibodies to HIV by latex agglutination, and results were compared with those of a commercial enzyme immunoassay. Latex agglutination was also compared with, and found to be completely concordant with, Western blot (immunoblot) analysis with virion antigens.     

Serological grouping of meningococci and encapsulated Haemophilus influenzae strains by latex agglutination.

The latex agglutination method, utilizing antibody-coated latex particles, was adapted for serogrouping of Neisseria meningitidis and serotyping of encapsulated Haemophilus influenzae strains from agar plates. It was found to give more clear-cut results than conventional slide agglutination. A 100% agreement with the antiserum agar method was found for all strains isolated from blood or cerebrospinal fluid. Many meningococcal strains from nasopharyngeal carriers are autoagglutinable, but some of these gave a positive reaction with the group B latex reagent, although they were negative by the antiserum agar method. The latex agglutination method has several advantages over others: the lack of autoagglutination, easy performance, easy interpretation, and very low consumption of antisera.     

Detection of pneumococci in blood cultures by latex agglutination

Latex agglutination by use of the Pneumoslide test on clinical blood cultures detected 22 Streptococcus pneumoniae strains as the etiological agents in 47 streptococcal septic episodes. The other 25 isolates were identified as viridans streptococci or streptococci of groups A, B, D, or G. The test demonstrated 100% sensitivity, 92% specificity, and predictive values for positive and negative reactions of 91 and 92%, respectively. Two false-positive reactions were caused by strains of viridans streptococci. The two strains continued to give positive reactions when colonies from blood agar plates were tested according to the instructions of the manufacturer. This latex agglutination test is an effective tool for the rapid diagnosis of pneumococci in blood cultures.     

Second serogroup of Legionella feeleii strains isolated from humans.

Three strains of Legionella feeleii from patients with pneumonia (425-MI-H, 691-WI-H, and 693-WI-H) and one environmental strain (713-MI-E) received at the Centers for Disease Control for reference diagnostic testing were compared with the type strain WO-44C-C3 (ATCC 35072) by DNA hybridization, chemical analysis of cellular fatty acids and ubiquinones, biochemical tests, and serological characteristics. All four isolates were assigned to the L. feeleii species on the basis of DNA hybridization results. However, strains 691-WI-H and 693-WI-H were serologically distinct from strain WO-44C-C3, as shown by their minimal reactivity (1 to 2+) with a direct immunofluorescence conjugate prepared against L. feeleii serogroup 1 (strain WO-44C-C3). Therefore, strains 691-WI-H and 693-WI-H were placed in a new L. feeleii serogroup (serogroup 2). The reference strain of L. feeleii serogroup 2 is 691-WI-H (ATCC 35849).