Plouffe J F, File T M, Breiman R F, Hackman B A, Salstrom S J, Marston B J, Fields B S
Ohio State University Medical Center, Columbus 43210, USA.
Clin Infect Dis. 1995 May;20(5):1286-91. doi: 10.1093/clinids/20.5.1286.
Cases of Legionnaires' disease have been categorized as definitive and presumptive. The sensitivity and specificity of antibody titers of > or = 256 and of urinary antigen ratios of > or = 3 were evaluated in 68 patients with "definitive" Legionnaires' disease and in 636 patients with pneumonia who had negative cultures and did not have fourfold rises in titers of antibody to Legionella pneumophila. An acute-phase antibody titer of > or = 256 did not discriminate between cases and noncases (10% vs. 6%; P = .29). The urinary antigen assay gave a positive result in fewer than 1% of noncases but was positive in 55.9% of all cases. This assay was most sensitive (80%) in cases in which L. pneumophila serogroup 1 was isolated. We propose that the case definition for definitive Legionnaires' disease be expanded to include positive urinary antigen assays and that the category of presumptive Legionnaires' disease--based on acute-phase or standing antibody titers of > or = 256 in the nonoutbreak setting--be discarded. The urinary antigen assay will be a valuable tool in the prompt diagnosis of Legionnaires' disease.
军团病病例已被分为确诊病例和疑似病例。对68例“确诊”军团病患者以及636例培养结果为阴性且嗜肺军团菌抗体滴度未呈四倍升高的肺炎患者，评估了抗体滴度≥256以及尿抗原比值≥3时的敏感性和特异性。急性期抗体滴度≥256无法区分病例和非病例（分别为10%和6%；P = 0.29）。尿抗原检测在不到1%的非病例中呈阳性结果，但在所有病例中有55.9%呈阳性。该检测在分离出嗜肺军团菌血清1型的病例中最为敏感（80%）。我们建议将确诊军团病的病例定义扩大到包括尿抗原检测呈阳性，并摒弃基于非暴发情况下急性期或静态抗体滴度≥256的疑似军团病类别。尿抗原检测将成为军团病快速诊断的一项有价值工具。
