Legionella

The genus Legionella is a pathogenic group of Gram-negative bacteria that includes the species L. pneumophila, causing legionellosis (all illnesses caused by Legionella) including a pneumonia-type illness called Legionnaires' disease and a mild flu-like illness called Pontiac fever. Legionella may be visualized with a silver stain or cultured in cysteine-containing media such as buffered charcoal yeast extract agar. It is common in many environments, including soil and aquatic systems, with at least 50 species and 70 serogroups identified. These bacteria, however, are not transmissible from person to person; furthermore, most people exposed to the bacteria do not become ill. The side chains of the cell wall carry the bases responsible for the somatic antigen specificity of these organisms. The chemical composition of these side chains both with respect to components and arrangement of the different sugars determines the nature of the somatic or O antigen determinants, which are essential means of serologically classifying many Gram-negative bacteria. Legionella acquired its name after an outbreak of a then-unknown 'mystery disease' sickened 221 persons, causing 34 deaths. The outbreak was first noticed among people attending a convention of the American Legion—an association of U.S. military veterans. The convention occurred in Philadelphia during the U.S. Bicentennial year in July 21–24, 1976. This epidemic among U.S. war veterans, occurring in the same city as—and within days of the 200th anniversary of—the signing of the Declaration of Independence, was widely publicized and caused great concern in the United States. On January 18, 1977, the causative agent was identified as a previously unknown bacterium subsequently named Legionella. See Legionnaires' disease for full details. Legionella is traditionally detected by culture on buffered charcoal yeast extract agar. Legionella requires the presence of cysteine and iron to grow, so does not grow on common blood agar media used for laboratory-based total viable counts or on-site dipslides. Common laboratory procedures for the detection of Legionella in water concentrate the bacteria (by centrifugation and/or filtration through 0.2-μm filters) before inoculation onto a charcoal yeast extract agar containing selective agents (e.g. glycine, vancomycin, polymixin, cyclohexamide, GVPC) to suppress other flora in the sample. Heat or acid treatment are also used to reduce interference from other microbes in the sample. After incubation for up to 10 days, suspect colonies are confirmed as Legionella if they grow on buffered charcoal yeast extract agar containing cysteine, but not on agar without cysteine added. Immunological techniques are then commonly used to determine the species and/or serogroups of bacteria present in the sample. Although the plating method is quite specific for most species of Legionella, one study has shown that a coculture method that accounts for the close relationship with amoebae may be more sensitive since it can detect the presence of the bacteria even when masked by their presence inside the amoeba. Consequently, the clinical and environmental prevalence of the bacteria is likely to be underestimated due to the current lab methodology.