What You Need To Know
Key Points or Updates:
- Legionnaires’ disease cases rise during warmer months and typically peak in summer or early fall. The New Jersey Department of Health (NJDOH) is currently seeing an increase in reported cases statewide.
- Consider Legionella in all patients presenting with pneumonia, whether community-acquired or healthcare-associated.
- Collect both a urine specimen for Legionella urinary antigen testing (UAT) and a lower respiratory specimen for Legionella culture or PCR testing.
- The Legionella UAT only detects Legionella pneumophila serogroup 1.
- Other species/serogroups may be missed unless a lower respiratory specimen is tested by culture or PCR.
- If a patient tests positive on the Legionella UAT, please send a lower respiratory specimen to NJDOH’s Public Health Environmental Laboratories (PHEL) for further testing.
- Please distribute to all clinical staff in Internal Medicine, Geriatrics, Primary Care, Infectious Diseases, Emergency Medicine, Family Medicine, Laboratory Medicine, and Infection Control.
INFORMATION FOR HEALTHCARE PROVIDERS, FACILITIES, AND CLINICAL LABORATORIES
Healthcare providers should consider Legionnaires’ disease in patients with pneumonia. The urinary antigen test (UAT) is a rapid diagnostic test that detects Legionella pneumophila serogroup 1, but a negative result does not rule out infection from other Legionella species or serogroups. Legionella culture and/or PCR testing of a lower respiratory specimen (e.g., sputum, tracheal aspirate, or BAL fluid) performed in addition to the UAT allows for the detection of other Legionella species.
For patients who test positive by the UAT, indicating likely infection with L. pneumophila serogroup 1:
- Collect a lower respiratory specimen (e.g., sputum, BAL, tracheal aspirate, or lung tissue) as soon as possible, ideally before starting antibiotics. However, do not delay treatment to collect the specimen. If antibiotics have already been started, collect the specimen as soon as possible afterward.
- Freeze the specimen immediately at -20°C or below.
- Ship the frozen specimen on dry ice to NJDOH PHEL via ground courier or next-day delivery service. In warm weather, use extra dry ice to prevent thawing. Thawed specimens may be rejected.
- Deliveries are accepted Monday through Friday 8:30 am to 3:30 pm, except state holidays.
Submitted specimens will undergo Legionella PCR and culture testing at no cost. If a Legionella isolate is recovered, molecular testing can be performed to identify links between clinical and environmental Legionella isolates, which is critical for detecting and confirming outbreaks.
Please notify NJDOH at PreventLD@doh.nj.gov when submitting specimens.
Reporting
Health care providers and administrators are required to report cases of legionellosis (Legionnaires’ disease and Pontiac fever) to the local health department where the patient resides within 24 hours of diagnosis (N.J.A.C. 8:57 – 1.4). If the patient residence is unknown, report to your own local health department. Contact information is available at: localhealth.nj.gov.
Timely identification and reporting of cases of legionellosis is important, as this allows public health officials to quickly identify and stop potential clusters and outbreaks by linking new cases to previously reported ones.
Contact Information:
Water Systems and Environmental Infection Control Unit, Communicable Disease Service, PreventLD@doh.nj.gov