Legionella and Legionnaires' Disease: 25 Years of Investigation
10.1128/cmr.15.3.506-526.2002
Crossref journal-article
American Society for Microbiology
Clinical Microbiology Reviews (235)
Abstract

SUMMARY There is still a low level of clinical awareness regarding Legionnaires' disease 25 years after it was first detected. The causative agents, legionellae, are freshwater bacteria with a fascinating ecology. These bacteria are intracellular pathogens of freshwater protozoa and utilize a similar mechanism to infect human phagocytic cells. There have been major advances in delineating the pathogenesis of legionellae through the identification of genes which allow the organism to bypass the endocytic pathways of both protozoan and human cells. Other bacteria that may share this novel infectious process are Coxiella burnetti and Brucella spp. More than 40 species and numerous serogroups of legionellae have been identified. Most diagnostic tests are directed at the species that causes most of the reported human cases of legionellosis, L. pneumophila serogroup 1. For this reason, information on the incidence of human respiratory disease attributable to other species and serogroups of legionellae is lacking. Improvements in diagnostic tests such as the urine antigen assay have inadvertently caused a decrease in the use of culture to detect infection, resulting in incomplete surveillance for legionellosis. Large, focal outbreaks of Legionnaires' disease continue to occur worldwide, and there is a critical need for surveillance for travel-related legionellosis in the United States. There is optimism that newly developed guidelines and water treatment practices can greatly reduce the incidence of this preventable illness.

Bibliography

Fields, B. S., Benson, R. F., & Besser, R. E. (2002). Legionella and Legionnaires’ Disease: 25 Years of Investigation. Clinical Microbiology Reviews, 15(3), 506–526.

Authors 3
  1. Barry S. Fields (first)
  2. Robert F. Benson (additional)
  3. Richard E. Besser (additional)
References 294 Referenced 1,309
  1. 10.1128/aem.62.6.2022-2028.1996
  2. 10.1128/iai.62.5.1860-1866.1994
  3. 10.1128/AEM.64.9.3127-3133.1998
  4. 10.3201/eid0203.960311
  5. Adeleke, A. A., B. S. Fields, R. F. Benson, M. I. Daneshvar, J. M. Purckler, R. M. Ratcliff, T. G. Harrison, R. S. Weyant, R. J. Birtles, D. Raoult, and M. A. Halablab. 2001. Legionella drozanskii sp. nov., Legionella rowbothamii sp. nov. and Legionella fallonii sp. nov.: three unusual new Legionella species. Int. J. Syst. Evol. Microbiol. 51:1151-1160. / Int. J. Syst. E (2001)
  6. 10.1128/jcm.26.9.1775-1778.1988
  7. Allegheny County Health Department. 1997. Approaches to prevention and control of Legionella infection in Allegheny County health care facilities 2nd ed. Allegheny County Health Department Pittsburgh Pa.
  8. American Society of Heating Refrigeration and Air-Conditioning Engineers. 2000. ASHRAE Guideline 12-2000 — minimizing the risk of legionellosis associated with building water systems. American Society for Heating Refrigeration and Air-Conditioning Engineers Inc. Atlanta Ga.
  9. Anonymous. 2000. Outbreak of Legionnaires' disease associated with an aquarium in Australia. CDR Wkly.10:161. / CDR Wkly. (2000)
  10. Reference deleted.
  11. 10.1128/IAI.69.1.177-185.2001
  12. 10.1128/IAI.68.4.1855-1863.2000
  13. 10.1128/JCM.38.11.4215-4218.2000
  14. 10.1111/j.1699-0463.1991.tb01271.x
  15. 10.1111/j.1699-0463.1994.tb05197.x
  16. Barbaree, J. M. 1993. Selecting a subtyping technique for use in investigations of Legionellosis epidemics, p. 169-172. In J. M. Barbaree, R. F. Breiman, and A. P. Dufour (ed.), Legionella: current status and emerging perspectives. American Society for Microbiology, Washington, D.C. / Legionella: current status and emerging perspectives (1993)
  17. 10.1128/aem.51.2.422-424.1986
  18. 10.1016/0022-1759(86)90435-7
  19. 10.1086/313954
  20. 10.1084/jem.172.4.1201
  21. 10.1086/338060
  22. 10.1093/ije/29.6.1092
  23. Benson, R. F., and B. S. Fields. 1998. Classification of the genus Legionella. Semin. Respir. Infect.13:90-99. / Semin. Respir. Infect. (1998)
  24. 10.1128/JCM.38.7.2763-2765.2000
  25. 10.1128/jcm.25.4.594-596.1987
  26. 10.1017/S0950268800056995
  27. 10.1128/jcm.9.5.575-578.1979
  28. 10.1111/j.1365-2958.1993.tb01092.x
  29. 10.3109/00365549409008653
  30. 10.1093/clinids/18.2.227
  31. Bornstein, N., N. Janin, G. Bourguignon, M. Surgot, and J. Fleurette. 1986. Prevalence of anti-Legionella antibodies in a healthy population and in patients with tuberculosis or pneumonia. Isr. J. Med. Sci.22:740-744. / Isr. J. Med. Sci. (1986)
  32. 10.1128/jcm.29.5.953-956.1991
  33. 10.1086/322049
  34. 10.1006/mpat.1997.0134
  35. 10.1136/jcp.49.7.584
  36. 10.1017/S095026880005024X
  37. 10.1128/iai.64.2.668-673.1996
  38. 10.7326/0003-4819-90-4-656
  39. 10.1007/BF01642803
  40. 10.1128/jcm.17.6.1153-1155.1983
  41. Butler, J., and R. Breiman. 1998. Legionellosis, p. 355-376. In A. Evans and P. Brachman (ed.), Bacterial infections in humans: epidemiology and control, 3rd ed. Plenum Medical Book Company, New York, N.Y. / Bacterial infections in humans: epidemiology and control (1998)
  42. Centers for Disease Control and Prevention. 2000. CDC/IDSA/ASBMT guidelines for the prevention of opportunistic infections in hematopoietic stem cell transplant recipients. Morb. Mortal. Wkly. Rep.49:RR-1:1-128. / Morb. Mortal. Wkly. Rep. (2000)
  43. Centers for Disease Control and Prevention. 1995. Final recommendations to minimize transmission of Legionnaires' disease from whirlpool spas on cruise ships. Centers for Disease Control and Prevention Atlanta Ga.
  44. Centers for Disease Control and Prevention. 1997. Guidelines for prevention of nosocomial pneumonia. Morb. Mortal. Wkly. Rep.46:RR-1:1-79. / Morb. Mortal. Wkly. Rep. (1997)
  45. Centers for Disease Control and Prevention. 2000. Legionnaires' disease associated with potting soil—California, Oregon, and Washington, May-June 2000. Morb. Mortal. Wkly. Rep.49:777-778. / Morb. Mortal. Wkly. Rep. (2000)
  46. 10.1128/jcm.34.10.2628-2629.1996
  47. 10.1128/iai.58.9.2912-2918.1990
  48. 10.1128/iai.57.4.1255-1262.1989
  49. 10.1073/pnas.89.11.5188
  50. 10.1128/IAI.67.9.4427-4434.1999
  51. 10.1128/JCM.38.5.1709-1712.2000
  52. 10.1128/iai.39.3.1428-1440.1983
  53. 10.1128/iai.39.3.1441-1456.1983
  54. 10.1128/jcm.19.6.757-762.1984
  55. Commission H. S. 1991. The prevention or control of legionellosis (including legionnaires' disease). Health and Safety Executive London England.
  56. 10.1099/00222615-48-3-269
  57. 10.1086/520479
  58. 10.3201/eid0801.010176
  59. de Ory, F., J. M. Echevarria, C. Pelaz, A. Tellez, M. A. Mateo, and J. Lopez. 2000. Detection of specific IgM antibody in the investigation of an outbreak of pneumonia due to Legionella pneumophila serogroup 1. Clin. Microbiol. Infect.6:64-68. / Clin. Microbiol. Infect. (2000)
  60. 10.1128/iai.58.7.2320-2328.1990
  61. 10.1007/BF01975041
  62. 10.1007/s100960050427
  63. 10.1128/JCM.36.9.2718-2722.1998
  64. 10.1128/jcm.34.9.2334-2336.1996
  65. 10.1128/jcm.35.6.1627-1629.1997
  66. Donlan, R., R. Murga, J. Carpenter, E. Brown, R. Besser, and B. Fields. 2002. Monochloramine disinfection of biofilm-associated Legionella pneumophila in a potable water model system, p. 406-410. In R. Marre, Y. Abu Kwaik, C. Bartlett, N. P. Cianciotto, B. S. Fields, M. Frosch, J. Hacker, and P. C. Luck (ed.), Legionella. American Society for Microbiology, Washington, D.C. / Legionella (2002)
  67. Dournon, E. 1988. Isolation of legionellae from clinical specimens, p. 13-30. In T. G. Harrison and A. G. Taylor (ed.), A laboratory manual for Legionella. John Wiley and Sons, New York, N.Y. / A laboratory manual for Legionella (1988)
  68. Drozanski, W. 1956. Fatal bacterial infection in soil amoebae. Acta Microbiol. Pol.5:315-317. / Acta Microbiol. Pol. (1956)
  69. Dwyer, D. E., V. L. Gibbons, L. M. Brady, and A. L. Cunningham. 1988. Serological reaction to Legionella pneumophila group 4 in a patient with Q fever. J. Infect. Dis.158:499-500. / J. Infect. Dis. (1988)
  70. 10.7326/0003-4819-129-4-199808150-00012
  71. 10.1128/jcm.16.4.697-699.1982
  72. Edelstein, P. H. 1997. Detection of antibodies to Legionella spp., p. 502-509. In N. R. Rose, E. C. de Macario, J. D. Folds, H. C. Lane, and R. M. Nakamura (ed.), Manual of clinical laboratory immunology,vol. 5. American Society for Microbiology, Washington, D.C. / Manual of clinical laboratory immunology (1997)
  73. 10.1128/jcm.14.3.298-303.1981
  74. Edelstein, P. H. 1987. The laboratory diagnosis of Legionnaires' disease. Semin. Respir. Infect.2:235-241. / Semin. Respir. Infect. (1987)
  75. Edelstein, P. H. 1993. Laboratory diagnosis of Legionnaires' disease: an update from 1984, p. 7-11. In J. M. Barbaree, R. F. Breiman, and A. P. Dufour (ed.), Legionella: current status and emerging perspectives. American Society for Microbiology, Washington, D.C. / Legionella: current status and emerging perspectives (1993)
  76. 10.1093/clind/16.6.741
  77. 10.1128/jcm.22.3.419-421.1985
  78. 10.1128/jcm.25.6.1022-1026.1987
  79. 10.1128/jcm.27.11.2455-2458.1989
  80. 10.1093/infdis/141.5.652
  81. 10.1128/jcm.16.6.1061-1065.1982
  82. 10.1128/iai.57.4.1263-1270.1989
  83. 10.1136/jcp.35.4.434
  84. 10.7326/0003-4819-90-4-690
  85. 10.1128/jcm.7.4.327-331.1978
  86. 10.1007/PL00008255
  87. 10.1128/jcm.10.4.437-441.1979
  88. 10.1128/jcm.8.3.320-325.1978
  89. Ferguson, D. A., Jr., and W. R. Mayberry. 1987. Differentiation of Legionella species by soluble protein patterns in polyacrylamide slab gels. Microbios52:105-114. / Microbios (1987)
  90. Fields, B. S. 1997. Legionellae and Legionnaires' disease, p. 666-675. In C. J. Hurst, G. R. Knudsen, M. J. McInerney, L. D. Stetzenbach, and M. V. Walter (ed.), Manual of environmental microbiology,vol. 1. American Society for Microbiology, Washington, D.C. / Manual of environmental microbiology (1997)
  91. 10.1016/0966-842X(96)10041-X
  92. Fields B. S. 1992. Procedures for the recovery of Legionella from the environment vol. 2. U.S. Department of Health and Human Services Atlanta Ga.
  93. 10.1093/infdis/167.5.1146
  94. 10.1099/00222615-38-3-183
  95. 10.1086/501642
  96. 10.1086/516309
  97. 10.1111/j.1365-2958.1992.tb00858.x
  98. 10.1128/aem.41.1.9-16.1981
  99. 10.1016/0732-8893(88)90106-X
  100. Formica, N., G. Tallis, B. Zwolak, J. Camie, M. Beers, G. Hogg, N. Ryan, and M. Yates. 2000. Legionnaires' disease outbreak: Victoria's largest identified outbreak. Commun. Dis. Intel.24:199-202. / Commun. Dis. Intel. (2000)
  101. 10.1128/jcm.27.9.1952-1955.1989
  102. 10.1139/m93-069
  103. Fraser, D. W. 1984. Sources of legionellosis, p. 277-280. In A. Balows, C. Thornsberry, J. C. Feeley, and W. Jakubowski (ed.), Proceedings of the Second International Symposium on Legionella. American Society for Microbiology, Washington, D.C. / Proceedings of the Second International Symposium on Legionella (1984)
  104. 10.1056/NEJM197712012972201
  105. 10.1007/s100960000359
  106. 10.1099/00221287-137-5-1215
  107. 10.1128/IAI.67.2.862-870.1999
  108. 10.1046/j.1462-2920.2000.00076.x
  109. 10.1128/iai.65.11.4738-4746.1997
  110. 10.1006/mpat.1998.0237
  111. Garcia, M., I. Campbell, P. Tang, and C. Krishnan. 1993. Incidence of Legionnaires' disease and report of Legionella sainthelensi serogroup 1 infection in Toronto, Canada, p. 37-39. In J. M. Barbaree, R. F. Breiman, and A. P. DuFour (ed.), Legionella: current status and emerging perspectives. American Society for Microbiology, Washington, D.C. / Legionella: current status and emerging perspectives (1993)
  112. 10.1099/00207713-30-4-609
  113. 10.1128/jcm.32.12.2989-2994.1994
  114. 10.1093/oxfordjournals.aje.a112517
  115. 10.1097/00006454-199203000-00015
  116. 10.1128/jcm.31.7.1940-1942.1993
  117. 10.1128/jcm.20.6.1031-1035.1984
  118. 10.7326/0003-4819-90-4-607
  119. 10.1128/jcm.29.1.200-201.1991
  120. 10.1111/j.1365-2672.1993.tb05143.x
  121. 10.1093/clinids/21.3.712
  122. 10.1128/jcm.34.6.1579-1580.1996
  123. 10.1046/j.1462-5822.2000.00044.x
  124. 10.1111/j.1574-6968.1998.tb13298.x
  125. 10.1046/j.1365-2958.1999.01519.x
  126. 10.1136/jcp.40.1.77
  127. 10.1136/jcp.35.2.211
  128. Harrison, T. G., and A. G. Taylor. 1988. The diagnosis of Legionnaires' disease by estimation of antibody levels, p. 113-135. In T. G. Harrison and A. G. Taylor (ed.), A laboratory manual for Legionella,vol. 1. John Wiley and Sons, Ltd., Chichester, England. / A laboratory manual for Legionella (1988)
  129. Harrison T. G. and A. G. Taylor. 1988. A laboratory manual for Legionella . Wiley New York N.Y.
  130. 10.1136/jcp.35.9.1028
  131. 10.1128/JCM.39.7.2618-2626.2001
  132. 10.1007/BF01695659
  133. 10.1128/jcm.13.1.240-242.1981
  134. Reference deleted.
  135. 10.1099/0022-1317-50-6-509
  136. 10.1007/s100960050384
  137. 10.1128/jcm.35.11.2841-2845.1997
  138. 10.1128/cdli.2.2.160-165.1995
  139. 10.1007/BF01568530
  140. 10.1136/jcp.36.4.466
  141. 10.1136/jcp.33.12.1174
  142. 10.1136/jcp.43.10.860
  143. 10.1099/00207713-46-2-526
  144. 10.1084/jem.158.4.1319
  145. 10.1084/jem.158.6.2108
  146. 10.1016/0092-8674(84)90070-9
  147. 10.1083/jcb.99.6.1936
  148. 10.1172/JCI109874
  149. 10.2807/esm.01.05.00169-en
  150. 10.1128/jcm.32.1.209-210.1994
  151. 10.1128/jcm.30.4.920-924.1992
  152. 10.3201/eid0707.017717
  153. 10.1016/S0140-6736(96)91137-X
  154. Jimenez-Lucho, V., M. Shulman, and J. Johnson. 1994. Bordetella bronchiseptica in an AIDS patient cross-reacts with Legionella antisera. J. Clin. Microbiol.32:3095-3096. / J. Clin. Microbiol. (1994)
  155. 10.1128/jcm.23.4.768-771.1986
  156. 10.1128/jcm.33.5.1247-1252.1995
  157. Kallings, I., and K. Nordstrom. 1983. The pattern of immunoglobulins with special reference to IgM in Legionnaires' disease patients during a 2 year follow-up period. Zentralbl. Bakteriol. Mikrobiol. Hyg. A255:27-32. / Zentralbl. Bakteriol. Mikrobiol. Hyg. A (1983)
  158. 10.1016/0732-8893(96)00010-7
  159. Katz, S. M., and J. M. Hammel. 1987. The effect of drying, heat, and pH on the survival of Legionella pneumophila. Ann. Clin. Lab. Sci.17:150-156. / Ann. Clin. Lab. Sci. (1987)
  160. 10.1128/jcm.35.4.954-956.1997
  161. 10.1128/jcm.31.12.3325-3328.1993
  162. 10.1128/iai.59.3.758-763.1991
  163. Kirmeyer G. G. Foust G. Pierson J. Simmler and M. MeChevalier. 1993. Optimizing chloramine treatment. American Water Works Research Foundation Denver Colo.
  164. 10.1128/jcm.11.1.27-29.1980
  165. 10.1128/jcm.10.5.754-755.1979
  166. 10.1093/infdis/152.5.1007
  167. 10.1128/jcm.20.4.605-607.1984
  168. 10.7326/0003-4819-94-5-601
  169. 10.1093/clinids/21.1.199
  170. 10.1086/501587
  171. 10.1017/S095026880000474X
  172. 10.1016/S0140-6736(98)06394-6
  173. 10.2307/30142014
  174. 10.1111/j.1365-2672.1994.tb03450.x
  175. 10.1128/jcm.26.8.1442-1444.1988
  176. 10.1099/00222615-48-4-327
  177. 10.1139/m95-116
  178. 10.1128/jcm.17.6.1132-1140.1983
  179. 10.2307/30142015
  180. 10.1046/j.1365-2958.1999.01239.x
  181. 10.1128/IAI.66.4.1776-1782.1998
  182. 10.1128/jcm.32.12.3068-3069.1994
  183. 10.1007/BF01974541
  184. Lo Presti, F., S. Riffard, H. Meugnier, M. Reyrolle, Y. Lasne, P. A. D. Grimont, F. Grimont, R. F. Benson, D. J. Brenner, A. G. Steigerwalt, J. Etienne, and J. Freney. 2001. Legionella gresilensis sp. nov. and Legionella beliardensis sp. nov., isolated from water in France. Int. J. Syst. Evol. Microbiol. 51:1949-1957. / Int. J. Syst. E (2001)
  185. 10.1099/00207713-49-2-397
  186. 10.1086/516354
  187. 10.1093/nar/15.3.1335
  188. 10.1136/thx.39.1.28
  189. 10.1016/0890-8508(90)90051-Z
  190. 10.1128/jcm.25.12.2281-2284.1987
  191. 10.1128/jcm.18.6.1422-1423.1983
  192. 10.1016/S0167-7012(98)00041-4
  193. 10.1007/BF02112614
  194. 10.2307/30149747
  195. 10.1001/jama.1985.03350280091026
  196. 10.1073/pnas.89.20.9607
  197. 10.1128/JCM.37.1.251-254.1999
  198. 10.1017/S0950268800057757
  199. 10.1001/archinte.1994.00420210049006
  200. 10.1001/archinte.1997.00440360129015
  201. 10.1128/jcm.32.6.1503-1505.1994
  202. Matsiota-Bernard, P., S. Waser, and G. Vrioni. 2000. Detection of Legionella pneumophila DNA in urine and serum samples from patients with pneumonia. Clin. Microbiol. Infect.6:223-225. / Clin. Microbiol. Infect. (2000)
  203. 10.1056/NEJM197712012972202
  204. 10.1017/S0950268800054509
  205. 10.2307/30140946
  206. 10.1128/aem.63.7.2489-2494.1997
  207. 10.1128/jcm.28.3.616-618.1990
  208. 10.1128/jcm.9.5.648-649.1979
  209. 10.1086/313656
  210. 10.1093/clinids/23.3.475
  211. 10.1099/00221287-147-11-3121
  212. 10.1128/cdli.4.2.208-212.1997
  213. 10.1093/emboj/20.21.5962
  214. 10.1017/S0022172400026176
  215. Reference deleted.
  216. 10.1007/BF01690990
  217. Office of Water U.S. Environmental Protection Agency. 1999. 40 CFR parts 9 141 and 142. National primary drinking water regulations: disinfectants and disinfection byproducts. Office of Water U.S. Environmental Protection Agency Washington D.C.
  218. 10.1093/infdis/138.2.260
  219. 10.1128/jcm.17.2.332-337.1983
  220. 10.1128/jcm.18.4.895-900.1983
  221. 10.1093/infdis/141.6.727
  222. 10.1128/jcm.27.10.2350-2358.1989
  223. 10.1084/jem.166.5.1377
  224. 10.1128/jcm.9.5.615-626.1979
  225. 10.1128/jcm.25.11.2080-2084.1987
  226. 10.1093/clinids/20.5.1286
  227. 10.1128/iai.63.12.4928-4932.1995
  228. 10.1128/jcm.33.11.2872-2875.1995
  229. 10.1016/0732-8893(95)00254-5
  230. Ramirez, J. A., and J. T. Summersgill. 1994. Rapid tests for the diagnosis of Legionella infections. J. Ky. Med. Assoc.92:62-65. / J. Ky. Med. Assoc. (1994)
  231. 10.1046/j.1365-2958.1997.5471908.x
  232. 10.1128/JCM.36.6.1560-1567.1998
  233. 10.1128/JCM.36.1.161-167.1998
  234. 10.1016/S0732-8893(97)89153-5
  235. 10.1128/aem.60.5.1585-1592.1994
  236. 10.1007/BF01569994
  237. 10.1128/aem.58.7.2326-2330.1992
  238. 10.1378/chest.105.6.1817
  239. 10.1128/IAI.69.4.2092-2098.2001
  240. Rowbotham, T. J. 1986. Current views on the relationships between amoebae, legionellae and man. Isr. J. Med. Sci.22:678-689. / Isr. J. Med. Sci. (1986)
  241. 10.1086/517095
  242. Rowbotham, T. J. 1993. Legionella-like amoebal pathogens, p. 137-140. In J. M. Barbaree, R. F. Breiman, and A. P. Dufour (ed.), Legionella: current status and emerging perspectives. American Society for Microbiology, Washington, D.C. / Legionella: current status and emerging perspectives (1993)
  243. 10.1136/jcp.33.12.1179
  244. 10.5694/j.1326-5377.1996.tb94110.x
  245. 10.1128/iai.61.12.5361-5373.1993
  246. 10.1128/jcm.29.4.836-841.1991
  247. 10.1128/jcm.23.1.92-99.1986
  248. 10.1128/jcm.18.6.1340-1344.1983
  249. 10.1099/00222615-31-1-45
  250. 10.1099/00222615-35-3-152
  251. 10.1128/jcm.30.6.1491-1498.1992
  252. 10.1128/jb.163.3.1021-1037.1985
  253. 10.1007/BF02817623
  254. 10.1128/IAI.68.5.2939-2947.2000
  255. 10.1093/oxfordjournals.aje.a113953
  256. 10.1128/jcm.27.6.1257-1261.1989
  257. 10.5694/j.1326-5377.1989.tb128470.x
  258. 10.1128/jcm.29.2.346-354.1991
  259. 10.1128/IAI.66.4.1768-1775.1998
  260. 10.1093/infdis/157.3.486
  261. 10.1056/NEJM199709043371006
  262. 10.1001/archinte.1996.00440140115011
  263. 10.1146/annurev.micro.54.1.567
  264. 10.1128/iai.63.9.3609-3620.1995
  265. Tang, P., and C. Krishnan. 1993. Legionella antigenuria: six-year study of broad-spectrum enzyme-linked immunosorbent assay as a routine diagnostic test, p. 12-13. In J. M. Barbaree, R. F. Breiman, and A. P. DuFour (ed.), Legionella: current status and emerging perspectives. American Society for Microbiology, Washington, D.C. / Legionella: current status and emerging perspectives (1993)
  266. 10.1128/jcm.24.4.556-558.1986
  267. 10.1128/jcm.27.4.783-784.1989
  268. 10.3181/00379727-57-14711
  269. Taylor, A. G., and T. G. Harrison. 1983. Serological tests for Legionella pneumophila serogroup 1 infections. Zentralbl. Bakteriol. Mikrobiol. Hyg. A255:20-26. / Zentralbl. Bakteriol. Mikrobiol. Hyg. A (1983)
  270. 10.1128/jcm.21.5.779-782.1985
  271. 10.7326/0003-4819-90-4-697
  272. Tobin, J. O., I. D. Watkins, S. Woodhead, and R. G. Mitchell. 1986. Epidemiological studies using monoclonal antibodies to Legionella pneumophila serogroup 1. Isr. J. Med. Sci.22:711-714. / Isr. J. Med. Sci. (1986)
  273. 10.7326/0003-4819-90-4-509
  274. 10.1128/jcm.33.7.1716-1719.1995
  275. 10.1016/0923-2508(96)84715-2
  276. 10.1128/jcm.31.8.2198-2200.1993
  277. 10.1084/jem.186.4.537
  278. 10.1111/j.1365-2672.1988.tb01900.x
  279. 10.1128/jcm.13.2.380-382.1981
  280. Vickers, R. M., J. E. Stout, V. L. Yu, and J. D. Rihs. 1987. Manual of culture methodology for Legionella. Semin. Respir. Infect.2:274-279. / Semin. Respir. Infect. (1987)
  281. 10.1126/science.279.5352.873
  282. 10.1111/j.1574-6968.1993.tb06504.x
  283. 10.1017/S0022172400062641
  284. 10.1093/ajcp/110.3.295
  285. Wilkinson H. W. 1987. Hospital-laboratory diagnosis of Legionella infections. U.S. Dept. of Health and Human Services Public Health Service Centers for Disease Control Atlanta Ga.
  286. 10.1128/jcm.16.5.979-981.1982
  287. 10.1128/jcm.13.1.139-146.1981
  288. 10.1128/jcm.10.5.685-689.1979
  289. 10.1128/jcm.9.3.379-383.1979
  290. 10.1093/infdis/147.1.23
  291. 10.1128/jcm.23.2.217-220.1986
  292. 10.1016/S0163-4453(95)92691-7
  293. 10.1128/jcm.13.6.1040-1045.1981
  294. 10.1128/jcm.16.6.1007-1011.1982
Dates
Type When
Created 23 years, 1 month ago (July 28, 2002, 7:07 p.m.)
Deposited 3 years, 6 months ago (Feb. 23, 2022, 5:19 a.m.)
Indexed 2 days, 9 hours ago (Aug. 30, 2025, 12:59 p.m.)
Issued 23 years, 2 months ago (July 1, 2002)
Published 23 years, 2 months ago (July 1, 2002)
Published Print 23 years, 2 months ago (July 1, 2002)
Funders 0

None

@article{Fields_2002, title={Legionella and Legionnaires’ Disease: 25 Years of Investigation}, volume={15}, ISSN={1098-6618}, url={http://dx.doi.org/10.1128/cmr.15.3.506-526.2002}, DOI={10.1128/cmr.15.3.506-526.2002}, number={3}, journal={Clinical Microbiology Reviews}, publisher={American Society for Microbiology}, author={Fields, Barry S. and Benson, Robert F. and Besser, Richard E.}, year={2002}, month=jul, pages={506–526} }