MICROBIOLOGICAL ASPECTS OF AN OUTBREAK OF LEGIONNAIRES-DISEASE IN SOUTH WESTERN SYDNEY

In April 1992 an outbreak of Legionnaires' disease occurred in south w estern Sydney, Twenty four patients were diagnosed as having Legionnai res' disease either on the basis of a positive culture of Legionella p neumophila serogroup I from a respiratory specimen (14 patients) or a four-fold or greater rise in antibody titre or isolated convalescent t itre >1024 with IgM antibodies present (10 patients). This is the larg est outbreak in New South Wales since 44 cases of Legionnaires' diseas e were reported in Wollongong in 1987. Culture and direct immunofluore scent staining (DFA) were performed for early laboratory diagnosis. Th e DFA test and a set of defined clinical criteria were then used to cl assify patients as probable cases of Legionnaires' disease for subsequ ent Public Health investigations. The DFA test had a predictive value for a positive culture of 45.8% and for a negative culture of 97.1%. I ts positive predictive value for a definite diagnosis of Legionnaires' disease (either positive culture or seroconversion), however, was 78. 3% with a negative predictive valve of 95.1%. During a 27 day period D FA and culture for Legionella species were performed on 198 specimens from 127 patients. Cultures became positive after a mean of 5 days inc ubation (range 1-11 days). The use of both selective and non-selective media is recommended for optimal recovery of L. pneumophila since som e isolates were obtained on only one culture plate. After an initial e valuation of heat decontamination of specimens this process was abando ned, since in 8/63 specimens so treated, L. pneumophila was recovered prior to but not following heat decontamination and was not grown only in heated specimens. The microbiological investigations of this outbr eak caused profound disruption to the routine laboratory. As a result of our experience we recommend the Microbiology laboratories formulate contingency plans in anticipation of involvement in an outbreak. Labo ratory equipment may need to be augmented, channels of communication m ust be developed to convey frequent updates of laboratory results, a c entralized media release team - organized by the Area Public Health Un it - should co-ordinate liaison with the media, and due recognition sh ould be given to the inevitable cost of laboratory reagents and staff overtime. The provision of an area microbiology diagnostic and consult ative service to most hospitals in south western Sydney from our Micro biology Department facilitated the initial recognition of the outbreak , the definition of probable cases and the Public Health investigation of possible sources of the outbreak.