Infection with Legionella causes two distinct illnesses: (1) legionnaires' disease, manifested by fever, myalgia, cough, and pneumonia, and (2) Pontiac fever, which is a milder illness without pneumonia. Laboratory confirmation of Legionella infection can be made by any of the following methods: (1) isolation of Legionella from respiratory secretions, lung tissue, pleural fluid, or other normally sterile site, (2) demonstration of fourfold or greater rise in reciprocal immunofluorescence antibody titer to greater than or equal to 128 against Legionella pneumophila serogroup 1 between paired acute and convalescent serum specimens, (3) detection of L.
pneumophila serogroup 1 in respiratory secretions, lung tissue, or pleural fluid by direct fluorescent antibody testing, or (4) detection of L. pneumophila serogroup 1 antigen in urine by radioimmunoassay or enzyme-linked immunosorbent assay.
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