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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Microbio.</journal-id>
<journal-title>Frontiers in Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Microbio.</abbrev-journal-title>
<issn pub-type="epub">1664-302X</issn>
<publisher>
<publisher-name>Frontiers Research Foundation</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmicb.2010.00123</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Microbiology</subject>
<subj-group>
<subject>Perspective Article</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Molecular Detection of <italic>Legionella</italic>: Moving on From <italic>mip</italic></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Yong</surname> <given-names>Stacey F. Y.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Tan</surname> <given-names>Shin Hwa</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Wee</surname> <given-names>Joanne</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Tee</surname> <given-names>Jing Jhi</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Sansom</surname> <given-names>Fiona M.</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Newton</surname> <given-names>Hayley J.</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Hartland</surname> <given-names>Elizabeth L.</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="author-notes" rid="fn001">&#x0002A;</xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>School of Science, Monash University</institution> <country>Bandar Sunway, Selangor, Malaysia</country></aff>
<aff id="aff2"><sup>2</sup><institution>School of Biomedical Science, Taylor&#x00027;s University College</institution> <country>Subang Jaya, Selangor, Malaysia</country></aff>
<aff id="aff3"><sup>3</sup><institution>Department of Microbiology and Immunology, University of Melbourne</institution> <country>Parkville, VIC, Australia</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Amal Amer, The Ohio State University, USA</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Zhao-Qing Luo, Purdue University, USA; Stephanie M. Seveau, The Ohio State University, USA; Abul K. Azad, The Ohio State University, USA</p></fn>
<fn fn-type="corresp" id="fn001"><p>&#x0002A;Correspondence: Elizabeth L. Hartland, Department of Microbiology and Immunology, University of Melbourne, Parkville,VIC 3010, Australia. e-mail: <email>hartland&#x00040;unimelb.edu.au</email></p></fn>
<fn fn-type="other" id="fn002"><p>This article was submitted to Frontiers in Cellular and Infection Microbiology, a specialty of Frontiers in Microbiology.</p></fn>
</author-notes>
<pub-date pub-type="epreprint">
<day>28</day>
<month>09</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="epub">
<day>11</day>
<month>11</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="collection">
<year>2010</year>
</pub-date>
<volume>1</volume>
<elocation-id>123</elocation-id>
<history>
<date date-type="received">
<day>06</day>
<month>09</month>
<year>2010</year>
</date>
<date date-type="accepted">
<day>21</day>
<month>10</month>
<year>2010</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2010 Yong, Tan, Wee, Tee, Sansom, Newton and Hartland.</copyright-statement>
<copyright-year>2010</copyright-year>
<license license-type="open-access" xlink:href="http://www.frontiersin.org/licenseagreement"><p>This is an open-access article subject to an exclusive license agreement between the authors and the Frontiers Research Foundation, which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited.</p></license>
</permissions>
<abstract>
<p>The detection of <italic>Legionella pneumophila</italic> in environmental and clinical samples is frequently performed by PCR amplification of the <italic>mip</italic> and/or 16S rRNA genes. Combined with DNA sequencing, these two genetic loci can be used to distinguish different species of <italic>Legionella</italic> and identify <italic>L. pneumophila</italic>. However, the recent <italic>Legionella</italic> genome sequences have opened up hundreds of possibilities for the development of new molecular targets for detection and diagnosis. Ongoing comparative genomics has the potential to fine tune the identification of <italic>Legionella</italic> species and serogroups by combining specific and general genetic targets. For example, the coincident detection of LPS biosynthesis genes and virulence genes may allow the differentiation of both pathogen and serogroup without the need for nucleotide sequencing. We tested this idea using data derived from a previous genomic subtractive hybridization we performed between <italic>L. pneumophila</italic> serogroup 1 and <italic>L. micdadei</italic>. Although not yet formally tested, these targets serve as an example of how comparative genomics has the potential to improve the scope and accuracy of <italic>Legionella</italic> molecular detection if embraced by laboratories undertaking <italic>Legionella</italic> surveillance.</p>
</abstract>
<kwd-group>
<kwd><italic>Legionella</italic></kwd>
<kwd>virulence</kwd>
<kwd>genomics</kwd>
<kwd>molecular testing</kwd>
</kwd-group>
<counts>
<fig-count count="2"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="45"/>
<page-count count="5"/>
<word-count count="4573"/>
</counts>
</article-meta>
</front>
<body>
<sec sec-type="introduction">
<title>Introduction</title>
<p>Bacteria of the genus <italic>Legionella</italic> are ubiquitous in soil and water environments where they persist and multiply in free living protozoa. Despite the pathogen being adapted for an environmental niche, humans may become infected with <italic>Legionella</italic> through the inhalation of contaminated aerosols. The ability of <italic>Legionella</italic> to replicate in environmental protozoa has equipped the bacteria with the capacity to replicate in human alveolar macrophages (Newton et al., <xref ref-type="bibr" rid="B25">2010</xref>). Intracellular replication requires a specialized type IV secretion system termed the defective in organelle trafficking/intracellular multiplication (Dot/Icm) system. Although ancestrally related to DNA conjugation systems, the Dot/Icm system transports multiple effector proteins into the host cell to establish a vacuole that evades lysosome fusion and interacts instead with membranes and vesicles of the secretory pathway (Shin and Roy, <xref ref-type="bibr" rid="B36">2008</xref>; Franco et al., <xref ref-type="bibr" rid="B13">2009</xref>; Isberg et al., <xref ref-type="bibr" rid="B18">2009</xref>; Nora et al., <xref ref-type="bibr" rid="B28">2009</xref>; Newton et al., <xref ref-type="bibr" rid="B25">2010</xref>). The formation of the specialized <italic>Legionella</italic> containing vacuole (LCV) is critical for pathogen replication and spread to new host cells.</p>
<p>Although several <italic>Legionella</italic> species have been associated with human infection, <italic>Legionella pneumophila</italic> is the most common cause of Legionnaire&#x00027;s disease (Fields et al., <xref ref-type="bibr" rid="B11">2002</xref>). In particular, serogroup 1 isolates of <italic>L. pneumophila</italic> represent the majority of clinical strains and many diagnostic tests are specific for the detection and diagnosis of this serogroup (Yu et al., <xref ref-type="bibr" rid="B45">2002</xref>; Tronel and Hartemann, <xref ref-type="bibr" rid="B39">2009</xref>). The difficulty of culturing of <italic>Legionella</italic> isolates from clinical and environmental samples has led to the development of rapid molecular tests for the detection of <italic>Legionella</italic> DNA (Rantakokko-Jalava and Jalava, <xref ref-type="bibr" rid="B29">2001</xref>; Reischl et al., <xref ref-type="bibr" rid="B31">2002</xref>; Templeton et al., <xref ref-type="bibr" rid="B37">2003</xref>; Wilson et al., <xref ref-type="bibr" rid="B42">2003</xref>; Bencini et al., <xref ref-type="bibr" rid="B2">2007</xref>; Wilson et al., <xref ref-type="bibr" rid="B41">2007</xref>). The current gold standard in molecular diagnosis is based on detection of the <italic>mip</italic> gene specific for <italic>L. pneumophila</italic> and 16S rRNA for identification of the <italic>Legionella</italic> genus (Ratcliff et al., <xref ref-type="bibr" rid="B30">1998</xref>; Templeton et al., <xref ref-type="bibr" rid="B37">2003</xref>). The <italic>mip</italic> gene was one of the first genes associated with the ability of <italic>L. pneumophila</italic> to replicate in eukaryotic cells and encodes a surface located peptidylprolyl cis/trans isomerase (PPIase) (Cianciotto et al., <xref ref-type="bibr" rid="B8">1990</xref>; Cianciotto and Fields, <xref ref-type="bibr" rid="B9">1992</xref>; Fischer et al., <xref ref-type="bibr" rid="B12">1992</xref>; Wintermeyer et al., <xref ref-type="bibr" rid="B43">1995</xref>). The 24&#x02009;kDa <italic>mip</italic> product shares amino acid sequence similarity and is a structural mimic of the mainly eukaryotic family of FK-506 binding proteins, a class of immunophilins (Fischer et al., <xref ref-type="bibr" rid="B12">1992</xref>; Hacker and Fischer, <xref ref-type="bibr" rid="B17">1993</xref>; Riboldi-Tunnicliffe et al., <xref ref-type="bibr" rid="B32">2001</xref>).</p>
<p>The limitation of using <italic>mip</italic> and 16S rRNA for molecular detection or the 23S&#x02013;5S rRNA gene spacer region is that without nucleotide sequencing or other post-PCR analysis, these targets cannot distinguish serogroup 1 <italic>L. pneumophila</italic> from other serogroups and/or cannot detect non-<italic>pneumophila</italic> species of <italic>Legionella</italic> (Maurin et al., <xref ref-type="bibr" rid="B22">2010</xref>; Yang et al., <xref ref-type="bibr" rid="B44">2010</xref>). Since other serogroups of <italic>L. pneumophila</italic> and other species, such as <italic>L. longbeachae</italic> cause a significant burden of disease in many parts of the world (Yu et al., <xref ref-type="bibr" rid="B45">2002</xref>; Gobin et al., <xref ref-type="bibr" rid="B15">2009</xref>), their diagnosis and detection should be incorporated into any new molecular test. Non-serogroup 1 <italic>L. pneumophila</italic> and other species are currently likely to be significantly underrepresented given the bias of available tests such as the urine antigen test to the detection of <italic>L. pneumophila</italic> serogroup 1 (Benin et al., <xref ref-type="bibr" rid="B3">2002</xref>). Therefore, there is significant scope to expand and improve current testing for <italic>Legionella</italic>.</p>
</sec>
<sec>
<title>Can <italic>Legionella</italic> Genomics Inform Molecular Detection Methods?</title>
<p>The recent <italic>L. pneumophila</italic> serogroup 1 genome sequences are an invaluable resource for molecular epidemiology and analysis of <italic>L. pneumophila</italic> genetic diversity. The six available <italic>L. pneumophila</italic> genome sequences are all serogroup 1 human clinical isolates with worldwide distribution, and include endemic and epidemic strains (McDade et al., <xref ref-type="bibr" rid="B23">1977</xref>; Jepras et al., <xref ref-type="bibr" rid="B19">1985</xref>; Aurell et al., <xref ref-type="bibr" rid="B1">2003</xref>; Nguyen et al., <xref ref-type="bibr" rid="B27">2006</xref>; D&#x00027;Auria et al., <xref ref-type="bibr" rid="B10">2010</xref>; Schroeder et al., <xref ref-type="bibr" rid="B35">2010</xref>). The core <italic>L. pneumophila</italic> genome contains many of the factors associated with the ability of the bacteria to replicate in eukaryotic cells but there is also great variability between strains (Cazalet et al., <xref ref-type="bibr" rid="B5">2008</xref>). Comparative analysis of the <italic>L. pneumophila</italic> genomes has revealed a diverse species where 7&#x02013;11% of the genes in each <italic>L. pneumophila</italic> isolate are strain specific (Gomez-Valero et al., <xref ref-type="bibr" rid="B16">2009</xref>). The genome exhibits high plasticity which presumably reflects the ability of the pathogen to acquire new genetic factors that enhance environmental survival and bacterial replication in eukaryotic cells. Some of the diversity occurs among genes encoding Dot/Icm effectors, including those within the same family (Cazalet et al., <xref ref-type="bibr" rid="B5">2008</xref>). Nevertheless, many elements of the <italic>L. pneumophila</italic> genome are highly conserved and these less variable factors may constitute useful targets for molecular detection and typing. In contrast to <italic>L. pneumophila</italic>, the <italic>L. longbeachae</italic> genome appears more highly conserved with few differences between strains and serotypes (Cazalet et al., <xref ref-type="bibr" rid="B4">2010</xref>; Kozak et al., <xref ref-type="bibr" rid="B20">2010</xref>).</p>
<p>One of the most striking features of the <italic>L. pneumophila</italic> genome is the number and type of genes predicted to encode products that share similarity with eukaryotic proteins (Cazalet et al., <xref ref-type="bibr" rid="B6">2004</xref>; Gomez-Valero et al., <xref ref-type="bibr" rid="B16">2009</xref>; Lomma et al., <xref ref-type="bibr" rid="B21">2009</xref>; Schroeder et al., <xref ref-type="bibr" rid="B35">2010</xref>). For example, <italic>L. pneumophila</italic> produces two enzymes that belong to the mammalian CD39 family of ecto-nucleoside triphosphate diphosphohydrolases (NTPDases) (Sansom et al., <xref ref-type="bibr" rid="B33">2007</xref>; Galka et al., <xref ref-type="bibr" rid="B14">2008</xref>). NTPDases are associated almost exclusively with eukaryotes and so the <italic>L. pneumophila</italic> proteins, Lpg1905, and Lpg0971 are likely to contribute to the way the bacteria interact with eukaryotic cells by mimicking eukaryotic NTPDases. Indeed, we showed recently that the bacterial protein is a conserved structural mimic of mammalian NTPDases (Vivian et al., <xref ref-type="bibr" rid="B40">2010</xref>) and that Lpg1905 enhances <italic>L. pneumophila</italic> intracellular replication (Sansom et al., <xref ref-type="bibr" rid="B33">2007</xref>; Sansom et al., <xref ref-type="bibr" rid="B34">2008</xref>). Virulence genes of <italic>L. pneumophila</italic> such as the eukaryotic type effectors or even genes of the Dot/Icm type IV secretion system have not yet been used widely as targets for molecular detection. However, since much of the detailed genetic information on <italic>L. pneumophila</italic> has only been obtained in recent years, the field of molecular diagnostics and detection is perhaps yet to capitalize on the usefulness of this information to inform molecular testing. Given the limited scope of the current PCR based tests, we believe that a knowledge of <italic>Legionella</italic> genomics could be used to improve rapid molecular detection of <italic>Legionella</italic> in environmental and clinical samples.</p>
</sec>
<sec>
<title>Development of New Generation Molecular Tests: An Example in Progress</title>
<p>Although the identification of <italic>Legionella</italic> species and serogroup is important for clinical and environmental management as well as epidemiological analysis, few rapid molecular tests can differentiate isolates of <italic>L. pneumophila</italic> serogroup 1 from other serogroups as well as <italic>L. pneumophila</italic> from other <italic>Legionella</italic> species (Tronel and Hartemann, <xref ref-type="bibr" rid="B39">2009</xref>). Prior to determination of the <italic>Legionella</italic> genome sequences, we identified genes that were specific to <italic>L. pneumophila</italic> by experimental genomic subtractive hybridization of <italic>L. pneumophila</italic> with <italic>L. micdadei</italic> (Newton et al., <xref ref-type="bibr" rid="B26">2006</xref>; Sansom et al., <xref ref-type="bibr" rid="B33">2007</xref>). Two targets emerged as potentially useful for discriminating <italic>Legionella</italic> species and serogroups based on the fact that one, <italic>lpg0774</italic> (<italic>lpp0839</italic>) (Cazalet et al., <xref ref-type="bibr" rid="B5">2008</xref>), was associated with the serogroup 1 LPS biosynthesis region and another, <italic>lpg1905</italic> (<italic>lpp1880</italic>) encoding one of the <italic>L. pneumophila</italic> ecto-NTPDases (Sansom et al., <xref ref-type="bibr" rid="B33">2007</xref>; Sansom et al., <xref ref-type="bibr" rid="B34">2008</xref>), was specifically associated with <italic>L. pneumophila</italic>. We then assessed the suitability of these genes for the detection of <italic>L. pneumophila</italic> in clinical and environmental samples by designing a multiplex PCR to include <italic>lpg0774</italic>, <italic>lpg1905,</italic> and 16S rRNA. This multiplex PCR allowed the simultaneous identification of the genus <italic>Legionella</italic>, <italic>L. pneumophila,</italic> and serogroup 1 isolates of <italic>L. pneumophila</italic> when tested against a culture collection that comprised 36 strains of <italic>L. pneumophila</italic> of various serogroups and 20 non-<italic>pneumophila</italic> species (Figure <xref ref-type="fig" rid="F1">1</xref> and not shown). The PCR was also effective when tested on a limited number of environmental and clinical samples (Figure <xref ref-type="fig" rid="F2">2</xref>). To our knowledge this is the first attempt to distinguish <italic>L. pneumophila</italic> from other <italic>Legionella</italic> species that does not rely on knowledge of the <italic>mip</italic> or 16S rRNA nucleotide sequence and that can identify serogroup 1 <italic>L. pneumophila</italic> without post-PCR analysis.</p>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption><p><bold>Representative gel showing simultaneous detection of <italic>lpg1905</italic>, <italic>lpg0774,</italic> and 16SrRNA by multiplex PCR</bold>. Std, 100 base pair marker (Promega); Lane 1, no DNA control; Lane 2, <italic>L. pneumophila</italic> serogroup 1 strain 02/41; Lane 3, <italic>L. pneumophila</italic> serogroup 1 strain B6; Lane 4, <italic>L. pneumophila</italic> serogroup 1 strain CS1; Lane 5, <italic>L. pneumophila</italic> serogroup 1 strain 02/41; Lane 6, <italic>L. pneumophila</italic> serogroup 2&#x02013;14 strain C11(1); Lane 7, <italic>L. pneumophila</italic> serogroup 2&#x02013;14 strain C4(1); Lane 8, <italic>L. gormanii</italic> strain C9; Lane 9, <italic>L. anisa</italic> strain L041; Lane 10, <italic>L. gormanii</italic> 03/69; 11, <italic>L. longbeachae</italic> A4C5; 12, <italic>L. longbeachae</italic> ATCC33462; 13, <italic>L. longbeachae</italic> Atlanta 5. For <italic>lpg0774</italic> (Gene Bank: AY688227) the upstream primer started at base 46: 5&#x02032;-TGCTAACAACCACTATCCCAAA-3&#x02032; and downstream primer started at base 202: 5&#x02032;-GTTTCAATAAAAGCGTGCTCCT-3&#x02032;. The upstream primer of <italic>lpg1905</italic> (Gene Bank: NC_002942) started at base 328: 5&#x02032;-TTGCCTAAAACTCACCACAGAA-3&#x02032; and downstream primer started at base 857: 5&#x02032;-5&#x02032;ATGCCGCCCAAAATATACC-3&#x02032;. The 16S rRNA primers included in the triplex PCR to identify the genus <italic>Legionella</italic> have been described previously (Miyamoto et al., <xref ref-type="bibr" rid="B24">1997</xref>). Triplex PCR was performed using 20&#x02009;ng of template DNA in a 25 &#x003BC;L PCR reaction mix containing 1 &#x000D7; Green GoTaq&#x000AE; Flexi Buffer (Promega), 2&#x02009;mM MgCl<sub>2</sub>, 200 &#x003BC;M dNTP, 0.5 &#x003BC;M of each primer and 1&#x02009;U GoTaq&#x000AE; DNA polymerase. The optimized triplex PCR condition was performed in MyCycler&#x02122; (BIORAD) at initial denaturation of 95&#x000B0;C for 4&#x02009;min followed by 35 cycles of 95&#x000B0;C for 1&#x02009;min, 57.5&#x000B0;C for 1&#x02009;min, and 72&#x000B0;C for 1&#x02009;min with a final extension at 72&#x000B0;C for 5&#x02009;min. The amplified products were then analyzed by DNA gel electrophoresis.</p></caption>
<graphic xlink:href="fmicb-01-00123-g001.tif"/>
</fig>
<fig id="F2" position="float">
<label>Figure 2</label>
<caption><p><bold>Detection of <italic>lpg1905</italic>, <italic>lpg0774,</italic> and 16SrRNA in environmental and clinical samples by multiplex PCR.</bold> <bold>(A)</bold> Detection of <italic>Legionella</italic> spp. in cooling towers at an office building. Std, 100 base pair marker (Promega); Lane 1, negative control (no DNA); Lane 2, <italic>L. pneumophila</italic> serogroup 1 strain 02/41; Lane 3, Cooling tower 1; Lane 4, Cooling tower 2. <bold>(B)</bold> Detection of <italic>Legionella</italic> spp. in cooling tower and shower head water samples collected from a hotel. Std, 100 base pair marker (Promega); Lane 1, negative control (no DNA); Lane 2, <italic>L. pneumophila</italic> serogroup 1 strain 02/41; Lane 3, Cooling tower surface water; Lane 4, Cooling tower sediment; Lane 5, Shower head 915; Lane 6, Shower head 1617. <bold>(C)</bold> Detection of <italic>Legionella</italic> spp. in patient samples. Std, 100 base pair marker (Promega); Lane 1, negative control (no DNA); Lane 2, <italic>L. pneumophila</italic> serogroup 1 strain 02/41; Lane 3, Sputum spiked with <italic>L. pneumophila</italic> serogroup 1 strain 02/41; Lane 4, Patient 1 (male, 22 years old), sputum sample; Lane 5, Patient 2 (male, 70 years old), bronchial wash; Lane 6, Patient 3 (male, 56 years old), sputum sample. In the above examples, 500&#x02009;ml of cooling tower water was collected by immersing a sterilized 1000&#x02009;ml bottle approximately 10&#x02009;cm below water surface. To collect a showerhead sample, hot water was turned on for 5&#x02009;min prior to collection of 50&#x02009;ml of sample. Water samples were pressure filtered through a 0.45 &#x003BC;m cellulose nitrate membrane (Millipore), and eluted with 5&#x02009;ml of sterile phosphate buffered saline (PBS pH 7.2). Following centrifugation (4,000&#x02009;rpm, 20&#x02009;min) the resulting sediment was resuspended in 2&#x02009;ml sterile distilled water. Total DNA was extracted from 200 &#x003BC;l of the sediment suspension using the QIAamp DNA Mini Kit (Qaigen, Germany). A further 1&#x02009;ml of sediment suspension was treated with 9&#x02009;ml of HCl&#x02013;KCl pH 2.2 (0.1&#x02009;M Tris HCl, 0.1&#x02009;M KCl) for 20&#x02009;min then cultured onto BCYE agar containing GVPC selective supplement (Oxoid). 100&#x02009;ml of the non-acid treated sediment suspension was also diluted 10-fold and cultured on BCYE-GVPC media. Total DNA was extracted from patient sputum and bronchial washes using QIAamp DNA blood mini kit (Qiagen). To liquefy viscose and sticky sputum samples, 40 &#x003BC;l of freshly prepared sputasol (0.75% [wt/vol]) (Oxoid) was added into 200 &#x003BC;l of sputum sample and the mixture was incubated at 37&#x000B0;C for 30&#x02009;min (Bencini et al., <xref ref-type="bibr" rid="B2">2007</xref>). The remaining 200 &#x003BC;l sputum or bronchial wash was cultured on BCYE media containing BMPA selective supplement (Oxoid). &#x0002A; indicates samples that were also positive for <italic>L. pneumophila</italic> by bacteriological culture.</p></caption>
<graphic xlink:href="fmicb-01-00123-g002.tif"/>
</fig>
</sec>
<sec>
<title>What is the Scope for Future Molecular Detection of <italic>Legionella</italic>?</title>
<p>The recent advances in <italic>Legionella</italic> genomics offer the possibility to rethink the targets currently used for molecular detection and diagnostics. Analysis of the nucleotide sequence of the LPS biosynthesis regions for various serogroups could be adapted to the type of multiplexing described above and used to detect less common serogroups that have been associated with infection such as serogroup 3 (Chien et al., <xref ref-type="bibr" rid="B7">2010</xref>). Additionally, with new knowledge of the genomes of other <italic>Legionella</italic> pathogens, such as <italic>L. longbeachae</italic> and <italic>L. micdadei</italic>, simple tests could be developed to identify multiple <italic>Legionella</italic> species using species-specific genetic targets. Targets drawn from comparative genomics will need to be validated against a large and diverse <italic>Legionella</italic> culture collection to ensure that they are as sensitive and accurate as possible. For example, although our own work suggested that <italic>lpg0774</italic> was exclusively associated with serogroup 1 strains of <italic>L. pneumophila</italic>, a recent genome screen by microarray suggested that <italic>lpg0774</italic> was present in 1 of 66 non-serogroup 1 strains of <italic>L. pneumophila</italic> (Cazalet et al., <xref ref-type="bibr" rid="B5">2008</xref>). In addition <italic>lpg0774</italic> was present in the majority but not all serogroup 1 <italic>L. pneumophila</italic> (128 of 150 isolates) (Cazalet et al., <xref ref-type="bibr" rid="B5">2008</xref>). The multi-genome analysis performed by Cazalet et al. (<xref ref-type="bibr" rid="B5">2008</xref>) did suggest however that other LPS biosynthesis genes, <italic>lpg0766</italic> (lpp0831), <italic>lpg0772</italic> (<italic>lpp0837</italic>/<italic>wzm</italic>), and <italic>lpg0773</italic> (<italic>lpp0873</italic>/<italic>wzt</italic>) may be useful markers of serogroup 1 strains of <italic>L. pneumophila</italic> as they were present in all serogroup 1 strains examined (150 isolates) and no non-serogroup 1 strains (66 isolates). Thus multiplex PCR using targets identified from comparative genomics, possibly combined with a recently described PCR based typing scheme that discriminates between monoclonal antibody subgroups of serogroup 1 strains (Thurmer et al., <xref ref-type="bibr" rid="B38">2009</xref>), could significantly enhance our ability to detect and identify species and subgroups of <italic>Legionella</italic> rapidly and accurately. With an ever increasing knowledge of genomics and gene variation in <italic>Legionella</italic>, it is timely to update detection procedures to provide more precise and discriminatory testing for <italic>Legionella</italic> in clinical and environmental samples.</p>
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<sec>
<title>Conflict of Interest Statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
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</body>
<back>
<ack><p>This work was supported by grants awarded to Elizabeth L. Hartland from the Australian National Health and Medical Research Council (NHMRC) and Stacey F. Y. Yong from the Ministry of Science, Technology and Innovation, Malaysia. Elizabeth L. Hartland is supported by an Australian Research Council Future Fellowship. Hayley J. Newton and Fiona M. Sansom are supported by NHMRC training fellowships.</p></ack>
<ref-list>
<title>References</title>
<ref id="B1"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Aurell</surname> <given-names>H.</given-names></name> <name><surname>Etienne</surname> <given-names>J.</given-names></name> <name><surname>Forey</surname> <given-names>F.</given-names></name> <name><surname>Reyrolle</surname> <given-names>M.</given-names></name> <name><surname>Girardo</surname> <given-names>P.</given-names></name> <name><surname>Farge</surname> <given-names>P.</given-names></name> <name><surname>Decludt</surname> <given-names>B.</given-names></name> <name><surname>Campese</surname> <given-names>C.</given-names></name> <name><surname>Vandenesch</surname> <given-names>F.</given-names></name> <name><surname>Jarraud</surname> <given-names>S.</given-names></name></person-group> (<year>2003</year>). <article-title><italic>Legionella pneumophila</italic> serogroup 1 strain Paris: endemic distribution throughout France</article-title>. <source>J. Clin. Microbiol.</source> <volume>41</volume>, <fpage>3320</fpage>&#x02013;<lpage>3322</lpage>.<pub-id pub-id-type="doi">10.1128/JCM.41.7.3320-3322.2003</pub-id><pub-id pub-id-type="pmid">12843082</pub-id></citation></ref>
<ref id="B2"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bencini</surname> <given-names>M. A.</given-names></name> <name><surname>van den Brule</surname> <given-names>A. J.</given-names></name> <name><surname>Claas</surname> <given-names>E. C.</given-names></name> <name><surname>Hermans</surname> <given-names>M. H.</given-names></name> <name><surname>Melchers</surname> <given-names>W. J.</given-names></name> <name><surname>Noordhoek</surname> <given-names>G. T.</given-names></name> <name><surname>Salimans</surname> <given-names>M. M.</given-names></name> <name><surname>Schirm</surname> <given-names>J.</given-names></name> <name><surname>Vink</surname> <given-names>C.</given-names></name> <name><surname>van der Zee</surname> <given-names>A.</given-names></name> <name><surname>Jansen</surname> <given-names>R.</given-names></name></person-group> (<year>2007</year>). <article-title>Multicenter comparison of molecular methods for detection of <italic>Legionella</italic> spp. in sputum samples</article-title>. <source>J. Clin. Microbiol.</source> <volume>45</volume>, <fpage>3390</fpage>&#x02013;<lpage>3392</lpage>.<pub-id pub-id-type="doi">10.1128/JCM.00505-07</pub-id><pub-id pub-id-type="pmid">17670926</pub-id></citation></ref>
<ref id="B3"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Benin</surname> <given-names>A. L.</given-names></name> <name><surname>Benson</surname> <given-names>R. F.</given-names></name> <name><surname>Arnold</surname> <given-names>K. E.</given-names></name> <name><surname>Fiore</surname> <given-names>A. E.</given-names></name> <name><surname>Cook</surname> <given-names>P. G.</given-names></name> <name><surname>Williams</surname> <given-names>L. K.</given-names></name> <name><surname>Fields</surname> <given-names>B.</given-names></name> <name><surname>Besser</surname> <given-names>R. E.</given-names></name></person-group> (<year>2002</year>). <article-title>An outbreak of travel-associated Legionnaires disease and Pontiac fever: the need for enhanced surveillance of travel-associated legionellosis in the United States</article-title>. <source>J. Infect. Dis.</source> <volume>185</volume>, <fpage>237</fpage>&#x02013;<lpage>243</lpage>.<pub-id pub-id-type="doi">10.1086/338060</pub-id><pub-id pub-id-type="pmid">11807698</pub-id></citation></ref>
<ref id="B4"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cazalet</surname> <given-names>C.</given-names></name> <name><surname>Gomez-Valero</surname> <given-names>L.</given-names></name> <name><surname>Rusniok</surname> <given-names>C.</given-names></name> <name><surname>Lomma</surname> <given-names>M.</given-names></name> <name><surname>Dervins-Ravault</surname> <given-names>D.</given-names></name> <name><surname>Newton</surname> <given-names>H. J.</given-names></name> <name><surname>Sansom</surname> <given-names>F. M.</given-names></name> <name><surname>Jarraud</surname> <given-names>S.</given-names></name> <name><surname>Zidane</surname> <given-names>N.</given-names></name> <name><surname>Ma</surname> <given-names>L.</given-names></name> <name><surname>Bouchier</surname> <given-names>C.</given-names></name> <name><surname>Etienne</surname> <given-names>J.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name> <name><surname>Buchrieser</surname> <given-names>C.</given-names></name></person-group> (<year>2010</year>). <article-title>Analysis of the <italic>Legionella</italic> longbeachae genome and transcriptome uncovers unique strategies to cause Legionnaires&#x02019; disease</article-title>. <source>PLoS Genet.</source> <volume>6</volume>, <fpage>e1000851</fpage>. <pub-id pub-id-type="doi">10.1371/journal.pgen.1000851</pub-id><pub-id pub-id-type="pmid">20174605</pub-id></citation></ref>
<ref id="B5"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cazalet</surname> <given-names>C.</given-names></name> <name><surname>Jarraud</surname> <given-names>S.</given-names></name> <name><surname>Ghavi-Helm</surname> <given-names>Y.</given-names></name> <name><surname>Kunst</surname> <given-names>F.</given-names></name> <name><surname>Glaser</surname> <given-names>P.</given-names></name> <name><surname>Etienne</surname> <given-names>J.</given-names></name> <name><surname>Buchrieser</surname> <given-names>C.</given-names></name></person-group> (<year>2008</year>). <article-title>Multigenome analysis identifies a worldwide distributed epidemic <italic>Legionella pneumophila</italic> clone that emerged within a highly diverse species</article-title>. <source>Genome Res.</source> <volume>18</volume>, <fpage>431</fpage>&#x02013;<lpage>441</lpage>.<pub-id pub-id-type="doi">10.1101/gr.7229808</pub-id><pub-id pub-id-type="pmid">18256241</pub-id></citation></ref>
<ref id="B6"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cazalet</surname> <given-names>C.</given-names></name> <name><surname>Rusniok</surname> <given-names>C.</given-names></name> <name><surname>Bruggemann</surname> <given-names>H.</given-names></name> <name><surname>Zidane</surname> <given-names>N.</given-names></name> <name><surname>Magnier</surname> <given-names>A.</given-names></name> <name><surname>Ma</surname> <given-names>L.</given-names></name> <name><surname>Tichit</surname> <given-names>M.</given-names></name> <name><surname>Jarraud</surname> <given-names>S.</given-names></name> <name><surname>Bouchier</surname> <given-names>C.</given-names></name> <name><surname>Vandenesch</surname> <given-names>F.</given-names></name> <name><surname>Kunst</surname> <given-names>F.</given-names></name> <name><surname>Etienne</surname> <given-names>J.</given-names></name> <name><surname>Glaser</surname> <given-names>P.</given-names></name> <name><surname>Buchrieser</surname> <given-names>C.</given-names></name></person-group> (<year>2004</year>). <article-title>Evidence in the <italic>Legionella pneumophila</italic> genome for exploitation of host cell functions and high genome plasticity</article-title>. <source>Nat. Genet.</source> <volume>36</volume>, <fpage>1165</fpage>&#x02013;<lpage>1173</lpage>.<pub-id pub-id-type="doi">10.1038/ng1447</pub-id><pub-id pub-id-type="pmid">15467720</pub-id></citation></ref>
<ref id="B7"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Chien</surname> <given-names>S. T.</given-names></name> <name><surname>Hsueh</surname> <given-names>J. C.</given-names></name> <name><surname>Lin</surname> <given-names>H. H.</given-names></name> <name><surname>Shih</surname> <given-names>H. Y.</given-names></name> <name><surname>Lee</surname> <given-names>T. M.</given-names></name> <name><surname>Ben</surname> <given-names>R. J.</given-names></name> <name><surname>Chou</surname> <given-names>S. T.</given-names></name> <name><surname>Fong</surname> <given-names>C. M.</given-names></name> <name><surname>Lin</surname> <given-names>Y. E.</given-names></name> <name><surname>Tseng</surname> <given-names>L. R.</given-names></name> <name><surname>Chiang</surname> <given-names>C. S.</given-names></name></person-group> (<year>2010</year>). <article-title>Epidemiological investigation of a case of nosocomial Legionnaires&#x02019; disease in Taiwan: implications for routine environmental surveillance</article-title>. <source>Clin. Microbiol. Infect.</source> <volume>16</volume>, <fpage>761</fpage>&#x02013;<lpage>763</lpage>.<pub-id pub-id-type="pmid">19624501</pub-id></citation></ref>
<ref id="B8"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cianciotto</surname> <given-names>N. P.</given-names></name> <name><surname>Bangsborg</surname> <given-names>J. M.</given-names></name> <name><surname>Eisenstein</surname> <given-names>B. I.</given-names></name> <name><surname>Engleberg</surname> <given-names>N. C.</given-names></name></person-group> (<year>1990</year>). <article-title>Identification of mip-like genes in the genus <italic>Legionella</italic></article-title>. <source>Infect. Immun.</source> <volume>58</volume>, <fpage>2912</fpage>&#x02013;<lpage>2918</lpage>.<pub-id pub-id-type="pmid">2387627</pub-id></citation></ref>
<ref id="B9"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cianciotto</surname> <given-names>N. P.</given-names></name> <name><surname>Fields</surname> <given-names>B. S.</given-names></name></person-group> (<year>1992</year>). <article-title><italic>Legionella pneumophila</italic> mip gene potentiates intracellular infection of protozoa and human macrophages</article-title>. <source>Proc. Natl. Acad. Sci. U.S.A.</source> <volume>89</volume>, <fpage>5188</fpage>&#x02013;<lpage>5191</lpage>.<pub-id pub-id-type="doi">10.1073/pnas.89.11.5188</pub-id><pub-id pub-id-type="pmid">1594630</pub-id></citation></ref>
<ref id="B10"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>D&#x00027;Auria</surname> <given-names>G.</given-names></name> <name><surname>Jimenez-Hernandez</surname> <given-names>N.</given-names></name> <name><surname>Peris-Bondia</surname> <given-names>F.</given-names></name> <name><surname>Moya</surname> <given-names>A.</given-names></name> <name><surname>Latorre</surname> <given-names>A.</given-names></name></person-group> (<year>2010</year>). <article-title><italic>Legionella pneumophila</italic> pangenome reveals strain-specific virulence factors</article-title>. <source>BMC Genomics</source> <volume>11</volume>, <fpage>181</fpage>. <pub-id pub-id-type="doi">10.1186/1471-2164-11-181</pub-id><pub-id pub-id-type="pmid">20236513</pub-id></citation></ref>
<ref id="B11"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Fields</surname> <given-names>B. S.</given-names></name> <name><surname>Benson</surname> <given-names>R. F.</given-names></name> <name><surname>Besser</surname> <given-names>R. E.</given-names></name></person-group> (<year>2002</year>). <article-title><italic>Legionella</italic> and Legionnaires&#x02019; disease: 25 years of investigation</article-title>. <source>Clin. Microbiol. Rev.</source> <volume>15</volume>, <fpage>506</fpage>&#x02013;<lpage>526</lpage>.<pub-id pub-id-type="doi">10.1128/CMR.15.3.506-526.2002</pub-id><pub-id pub-id-type="pmid">12097254</pub-id></citation></ref>
<ref id="B12"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Fischer</surname> <given-names>G.</given-names></name> <name><surname>Bang</surname> <given-names>H.</given-names></name> <name><surname>Ludwig</surname> <given-names>B.</given-names></name> <name><surname>Mann</surname> <given-names>K.</given-names></name> <name><surname>Hacker</surname> <given-names>J.</given-names></name></person-group> (<year>1992</year>). <article-title>Mip protein of <italic>Legionella pneumophila</italic> exhibits peptidyl-prolyl-cis/trans isomerase (PPlase) activity</article-title>. <source>Mol. Microbiol.</source> <volume>6</volume>, <fpage>1375</fpage>&#x02013;<lpage>1383</lpage>.<pub-id pub-id-type="doi">10.1111/j.1365-2958.1992.tb00858.x</pub-id><pub-id pub-id-type="pmid">1379319</pub-id></citation></ref>
<ref id="B13"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Franco</surname> <given-names>I. S.</given-names></name> <name><surname>Shuman</surname> <given-names>H. A.</given-names></name> <name><surname>Charpentier</surname> <given-names>X.</given-names></name></person-group> (<year>2009</year>). <article-title>The perplexing functions and surprising origins of <italic>Legionella pneumophila</italic> type IV secretion effectors</article-title>. <source>Cell. Microbiol.</source> <volume>11</volume>, <fpage>1435</fpage>&#x02013;<lpage>1443</lpage>.<pub-id pub-id-type="doi">10.1111/j.1462-5822.2009.01351.x</pub-id><pub-id pub-id-type="pmid">19563462</pub-id></citation></ref>
<ref id="B14"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Galka</surname> <given-names>F.</given-names></name> <name><surname>Wai</surname> <given-names>S. N.</given-names></name> <name><surname>Kusch</surname> <given-names>H.</given-names></name> <name><surname>Engelmann</surname> <given-names>S.</given-names></name> <name><surname>Hecker</surname> <given-names>M.</given-names></name> <name><surname>Schmeck</surname> <given-names>B.</given-names></name> <name><surname>Hippenstiel</surname> <given-names>S.</given-names></name> <name><surname>Uhlin</surname> <given-names>B. E.</given-names></name> <name><surname>Steinert</surname> <given-names>M.</given-names></name></person-group> (<year>2008</year>). <article-title>Proteomic characterization of the whole secretome of <italic>Legionella pneumophila</italic> and functional analysis of outer membrane vesicles</article-title>. <source>Infect. Immun.</source> <volume>76</volume>, <fpage>1825</fpage>&#x02013;<lpage>1836</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.01396-07</pub-id><pub-id pub-id-type="pmid">18250176</pub-id></citation></ref>
<ref id="B15"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gobin</surname> <given-names>I.</given-names></name> <name><surname>Newton</surname> <given-names>P. R.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name> <name><surname>Newton</surname> <given-names>H. J.</given-names></name></person-group> (<year>2009</year>). <article-title>Infections caused by non-pneumophila species of <italic>Legionella</italic></article-title>. <source>Rev. Med. Microbiol.</source> <volume>20</volume>, <fpage>1</fpage>&#x02013;<lpage>11</lpage>.</citation></ref>
<ref id="B16"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gomez-Valero</surname> <given-names>L.</given-names></name> <name><surname>Rusniok</surname> <given-names>C.</given-names></name> <name><surname>Buchrieser</surname> <given-names>C.</given-names></name></person-group> (<year>2009</year>). <article-title><italic>Legionella pneumophila</italic>: population genetics, phylogeny and genomics</article-title>. <source>Infect. Genet. Evol.</source> <volume>9</volume>, <fpage>727</fpage>&#x02013;<lpage>739</lpage>.<pub-id pub-id-type="doi">10.1016/j.meegid.2009.05.004</pub-id><pub-id pub-id-type="pmid">19450709</pub-id></citation></ref>
<ref id="B17"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hacker</surname> <given-names>J.</given-names></name> <name><surname>Fischer</surname> <given-names>G.</given-names></name></person-group> (<year>1993</year>). <article-title>Immunophilins: structure-function relationship and possible role in microbial pathogenicity</article-title>. <source>Mol. Microbiol.</source> <volume>10</volume>, <fpage>445</fpage>&#x02013;<lpage>456</lpage>.<pub-id pub-id-type="doi">10.1111/j.1365-2958.1993.tb00917.x</pub-id><pub-id pub-id-type="pmid">7526121</pub-id></citation></ref>
<ref id="B18"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Isberg</surname> <given-names>R. R.</given-names></name> <name><surname>O&#x00027;Connor</surname> <given-names>T. J.</given-names></name> <name><surname>Heidtman</surname> <given-names>M.</given-names></name></person-group> (<year>2009</year>). <article-title>The <italic>Legionella pneumophila</italic> replication vacuole: making a cosy niche inside host cells</article-title>. <source>Nat. Rev. Microbiol.</source> <volume>7</volume>, <fpage>13</fpage>&#x02013;<lpage>24</lpage>.<pub-id pub-id-type="doi">10.1038/nrmicro1967</pub-id><pub-id pub-id-type="pmid">19011659</pub-id></citation></ref>
<ref id="B19"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Jepras</surname> <given-names>R. I.</given-names></name> <name><surname>Fitzgeorge</surname> <given-names>R. B.</given-names></name> <name><surname>Baskerville</surname> <given-names>A.</given-names></name></person-group> (<year>1985</year>). <article-title>A comparison of virulence of two strains of <italic>Legionella pneumophila</italic> based on experimental aerosol infection of guinea-pigs</article-title>. <source>J. Hyg. (Lond.)</source> <volume>95</volume>, <fpage>29</fpage>&#x02013;<lpage>38</lpage>.<pub-id pub-id-type="doi">10.1017/S0022172400062252</pub-id><pub-id pub-id-type="pmid">4020112</pub-id></citation></ref>
<ref id="B20"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kozak</surname> <given-names>N. A.</given-names></name> <name><surname>Buss</surname> <given-names>M.</given-names></name> <name><surname>Lucas</surname> <given-names>C. E.</given-names></name> <name><surname>Frace</surname> <given-names>M.</given-names></name> <name><surname>Govil</surname> <given-names>D.</given-names></name> <name><surname>Travis</surname> <given-names>T.</given-names></name> <name><surname>Olsen-Rasmussen</surname> <given-names>M.</given-names></name> <name><surname>Benson</surname> <given-names>R. F.</given-names></name> <name><surname>Fields</surname> <given-names>B. S.</given-names></name></person-group> (<year>2010</year>). <article-title>Virulence factors encoded by <italic>Legionella</italic> longbeachae identified on the basis of the genome sequence analysis of clinical isolate D-4968</article-title>. <source>J. Bacteriol.</source> <volume>192</volume>, <fpage>1030</fpage>&#x02013;<lpage>1044</lpage>.<pub-id pub-id-type="doi">10.1128/JB.01272-09</pub-id><pub-id pub-id-type="pmid">20008069</pub-id></citation></ref>
<ref id="B21"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lomma</surname> <given-names>M.</given-names></name> <name><surname>Gomez-Valero</surname> <given-names>L.</given-names></name> <name><surname>Rusniok</surname> <given-names>C.</given-names></name> <name><surname>Buchrieser</surname> <given-names>C.</given-names></name></person-group> (<year>2009</year>). <article-title><italic>Legionella pneumophila</italic> &#x02013; host interactions: insights gained from comparative genomics and cell biology</article-title>. <source>Genome Dyn.</source> <volume>6</volume>, <fpage>170</fpage>&#x02013;<lpage>186</lpage>.<pub-id pub-id-type="doi">10.1159/000235770</pub-id><pub-id pub-id-type="pmid">19696501</pub-id></citation></ref>
<ref id="B22"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Maurin</surname> <given-names>M.</given-names></name> <name><surname>Hammer</surname> <given-names>L.</given-names></name> <name><surname>Gestin</surname> <given-names>B.</given-names></name> <name><surname>Timsit</surname> <given-names>J. F.</given-names></name> <name><surname>Rogeaux</surname> <given-names>O.</given-names></name> <name><surname>Delavena</surname> <given-names>F.</given-names></name> <name><surname>Tous</surname> <given-names>J.</given-names></name> <name><surname>Epaulard</surname> <given-names>O.</given-names></name> <name><surname>Brion</surname> <given-names>J. P.</given-names></name> <name><surname>Croize</surname> <given-names>J.</given-names></name></person-group> (<year>2010</year>). <article-title>Quantitative real-time PCR tests for diagnostic and prognostic purposes in cases of legionellosis</article-title>. <source>Clin. Microbiol. Infect.</source> <volume>16</volume>, <fpage>379</fpage>&#x02013;<lpage>384</lpage>.<pub-id pub-id-type="doi">10.1111/j.1469-0691.2009.02812.x</pub-id><pub-id pub-id-type="pmid">19519843</pub-id></citation></ref>
<ref id="B23"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>McDade</surname> <given-names>J. E.</given-names></name> <name><surname>Shepard</surname> <given-names>C. C.</given-names></name> <name><surname>Fraser</surname> <given-names>D. W.</given-names></name> <name><surname>Tsai</surname> <given-names>T. R.</given-names></name> <name><surname>Redus</surname> <given-names>M. A.</given-names></name> <name><surname>Dowdle</surname> <given-names>W. R.</given-names></name></person-group> (<year>1977</year>). <article-title>Legionnaires&#x02019; disease: isolation of a bacterium and demonstration of its role in other respiratory disease</article-title>. <source>N. Engl. J. Med.</source> <volume>297</volume>, <fpage>1197</fpage>&#x02013;<lpage>1203</lpage>.<pub-id pub-id-type="doi">10.1056/NEJM197712012972202</pub-id><pub-id pub-id-type="pmid">335245</pub-id></citation></ref>
<ref id="B24"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Miyamoto</surname> <given-names>H.</given-names></name> <name><surname>Yamamoto</surname> <given-names>H.</given-names></name> <name><surname>Arima</surname> <given-names>K.</given-names></name> <name><surname>Fujii</surname> <given-names>J.</given-names></name> <name><surname>Maruta</surname> <given-names>K.</given-names></name> <name><surname>Izu</surname> <given-names>K.</given-names></name> <name><surname>Shiomori</surname> <given-names>T.</given-names></name> <name><surname>Yoshida</surname> <given-names>S.</given-names></name></person-group> (<year>1997</year>). <article-title>Development of a new seminested PCR method for detection of <italic>Legionella</italic> species and its application to surveillance of legionellae in hospital cooling tower water</article-title>. <source>Appl. Environ. Microbiol.</source> <volume>63</volume>, <fpage>2489</fpage>&#x02013;<lpage>2494</lpage>.<pub-id pub-id-type="pmid">9212400</pub-id></citation></ref>
<ref id="B25"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Newton</surname> <given-names>H. J.</given-names></name> <name><surname>Ang</surname> <given-names>D. K.</given-names></name> <name><surname>van Driel</surname> <given-names>I. R.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name></person-group> (<year>2010</year>). <article-title>Molecular pathogenesis of infections caused by <italic>Legionella pneumophila</italic></article-title>. <source>Clin. Microbiol. Rev.</source> <volume>23</volume>, <fpage>274</fpage>&#x02013;<lpage>298</lpage>.<pub-id pub-id-type="doi">10.1128/CMR.00052-09</pub-id><pub-id pub-id-type="pmid">20375353</pub-id></citation></ref>
<ref id="B26"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Newton</surname> <given-names>H. J.</given-names></name> <name><surname>Sansom</surname> <given-names>F. M.</given-names></name> <name><surname>Bennett-Wood</surname> <given-names>V.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name></person-group> (<year>2006</year>). <article-title>Identification of <italic>Legionella pneumophila</italic>-specific genes by genomic subtractive hybridization with <italic>Legionella micdadei</italic> and identification of lpnE, a gene required for efficient host cell entry</article-title>. <source>Infect. Immun.</source> <volume>74</volume>, <fpage>1683</fpage>&#x02013;<lpage>1691</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.74.3.1683-1691.2006</pub-id><pub-id pub-id-type="pmid">16495539</pub-id></citation></ref>
<ref id="B27"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Nguyen</surname> <given-names>T. M.</given-names></name> <name><surname>Ilef</surname> <given-names>D.</given-names></name> <name><surname>Jarraud</surname> <given-names>S.</given-names></name> <name><surname>Rouil</surname> <given-names>L.</given-names></name> <name><surname>Campese</surname> <given-names>C.</given-names></name> <name><surname>Che</surname> <given-names>D.</given-names></name> <name><surname>Haeghebaert</surname> <given-names>S.</given-names></name> <name><surname>Ganiayre</surname> <given-names>F.</given-names></name> <name><surname>Marcel</surname> <given-names>F.</given-names></name> <name><surname>Etienne</surname> <given-names>J.</given-names></name> <name><surname>Desenclos</surname> <given-names>J. C.</given-names></name></person-group> (<year>2006</year>). <article-title>A community-wide outbreak of legionnaires disease linked to industrial cooling towers&#x02013; how far can contaminated aerosols spread? J</article-title>. <source>Infect. Dis</source>. <volume>193</volume>, <fpage>102</fpage>&#x02013;<lpage>111</lpage>.<pub-id pub-id-type="doi">10.1086/498575</pub-id><pub-id pub-id-type="pmid">16323138</pub-id></citation></ref>
<ref id="B28"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Nora</surname> <given-names>T.</given-names></name> <name><surname>Lomma</surname> <given-names>M.</given-names></name> <name><surname>Gomez-Valero</surname> <given-names>L.</given-names></name> <name><surname>Buchrieser</surname> <given-names>C.</given-names></name></person-group> (<year>2009</year>). <article-title>Molecular mimicry: an important virulence strategy employed by <italic>Legionella pneumophila</italic> to subvert host functions</article-title>. <source>Future Microbiol.</source> <volume>4</volume>, <fpage>691</fpage>&#x02013;<lpage>701</lpage>.<pub-id pub-id-type="doi">10.2217/fmb.09.47</pub-id><pub-id pub-id-type="pmid">19659425</pub-id></citation></ref>
<ref id="B29"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rantakokko-Jalava</surname> <given-names>K.</given-names></name> <name><surname>Jalava</surname> <given-names>J.</given-names></name></person-group> (<year>2001</year>). <article-title>Development of conventional and real-time PCR assays for detection of <italic>Legionella</italic> DNA in respiratory specimens</article-title>. <source>J. Clin. Microbiol.</source> <volume>39</volume>, <fpage>2904</fpage>&#x02013;<lpage>2910</lpage>.<pub-id pub-id-type="doi">10.1128/JCM.39.8.2904-2910.2001</pub-id><pub-id pub-id-type="pmid">11474011</pub-id></citation></ref>
<ref id="B30"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ratcliff</surname> <given-names>R. M.</given-names></name> <name><surname>Lanser</surname> <given-names>J. A.</given-names></name> <name><surname>Manning</surname> <given-names>P. A.</given-names></name> <name><surname>Heuzenroeder</surname> <given-names>M. W.</given-names></name></person-group> (<year>1998</year>). <article-title>Sequence-based classification scheme for the genus <italic>Legionella</italic> targeting the mip gene</article-title>. <source>J. Clin. Microbiol.</source> <volume>36</volume>, <fpage>1560</fpage>&#x02013;<lpage>1567</lpage>.<pub-id pub-id-type="pmid">9620377</pub-id></citation></ref>
<ref id="B31"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Reischl</surname> <given-names>U.</given-names></name> <name><surname>Linde</surname> <given-names>H. J.</given-names></name> <name><surname>Lehn</surname> <given-names>N.</given-names></name> <name><surname>Landt</surname> <given-names>O.</given-names></name> <name><surname>Barratt</surname> <given-names>K.</given-names></name> <name><surname>Wellinghausen</surname> <given-names>N.</given-names></name></person-group> (<year>2002</year>). <article-title>Direct detection and differentiation of <italic>Legionella</italic> spp. and <italic>Legionella pneumophila</italic> in clinical specimens by dual-color real-time PCR and melting curve analysis</article-title>. <source>J. Clin. Microbiol.</source> <volume>40</volume>, <fpage>3814</fpage>&#x02013;<lpage>3817</lpage>.<pub-id pub-id-type="doi">10.1128/JCM.40.10.3814-3817.2002</pub-id><pub-id pub-id-type="pmid">12354888</pub-id></citation></ref>
<ref id="B32"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Riboldi-Tunnicliffe</surname> <given-names>A.</given-names></name> <name><surname>Konig</surname> <given-names>B.</given-names></name> <name><surname>Jessen</surname> <given-names>S.</given-names></name> <name><surname>Weiss</surname> <given-names>M. S.</given-names></name> <name><surname>Rahfeld</surname> <given-names>J.</given-names></name> <name><surname>Hacker</surname> <given-names>J.</given-names></name> <name><surname>Fischer</surname> <given-names>G.</given-names></name> <name><surname>Hilgenfeld</surname> <given-names>R.</given-names></name></person-group> (<year>2001</year>). <article-title>Crystal structure of Mip, a prolylisomerase from <italic>Legionella pneumophila</italic></article-title>. <source>Nat. Struct. Biol.</source> <volume>8</volume>, <fpage>779</fpage>&#x02013;<lpage>783</lpage>.<pub-id pub-id-type="doi">10.1038/nsb0901-779</pub-id><pub-id pub-id-type="pmid">11524681</pub-id></citation></ref>
<ref id="B33"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Sansom</surname> <given-names>F. M.</given-names></name> <name><surname>Newton</surname> <given-names>H. J.</given-names></name> <name><surname>Crikis</surname> <given-names>S.</given-names></name> <name><surname>Cianciotto</surname> <given-names>N. P.</given-names></name> <name><surname>Cowan</surname> <given-names>P. J.</given-names></name> <name><surname>d&#x00027;Apice</surname> <given-names>A. J.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name></person-group> (<year>2007</year>). <article-title>A bacterial ecto-triphosphate diphosphohydrolase similar to human CD39 is essential for intracellular multiplication of <italic>Legionella pneumophila</italic></article-title>. <source>Cell. Microbiol.</source> <volume>9</volume>, <fpage>1922</fpage>&#x02013;<lpage>1935</lpage>.<pub-id pub-id-type="doi">10.1111/j.1462-5822.2007.00924.x</pub-id><pub-id pub-id-type="pmid">17388784</pub-id></citation></ref>
<ref id="B34"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Sansom</surname> <given-names>F. M.</given-names></name> <name><surname>Riedmaier</surname> <given-names>P.</given-names></name> <name><surname>Newton</surname> <given-names>H. J.</given-names></name> <name><surname>Dunstone</surname> <given-names>M. A.</given-names></name> <name><surname>Muller</surname> <given-names>C. E.</given-names></name> <name><surname>Stephan</surname> <given-names>H.</given-names></name> <name><surname>Byres</surname> <given-names>E.</given-names></name> <name><surname>Beddoe</surname> <given-names>T.</given-names></name> <name><surname>Rossjohn</surname> <given-names>J.</given-names></name> <name><surname>Cowan</surname> <given-names>P. J.</given-names></name> <name><surname>d&#x00027;Apice</surname> <given-names>A. J.</given-names></name> <name><surname>Robson</surname> <given-names>S. C.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name></person-group> (<year>2008</year>). <article-title>Enzymatic properties of an ecto-nucleoside triphosphate diphosphohydrolase from <italic>Legionella pneumophila</italic>: substrate specificity and requirement for virulence</article-title>. <source>J. Biol. Chem.</source> <volume>283</volume>, <fpage>12909</fpage>&#x02013;<lpage>12918</lpage>.<pub-id pub-id-type="doi">10.1074/jbc.M801006200</pub-id><pub-id pub-id-type="pmid">18337253</pub-id></citation></ref>
<ref id="B35"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Schroeder</surname> <given-names>G. N.</given-names></name> <name><surname>Petty</surname> <given-names>N. K.</given-names></name> <name><surname>Mousnier</surname> <given-names>A.</given-names></name> <name><surname>Harding</surname> <given-names>C. R.</given-names></name> <name><surname>Vogrin</surname> <given-names>A. J.</given-names></name> <name><surname>Wee</surname> <given-names>B.</given-names></name> <name><surname>Fry</surname> <given-names>N. K.</given-names></name> <name><surname>Harrison</surname> <given-names>T. G.</given-names></name> <name><surname>Newton</surname> <given-names>H. J.</given-names></name> <name><surname>Thomson</surname> <given-names>N. R.</given-names></name> <name><surname>Beatson</surname> <given-names>S.</given-names></name> <name><surname>Dougan</surname> <given-names>G.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name> <name><surname>Frankel</surname> <given-names>G.</given-names></name></person-group> (<year>2010</year>). <article-title><italic>Legionella pneumophila</italic> strain 130b possesses a unique combination of type IV secretion systems and novel Dot/Icm type IV secretion system effector proteins</article-title>. <source>J. Bacteriol.</source> <volume>192</volume>, <fpage>6001</fpage>&#x02013;<lpage>6016</lpage>.<pub-id pub-id-type="doi">10.1128/JB.00778-10</pub-id><pub-id pub-id-type="pmid">20833813</pub-id></citation></ref>
<ref id="B36"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Shin</surname> <given-names>S.</given-names></name> <name><surname>Roy</surname> <given-names>C. R.</given-names></name></person-group> (<year>2008</year>). <article-title>Host cell processes that influence the intracellular survival of <italic>Legionella pneumophila</italic></article-title>. <source>Cell. Microbiol.</source> <volume>10</volume>, <fpage>1209</fpage>&#x02013;<lpage>1220</lpage>.<pub-id pub-id-type="doi">10.1111/j.1462-5822.2008.01145.x</pub-id><pub-id pub-id-type="pmid">18363881</pub-id></citation></ref>
<ref id="B37"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Templeton</surname> <given-names>K. E.</given-names></name> <name><surname>Scheltinga</surname> <given-names>S. A.</given-names></name> <name><surname>Sillekens</surname> <given-names>P.</given-names></name> <name><surname>Crielaard</surname> <given-names>J. W.</given-names></name> <name><surname>van Dam</surname> <given-names>A. P.</given-names></name> <name><surname>Goossens</surname> <given-names>H.</given-names></name> <name><surname>Claas</surname> <given-names>E. C.</given-names></name></person-group> (<year>2003</year>). <article-title>Development and clinical evaluation of an internally controlled, single-tube multiplex real-time PCR assay for detection of <italic>Legionella pneumophila</italic> and other <italic>Legionella</italic> species</article-title>. <source>J. Clin. Microbiol.</source> <volume>41</volume>, <fpage>4016</fpage>&#x02013;<lpage>4021</lpage>.<pub-id pub-id-type="doi">10.1128/JCM.41.9.4016-4021.2003</pub-id><pub-id pub-id-type="pmid">12958219</pub-id></citation></ref>
<ref id="B38"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Thurmer</surname> <given-names>A.</given-names></name> <name><surname>Helbig</surname> <given-names>J. H.</given-names></name> <name><surname>Jacobs</surname> <given-names>E.</given-names></name> <name><surname>Luck</surname> <given-names>P. C.</given-names></name></person-group> (<year>2009</year>). <article-title>PCR-based &#x0201C;serotyping&#x0201D; of <italic>Legionella pneumophila</italic></article-title>. <source>J. Med. Microbiol.</source> <volume>58</volume>, <fpage>588</fpage>&#x02013;<lpage>595</lpage>.<pub-id pub-id-type="doi">10.1099/jmm.0.008508-0</pub-id><pub-id pub-id-type="pmid">19369520</pub-id></citation></ref>
<ref id="B39"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Tronel</surname> <given-names>H.</given-names></name> <name><surname>Hartemann</surname> <given-names>P.</given-names></name></person-group> (<year>2009</year>). <article-title>Overview of diagnostic and detection methods for legionellosis and <italic>Legionella</italic> spp</article-title>. <source>Lett. Appl. Microbiol.</source> <volume>48</volume>, <fpage>653</fpage>&#x02013;<lpage>656</lpage>.<pub-id pub-id-type="pmid">19291209</pub-id></citation></ref>
<ref id="B40"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Vivian</surname> <given-names>J. P.</given-names></name> <name><surname>Riedmaier</surname> <given-names>P.</given-names></name> <name><surname>Ge</surname> <given-names>H.</given-names></name> <name><surname>Le Nours</surname> <given-names>J.</given-names></name> <name><surname>Sansom</surname> <given-names>F. M.</given-names></name> <name><surname>Wilce</surname> <given-names>M. C.</given-names></name> <name><surname>Byres</surname> <given-names>E.</given-names></name> <name><surname>Dias</surname> <given-names>M.</given-names></name> <name><surname>Schmidberger</surname> <given-names>J. W.</given-names></name> <name><surname>Cowan</surname> <given-names>P. J.</given-names></name> <name><surname>d&#x00027;Apice</surname> <given-names>A. J.</given-names></name> <name><surname>Hartland</surname> <given-names>E. L.</given-names></name> <name><surname>Rossjohn</surname> <given-names>J.</given-names></name> <name><surname>Beddoe</surname> <given-names>T.</given-names></name></person-group> (<year>2010</year>). <article-title>Crystal structure of a <italic>Legionella pneumophila</italic> ecto-triphosphate diphosphohydrolase, a structural and functional homolog of the eukaryotic NTPDases</article-title>. <source>Structure</source> <volume>18</volume>, <fpage>228</fpage>&#x02013;<lpage>238</lpage>.<pub-id pub-id-type="doi">10.1016/j.str.2009.11.014</pub-id><pub-id pub-id-type="pmid">20159467</pub-id></citation></ref>
<ref id="B41"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wilson</surname> <given-names>D. A.</given-names></name> <name><surname>Reischl</surname> <given-names>U.</given-names></name> <name><surname>Hall</surname> <given-names>G. S.</given-names></name> <name><surname>Procop</surname> <given-names>G. W.</given-names></name></person-group> (<year>2007</year>). <article-title>Use of partial 16S rRNA gene sequencing for identification of <italic>Legionella pneumophila</italic> and non-pneumophila <italic>Legionella</italic> spp</article-title>. <source>J. Clin. Microbiol.</source> <volume>45</volume>, <fpage>257</fpage>&#x02013;<lpage>258</lpage>.<pub-id pub-id-type="doi">10.1128/JCM.01552-06</pub-id><pub-id pub-id-type="pmid">17108074</pub-id></citation></ref>
<ref id="B42"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wilson</surname> <given-names>D. A.</given-names></name> <name><surname>Yen-Lieberman</surname> <given-names>B.</given-names></name> <name><surname>Reischl</surname> <given-names>U.</given-names></name> <name><surname>Gordon</surname> <given-names>S. M.</given-names></name> <name><surname>Procop</surname> <given-names>G. W.</given-names></name></person-group> (<year>2003</year>). <article-title>Detection of <italic>Legionella pneumophila</italic> by real-time PCR for the mip gene</article-title>. <source>J. Clin. Microbiol.</source> <volume>41</volume>, <fpage>3327</fpage>&#x02013;<lpage>3330</lpage>.<pub-id pub-id-type="doi">10.1128/JCM.41.7.3327-3330.2003</pub-id><pub-id pub-id-type="pmid">12843084</pub-id></citation></ref>
<ref id="B43"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wintermeyer</surname> <given-names>E.</given-names></name> <name><surname>Ludwig</surname> <given-names>B.</given-names></name> <name><surname>Steinert</surname> <given-names>M.</given-names></name> <name><surname>Schmidt</surname> <given-names>B.</given-names></name> <name><surname>Fischer</surname> <given-names>G.</given-names></name> <name><surname>Hacker</surname> <given-names>J.</given-names></name></person-group> (<year>1995</year>). <article-title>Influence of site specifically altered Mip proteins on intracellular survival of <italic>Legionella pneumophila</italic> in eukaryotic cells</article-title>. <source>Infect. Immun.</source> <volume>63</volume>, <fpage>4576</fpage>&#x02013;<lpage>4583</lpage>.<pub-id pub-id-type="pmid">7591108</pub-id></citation></ref>
<ref id="B44"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Yang</surname> <given-names>G.</given-names></name> <name><surname>Benson</surname> <given-names>R.</given-names></name> <name><surname>Pelish</surname> <given-names>T.</given-names></name> <name><surname>Brown</surname> <given-names>E.</given-names></name> <name><surname>Winchell</surname> <given-names>J. M.</given-names></name> <name><surname>Fields</surname> <given-names>B.</given-names></name></person-group> (<year>2010</year>). <article-title>Dual detection of <italic>Legionella pneumophila</italic> and <italic>Legionella</italic> species by real-time PCR targeting the 23S-5S rRNA gene spacer region</article-title>. <source>Clin. Microbiol. Infect.</source> <volume>16</volume>, <fpage>255</fpage>&#x02013;<lpage>261</lpage>.<pub-id pub-id-type="doi">10.1111/j.1469-0691.2009.02766.x</pub-id><pub-id pub-id-type="pmid">19438641</pub-id></citation></ref>
<ref id="B45"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Yu</surname> <given-names>V. L.</given-names></name> <name><surname>Plouffe</surname> <given-names>J. F.</given-names></name> <name><surname>Pastoris</surname> <given-names>M. C.</given-names></name> <name><surname>Stout</surname> <given-names>J. E.</given-names></name> <name><surname>Schousboe</surname> <given-names>M.</given-names></name> <name><surname>Widmer</surname> <given-names>A.</given-names></name> <name><surname>Summersgill</surname> <given-names>J.</given-names></name> <name><surname>File</surname> <given-names>T.</given-names></name> <name><surname>Heath</surname> <given-names>C. M.</given-names></name> <name><surname>Paterson</surname> <given-names>D. L.</given-names></name> <name><surname>Chereshsky</surname> <given-names>A.</given-names></name></person-group> (<year>2002</year>). <article-title>Distribution of <italic>Legionella</italic> species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey</article-title>. <source>J. Infect. Dis.</source> <volume>186</volume>, <fpage>127</fpage>&#x02013;<lpage>128</lpage>.<pub-id pub-id-type="doi">10.1086/341087</pub-id><pub-id pub-id-type="pmid">12089674</pub-id></citation></ref>
</ref-list>
</back>
</article>