National survey of physicians in Japan regarding their use of diagnostic tests for legionellosis

  • Takeshi Kinjo
    Correspondence
    Corresponding author. 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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  • Akihiro Ito
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
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  • Makoto Ishii
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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  • Kosaku Komiya
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Respiratory Medicine and Infectious Diseases, Oita University, Oita, Japan
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  • Mari Yamasue
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Respiratory Medicine and Infectious Diseases, Oita University, Oita, Japan
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  • Tetsuo Yamaguchi
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
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  • Yoshifumi Imamura
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Medical Education Development Center, Nagasaki University Hospital, Nagasaki, Japan
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  • Naoki Iwanaga
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
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  • Kazuhiro Tateda
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
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  • Kazuyoshi Kawakami
    Affiliations
    Legionellosis Surveillance Working Group of the Japanese Association for Infectious Diseases, Japan

    Department of Medical Microbiology, Mycology and Immunology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Published:December 18, 2021DOI:https://doi.org/10.1016/j.jiac.2021.12.008

      Abstract

      Introduction

      Bacterial culture remains the gold standard for the diagnosis of legionellosis. However, past reports indicate that most physicians use the urinary antigen test (UAT) alone. Combining it with other tests is important, especially in patients with negative UAT results. The aim of this study was to investigate the current situation of legionellosis diagnostics and clarify the issues that need to be addressed.

      Methods

      Between March 1, 2021 and April 30, 2021, a questionnaire survey was conducted in an anonymous manner among physicians working in Japan. Questionnaires were generated on a website and asked questions in a multiple-choice format.

      Results

      Valid responses were received from 309 physicians during the study period. Most (92.9%) physicians reported using UAT as the initial test for patients suspected of having legionellosis, and <10% reported using other tests (e.g., culture, nucleic acid amplification test [NAAT], Gimenez staining, and serum antibody titer measurement [ATM]). When the initial test result was negative, 63% of physicians reported not conducting additional tests. Even when they chose to run additional tests, at most 27.8%, 23.6%, 12.3%, and 10.4% of all physicians used NAAT, culture, Gimenez staining, and serum ATM, respectively. The major reasons for not using tests other than UAT were “unavailability in the medical facility,” “long turn-around time,” and “difficult to collect sputum.”

      Conclusions

      The present survey revealed that most physicians in Japan used UAT alone for diagnosing legionellosis. Eliminating barriers to creating a reasonable environment and edification of physicians are needed to improve the current situation.

      Keywords

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