Preface 



This laboratory manual was designed to be used in training activities related to Legionnaires' 

 disease methodology and as such is intended to be a working model. It represents a concerted 

 effort to compile useful information for the medical community on the progress which has been 

 made at the Center for Disease Control (CDC) in defining a disease entity and its causative agent. 



The history and nature of Legionnaires' disease are discussed on the basis of evidence 

 gathered through examination of the clinical and pathological features of the disease. 



All of the known characteristics of the Legionnaires' disease bacterium (LDB), including 

 cellular fatty acid composition, antimicrobial susceptibility, and deoxyribonucleic acid (DNA) 

 hybridization, are described in a series of chapters. Brenner et al. proposed the classification 

 Legionella pueiuuophilu sp. nov. for the LDB after evaluating the results of their extensive DNA 

 relatedness studies with LDB strains from serogroups 1, 2, and 3. The recently described sero- 

 group 4, as well as some future LDB isolates, may or may not be closely related to these first 

 three serogroups; therefore, until proven to be L. piieuinopliila, they should be designated by the 

 broader term LDB. Since a clear-cut distinction is not always made between serogroups 1-3 

 (Z.. pneuniopliila) and serogroup 4, the editors and authors have used the more general and 

 familiar designation LDB when discussing the causative organism of Legionnaires' disease. 



Specific procedures are detailed for animal and egg inoculation, media preparation and use, 

 direct and indirect immunotluorescence, and various other methods for safely testing clinical 

 and environmental material. Although modifications in technique will continue to appear as 

 research progresses, the procedures outlined in this manual have proven reliable and can be used 

 diagnostically. 



Another section of the manual catalogs most aspects of the CDC assistance program pertain- 

 ing to Legionnaires" disease. Included are pohcies regarding technical support and consultation and 

 procedures to follow in obtaining materials and services beyond the scope of many institutions. 



The final section of the manual contains a reading bibliography as a general reference. We 

 realize that the rapidity with which new material on Legionnaires' disease is being published 

 makes any such listing incomplete. but it is offered to the reader as a reference base. 



Although the material presented in this manual reflects the "state of the science" relative 

 to the LDB at CDC, the editors wish to stress the fact that this is not an all-inclusive publication. 

 Valuable work is being reported from other institutions, and we urge the reader to utilize these 

 resources as they become available. 



In addition to the contributors listed elsewhere, this manual could not have been produced 

 without the assistance of Glenda S. Cowart and Thena M. Durham of the Biological Products 

 Division. Bureau of Laboratories; the staff of Publications Management Branch, and Louise 

 Lewis, CDC Library, Office of the Center Director; Fay Neal, Gerri Stedman, and Lois Jennings 

 of the Laboratory Training and Consultation Division, and Claudia Lewis, Effie Spencer, Donna 

 Mills, and Barbara Gary of the Word Processing Activity, Bureau of Laboratories. 



Gilchi L Jones 

 G. Ann Hebert 

 Editors 



IX 



