Diagnostic Challenges of Binax Urinary EIA for Detection of Legionella pneumophila

Abstract

A middle-aged African American male with a history of stage 2 chronic kidney disease status post double kidney transplant was admitted after developing symptoms of respiratory infection during the peak of COVID-19. The patient rapidly developed acute hypoxemic respiratory failure. Differentials for the patient included COVID-19, opportunistic infection such as mycoplasma, and legionella. During the admission, the patient had numerous infectious disease screening tests run including a COVID-19 test and Binax urine antigen test for legionella that all came back negative. The patient was started on Doxycycline, due to a recent Mycoplasma infection, Ceftriaxone, Lasix, and Methylprednisolone. Treatment was ineffective and the decision was made to step up investigations to a more invasive procedure. The patient then had bronchoalveolar lavage samples cultured returning a positive legionella sample. The patient was then successfully treated with Azithromycin with resolution of symptoms.