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The diagnosis of coccidioidomycosis relies heavily on serologic test results in addition to clinical history, physical examination, and radiographic findings. Use of the enzyme immunoassay (EIA) has increased because it is rapidly performed and does not require referral to a reference laboratory, as do complement fixation and immunodiffusion tests. However, interpretation of immunoglobulin M (IgM) reactivity by EIA in the absence of immunoglobulin G (IgG) reactivity has been problematic. We conducted a retrospective medical record review of all patients with such IgM reactivity at our institution to identify situations where the finding was more likely to be clinically specific for coccidioidal infection. From 1 January 2004 through 31 December 2008, a total of 1,117 patients had positive EIA coccidioidal serology or EIA IgM-only reactivity; of these, 102 patients (9%) had EIA IgM-only reactivity. Among the 102 patients with EIA IgM-only reactivity, 60 were tested to evaluate symptomatic illness, 13 for follow-up of previously abnormal serology, and 29 for screening purposes. Of the 102 patients, 80 (78%) had positive serologic findings by other methods or had positive culture or histology. Fifty-four (90%) of the 60 patients whose serology was performed to evaluate symptomatic illness had coccidioidal infection, whereas 13 (45%) of 29 patients whose serology was performed for screening purposes had coccidioidal infection. Of the 102 patients with isolated IgM reactivity by EIA, 12 later seroconverted to IgG and IgM reactivity. The use of EIA for screening in 29 asymptomatic persons was associated with unconfirmable results in 13 (45%). Although the majority of patients in our study with isolated IgM reactivity by EIA had probable or confirmed coccidioidomycosis, this result must be interpreted with caution for asymptomatic patients.

Coccidioidomycosis is associated with high morbidity and mortality in allo-HSCT recipients in an area endemic for Coccidioides. Diagnosis of this infection can be difficult and often requires multiple and frequently invasive tests. Antifungal prophylaxis should be considered for patients at highest risk.

1. Introduction. It is well known that there are infinitely many quadratic number fields with class number divisible by a given integer n (see Nagell [8] (1922) for imaginary fields and Yamamoto [11] (1970) and Weinberger [10] (1973) for real fields). A related question concerns the n-rank of the field, that is, the greatest integer r for which the class group contains a subgroup isomorphic to (Z/nZ) r . In [11], Yamamoto showed that infinitely many imaginary quadratic number fields have n-rank ≥ 2 for any positive integer n ≥ 2. In 1978, Diaz y Diaz [2] developed an algorithm for generating imaginary quadratic fields with 3-rank at least 2, and Craig [1] showed in 1973 that there are infinitely many real quadratic number fields with 3-rank at least 2 and infinitely many imaginary quadratic number fields with 3-rank at least 3. A few examples of higher 3-rank have also been found (see for instance Llorente and Quer [6,9] who found in 1987/1988 three imaginary quadratic number fields with 3-rank 6). In this paper, we give infinite, simply parameterized families of real and imaginary quadratic fields with 3-rank 2. Although the existence of such fields has been known, the fields here are much easier to describe, and the parameterization yields a new lower bound on the number of fields with discriminant < x and 3-rank ≥ 2 (see [7]).The main result is as follows:

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