Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts

Abstract

Serologic studies are an important diagnostic tool in the clinical evaluation and follow-up of persons with coccidioidomycosis. Numerous types of serologic tests are available, including immunodiffusion, enzyme immunoassay, and complement fixation. We conducted a retrospective review of the results of 1,797 serologic tests spanning 12 months from the onset of coccidioidomycosis in 298 immunocompetent and 62 immunosuppressed persons with symptomatic infection. Using the onset of symptoms as a reference point, we plotted the positive or negative serologic results over time for both groups. Compared with the immunocompetent group, immunosuppressed persons had lower rates of seropositivity for every type of test during the first year after onset of symptoms for coccidioidomycosis, although many results did not achieve statistical significance. Combining the results of these tests increased the sensitivity of the serologic evaluation in immunocompromised patients. Immunosuppressed persons have the ability to mount a serologic response to coccidioidomycosis, but in some circumstances, multiple methods may be required to improve detection.

Coccidioidomicosis cutánea: Comunicación de seis casos mexicanos

“…La inmunodifusión (ID) es una prueba muy específica que se usa como prueba confirmatoria de EIA. Las dos últimas se realizan en laboratorios de referencia 10,11 .…”

Clinical Specificity of the Enzyme Immunoassay Test for Coccidioidomycosis Varies According to the Reason for Its Performance

“…The EIA is a useful test because it can be done locally and has demonstrated better sensitivity in early coccidioidal illness than other methods (3,4). Two EIA kits are available commercially, without discernible differences in performance between them; both are easy in use, have a rapid turnaround time, and can be performed in local laboratories.…”

“…While serologic tests for Coccidioides organisms are considered more reliable than for other fungal infections (2), the sensitivity of coccidioidal serologic testing ranges from 0% to 100%, depending on the ability to mount an antibody response to the infection, the presence of an immunocompromising illness or medication, and the timing of the blood draw relative to the onset of symptoms (3).…”

“…In addition, the EIA is more sensitive early in the disease process than are complement fixation (CF) and immunodiffusion (ID) (3,4). However, the EIA has generated some controversy, especially as it pertains to the particular finding of immunoglobulin M (IgM) reactivity in the absence of any immunoglobulin G (IgG) detected (EIA IgM ϩ /IgG Ϫ ).…”

The Utility of Fine Needle Aspiration for Diagnosis of Extrapulmonary Coccidioidomycosis: A Case Report and Discussion

“…Serologic antibody detection tests for Coccidioides are usually immunodiffusion or complement fixationbased, but they carry the disadvantage of being labor intensive and sometimes lacking sensitivity, particularly in the early stages of infection. [4][5][6] Skin antigen testing is becoming available, but will remain positive in the case of asymptomatic or remote infections. 7,8 Additionally, patients with extensive disease may be anergic.…”