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Open AccessArticle

Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis

1
California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA
2
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
3
Department of Medical Microbiology, University of California School of Medicine, Davis, CA 95616, USA
4
IMMY, Inc., 2701 Corporate Center Drive, Norman, OK 73069, USA
*
Author to whom correspondence should be addressed.
J. Fungi 2020, 6(3), 125; https://doi.org/10.3390/jof6030125
Received: 13 June 2020 / Revised: 27 July 2020 / Accepted: 28 July 2020 / Published: 4 August 2020
(This article belongs to the Special Issue Coccidioides and Coccidioidomycosis 2020)
Meningitis is the most devastating form of coccidioidomycosis. A convenient, rapid diagnostic method could result in early treatment and avoid many meningitis complications. We studied cerebrospinal fluid (CSF) samples in patients with documented coccidioidal meningitis, and controls, with complement fixation (CF), immunodiffusion (ID) (the “classical” assays), lateral flow assays (LFA; one-strip and two-strip), and two enzyme immunoassays (EIA). The two-strip LFA and EIAs not only enabled separate testing for IgG and IgM antibodies separately, but also could aggregate results for each method. CF with ID or the aggregate use of IgG and IgM tests were considered optimal test uses. LFAs and EIAs were evaluated at 1:21 and 1:441 dilutions of specimens. All assays were compared to true patient status. With 49 patient specimens and 40 controls, this is the largest comparative study of CSF coccidioidal diagnostics. Sensitivity of these tests ranged from 71–95% and specificity 90–100%. IgM assays were less sensitive. Assays at 1:441 were similarly specific but less sensitive, suggesting that serial dilutions of samples could result in assays yielding titers. Agreement of positive results on cases was 87–100%. When kits are available, hospital laboratories in endemic areas can perform testing. LFA assays do not require a laboratory, are simple to use, and give rapid results, potentially even at the bedside. View Full-Text
Keywords: Coccidioides; coccidioidomycosis; meningitis; enzyme immunoassay; lateral flow assay; fungal diagnosis Coccidioides; coccidioidomycosis; meningitis; enzyme immunoassay; lateral flow assay; fungal diagnosis
MDPI and ACS Style

Stevens, D.A.; Martinez, M.; Sass, G.; Pappagianis, D.; Doherty, B.; Kutsche, H.; McGuire, M. Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis. J. Fungi 2020, 6, 125.

AMA Style

Stevens DA, Martinez M, Sass G, Pappagianis D, Doherty B, Kutsche H, McGuire M. Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis. Journal of Fungi. 2020; 6(3):125.

Chicago/Turabian Style

Stevens, David A.; Martinez, Marife; Sass, Gabriele; Pappagianis, Demosthenes; Doherty, Brian; Kutsche, Hannah; McGuire, Meredith. 2020. "Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis" J. Fungi 6, no. 3: 125.

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