Coccidioidomycosis: Laboratory diagnosis and screening
- John N Galgiani, MD
John N Galgiani, MD
- Professor of Medicine
- University of Arizona
Coccidioides spp (C. immitis and C. posadasii), which are fungi endemic in desert regions of the southwestern United States and Central and South America, cause coccidioidomycosis. Coccidioidomycosis has protean manifestations and is frequently unrecognized, especially in travelers to endemic areas who return to locations where the disease is not typically encountered. Without specific laboratory tests, it is generally not possible to differentiate coccidioidal infections from numerous other illnesses. This is especially true for the initial respiratory illness .
Several routine tests are commonly abnormal, especially with early coccidioidal pneumonia, but all are nonspecific. These include a slight increase in the peripheral white blood cell count, peripheral eosinophilia, and an elevated erythrocyte sedimentation rate . Notably, serum procalcitonin levels are often normal . Similarly, chest radiographs or other imaging procedures may also reveal abnormalities. Although occasionally suggestive of the precise diagnosis , confirmatory tests are nearly always needed.
Conventional approaches to diagnosing coccidioidomycosis involve identification or recovery of Coccidioides spp from clinical specimens and detection of specific anticoccidioidal antibodies in serum or other body fluids. The laboratory diagnosis of coccidioidomycosis will be reviewed here. The epidemiology, clinical manifestations, and treatment of coccidioidomycosis are discussed separately. (See "Primary coccidioidal infection" and "Coccidioidal meningitis" and "Coccidioidomycosis in compromised hosts" and "Management of pulmonary sequelae and complications of coccidioidomycosis" and "Manifestations and treatment of extrapulmonary coccidioidomycosis".)
DIAGNOSING PATIENTS WITH SYMPTOMATIC DISEASE
Approach to diagnosis — A variety of different tests can be used to diagnose coccidioidal infection. Which test to use depends in part upon the patient's signs and symptoms. Specific considerations for immunocompromised hosts and those with complications are presented elsewhere. (See "Coccidioidomycosis in compromised hosts" and "Manifestations and treatment of extrapulmonary coccidioidomycosis" and "Coccidioidal meningitis" and "Management of pulmonary sequelae and complications of coccidioidomycosis".)
Most ambulatory patients who are suspected of having coccidioidomycosis are evaluated with serologic testing. There are several serologic tests available:
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- DIAGNOSING PATIENTS WITH SYMPTOMATIC DISEASE
- Approach to diagnosis
- Diagnostic tests
- - Detection of anticoccidioidal antibodies
- Enzyme-linked immunoassays
- Complement fixing antibodies
- Tube precipitin-type antibodies
- Latex tests
- - Recovery of Coccidioides spp from clinical specimens
- Staining characteristics
- - Antigen detection
- SCREENING ASYMPTOMATIC PATIENTS
- Immunocompetent patients
- Immunocompromised hosts
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS