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Role of Coccidioides Antigen testing in the Cerebrospinal Fluid for the Diagnosis of Coccidioidal Meningitis.
Clin Infect Dis. 2015 Jul 24;
Authors: Kassis C, Zaidi S, Kuberski T, Moran A, Gonzalez O, Hussain S, Hartmann-Manrique C, Al-Jashaami L, Chebbo A, Myers RA, Wheat LJ
Abstract
BACKGROUND: Coccidioidal meningitis (CM), a common cause of chronic meningitis in endemic area, is usually diagnosed by detection of anti-Coccidioides antibodies in cerebrospinal fluid (CSF), which may be negative in up to 1/3 of cases. CSF cultures and cytology are infrequently positive. Antigen detection has been used for the diagnosis of other forms of coccidioidomycosis, and meningitis caused by other mycoses. The purpose of this study is to assess the diagnostic utility of CSF Coccidioides antigen (CAg) detection for the diagnosis of CM.
METHOD: The medical records of patients with clinically suspected meningitis, in whom CSF was tested for Coccidioides antibodies and CAg, were retrospectively reviewed at Maricopa Integrated Health System. CSF CAg testing was prospectively conducted on patients with CM at St. Joseph's Hospital and Medical Center. All specimens were submitted to MiraVista Diagnostics for CAg testing.
RESULTS: Thirty six patients with 42 episode of CM were studied. The sensitivity and specificity of CAg was 93% and 100% respectively. Cultures of CSF were positive in 7%, antibodies by ID in 67%, antibodies by CF in 70 %, IgM antibodies by EIA in 8% and IgG antibodies by EIA in 85 %.
CONCLUSION: Testing CSF for Coccidioides antigen is a useful addition to the diagnostic armamentarium in suspected CM, and complements testing by CSF antibodies and culture.
PMID: 26209683 [PubMed - as supplied by publisher]