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Bryan AW, Sykes J, Crucillo K, Zhang K, Bays DJ, Cohen SH, Wilson MD, Thompson GR. Comparison of coccidioidal complement fixation and quantitative immunodiffusion serology at a reference laboratory. Med Mycol 2024; 62:myad121. [PMID: 38061838 DOI: 10.1093/mmy/myad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
The incidence of coccidioidomycosis continues to increase. The diagnosis frequently relies on non-invasive diagnostic testing with immunodiffusion and complement fixation (CF) testing the current gold standard. A direct comparison of quantitative immunodiffusion and CF for IgG antibodies has not been previously reported. In a comparison of 368 samples, there was close concordance observed (360/368 = 97.8%) (P-value < .001). These tests can be considerably interchangeable in the reference laboratory setting.
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Affiliation(s)
- Allen W Bryan
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Jane Sykes
- University of California, Davis, School of Veterinary Medicine, Davis, CA, USA
| | - Kelly Crucillo
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Kaihua Zhang
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
| | - Derek J Bays
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
| | - Stuart H Cohen
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
| | - Machelle D Wilson
- University of California, Davis, Department of Public Health Sciences, Division of Biostatistics, Clinical and Translational Science Center, Sacramento, CA, USA
| | - George R Thompson
- University of California, Davis, Department of Medical Microbiology and Immunology, Davis, CA, USA
- University of California, Davis, Coccidioidomycosis Serology Laboratory, Davis, CA, USA
- University of California, Davis, Department of Internal Medicine, Division of Infectious Diseases, Sacramento, CA, USA
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2
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Rozier LS, Mullaney SB, Thompson Iii GR, Moore GD, Ajufoh CO, Gerardo AA, Sykes JE. Coccidioides spp. exposure among military working dogs in endemic regions of the United States. Med Mycol 2023; 61:myad109. [PMID: 37935009 DOI: 10.1093/mmy/myad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023] Open
Abstract
Coccidioidomycosis is a fungal disease in arid regions of the United States that is predicted to expand with climate change. Cases in military personnel and military working dogs (MWDs) impact personnel readiness and result in healthcare costs. To examine Coccidioides exposure among MWDs, 276 banked serum samples were retrieved from dogs housed in California, Texas, Arizona, New Mexico, Nevada, and Utah. Using gel immunodiffusion, six (2.1%) specimens were IgG-positive and three (1.1%) were equivocally IgM-positive. The IgG-positive samples were from Arizona (2 [prevalence 8.0%]) and California (4 [3.7%]). These data will guide future efforts to study MWDs as sentinels for human coccidioidomycosis.
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Affiliation(s)
- Lege S Rozier
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - Sara B Mullaney
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - George R Thompson Iii
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Health, Sacramento, CA 95817, USA
- Medical Microbiology and Immunology, University of California, Davis, Davis, CA 95616, USA
| | - Gerald D Moore
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - Chiweta O Ajufoh
- Department of Chemistry and Life Science United States Military Academy, Bartlett Hall, West Point, NY 10996, USA
| | - Angelina A Gerardo
- Department of Defense Military Working Dog Veterinary Service, Lackland Air force base, 78236, USA
| | - Jane E Sykes
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA 95616, USA
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3
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Shah PJ, Ampel NM, Girardo ME, Blair JE. Serologic Rebound after Stopping Azoles for Primary Pulmonary Coccidioidomycosis: A Case-Controlled Observational Study. J Fungi (Basel) 2023; 9:901. [PMID: 37755009 PMCID: PMC10532748 DOI: 10.3390/jof9090901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND We sought to characterize the outcomes of patients with primary pulmonary coccidioidomycosis whose post-treatment complement fixation (CF) titer increased by more than 2 dilutions (serologic rebound) after discontinuation of antifungal treatment. METHODS We conducted a retrospective chart review of patients with primary pulmonary coccidioidomycosis and identified immunocompetent, non-pregnant adults who received antifungal treatment and then experienced a serologic rebound after treatment discontinuation. We compared these to matched controls similarly treated who did not have serologic rebound. RESULTS Fifty-eight patients experienced serologic rebound. Thirty (52%) of these were associated with symptoms. Nine were associated with radiographic progression. The median time to serologic rebound was 3.5 months. Antifungal treatment was reinitiated in 37 (63.7%) patients. Four of the 58 (6.9%) with rebounded serology subsequently developed extra-thoracic dissemination. Compared with matched controls, patients with rebounded serology were more likely to have post-treatment symptoms, reinitiation of antifungal therapy, and a longer duration of clinical follow-up. However, they were not more likely to experience extra-thoracic dissemination. CONCLUSION Serological rebound, manifested in at least 2-dilution rise of CF titer following antifungal treatment of primary pulmonary coccidioidomycosis, was uncommon, but resulted in longer clinical follow-up. Continued monitoring of such patients is important to identify the patients who develop subsequent symptoms, as well as extra-thoracic dissemination.
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Affiliation(s)
- Priyal J. Shah
- Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ 85054, USA; (P.J.S.); (N.M.A.)
| | - Neil M. Ampel
- Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ 85054, USA; (P.J.S.); (N.M.A.)
| | - Marlene E. Girardo
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ 85059, USA;
| | - Janis E. Blair
- Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ 85054, USA; (P.J.S.); (N.M.A.)
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4
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Abstract
Coccidioidomycosis, colloquially known as Valley Fever, is an invasive dimorphic fungal infection caused by Coccidioides immitis and C. posadasii. The fungi are found in the arid desert soils of the southwestern US, as well as in parts of Mexico and Central and South America. Acquisition is typically via inhalation of arthroconidia which become airborne after both natural (e.g., earthquakes, dust storms, and fires) and human-related events (e.g., military maneuvers, recreational activities, agriculture, and construction). The incidence of infection in increasing likely a result of both climatic and populational changes. Further, the recognized geographic distribution of Coccidioides spp. is expanding, as cases are being diagnosed in new areas (e.g., eastern Washington, Oregon, and Utah). Most coccidioidal infections are asymptomatic (60%); however, approximately one-third develop a pulmonary illness which is a leading cause of community-acquired pneumonia in highly endemic areas. Uncommonly (0.5–2% of cases), the infection disseminates to extrapulmonary locations (e.g., skin, bones/joints, and the central nervous system), and is most commonly seen among persons with cellular immunodeficiencies (e.g., transplant recipients, HIV, and pregnancy) and non-Caucasian races (especially African Americans and Filipinos). The diagnosis of coccidioidomycosis requires astute clinical suspicion and laboratory findings, including positive serology, cultures, and/or histopathology results. Treatment is warranted among persons with pneumonia who have risk factors for complicated disease and among those with extrapulmonary disease. Novel antifungals with improved fungicidal activity and rapidity of action with fewer side effects and drug interactions are needed. Preventive strategies (e.g., education regarding the disease, dust avoidance, mask wearing, including among select groups, antifungal prophylaxis, and surveillance laboratory testing) are advised for residents and travelers to endemic areas. Currently, no preventive vaccine is available. Coccidioidomycosis has been recognized for over a century, and an expanding wealth of knowledge has been gained regarding this emerging infectious disease which will be reviewed here.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Department, Scripps Health System, San Diego, CA, USA.
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Grill FJ, Grys TE, Grill MF, Roeder A, Blair JE, Lake DF. Development of a Quantitative Antigen Assay to Detect Coccidioidal Chitinase-1 (CTS1) in Human Serum. Open Forum Infect Dis 2021; 8:ofab344. [PMID: 34337097 PMCID: PMC8320284 DOI: 10.1093/ofid/ofab344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Coccidioidomycosis is often diagnosed with a collection of tests that rely on the patient's ability to mount an immune response to the fungus (antibody-based diagnostics), making diagnosis of this infection challenging. Here we present an antigen-based assay that detects and quantifies coccidioidal chitinase-1 (CTS1) in human serum. Methods An inhibition-based enzyme-linked immunoassay (ELISA) was developed that utilizes a monoclonal antibody specific for coccidioidal CTS1. CTS1 was quantified in commercial antigen preparations using recombinant CTS1 as a standard. Sera from 192 individuals from an endemic area were tested, which included 78 patients (40.6%) with proven or probable coccidioidomycosis. Results The quantity of CTS1 in diagnostic commercial antigen preparations from different suppliers varied. CTS1 antigenemia was detected in 87.2% of patients with proven or probable coccidioidomycosis. Specificity was determined to be 96.94% using serum from individuals who reside in the Phoenix, Arizona area who did not have coccidioidomycosis. Levels of CTS1 correlated with low- and high-titer serology from patients with a coccidioidomycosis diagnosis. Conclusions Since the CTS1 inhibition ELISA described in this report does not depend on the host immune response, it is a promising diagnostic tool to aid in diagnosis and disease monitoring of coccidioidomycosis.
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Affiliation(s)
- Francisca J Grill
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Thomas E Grys
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
| | - Marie F Grill
- Department of Neurology, Mayo Clinic, Phoenix, Arizona, USA
| | - Alexa Roeder
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Douglas F Lake
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
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6
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Galgiani JN, Blair JE, Ampel NM, Thompson GR. Treatment for Early, Uncomplicated Coccidioidomycosis: What Is Success? Clin Infect Dis 2021; 70:2008-2012. [PMID: 31544210 DOI: 10.1093/cid/ciz933] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
The care of primary pulmonary coccidioidomycosis remains challenging. Such infections produce a variety of signs, symptoms, and serologic responses that cause morbidity in patients and concern in treating clinicians for the possibility of extrapulmonary dissemination. Illness may be due to ongoing fungal growth that produces acute inflammatory responses, resulting in tissue damage and necrosis, and for this, administering an antifungal drug may be of benefit. In contrast, convalescence may be prolonged by other immunologic reactions to infection, even after fungal replication has been arrested, and in those situations, antifungal therapy is unlikely to yield clinical improvement. In this presentation, we discuss what findings are clinical indicators of fungal growth and what other sequelae are not. Understanding these differences provides a rational management strategy for deciding when to continue, discontinue, or reinstitute antifungal treatments.
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Affiliation(s)
- John N Galgiani
- Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.,Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Neil M Ampel
- Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.,Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA.,Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California, USA
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Donovan FM, Ramadan FA, Khan SA, Bhaskara A, Lainhart WD, Narang AT, Mosier JM, Ellingson KD, Bedrick EJ, Saubolle MA, Galgiani JN. Comparison of a Novel Rapid Lateral Flow Assay to Enzyme Immunoassay Results for Early Diagnosis of Coccidioidomycosis. Clin Infect Dis 2020; 73:e2746-e2753. [PMID: 32818956 DOI: 10.1093/cid/ciaa1205] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/13/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Coccidioidomycosis (CM) is a common cause of community acquired pneumonia (CAP) where CM is endemic. Manifestations include self-limited pulmonary infection, chronic fibrocavitary pulmonary disease, and disseminated coccidioidomycosis (DCM). Most infections are identified by serological assays including enzyme-linked immunoassay (EIA), complement fixation (CF) and immunodiffusion (IMDF). These are time-consuming and take days to result, impeding early diagnosis. A new lateral flow assay (LFA, Sōna, IMMY, Norman OK) improves time-to-result to one hour. METHODS We prospectively enrolled 392 suspected CM patients, compared the LFA to standard EIA and included procalcitonin evaluation. RESULTS Compared to standard EIA, LFA demonstrates 31% sensitivity (95% CI of 20%-44%) and 92% specificity (95% CI of 88%-95%). Acute pulmonary disease (74%) was the most common clinical syndrome. Hospitalized patients constituted 75% of subjects, and compared to outpatients, they more frequently had ≥ 3 previous healthcare facility visits (p = 0.05), received antibacterials (p & 0.01) and had > 3 antibacterial courses (p & 0.01). Procalcitonin (PCT) was &0.25 ng/ml in 52 (83%) EIA+ patients, suggesting infection was not bacterial. CONCLUSIONS When CM is a possible diagnosis, LFA identified nearly a third of EIA+ infections. Combined with PCT &0.25 ng/ml, LFA could reduce unnecessary antibacterial use by 77%.
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Affiliation(s)
- Fariba M Donovan
- The Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona.,The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - Ferris A Ramadan
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, Arizona
| | - Sher A Khan
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, Arizona
| | - Apoorva Bhaskara
- The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - William D Lainhart
- The University of Arizona College of Medicine-Tucson, Tucson, Arizona.,Department of Pathology, University of Arizona College of Medicine-Tucson, Tucson Arizona
| | - Aneesh T Narang
- University of Arizona College of Medicine-Phoenix, and Banner-University Medical Center Phoenix, Phoenix, Arizona
| | - Jarrod M Mosier
- The University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | - Katherine D Ellingson
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, Arizona
| | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, Arizona
| | - Michael A Saubolle
- University of Arizona College of Medicine-Phoenix, and Banner-University Medical Center Phoenix, Phoenix, Arizona
| | - John N Galgiani
- The Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona.,The University of Arizona College of Medicine-Tucson, Tucson, Arizona
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8
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Thompson GR, Lewis JS, Nix DE, Patterson TF. Current Concepts and Future Directions in the Pharmacology and Treatment of Coccidioidomycosis. Med Mycol 2019; 57:S76-S84. [PMID: 30690601 DOI: 10.1093/mmy/myy029] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/19/2022] Open
Abstract
Coccidioidomycosis remains a significant clinical problem with substantial morbidity and mortality. The vast majority of infections are asymptomatic and the need for early primary therapy remains controversial. The use of triazole antifungals has improved tolerability of therapy but concerns about acute and long-term toxicities among available agents limit their use. In addition, recent findings of decreased in vitro fluconazole susceptibility to as many as 37% of Coccidioides spp. isolates raises concerns regarding optimal therapy for these infections as fluconazole is commonly used for therapy including central nervous system disease. Thus, new agents from novel antifungal classes are currently in preclinical and clinical development aimed at reducing toxicity and improving outcomes of these serious infections.
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Affiliation(s)
- George R Thompson
- Department of Medical Microbiology and Immunology, University of California, Davis; Davis, California, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center; Sacramento, California, USA
| | - James S Lewis
- Department of Pharmacy, Oregon Health & Science University Hospital and Clinics, Portland, Oregon, USA
| | - David E Nix
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Thomas F Patterson
- Division of Infectious Diseases, UT Health San Antonio, and the South Texas Veterans Health Care System; San Antonio, Texas, USA
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Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals. J Clin Microbiol 2018; 56:JCM.01318-18. [PMID: 30257902 PMCID: PMC6258849 DOI: 10.1128/jcm.01318-18] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
Abstract
Coccidioidomycosis is associated with a broad spectrum of illness severity, ranging from asymptomatic or self-limited pulmonary infection to life-threatening manifestations of disseminated disease. Serologic studies before the widespread availability of antifungals established current understanding of serologic kinetics and dynamics. Coccidioidomycosis is associated with a broad spectrum of illness severity, ranging from asymptomatic or self-limited pulmonary infection to life-threatening manifestations of disseminated disease. Serologic studies before the widespread availability of antifungals established current understanding of serologic kinetics and dynamics. Chart histories and complement fixation (CF) titer trends were analyzed for 434 antifungal-treated coccidioidomycosis patients, who were classified by three infectious disease physicians as having either pulmonary uncomplicated coccidioidomycosis (PUC) (n = 248), pulmonary chronic coccidioidomycosis (PCC) (n = 64), disseminated coccidioidomycosis (DC) not including meningitis (n = 86), or coccidioidal meningitis (CM) (n = 36). The median maximal CF titers were 1:4 for PUC patients, 1:24 for PCC patients, 1:128 for DC patients, and 1:32 for CM patients. Approximately 25.4% of PUC patients, 6.2% of PCC patients, 2.3% of DC patients, and 8.3% of CM patients did not develop detectable titers during the study period. Maximal titers developed a mean of 31 days (95% confidence interval [CI], 13 to 50 days) after initial serologic positivity, with no significant differences between groups. Serologic recurrence occurred in 9% of PUC patients, 36% of PCC patients, 50% of DC patients, and 52% of CM patients. Median titer improvement rates were 91 days/dilution for PUC patients, 112 days/dilution for PCC patients, 136 days/dilution for DC patients, and 146 days/dilution for CM patients. Receiver operating characteristic (ROC) analysis revealed that CF testing retains moderate classification value for disseminated infections (area under the curve [AUC], 0.82 [95% CI, 0.78 to 0.87]) and complicated infections (AUC, 0.82 [95% CI, 0.77 to 0.86]). A suitable cutoff value for complicated infections is ≥1:32. Findings update serologic parameters that are relevant for clinical assessment of coccidioidomycosis patients in the triazole era.
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Donovan FM, Zangeneh TT, Malo J, Galgiani JN. Top Questions in the Diagnosis and Treatment of Coccidioidomycosis. Open Forum Infect Dis 2017; 4:ofx197. [PMID: 29670928 PMCID: PMC5903411 DOI: 10.1093/ofid/ofx197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/09/2017] [Indexed: 02/06/2023] Open
Abstract
Revised and greatly expanded treatment guidelines for coccidioidomycosis were published last year by the Infectious Diseases Society of America. We have selected 4 questions that commonly arise in the management of patients suspected of this disease and for which there remain divided opinions.
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Affiliation(s)
- Fariba M Donovan
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Tirdad T Zangeneh
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Joshua Malo
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - John N Galgiani
- The Valley Fever Center for Excellence and Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
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12
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Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, Johnson RH, Kusne S, Lisse J, MacDonald JD, Meyerson SL, Raksin PB, Siever J, Stevens DA, Sunenshine R, Theodore N. 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis 2016; 63:e112-46. [PMID: 27470238 DOI: 10.1093/cid/ciw360] [Citation(s) in RCA: 323] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.
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Affiliation(s)
| | - Neil M Ampel
- Division of Infectious Diseases, University of Arizona, Tucson
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Antonino Catanzaro
- Division of Pulmonary and Critical Care, University of California, San Diego
| | - Francesca Geertsma
- Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California
| | | | - Royce H Johnson
- David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California
| | - Shimon Kusne
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey Lisse
- Department of Rheumatology, University of Arizona, Tucson
| | - Joel D MacDonald
- Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City
| | - Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine
| | - Patricia B Raksin
- Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | | | - David A Stevens
- Division of Infectious Diseases, Stanford University School of Medicine, California
| | - Rebecca Sunenshine
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention Maricopa County Department of Public Health
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
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14
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Lee CY, Thompson III GR, Hastey CJ, Hodge GC, Lunetta JM, Pappagianis D, Heinrich V. Coccidioides Endospores and Spherules Draw Strong Chemotactic, Adhesive, and Phagocytic Responses by Individual Human Neutrophils. PLoS One 2015; 10:e0129522. [PMID: 26070210 PMCID: PMC4466529 DOI: 10.1371/journal.pone.0129522] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022] Open
Abstract
Coccidioides spp. are dimorphic pathogenic fungi whose parasitic forms cause coccidioidomycosis (Valley fever) in mammalian hosts. We use an innovative interdisciplinary approach to analyze one-on-one encounters between human neutrophils and two forms of Coccidioides posadasii. To examine the mechanisms by which the innate immune system coordinates different stages of the host response to fungal pathogens, we dissect the immune-cell response into chemotaxis, adhesion, and phagocytosis. Our single-cell technique reveals a surprisingly strong response by initially quiescent neutrophils to close encounters with C. posadasii, both from a distance (by complement-mediated chemotaxis) as well as upon contact (by serum-dependent adhesion and phagocytosis). This response closely resembles neutrophil interactions with Candida albicans and zymosan particles, and is significantly stronger than the neutrophil responses to Cryptococcus neoformans, Aspergillus fumigatus, and Rhizopus oryzae under identical conditions. The vigorous in vitro neutrophil response suggests that C. posadasii evades in vivo recognition by neutrophils through suppression of long-range mobilization and recruitment of the immune cells. This observation elucidates an important paradigm of the recognition of microbes, i.e., that intact immunotaxis comprises an intricate spatiotemporal hierarchy of distinct chemotactic processes. Moreover, in contrast to earlier reports, human neutrophils exhibit vigorous chemotaxis toward, and frustrated phagocytosis of, the large spherules of C. posadasii under physiological-like conditions. Finally, neutrophils from healthy donors and patients with chronic coccidioidomycosis display subtle differences in their responses to antibody-coated beads, even though the patient cells appear to interact normally with C. posadasii endospores.
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Affiliation(s)
- Cheng-Yuk Lee
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States of America
| | - George R. Thompson III
- Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California Davis, Davis, California, United States of America
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, United States of America
| | - Christine J. Hastey
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States of America
| | - Gregory C. Hodge
- Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California Davis, Davis, California, United States of America
| | - Jennine M. Lunetta
- Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California Davis, Davis, California, United States of America
| | - Demosthenes Pappagianis
- Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California Davis, Davis, California, United States of America
| | - Volkmar Heinrich
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States of America
- * E-mail:
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15
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Peptide based diagnostics: Are random-sequence peptides more useful than tiling proteome sequences? J Immunol Methods 2015; 417:10-21. [DOI: 10.1016/j.jim.2014.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/08/2014] [Accepted: 12/05/2014] [Indexed: 11/19/2022]
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16
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Blair JE, Chang YHH, Cheng MR, Vaszar LT, Vikram HR, Orenstein R, Kusne S, Ho S, Seville MT, Parish JM. Characteristics of patients with mild to moderate primary pulmonary coccidioidomycosis. Emerg Infect Dis 2015; 20:983-90. [PMID: 24865953 PMCID: PMC4036774 DOI: 10.3201/eid2006.131842] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In Arizona, USA, primary pulmonary coccidioidomycosis accounts for 15%-29% of community-acquired pneumonia. To determine the evolution of symptoms and changes in laboratory values for patients with mild to moderate coccidioidomycosis during 2010-2012, we conducted a prospective 24-week study of patients with primary pulmonary coccidioidomycosis. Of the 36 patients, 16 (44%) were men and 33 (92%) were White. Median age was 53 years, and 20 (56%) had received antifungal treatment at baseline. Symptom scores were higher for patients who received treatment than for those who did not. Median times from symptom onset to 50% reduction and to complete resolution for patients in treatment and nontreatment groups were 9.9 and 9.1 weeks, and 18.7 and 17.8 weeks, respectively. Median times to full return to work were 8.4 and 5.7 weeks, respectively. One patient who received treatment experienced disseminated infection. For otherwise healthy adults with acute coccidioidomycosis, convalescence was prolonged, regardless of whether they received antifungal treatment.
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Call for a California Coccidioidomycosis Consortium to Face the Top Ten Challenges Posed by a Recalcitrant Regional Disease. Mycopathologia 2014; 179:1-9. [DOI: 10.1007/s11046-014-9816-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
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18
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Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther 2014; 12:1103-35. [PMID: 25077519 PMCID: PMC4196523 DOI: 10.1586/14787210.2014.940900] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.
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Affiliation(s)
- Daniel J Cameron
- International Lyme and Associated Diseases Society,PO Box 341461, Bethesda MD, 20827-1461,USA
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19
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Recent advances in our understanding of the environmental, epidemiological, immunological, and clinical dimensions of coccidioidomycosis. Clin Microbiol Rev 2014; 26:505-25. [PMID: 23824371 DOI: 10.1128/cmr.00005-13] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Coccidioidomycosis is the endemic mycosis caused by the fungal pathogens Coccidioides immitis and C. posadasii. This review is a summary of the recent advances that have been made in the understanding of this pathogen, including its mycology, genetics, and niche in the environment. Updates on the epidemiology of the organism emphasize that it is a continuing, significant problem in areas of endemicity. For a variety of reasons, the number of reported coccidioidal infections has increased dramatically over the past decade. While continual improvements in the fields of organ transplantation and management of autoimmune disorders and patients with HIV have led to dilemmas with concurrent infection with coccidioidomycosis, they have also led to advances in the understanding of the human immune response to infection. There have been some advances in therapeutics with the increased use of newer azoles. Lastly, there is an overview of the ongoing search for a preventative vaccine.
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21
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Galgiani JN. Editorial Commentary: Elements of Style in Managing Coccidioidomycosis. Clin Infect Dis 2013; 56:1586-8. [DOI: 10.1093/cid/cit117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Guarner J. Detection of microorganisms in granulomas that have been formalin-fixed: review of the literature regarding use of molecular methods. SCIENTIFICA 2012; 2012:494571. [PMID: 24278704 PMCID: PMC3820445 DOI: 10.6064/2012/494571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 06/02/2023]
Abstract
Granuloma is an organized aggregate of immune cells that under the microscope appear as epithelioid macrophages. A granuloma can only be diagnosed when a pathologist observes this type of inflammation under the microscope. If a foreign body or a parasite is not observed inside the granuloma, stains for acid-fast bacilli and fungi are ordered since mycobacteria and fungi are frequently the cause of this type of inflammation. It is calculated that 12 to 36% of granulomas do not have a specific etiology and many have wondered if with new molecular methods we could reduce this number. This paper will summarize the frequently known causes of granulomas and will present the recent literature regarding the use of molecular techniques on tissue specimens and how these have helped in defining causative agents. We will also briefly describe new research regarding formation and function of granulomas and how this impacts our ability to find an etiologic agent.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA
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23
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Clinical specificity of the enzyme immunoassay test for coccidioidomycosis varies according to the reason for its performance. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 20:95-8. [PMID: 23155124 DOI: 10.1128/cvi.00531-12] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Abstract
The serum (1→3)-β-d-glucan assay has emerged as an important diagnostic test for invasive fungal disease. The utility of this assay in coccidioidomycosis has not been previously studied. Using a cutoff value of ≥80 pg/ml, we found the sensitivity (43.9%), specificity (91.1%), positive predictive value (81.8%), and negative predictive value (64.1%) to be similar to those of the assay in diagnosing other invasive mycoses.
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25
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Lee JW, Kim SI, Kim YJ, Kwon JC, Lim YJ, Park MH, Kim SA, Koh ES, Kim MJ, Kang MW. A Case of Coccidioidal Meningitis. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.2.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Woo Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Jeong Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Cheol Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ye Jee Lim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hee Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon A Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sil Koh
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ju Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Won Kang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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