Dosanjh A, Theodore J, Pappagianis D
Stanford University School of Medicine, CA, USA.
Pediatr Transplant. 1998 Nov;2(4):313-7.
Coccidioidomycosis is an acquired fungal infection that afflicts primarily the respiratory tract. Cystic fibrosis patients who are being treated with glucocorticoids and immunosuppressed organ recipients may be at risk for infection with Coccidiodes immitis or reactivation of latent infection. The diagnosis is best made by demonstration of the organism in pathologic specimens or by culture. Serologic screening is another method that is reliable in most patients. We studied 98 patients who had serologic screening for Coccidiodes immitis performed as part of their evaluation for lung transplantation. This study revealed that approximately 15% of the cystic fibrosis patients screened had putative coccidioidal IgM, in the absence of an IgG response. None of the patients studied had a positive fungal culture for the organism. None of the non-cystic fibrosis patients screened had detectable coccidioidal IgG or IgM. We hypothesize that cystic fibrosis patients may have hyperimmune sera which interferes with serologic screening tests. We would recommend repeat serologic testing and attempts to identify the organism in tissue or by culture to confirm the diagnosis in these patients.
球孢子菌病是一种主要侵袭呼吸道的后天性真菌感染。正在接受糖皮质激素治疗的囊性纤维化患者以及免疫抑制的器官移植受者可能有感染粗球孢子菌或潜伏感染再激活的风险。最佳诊断方法是在病理标本中发现该病原体或通过培养来确诊。血清学筛查是大多数患者中另一种可靠的方法。我们研究了98例作为肺移植评估一部分而进行粗球孢子菌血清学筛查的患者。这项研究表明，在接受筛查的囊性纤维化患者中，约15%有假定的球孢子菌IgM，而无IgG反应。所研究的患者均无该病原体的真菌培养阳性结果。接受筛查的非囊性纤维化患者均未检测到球孢子菌IgG或IgM。我们推测囊性纤维化患者可能有干扰血清学筛查试验的高免疫血清。我们建议对这些患者重复进行血清学检测，并尝试在组织中或通过培养来鉴定该病原体以确诊。
