Department of Medical Microbiology and Immunology, University of California, Davis, Davis, California, USA
Department of Medical Microbiology and Immunology, University of California, Davis, Davis, California, USA.
J Clin Microbiol. 2018 Nov 27;56(12). doi: 10.1128/JCM.01318-18. Print 2018 Dec.
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) ( = 248), pulmonary chronic coccidioidomycosis (PCC) ( = 64), disseminated coccidioidomycosis (DC) not including meningitis ( = 86), or coccidioidal meningitis (CM) ( = 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.
球孢子菌病与广泛的疾病严重程度相关，从无症状或自限性肺部感染到播散性疾病的危及生命表现。在广泛使用抗真菌药物之前进行的血清学研究确立了当前对血清动力学和动态的理解。对 434 例接受抗真菌治疗的球孢子菌病患者的图表病史和补体固定 (CF) 滴度趋势进行了分析，这些患者由三位传染病医生分为三组：单纯性肺部球孢子菌病 (PUC) ( = 248)、慢性肺部球孢子菌病 (PCC) ( = 64)、不包括脑膜炎的播散性球孢子菌病 (DC) ( = 86)或球孢子菌性脑膜炎 (CM) ( = 36)。PUC 患者的中位最大 CF 滴度为 1:4，PCC 患者为 1:24，DC 患者为 1:128，CM 患者为 1:32。大约 25.4%的 PUC 患者、6.2%的 PCC 患者、2.3%的 DC 患者和 8.3%的 CM 患者在研究期间未检测到可检测的滴度。最大滴度在初次血清学阳性后平均 31 天 (95%置信区间 [CI]，13 至 50 天) 出现，各组之间无显著差异。9%的 PUC 患者、36%的 PCC 患者、50%的 DC 患者和 52%的 CM 患者发生血清学复发。PUC 患者的平均滴度改善率为 91 天/稀释度，PCC 患者为 112 天/稀释度，DC 患者为 136 天/稀释度，CM 患者为 146 天/稀释度。受试者工作特征 (ROC) 分析显示，CF 检测对播散性感染 (曲线下面积 [AUC]，0.82 [95%CI，0.78 至 0.87]) 和复杂感染具有中等分类价值 (AUC，0.82 [95%CI，0.77 至 0.86])。复杂感染的合适截断值为≥1:32。这些发现更新了与三唑时代球孢子菌病患者临床评估相关的血清学参数。
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