Woodruff W W, Buckley C E, Gallis H A, Cohn J R, Wheat R W
Infect Immun. 1984 Mar;43(3):860-9. doi: 10.1128/iai.43.3.860-869.1984.
Delayed hypersensitivity skin tests with mycelium-derived (coccidioidin) or spherule-derived (spherulin) antigens (or both) can be used to identify patients who have been sensitized to the dimorphic fungus Coccidioides immitis. Prior studies suggest that coccidioidin and spherulin skin test antigens detect comparable numbers of reactors among exposed subjects. Studies in subjects residing in areas outside the United States where C. immitis is not endemic suggest that both antigens are specific for the fungus. The specificity and reactivity of coccidioidin and spherulin have not been compared in nonendemic regions of the United States in which the skin test antigens and an appropriate travel or exposure history are used to identify patients with possible C. immitis infection. A review of delayed cutaneous reactions to coccidioidin in 6,375 patients tested between 1970 and 1979 in the southeastern United States revealed 958 (15.0%) and 234 (5.7%) positive reactions (greater than or equal to 5 mm), respectively, at 24 and 48 h. Subsequent tests with spherulin in 2,775 patients tested in 1980 and 1981 revealed 866 (31.2%) and 288 (10.3%) positive reactions, respectively, at 24 and 48 h. False-positive immediate hypersensitivity reactions contributed to the large number of spherulin reactors at 24 h. Differences among the patients sampled, work exposure, and travel history were excluded as causes of this surprising and highly significant (P less than or equal to 0.0001) difference in the 48-h delayed cutaneous reaction. These observations suggest two possibilities: (i) spherulin is less specific than coccidioidin, or (ii) a surprising prevalence of C. immitis sensitization exists among patients in nonendemic regions of the United States.
使用菌丝体来源的（球孢子菌素）或球形体来源的（球孢子溶菌素）抗原（或两者）进行迟发型超敏皮肤试验，可用于识别已对双相真菌粗球孢子菌致敏的患者。先前的研究表明，球孢子菌素和球孢子溶菌素皮肤试验抗原在暴露人群中检测到的反应者数量相当。对居住在美国以外粗球孢子菌非流行地区的受试者进行的研究表明，这两种抗原对该真菌具有特异性。在美国非流行地区，尚未比较球孢子菌素和球孢子溶菌素的特异性和反应性，在这些地区，皮肤试验抗原以及适当的旅行或暴露史用于识别可能感染粗球孢子菌的患者。对1970年至1979年在美国东南部进行检测的6375名患者的球孢子菌素迟发型皮肤反应进行回顾，结果显示在24小时和48小时时，阳性反应（大于或等于5毫米）分别为958例（15.0%）和234例（5.7%）。随后在1980年和1981年对2775名患者进行球孢子溶菌素检测，结果显示在24小时和48小时时，阳性反应分别为866例（31.2%）和288例（10.3%）。假阳性速发型超敏反应导致24小时时球孢子溶菌素反应者数量众多。排除了所采样患者之间的差异、工作暴露和旅行史作为48小时迟发型皮肤反应中这种惊人且高度显著（P小于或等于0.0001）差异的原因。这些观察结果提示两种可能性：（i）球孢子溶菌素的特异性低于球孢子菌素，或（ii）在美国非流行地区的患者中存在粗球孢子菌致敏的惊人高患病率。
