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Early treatment with fluconazole may abrogate the development of IgG antibodies in coccidioidomycosis.
Clin Infect Dis. 2011 Sep; 53(6):e20-4.CI

Abstract

BACKGROUND

We have observed a number of patients who fail to develop coccidioidal complement fixing (CF) antibody (immunoglobulin [IgG]) after the initiation of early antifungal therapy. Although this is the first description of this phenomenon in mycology, a precedent for the abrogation of the immune response has been observed in other conditions, including primary syphilis and primary Lyme disease.

METHODS

We conducted a retrospective case-control study to determine any patient-specific risk factors associated with this observation. Additionally, in vitro analysis of the coccidioidal CF (IgG) antigen (Cts1) was performed after Coccidioides was grown under escalating fluconazole concentrations.

RESULTS

Seventeen patients persistently positive for coccidioidal IgM antibodies without developing an IgG response (cases) were compared with 64 consecutive patients who did develop coccidioidal CF (IgG) antibodies (controls). Early treatment with antifungals (within 2 weeks of symptom onset) was associated with an abrogation of IgG antibody production (P < .001). With immunodiffusion testing, control serum demonstrated a lack of IgG seroreactivity when Coccidioides posadasii grown in the presence of escalating fluconazole doses (0.5-128 μg/mL) was used as the antigen; however, control serum remained seroreactive for the presence of IgM. The coccidioidal IgG antigen (Cts1) was shown to be diminished when cultures were grown in the presence of fluconazole, lending further in vitro plausibility to our findings.

CONCLUSIONS

The abrogation of an IgG response in patients treated early in the course of coccidioidal infection may complicate serodiagnosis and epidemiologic studies, and further study to determine the potential clinical implications should be performed.

Authors+Show Affiliations

Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California, Davis, California 95616, USA. grthompson@ucdavis.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21865185

Citation

Thompson, George R., et al. "Early Treatment With Fluconazole May Abrogate the Development of IgG Antibodies in Coccidioidomycosis." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 53, no. 6, 2011, pp. e20-4.
Thompson GR, Lunetta JM, Johnson SM, et al. Early treatment with fluconazole may abrogate the development of IgG antibodies in coccidioidomycosis. Clin Infect Dis. 2011;53(6):e20-4.
Thompson, G. R., Lunetta, J. M., Johnson, S. M., Taylor, S., Bays, D., Cohen, S. H., & Pappagianis, D. (2011). Early treatment with fluconazole may abrogate the development of IgG antibodies in coccidioidomycosis. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 53(6), e20-4. https://doi.org/10.1093/cid/cir466
Thompson GR, et al. Early Treatment With Fluconazole May Abrogate the Development of IgG Antibodies in Coccidioidomycosis. Clin Infect Dis. 2011;53(6):e20-4. PubMed PMID: 21865185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early treatment with fluconazole may abrogate the development of IgG antibodies in coccidioidomycosis. AU - Thompson,George R,3rd AU - Lunetta,Jennine M, AU - Johnson,Suzanne M, AU - Taylor,Sandra, AU - Bays,Derek, AU - Cohen,Stuart H, AU - Pappagianis,Demosthenes, PY - 2011/8/26/entrez PY - 2011/8/26/pubmed PY - 2012/2/11/medline SP - e20 EP - 4 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 53 IS - 6 N2 - BACKGROUND: We have observed a number of patients who fail to develop coccidioidal complement fixing (CF) antibody (immunoglobulin [IgG]) after the initiation of early antifungal therapy. Although this is the first description of this phenomenon in mycology, a precedent for the abrogation of the immune response has been observed in other conditions, including primary syphilis and primary Lyme disease. METHODS: We conducted a retrospective case-control study to determine any patient-specific risk factors associated with this observation. Additionally, in vitro analysis of the coccidioidal CF (IgG) antigen (Cts1) was performed after Coccidioides was grown under escalating fluconazole concentrations. RESULTS: Seventeen patients persistently positive for coccidioidal IgM antibodies without developing an IgG response (cases) were compared with 64 consecutive patients who did develop coccidioidal CF (IgG) antibodies (controls). Early treatment with antifungals (within 2 weeks of symptom onset) was associated with an abrogation of IgG antibody production (P < .001). With immunodiffusion testing, control serum demonstrated a lack of IgG seroreactivity when Coccidioides posadasii grown in the presence of escalating fluconazole doses (0.5-128 μg/mL) was used as the antigen; however, control serum remained seroreactive for the presence of IgM. The coccidioidal IgG antigen (Cts1) was shown to be diminished when cultures were grown in the presence of fluconazole, lending further in vitro plausibility to our findings. CONCLUSIONS: The abrogation of an IgG response in patients treated early in the course of coccidioidal infection may complicate serodiagnosis and epidemiologic studies, and further study to determine the potential clinical implications should be performed. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/21865185/Early_treatment_with_fluconazole_may_abrogate_the_development_of_IgG_antibodies_in_coccidioidomycosis_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cir466 DB - PRIME DP - Unbound Medicine ER -