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Clinical specificity of the enzyme immunoassay test for coccidioidomycosis varies according to the reason for its performance.
Clin Vaccine Immunol. 2013 Jan; 20(1):95-8.CV

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.

Authors+Show Affiliations

Division of Infectious Diseases, Mayo Clinic, Scottsdale, AZ, USA. blair.janis@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

23155124

Citation

Blair, Janis E., et al. "Clinical Specificity of the Enzyme Immunoassay Test for Coccidioidomycosis Varies According to the Reason for Its Performance." Clinical and Vaccine Immunology : CVI, vol. 20, no. 1, 2013, pp. 95-8.
Blair JE, Mendoza N, Force S, et al. Clinical specificity of the enzyme immunoassay test for coccidioidomycosis varies according to the reason for its performance. Clin Vaccine Immunol. 2013;20(1):95-8.
Blair, J. E., Mendoza, N., Force, S., Chang, Y. H., & Grys, T. E. (2013). Clinical specificity of the enzyme immunoassay test for coccidioidomycosis varies according to the reason for its performance. Clinical and Vaccine Immunology : CVI, 20(1), 95-8. https://doi.org/10.1128/CVI.00531-12
Blair JE, et al. Clinical Specificity of the Enzyme Immunoassay Test for Coccidioidomycosis Varies According to the Reason for Its Performance. Clin Vaccine Immunol. 2013;20(1):95-8. PubMed PMID: 23155124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical specificity of the enzyme immunoassay test for coccidioidomycosis varies according to the reason for its performance. AU - Blair,Janis E, AU - Mendoza,Neil, AU - Force,Shannon, AU - Chang,Yu-Hui H, AU - Grys,Thomas E, Y1 - 2012/11/15/ PY - 2012/11/17/entrez PY - 2012/11/17/pubmed PY - 2013/6/12/medline SP - 95 EP - 8 JF - Clinical and vaccine immunology : CVI JO - Clin Vaccine Immunol VL - 20 IS - 1 N2 - 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. SN - 1556-679X UR - https://www.unboundmedicine.com/medline/citation/23155124/Clinical_specificity_of_the_enzyme_immunoassay_test_for_coccidioidomycosis_varies_according_to_the_reason_for_its_performance_ L2 - https://journals.asm.org/doi/10.1128/CVI.00531-12?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -