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Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals
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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society for Microbiology
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258849/ https://www.ncbi.nlm.nih.gov/pubmed/30257902 http://dx.doi.org/10.1128/JCM.01318-18 |
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author | McHardy, Ian H. Dinh, Bao-Tran N. Waldman, Sarah Stewart, Ethan Bays, Derek Pappagianis, Demosthenes Thompson, George R. |
author_facet | McHardy, Ian H. Dinh, Bao-Tran N. Waldman, Sarah Stewart, Ethan Bays, Derek Pappagianis, Demosthenes Thompson, George R. |
author_sort | McHardy, Ian H. |
collection | PubMed |
description | 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) (n = 248), pulmonary chronic coccidioidomycosis (PCC) (n = 64), disseminated coccidioidomycosis (DC) not including meningitis (n = 86), or coccidioidal meningitis (CM) (n = 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. |
format | Online Article Text |
id | pubmed-6258849 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | American Society for Microbiology |
record_format | MEDLINE/PubMed |
spelling | pubmed-62588492018-12-13 Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals McHardy, Ian H. Dinh, Bao-Tran N. Waldman, Sarah Stewart, Ethan Bays, Derek Pappagianis, Demosthenes Thompson, George R. J Clin Microbiol Mycology 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) (n = 248), pulmonary chronic coccidioidomycosis (PCC) (n = 64), disseminated coccidioidomycosis (DC) not including meningitis (n = 86), or coccidioidal meningitis (CM) (n = 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. American Society for Microbiology 2018-11-27 /pmc/articles/PMC6258849/ /pubmed/30257902 http://dx.doi.org/10.1128/JCM.01318-18 Text en Copyright © 2018 McHardy et al. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Mycology McHardy, Ian H. Dinh, Bao-Tran N. Waldman, Sarah Stewart, Ethan Bays, Derek Pappagianis, Demosthenes Thompson, George R. Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals |
title | Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals |
title_full | Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals |
title_fullStr | Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals |
title_full_unstemmed | Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals |
title_short | Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals |
title_sort | coccidioidomycosis complement fixation titer trends in the age of antifungals |
topic | Mycology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258849/ https://www.ncbi.nlm.nih.gov/pubmed/30257902 http://dx.doi.org/10.1128/JCM.01318-18 |
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