Coccidioidomycosis Complement Fixation Titer Trends in the Age of Antifungals
| Autor: | Sarah Waldman, Derek J. Bays, Demosthenes Pappagianis, Ian Howard Mchardy, Bao Tran N. Dinh, Ethan R. Stewart, George Richard Thompson |
|---|---|
| Přispěvatelé: | Warnock, David W |
| Rok vydání: | 2018 |
| Předmět: |
Male
0301 basic medicine Antifungal Agents Time Factors serology Disseminated coccidioidomycosis endemic mycoses valley fever Medical and Health Sciences Gastroenterology 0302 clinical medicine 80 and over Disseminated disease 030212 general & internal medicine Child Lung Aged 80 and over biology Complement Fixation Tests Area under the curve Biological Sciences Middle Aged Complement fixation test Titer Infectious Diseases Child Preschool Female medicine.symptom Infection Meningitis Adult Microbiology (medical) medicine.medical_specialty Adolescent coccidioidomycosis 030106 microbiology Mycology Microbiology Sensitivity and Specificity Asymptomatic Young Adult 03 medical and health sciences Internal medicine medicine Humans Coccidioides Preschool dimorphic fungus Aged Agricultural and Veterinary Sciences business.industry Infant Triazoles medicine.disease biology.organism_classification ROC Curve complement fixation business |
| Zdroj: | Journal of Clinical Microbiology Journal of clinical microbiology, vol 56, iss 12 |
| ISSN: | 1098-660X 0095-1137 |
| DOI: | 10.1128/jcm.01318-18 |
| Popis: | 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. 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. |
| Databáze: | OpenAIRE |
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