Comparative study of newer and established methods of diagnosing coccidioidal meningitis

David A. Stevens, Marife Martinez, Gabriele Sass, Demosthenes Pappagianis, Brian Doherty, Hannah Kutsche, Meredith McGuire

Research output: Contribution to journalArticlepeer-review

Abstract

Meningitis is the most devastating form of coccidioidomycosis. A convenient, rapid diagnostic method could result in early treatment and avoid many meningitis complications. We studied cerebrospinal fluid (CSF) samples in patients with documented coccidioidal meningitis, and controls, with complement fixation (CF), immunodiffusion (ID) (the “classical” assays), lateral flow assays (LFA; one‐strip and two‐strip), and two enzyme immunoassays (EIA). The two‐strip LFA and EIAs not only enabled separate testing for IgG and IgM antibodies separately, but also could aggregate results for each method. CF with ID or the aggregate use of IgG and IgM tests were considered optimal test uses. LFAs and EIAs were evaluated at 1:21 and 1:441 dilutions of specimens. All assays were compared to true patient status. With 49 patient specimens and 40 controls, this is the largest comparative study of CSF coccidioidal diagnostics. Sensitivity of these tests ranged from 71–95% and specificity 90–100%. IgM assays were less sensitive. Assays at 1:441 were similarly specific but less sensitive, suggesting that serial dilutions of samples could result in assays yielding titers. Agreement of positive results on cases was 87–100%. When kits are available, hospital laboratories in endemic areas can perform testing. LFA assays do not require a laboratory, are simple to use, and give rapid results, potentially even at the bedside.

Original languageEnglish (US)
Article number125
Pages (from-to)1-12
Number of pages12
JournalJournal of Fungi
Volume6
Issue number3
DOIs
StatePublished - Aug 2020

Keywords

  • Coccidioides
  • Coccidioidomycosis
  • Enzyme immunoassay
  • Fungal diagnosis
  • Lateral flow assay
  • Meningitis

ASJC Scopus subject areas

  • Ecology, Evolution, Behavior and Systematics
  • Plant Science
  • Microbiology (medical)

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