Coccidioidomycosis: adenosine deaminase levels, serologic parameters, culture results, and polymerase chain reaction testing in pleural fluid.

BACKGROUND In a patient with positive serum serology for coccidioidomycosis, the differential diagnosis of concurrent pleural effusions can be challenging. We, therefore, sought to clarify the performance characteristics of biochemical, serologic, and nucleic-acid-based testing in an attempt to avoid invasive procedures. The utility of adenosine deaminase (ADA), coccidioidal serology, and polymerase chain reaction (PCR) in the evaluation of pleuropulmonary coccidioidomycosis has not been previously reported. METHODS Forty consecutive patients evaluated for pleuropulmonary coccidioidomycosis were included. Demographic data, pleural fluid values, culture results, and clinical diagnoses were obtained from patient chart review. ADA testing was performed by ARUP Laboratories, coccidioidal serologic testing was performed by the University of California-Davis coccidioidomycosis serology laboratory, and PCR testing was performed by the Translational Genomics Research Institute using a previously published methodology. RESULTS Fifteen patients were diagnosed with pleuropulmonary coccidioidomycosis by European Organization for the Research and Treatment of Cancer/Mycoses Study Group criteria. Pleural fluid ADA concentrations were < 40 IU/L in all patients (range, < 1.0-28.6 IU/L; median, 4.7). The sensitivity and specificity of coccidioidal serologic testing was 100% in this study. The specificity of PCR testing was high (100%), although the overall sensitivity remained low, and was comparable to the experience of others in the clinical use of PCR for coccidioidal diagnostics. CONCLUSION Contrary to prior speculation, ADA levels in pleuropulmonary coccidioidomycosis were not elevated in this study. The sensitivity and specificity of coccidioidal serologic testing in nonserum samples remained high, but the clinical usefulness of PCR testing in pleural fluid was disappointing and was comparable to pleural fluid culture.

[1]  J. M. Porcel,et al.  Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients. , 2010, European journal of internal medicine.

[2]  J. Parish,et al.  The Utility of Coccidioides Polymerase Chain Reaction Testing in the Clinical Setting , 2010, Mycopathologia.

[3]  J. Perfect,et al.  Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  Huanzhong Shi,et al.  Diagnostic accuracy of adenosine deaminase in tuberculous pleurisy: a meta-analysis. , 2008, Respiratory medicine.

[5]  A. Romero,et al.  Pleural effusion in hospitalized patients with Coccidioidomycosis. , 2008, Respiratory medicine.

[6]  Y. Tomizawa,et al.  Primary Sjogren's syndrome complicated by bilateral pleural effusion , 2007, Respirology.

[7]  D. Engelthaler,et al.  Public Health Surveillance for Coccidioidomycosis in Arizona , 2007, Annals of the New York Academy of Sciences.

[8]  R. Laniado-Laborín Adenosine deaminase in the diagnosis of tuberculous pleural effusion: is it really an ideal test? A word of caution. , 2005, Chest.

[9]  Suzanne M Johnson,et al.  Amplification of Coccidioidal DNA in Clinical Specimens by PCR , 2004, Journal of Clinical Microbiology.

[10]  D. Pappagianis Serologic studies in coccidioidomycosis. , 2001, Seminars in respiratory infections.

[11]  C. Dye,et al.  Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. , 1999, JAMA.

[12]  B. Roth,et al.  Searching for tuberculosis in the pleural space. , 1999, Chest.

[13]  L. Valdés,et al.  Tuberculous pleurisy: a study of 254 patients. , 1998, Archives of internal medicine.

[14]  X. Muñoz,et al.  Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study. , 1996, Chest.

[15]  B. Anderson,et al.  Antimycobacterial antibody levels in pleural fluid as reflection of passive diffusion from serum. , 1990, Chest.

[16]  A. Catanzaro,et al.  Acute coccidioidal pleural effusion. , 1976, The American review of respiratory disease.

[17]  W. C. Ball,et al.  Pleural effusions: the diagnostic separation of transudates and exudates. , 1972, Annals of internal medicine.

[18]  D. Pappagianis,et al.  Antibody in cerebrospinal fluid in non-meningitic coccidioidomycosis. , 1972, Sabouraudia.

[19]  R. Beard,et al.  Serological tests in the diagnosis and prognosis of coccidioidomycosis. , 1950, American journal of hygiene.

[20]  D. Vugia,et al.  Increase in Coccidioidomycosis - California, 2000-2007. , 2009, MMWR. Morbidity and mortality weekly report.