Document Detail


Coccidioidomycosis: adenosine deaminase levels, serologic parameters, culture results, and polymerase chain reaction testing in pleural fluid.
MedLine Citation:
PMID:  23187746     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
George R Thompson; Shobha Sharma; Derek J Bays; Rachel Pruitt; David M Engelthaler; Jolene Bowers; Elizabeth M Driebe; Michael Davis; Robert Libke; Stuart H Cohen; Demosthenes Pappagianis
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Chest     Volume:  143     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-04-11     Completed Date:  2013-07-08     Revised Date:  2014-03-07    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  776-81     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adenosine Deaminase / blood*
Adolescent
Adult
Aged
Aged, 80 and over
Child
Coccidioidomycosis / diagnosis*,  enzymology
Complement Fixation Tests
Female
Humans
Lung Diseases, Fungal / diagnosis*,  enzymology
Male
Middle Aged
Pleural Effusion / metabolism*
Polymerase Chain Reaction
Sensitivity and Specificity
Young Adult
Grant Support
ID/Acronym/Agency:
R21AI076773/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
EC 3.5.4.4/Adenosine Deaminase
Comments/Corrections

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