Sorted By Test Name - Mayo Medical Laboratories

CCOC
81542
Interpretation: Complement Fixation (CF): Titers of > or =1:2 may suggest active disease; however,
titers may persist for months after infection has resolved. Increasing CF titers in serial specimens are
diagnostic of active disease. Immunodiffusion (ID): The presence of IgM antibody may be detectable
within 2 weeks after the onset of symptoms; however, antibody may be detected longer than 6 months
after infection. The presence of IgG antibody parallels the CF antibody and may suggest an active or a
recent asymptomatic infection with Coccidioides immitis; however, antibody may persist after the
infection has resolved. An equivocal result (a band of nonidentity) cannot be interpreted as significant for
a specific diagnosis. However, this may be an indication that a patient should be followed serologically.
Over 90% of primary symptomatic cases will be detected by combined ID and CF testing.
Reference Values:
COMPLEMENT FIXATION
Negative
If positive, results are titered.
IMMUNODIFFUSION
Negative
Results are reported as positive, negative, or equivocal.
Clinical References: Larone D, Mitchell T, Walsh T: Histoplasma, blastomyces, coccidioides, and
other dimorphic fungi causing systemic mycoses. In Manual of Clinical Microbiology. 7th edition. Edited
by PR Murray, EJ Baron, MA Pfaller, et al: Washington, DC, American Society for Microbiology, 1999,
pp 1260-1261
Coccidioides Antibody, Spinal Fluid
Clinical Information: Coccidioidomycosis (valley fever, San Joaquin Valley fever) is a fungal
infection found in the southwestern United States, Central America, and South America. It is acquired by
inhalation of arthroconidia of Coccidioides immitis. Usually, it is a mild, self-limiting pulmonary
infection, often leaving a coin-like lesion. Less commonly, chronic pneumonia may persist or progress to
fibronodular, cavitary disease. A rash often develops within 1 to 2 days, followed by erythema nodosum
or multiforme and accompanying arthralgias. About 2 weeks after exposure, symptomatic patients
develop fever, cough, malaise, and anorexia; chest pain is often severe. Coccidioidomycosis may
disseminate beyond the lungs to involve multiple organs including the meninges.
Useful For: Serologic testing for coccidioidomycosis should be considered when patients exhibit
symptoms of meningeal infection and have lived or traveled in areas where Coccidioides immitis is
endemic. Any history of exposure to the organism or travel cannot be overemphasized when
coccidioidomycosis serologic tests are being considered.
Interpretation: Complement Fixation (CF): IgG antibody is detected by CF testing. Any CF titer in
cerebrospinal fluid (CSF) should be considered significant. A positive complement fixation test in
unconcentrated CSF is diagnostic of meningitis. Immunodiffusion (ID): IgM and IgG precipitins are
rarely found in CSF. However, when present, they are diagnostic of meningitis (100% specific). Since the
ID test is 100% specific, it is helpful in interpreting CF results. Early primary antibody (IgM) found in
coccidioidomycosis can be detected by the IgM-specific ID test. IgM precipitins may be detectable within
1 to 4 weeks after the onset of symptoms. The presence of IgG antibody parallels the CF antibody and
indicates an active or a recent asymptomatic infection with Coccidioides immitis. Both IgG and IgM
antibodies are rarely detected 6 months after infection. However, in some patients having disseminated
infection, both IgG and IgM antibodies may be present for several years. IgM and IgG precipitins are not
prognostic. An equivocal result (a band of nonidentity) cannot be interpreted as significant for a specific
diagnosis. However, this may be an indication that a patient should be followed serologically. The
sensitivity of serologic testing (CF and ID combined) for coccidioidomycosis is >90% for primary
symptomatic cases.
Reference Values:
COMPLEMENT FIXATION
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