title: Diagnosis of neuroparacoccidioidomycosis by detection of circulating antigen and antibody in cerebrospinal fluid.
abstract: Neuroparacoccidioidomycosis (neuroPCM) is the central nervous system infection by the fungus Paracoccidioides brasiliensis. Its diagnosis is a difficult task that depends on neuroimaging techniques such as computed tomography and magnetic resonance imaging. However, the detection of circulating P. brasiliensis antigens in body fluids by inhibition enzyme-linked immunosorbent assay (inh-ELISA) has provided encouraging results. In this study, 14 cerebrospinal fluid (CSF) and 11 serum samples of patients with neuroPCM were analyzed by inh-ELISA for detection of circulating glycoprotein antigens of 43 kDa (gp43) and 70 kDa (gp70). Circulating gp43 and gp70 antigens were detected in all CSF samples from patients with neuroPCM at mean concentrations of 19.3 and 6.8 mug/ml, respectively. In addition, both gp43 and gp70 antigens were detected in 10 of 11 serum samples analyzed at mean concentrations of 4.6 and 4.0 mug/ml, respectively. By immunodiffusion test, CSF samples were determined to be negative in 13 of 14 samples. The detection of anti-gp43 and anti-gp70 antibodies by conventional ELISA showed positive results for all CSF samples, with titers ranging from 1:50 to 1:51,200. Therefore, the high sensitivity of the inh-ELISA technique in detecting gp43 and gp70 antigens in the CSF of neuroPCM patients strongly indicates that this assay can be considered as a powerful diagnostic tool. In addition, the finding of anti-gp43 and anti-gp70 antibodies in CSF samples by conventional ELISA also seems to be a promising diagnostic method for this special modality of PCM.
authors.affiliation: Department of Microbiology, Immunology and Parasitology, Federal de São Paulo, Brazil.
authors.forename: Silvia Helena Marques
authors.initials: SH
authors.lastname: da Silva
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
authors.forename: Maria Heloisa Souza Lima
authors.initials: MH
authors.lastname: Blotta
authors.forename: Flávio
authors.initials: F
authors.lastname: Queiroz-Telles
authors.forename: José Daniel
authors.initials: JD
authors.lastname: Lopes
authors.forename: Zoilo Pires
authors.initials: ZP
authors.lastname: de Camargo
mesh_terms: D000908:Antibodies, Fungal / Q000097:blood / Q000134:cerebrospinal fluid*; D000946:Antigens, Fungal / Q000097:blood / Q000134:cerebrospinal fluid*; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000382:microbiology; D004797:Enzyme-Linked Immunosorbent Assay; D005656:Fungal Proteins / Q000097:blood / Q000134:cerebrospinal fluid*; D006023:Glycoproteins / Q000097:blood / Q000134:cerebrospinal fluid*; D006801:Humans; D010228:Paracoccidioides / Q000276:immunology* / Q000302:isolation & purification; D010229:Paracoccidioidomycosis / Q000175:diagnosis* / Q000382:microbiology; D012680:Sensitivity and Specificity
chemical_list: C103180:43 kDa protein, Paracoccidioides; D000908:Antibodies, Fungal; D000946:Antigens, Fungal; D005656:Fungal Proteins; D006023:Glycoproteins