title: Coccidioidal pericarditis: a rapid presumptive diagnosis by an in-house antigen confirmed by mycological and molecular methods.
abstract: Coccidioidal pericarditis is a condition found in approximately 1-5% of patients infected by Coccidioides species. It is associated with widely diverse clinical symptoms. This paper reports a case of coccidioidal pericarditis diagnosed by an in-house Coccidioides posadasii antigen and confirmed with mycological and molecular methods. From February to September 2005, the patient suffered from fever, weight loss, a non-productive cough, thoracic pain and tachycardia. He received a positive diagnosis of coccidioidal pericarditis only in October 2005. The macromorphological examination of the culture showed a whitish felt-like colony, which became brownish with age. Preparations in lactophenol cotton blue stain showed hyaline septate hyphae with fragmentation and thin arthroconidia-like structures. Pericardial fluid and sera samples were positive for Coccidioides antibodies by immunodiffusion and ELISA with a C. posadasii in-house antigen preparation. The C. posadasii identification was confirmed by nested PCR of the antigen 2/proline-rich antigen (Ag2/PRA) encoding gene.
authors.affiliation: Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Raimunda S N
authors.initials: RSN
authors.lastname: Brilhante
authors.affiliation: Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Department of Biological Science, State University of Ceará, Fortaleza, Ceará, Brazil.|Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Rossana A
authors.initials: RA
authors.lastname: Cordeiro
authors.affiliation: Postgraduate Program in Veterinary Science, State University of Ceará, Fortaleza, Ceará, Brazil.|Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Marcos F G
authors.initials: MFG
authors.lastname: Rocha
authors.affiliation: Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Maria A B
authors.initials: MAB
authors.lastname: Fechine
authors.affiliation: Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Felipe M
authors.initials: FM
authors.lastname: Furtado
authors.affiliation: Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Aparecida T
authors.initials: AT
authors.lastname: Nagao-Dias
authors.affiliation: Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Zoilo P
authors.initials: ZP
authors.lastname: Camargo
authors.affiliation: Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Ceará, Brazil.|Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: José J C
authors.initials: JJC
authors.lastname: Sidrim
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000235:genetics / Q000276:immunology*; D003045:Coccidioides / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D005779:Immunodiffusion; D008297:Male; D016533:Mycological Typing Techniques; D010493:Pericarditis / Q000188:drug therapy / Q000382:microbiology*; D016133:Polymerase Chain Reaction
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal; D015725:Fluconazole