title: Coccidioidomycosis: adenosine deaminase levels, serologic parameters, culture results, and polymerase chain reaction testing in pleural fluid.
abstract: 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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California-Davis, Davis, CA; Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Davis, CA. Electronic address: grthompson@ucdavis.edu.
authors.forename: George R
authors.initials: GR
authors.lastname: Thompson
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of California at San Francisco-Fresno Medical Center, Fresno, CA.
authors.forename: Shobha
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California-Davis, Davis, CA.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Bays
authors.affiliation: Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California-Davis, Davis, CA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Pruitt
authors.affiliation: Translational Genomics Research Institute, Flagstaff, AZ.
authors.forename: David M
authors.initials: DM
authors.lastname: Engelthaler
authors.affiliation: Translational Genomics Research Institute, Flagstaff, AZ.
authors.forename: Jolene
authors.initials: J
authors.lastname: Bowers
authors.affiliation: Translational Genomics Research Institute, Flagstaff, AZ.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Driebe
authors.affiliation: Doctors Hospital of Manteca, Manteca, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Davis
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of California at San Francisco-Fresno Medical Center, Fresno, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Libke
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Davis, CA.
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Cohen
authors.affiliation: Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, University of California-Davis, Davis, CA.
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Pappagianis
mesh_terms: D000243:Adenosine Deaminase / Q000097:blood*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000201:enzymology; D003168:Complement Fixation Tests; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000378:metabolism*; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000243:Adenosine Deaminase