title: Role of Coccidioides Antigen Testing in the Cerebrospinal Fluid for the Diagnosis of Coccidioidal Meningitis.
abstract: BACKGROUND
  Coccidioidal meningitis (CM), a common cause of chronic meningitis in endemic area, is usually diagnosed by detection of anti-Coccidioides antibodies in cerebrospinal fluid (CSF), and findings may be negative in up to one-third of cases. CSF cultures and cytology are infrequently positive. Antigen detection has been used for the diagnosis of other forms of coccidioidomycosis and meningitis caused by other mycoses. The purpose of this study was to assess the diagnostic utility of CSF Coccidioides antigen (CAg) detection for the diagnosis of CM.
  
  
  METHODS
  The medical records of patients with clinically suspected meningitis, in whom CSF was tested for Coccidioides antibodies and CAg, were retrospectively reviewed, and CSF CAg testing was prospectively conducted in patients with CM. All specimens were submitted for CAg testing.
  
  
  RESULTS
  Thirty-six patients with 42 episode of CM were studied. The sensitivity and specificity of CAg were 93% and 100%, respectively. Cultures of CSF were positive in 7%, antibodies were demonstrated by immunodiffusion in 67% and complement fixation in 70%, and immunoglobulin M and G antibodies were demonstrated by enzyme immunoassay in 8% and 85%, respectively.
  
  
  CONCLUSIONS
  Testing CSF for CAg is a useful addition to diagnostic methods in suspected CM and complements testing with CSF antibodies and culture.
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Christelle
authors.initials: C
authors.lastname: Kassis
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Syed
authors.initials: S
authors.lastname: Zaidi
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kuberski
authors.affiliation: St Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Ana
authors.initials: A
authors.lastname: Moran
authors.affiliation: St Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Omar
authors.initials: O
authors.lastname: Gonzalez
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Sana
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Carlos
authors.initials: C
authors.lastname: Hartmann-Manrique
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Layth
authors.initials: L
authors.lastname: Al-Jashaami
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Chebbo
authors.affiliation: Maricopa Integrated Health System.
authors.forename: Robert Andy
authors.initials: RA
authors.lastname: Myers
authors.affiliation: MiraVista Diagnostics, Indianapolis, Indiana.
authors.forename: Laurence Joseph
authors.initials: LJ
authors.lastname: Wheat
mesh_terms: D000328:Adult; D000946:Antigens, Fungal / Q000032:analysis*; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D003045:Coccidioides / Q000737:chemistry*; D003047:Coccidioidomycosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D016921:Meningitis, Fungal / Q000175:diagnosis*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000946:Antigens, Fungal
keywords: coccidioidal meninigits; coccidioides antibodies; coccidioides antigen; disseminated coccidoidomycosis; fungal meninigits