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Comparative Study of Newer and Established Methods of Diagnosing Coccidioidal Meningitis

David A Stevens1,2, Marife Martinez1, Gabriele Sass1

  • 1California Institute for Medical Research, 2260 Clove Drive, San Jose, CA 95128, USA.

Journal of Fungi (Basel, Switzerland)
|August 8, 2020
PubMed

Insights

Rapid diagnostic tests for coccidioidal meningitis show high accuracy. New lateral flow assays (LFA) and enzyme immunoassays (EIA) offer convenient, early detection of fungal meningitis, improving patient outcomes.

Area of Science:

  • Medical Diagnostics
  • Infectious Diseases
  • Mycology

Background:

  • Coccidioidomycosis meningitis is a severe complication requiring early diagnosis.
  • Current diagnostic methods for coccidioidal meningitis can be time-consuming.
  • Development of rapid and convenient diagnostic tools is crucial for timely treatment.

Purpose of the Study:

  • To evaluate the diagnostic performance of various assays for coccidioidal meningitis using cerebrospinal fluid (CSF).
  • To compare classical methods (complement fixation, immunodiffusion) with newer lateral flow assays (LFA) and enzyme immunoassays (EIA).
  • To assess the utility of different antibody types (IgG, IgM) and specimen dilutions.

Main Methods:

  • Cerebrospinal fluid (CSF) samples from patients with coccidioidal meningitis and controls were tested.
  • Assays included complement fixation (CF), immunodiffusion (ID), two-strip LFA, and two EIA kits.
  • Tests were performed at 1:21 and 1:441 dilutions, with results compared to confirmed patient status.

Main Results:

  • Sensitivity ranged from 71-95% and specificity from 90-100% across all evaluated assays.
  • IgM assays demonstrated lower sensitivity compared to IgG.
  • Lateral flow assays (LFA) and EIAs showed high agreement with positive cases (87-100%).

Conclusions:

  • Newer diagnostic assays, particularly LFA and EIA, are effective for detecting coccidioidal meningitis in CSF.
  • LFAs offer rapid, bedside testing capabilities, potentially improving early treatment initiation.
  • Hospital laboratories in endemic areas can implement these kits for improved patient management.
Keywords:
Coccidioidescoccidioidomycosisenzyme immunoassayfungal diagnosislateral flow assaymeningitis

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