Mycopathologia

, Volume 170, Issue 5, pp 345–351

The Utility of Coccidioides Polymerase Chain Reaction Testing in the Clinical Setting

  • Darko Vucicevic
  • Janis E. Blair
  • Matthew J. Binnicker
  • Ann E. McCullough
  • Shimon Kusne
  • Holenarasipur R. Vikram
  • James M. Parish
  • Nancy L. Wengenack
Article

DOI: 10.1007/s11046-010-9327-0

Cite this article as:
Vucicevic, D., Blair, J.E., Binnicker, M.J. et al. Mycopathologia (2010) 170: 345. doi:10.1007/s11046-010-9327-0

Abstract

Coccidioidomycosis, the fungal infection caused by dimorphic Coccidioides sp., is typically diagnosed by histopathologic identification of spherules in affected secretions and tissues or by culture. These tests are reliable but time-intensive, delaying diagnosis and treatment. To evaluate a polymerase chain reaction (PCR) test developed to detect Coccidioides sp. in clinical specimens, we conducted a retrospective chart review of all patients (N = 145) who underwent Coccidioides PCR at our institution between April 27, 2007, and May 6, 2008, abstracting clinical, microbiologic, serologic, radiographic, treatment, and follow-up data. One hundred fifty-eight PCR tests (153 respiratory; 5 cerebrospinal fluid) produced 5 positive and 153 negative findings. Five of nine patients (56%) with confirmed or highly probable pulmonary coccidioidomycosis had a positive PCR on respiratory specimens, and four of nine (44%) had a positive culture. Among two patients with coccidioidal meningitis, none had a positive PCR, whereas Coccidioides sp. in fungal culture grew for one of two. Among six asymptomatic patients with probable coccidioidomycosis, none had a positive culture or PCR. Compared with culture of respiratory specimens, PCR demonstrated a sensitivity, specificity, positive predictive value, and negative predictive value of 75, 99, 60, and 99%, respectively. Coccidioides PCR appears accurate in identifying negative results, and its sensitivity is similar to that of fungal culture.

Keywords

Coccidioides sp.CoccidioidomycosisCultureDiagnosisPolymerase chain reaction

Abbreviations

Ag2/PRA

Antigen 2/proline rich antigen

CSF

Cerebrospinal fluid

IgG

Immunoglobulin G

ITS2

Internal transcribed spacer 2

MRSA

Methicillin-resistant Staphylococcus aureus

PCR

Polymerase chain reaction

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Darko Vucicevic
    • 1
  • Janis E. Blair
    • 1
  • Matthew J. Binnicker
    • 4
  • Ann E. McCullough
    • 2
  • Shimon Kusne
    • 1
  • Holenarasipur R. Vikram
    • 1
  • James M. Parish
    • 3
  • Nancy L. Wengenack
    • 4
  1. 1.Division of Infectious DiseasesMayo ClinicScottsdaleUSA
  2. 2.Department of Laboratory Medicine and PathologyMayo ClinicScottsdaleUSA
  3. 3.Division of Pulmonary MedicineMayo ClinicScottsdaleUSA
  4. 4.Division of Clinical MicrobiologyMayo ClinicRochesterUSA