, Volume 166, Issue 2, pp 77–82 | Cite as

Significance of Isolated Positive IgM Serologic Results by Enzyme Immunoassay for Coccidioidomycosis

  • Janis E. Blair
  • Jeremiah T. Currier


Serologic testing is important for diagnosis of coccidioidomycosis. Many methods are available for diagnostic testing. Enzyme immunoassay (EIA) can be performed quickly and locally but has the potential for false-positive results in patients manifesting a positive EIA for immunoglobulin M (IgM) antibodies and a negative EIA for immunoglobulin G (IgG). We retrospectively reviewed the charts of 405 patients with coccidioidal serologic testing performed between 1999 and 2003. Of 706 EIAs, 37 (5%) produced test results for 28 patients that showed isolated IgM positivity. Among these 28 patients, 24 (86%) had positive serologic findings by other methods (complement fixation or immunodiffusion or both), and 7 (25%) had positive microbiologic or histopathologic findings. All 4 (14%) patients without other positive serologic results had diagnostic tests with positive microbiologic or histopathologic results. No false-positive IgM assays were observed. We conclude that the false-positive rate of the EIA IgM is low, and that an isolated positive EIA IgM should prompt further follow-up and diagnostic testing.


Coccidioides Immunoenzyme techniques False-positive reactions Predictive value of tests 



Arizona Department of Health Services


Complement fixation


Enzyme immunoassay


Human immunodeficiency virus




Immunoglobulin G


Immunoglobulin M


  1. 1.
    Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR. Coccidioidomycosis: a descriptive survey of a reemerging disease: clinical characteristics and current controversies. Medicine (Baltimore). 2004;83:149–75.CrossRefGoogle Scholar
  2. 2.
    Chiller TM, Galgiani JN, Stevens DA. Coccidioidomycosis. Infect Dis Clin North Am. 2003;17:41–57.PubMedCrossRefGoogle Scholar
  3. 3.
    Anstead GM, Graybill JR. Coccidioidomycosis. Infect Dis Clin North Am. 2006;20:621–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Pappagianis D, Zimmer BL. Serology of coccidioidomycosis. Clin Microbiol Rev. 1990;3:247–68.PubMedGoogle Scholar
  5. 5.
    Blair JE, Coakley B, Santelli AC, Hentz JG, Wengenack NL. Serologic testing for symptomatic coccidioidomycosis in immunocompetent and immunosuppressed hosts. Mycopathologia. 2006;162:317–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Wieden MA, Lundergan LL, Blum J, Delgado KL, Coolbaugh R, Howard R, et al. Detection of coccidioidal antibodies by 33-kDa spherule antigen, Coccidioides EIA, and standard serologic tests in sera from patients evaluated for coccidioidomycosis. J Infect Dis. 1996;173:1273–7.PubMedGoogle Scholar
  7. 7.
    Kaufman L, Sekhon AS, Moledina N, Jalbert M, Pappagianis D. Comparative evaluation of commercial Premier EIA and microimmunodiffusion and complement fixation tests for Coccidioides immitis antibodies. J Clin Microbiol. 1995;33:618–9.PubMedGoogle Scholar
  8. 8.
    International classification of diseases, 9th revision, clinical modification: Med-Index ICD-9-CM. 4th ed. Salt Lake City (UT): Med-Index; 1994.Google Scholar
  9. 9.
    Palmer DF, Kaufman L, Kaplan W, Cavallaro JJ, editors. Serodiagnosis of mycotic diseases. Springfield (IL): Charles C Thomas; 1977.Google Scholar
  10. 10.
    Kuberski T, Myers R, Wheat LJ, Durkin M, Connolly P, Kubak BM, et al. Diagnosis of coccidioidomycosis by antigen detection using cross-reaction with a Histoplasma antigen. Clin Infect Dis. 2007;44:e50–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Saubolle MA, McKellar PP, Sussland D. Epidemiologic, clinical, and diagnostic aspects of coccidioidomycosis. J Clin Microbiol. 2007;45:26–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Martins TB, Jaskowski TD, Mouritsen CL, Hill HR. Comparison of commercially available enzyme immunoassay with traditional serological tests for detection of antibodies to Coccidioides immitis. J Clin Microbiol. 1995;33:940–3.PubMedGoogle Scholar
  13. 13.
    Pappagianis D. Serologic studies in coccidioidomycosis. Semin Respir Infect 2001;16:242–50.PubMedCrossRefGoogle Scholar
  14. 14.
    Smith CE, Saito MT, Beard RR, Kepp RM, Clark RW, Eddie BU. Serological tests in the diagnosis and prognosis of coccidioidomycosis. Am J Hyg. 1950;52:1–21.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Janis E. Blair
    • 1
  • Jeremiah T. Currier
    • 2
  1. 1.Division of Infectious DiseasesMayo ClinicScottsdaleUSA
  2. 2.Northern Arizona UniversityFlagstaffUSA

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