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

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. Coccidioidomycosis Culture Diagnosis Polymerase 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

References

  1. 1.
    Stevens DA. Coccidioidomycosis. N Engl J Med. 1995;332:1077–82.CrossRefPubMedGoogle Scholar
  2. 2.
    Saubolle MA. Laboratory aspects in the diagnosis of coccidioidomycosis. Ann N Y Acad Sci. 2007;1111:301–14.CrossRefPubMedGoogle Scholar
  3. 3.
    Sutton DA. Diagnosis of coccidioidomycosis by culture: safety considerations, traditional methods, and susceptibility testing. Ann N Y Acad Sci. 2007;1111:315–25.CrossRefPubMedGoogle Scholar
  4. 4.
    Schroter GP, Bakshandeh K, Husberg BS, Well R III. Coccidioidomycosis and renal transplantation. Transplantation. 1977;23:485–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Cohen IM, Galgiani JN, Potter D, Ogden DA. Coccidioidomycosis in renal replacement therapy. Arch Intern Med. 1982;142:489–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Blair JE, Logan JL. Coccidioidomycosis in solid organ transplantation. Clin Infect Dis. 2001;33:1536–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Assi MA, Binnicker MJ, Wengenack NL, Deziel PJ, Badley AD. Disseminated coccidioidomycosis in a liver transplant recipient with negative serology: use of polymerase chain reaction. Liver Transpl. 2006;12:1290–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Binnicker MJ, Buckwalter SP, Eisberner JJ, Stewart RA, McCullough AE, Wohlfiel SL, et al. Detection of Coccidioides species in clinical specimens by real-time PCR. J Clin Microbiol. 2007;45:173–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Wallace JM, Catanzaro A, Moser KM, Harrell JH II. Flexible fiberoptic bronchoscopy for diagnosing pulmonary coccidioidomycosis. Am Rev Respir Dis. 1981;123:286–90.PubMedGoogle Scholar
  10. 10.
    Williams PL. Coccidioidal meningitis. Ann N Y Acad Sci. 2007;1111:377–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Looney JM, Stein T. Coccidioidomycosis: the hazard involved in diagnostic procedures, with report of a case. N Engl J Med. 1950;242:77–82.CrossRefPubMedGoogle Scholar
  12. 12.
    Pike RM. Laboratory-associated infections: summary and analysis of 3921 cases. Health Lab Sci. 1976;13:105–14.PubMedGoogle Scholar
  13. 13.
    Sewell DL. Laboratory-associated infections and biosafety. Clin Microbiol Rev. 1995;8:389–405.PubMedGoogle Scholar
  14. 14.
    Bialek R, Kern J, Herrmann T, Tijerina R, Cecenas L, Reischl U, et al. PCR assays for identification of Coccidioides posadasii based on the nucleotide sequence of the antigen 2/proline-rich antigen. J Clin Microbiol. 2004;42:778–83.CrossRefPubMedGoogle Scholar
  15. 15.
    Johnson SM, Simmons KA, Pappagianis D. Amplification of coccidioidal DNA in clinical specimens by PCR. J Clin Microbiol. 2004;42:1982–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Umeyama T, Sano A, Kamei K, Niimi M, Nishimura K, Uehara Y. Novel approach to designing primers for identification and distinction of the human pathogenic fungi Coccidioides immitis and Coccidioides posadasii by PCR amplification. J Clin Microbiol. 2006;44:1859–62.CrossRefPubMedGoogle Scholar
  17. 17.
    de Aguiar Cordeiro R, Nogueira Brilhante RS, Gadelha Rocha MF, Araujo Moura FE, Pires de Camargo Z, Costa Sidrim JJ. Rapid diagnosis of coccidioidomycosis by nested PCR assay of sputum. Clin Microbiol Infect. 2007;13:449–51.CrossRefPubMedGoogle Scholar
  18. 18.
    Driebe E, Bowers J, Liu C, Schmoker M, Bosch C, Engelthaler DM. Counting cocci: quantitation of Coccidioides using real-time PCR. Presented at the 52nd Coccidioidomycosis Study Group Annual meeting. San Diego, CA; 2008.Google Scholar

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

Personalised recommendations