scholarly journals 263. Advances in Diagnosis of Progressive Coccidioidomycos: Experience in 164 Cases and 508 Controls

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S146-S146
Author(s):  
Robert Myers ◽  
Holbrook Eric ◽  
Lawrence J Wheat ◽  
Christelle Kassis ◽  
Michelle Durkin
Keyword(s):  
Retrospective Study ◽  
Sensitivity And Specificity ◽  
Advanced Disease ◽  
Turnaround Time ◽  
Antibody Detection ◽  
Immunocompromised Patients ◽  
Antibody Testing ◽  
Main Method ◽  
Antigen Testing ◽  
Urine And Serum

Abstract Background Antibody detection is the main method for diagnosis of coccidioidomycosis but has limitations including sensitivity and turnaround time. The MVISTA Coccidioides antigen enzyme immunoassay (EIA) is recommended for testing CSF in suspected Coccidioides meningitis. The early reports on urine and serum antigen testing evaluated small numbers of patients who were mostly immunocompromised with advanced disease. Methods A retrospective study, including all patients in whom Coccidioides antigen testing was performed between January 2013 and May 2017, was conducted at Maricopa Integrated Health System (MIHS). Sensitivity and specificity of antigen testing at MiraVista Diagnostics and antibody testing at MIHS or commercial laboratories were evaluated in 164 cases and 508 controls. Results The sensitivity of antigen testing was 51% and specificity was 99%. The sensitivity of antigen detection was highest if both urine and serum were tested (57%) than if only urine was tested (38%). The sensitivity of antibody testing was 84% and the specificity was 94% by immunodiffusion (ID). The sensitivity and specificity of antigen or ID antibody testing both were 94%. Sensitivity of antigen testing was 57% in proven and 58% in probable cases, ID antibody in 85% of proven and 75% of probable and antigen or ID antibody in 93% of proven and 95% of probable cases. Antigen was detected more often in disseminated (79%) than pulmonary cases (42%) as was ID antibody, 91% and 79%, respectively. Antigen testing was more sensitive in immunocompromised (76%) than non-immunocompromised patients (41%) while ID antibody was less sensitive in immunocompromised (74%) than in non-immunocompromised patients (93%). Combined antigen and ID antibody testing provided the highest sensitivity, 94% in all cases, 94% in immunocompromised and 95% in non-immunocompromised patients. Conclusion These findings support testing urine and serum for Coccidioides antigen and serum for ID antibodies for diagnosis of progressive pulmonary or disseminated coccidioidomycosis. Disclosures All authors: No reported disclosures.

scholarly journals Advances in Diagnosis of Progressive Pulmonary and Disseminated Coccidioidomycosis

2020 ◽  
Author(s):  
Christelle Kassis ◽  
Michelle Durkin ◽  
Eric Holbrook ◽  
Robert Myers ◽  
Lawrence Wheat
Keyword(s):  
Cerebrospinal Fluid ◽  
Retrospective Study ◽  
Medical Center ◽  
Antigen Detection ◽  
Antibody Detection ◽  
Main Method ◽  
System Sensitivity ◽  
Serum Antigen ◽  
Urine And Serum ◽  
Immunocompetent Patients

Abstract Background Antibody detection is the main method for diagnosis of coccidioidomycosis, but it has limitations. The Coccidioides antigen enzyme immunoassay is recommended for testing cerebrospinal fluid in suspected meningitis. Reports on urine and serum antigen detection evaluated small numbers of patients who were mostly immunocompromised. The purpose of this study was to assess the accuracy of combined antibody and antigen detection for diagnosis. Methods A retrospective study, including all patients in whom Coccidioides antigen detection in serum was performed between January 2013 and May 2017, was conducted at Valleywise Health Medical Center (formerly Maricopa Integrated Health System). Sensitivity and specificity of antigen and antibody were evaluated in 158 cases and 487 controls. Results The sensitivity of antibody detection by immunodiffusion (ID) was 84.2%. The sensitivity of antigen detection was 57.0% if both urine and serum were tested and 36.7% if urine alone was tested. The sensitivity of combining antigen and ID antibody detection was 93.0%. The sensitivity of urine and serum antigen detection was 55.4% in proven and 58.7% in probable cases, 79.1% in disseminated and 41.6% in pulmonary cases, and 74.7% in immunocompromised and 40.0% in immunocompetent patients. Specificity was 99.4% for antigen detection and 96.5% for ID antibody detection. Diagnostic accuracy was 95.4% for ID antibody and antigen detection, 93.6% for ID antibody alone, and 89.1% for pathology or culture. Conclusions These findings support combined antibody and antigen detection for diagnosis of progressive coccidioidomycosis. The diagnosis may have been missed if antigen detection was not performed.

scholarly journals Development of a Highly Sensitive and Specific Blastomycosis Antibody Enzyme Immunoassay Using Blastomyces dermatitidis Surface Protein BAD-1

2013 ◽  
Vol 21 (2) ◽  
pp. 143-146 ◽  
Author(s):  
Sarah M. Richer ◽  
Melinda L. Smedema ◽  
Michelle M. Durkin ◽  
T. Tristan Brandhorst ◽  
Chadi A. Hage ◽  
...  
Keyword(s):  
Enzyme Immunoassay ◽  
Surface Protein ◽  
Antibody Detection ◽  
Blastomyces Dermatitidis ◽  
Antibody Testing ◽  
Content Type ◽  
Negative Results ◽  
Highly Sensitive ◽  
Low Sensitivity ◽  
Antigen Testing

ABSTRACTSerologic tests for antibodies toBlastomyces dermatitidisare not thought to be useful for the diagnosis of blastomycosis, in part due to the low sensitivity of immunodiffusion and complement fixation. Earlier studies have shown that the enzyme immunoassay improves the sensitivity of antibody detection for the diagnosis of blastomycosis. Microplates coated with theB. dermatitidissurface protein BAD-1 were used for testing sera from patients with proven blastomycosis or histoplasmosis and controls. Semiquantification was accomplished by using standards containing human anti-B. dermatitidisantibodies. The antibodies were detected in 87.8% of the patients with blastomycosis by the enzyme immunoassay compared to 15.0% by immunodiffusion. The specificities were 99.2% for patients with nonfungal infections and healthy subjects and 94.0% for patients with histoplasmosis. The results were highly reproducible on repeat testing. When combined with antigen testing, antibody testing improved the sensitivity from 87.8% to 97.6%. Enzyme immunoassay detection of antibodies against BAD-1 is highly specific, has greatly improved sensitivity over immunodiffusion, and may identify cases with negative results by antigen testing. This assay has the potential to aid in the diagnosis of blastomycosis.

scholarly journals Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Camilla Mattiuzzi ◽  
Brandon M. Henry ◽  
Giuseppe Lippi
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Point Of Care ◽  
Turnaround Time ◽  
Molecular Testing ◽  
Upper Respiratory Tract ◽  
Making Sense ◽  
Skilled Personnel ◽  
Potential Benefits ◽  
Antigen Testing ◽  
Care Availability

AbstractAlthough the most effective strategy for preventing or containing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks relies on early diagnosis, the paramount and unprecedented number of tests needed to fully achieve this target is overwhelming worldwide testing supply and capacity. Molecular detection of SARS-CoV-2 RNA in nasopharyngeal swabs is still considered the reference diagnostic approach. Nonetheless, identification of SARS-CoV-2 proteins in upper respiratory tract specimens and/or saliva by means of rapid (antigen) immunoassays is emerging as a promising screening approach. These tests have some advantages compared to molecular analysis, such as point of care availability, no need of skilled personnel and dedicated instrumentation, lower costs and short turnaround time. However, these advantages are counterbalanced by lower diagnostic sensitivity compared to molecular testing, which would only enable to identifying patients with higher SARS-CoV-2 viral load. The evidence accumulated to-date has hence persuaded us to develop a tentative algorithm, which would magnify the potential benefits of rapid antigen testing in SARS-CoV-2 diagnostics.

scholarly journals Does Point-Of-Care SARS-CoV-2 Antibody Testing Have Similar Sensitivity and Specificity To High Complexity Serology?

2021 ◽  
Vol 147 (2) ◽  
pp. AB77
Author(s):  
Kelly O'Shea ◽  
Charles Schuler ◽  
Jesse Chen ◽  
Carmen Gherasim ◽  
Donald Giacherio ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Point Of Care ◽  
High Complexity ◽  
Antibody Testing

scholarly journals Human Immunodeficiency Virus Antibody Testing by Enzyme-Linked Fluorescent and Western Blot Assays Using Serum, Gingival-Crevicular Transudate, and Urine Samples

1999 ◽  
Vol 37 (4) ◽  
pp. 1100-1106 ◽  
Author(s):  
Prudencio Martínez Martínez ◽  
Antonio Rodríguez Torres ◽  
Raul Ortiz de Lejarazu ◽  
Ana Montoya ◽  
José Francisco Martín ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Western Blot ◽  
Stage Iv ◽  
Urine Samples ◽  
World Health ◽  
Antibody Detection ◽  
Lower Sensitivity ◽  
Antibody Testing ◽  
Immunodeficiency Virus

The aim of the present study was to evaluate the possible utilization of saliva and urine as alternative samples to serum for the diagnosis of human immunodeficiency virus (HIV) infection. A total of 302 individuals participated in the study: 187 HIV-infected individuals (106 had Centers for Disease Control and Prevention [CDC] stage II infection, 19 had CDC stage III infection, and 62 had CDC stage IV infection) and 115 noninfected persons (46 of the noninfected persons were blood donors and 69 belonged to a group at high risk of HIV infection). Paired saliva and urine samples were taken from each of the participants in the study. The presence of HIV-specific antibodies was detected by an enzyme-linked fluorescent assay (ELFA), and the result was confirmed by Western blot analysis (WB). The ELFA with saliva gave maximum sensitivity and specificity values, while ELFA had lower sensitivity (95.2%) and specificity (97.4%) values for detection of HIV antibody in urine samples. WB with all saliva samples fulfilled the World Health Organization criterion for positivity, while only 96.8% of the urine samples were confirmed to be positive by WB. Among the four reactivity patterns found by WB of these alternative samples, the most frequent included bands against three groups of HIV structural proteins (was ENV, POL, and GAG). The reactivity bands most frequently observed were those for the proteins gp160 and gp120. The least common reactivity band was the band for protein p17. The detection of HIV antibodies in saliva samples by means of ELFA with the possibility of later confirmation by WB makes saliva an alternative to serum for possible use in the diagnosis of infection. In contrast, HIV antibody detection in urine samples by the same methodology (ELFA) could be taken into consideration for use in epidemiological studies.

scholarly journals Evaluation of Coccidioides Antigen Detection in Dogs with Coccidioidomycosis

2012 ◽  
Vol 19 (3) ◽  
pp. 343-345 ◽  
Author(s):  
Emily J. Kirsch ◽  
Russell T. Greene ◽  
Annalisa Prahl ◽  
Stanley I. Rubin ◽  
Jane E. Sykes ◽  
...  
Keyword(s):  
Enzyme Immunoassay ◽  
Fungal Infections ◽  
Rapid Diagnosis ◽  
Antigen Detection ◽  
Antibody Testing ◽  
Content Type ◽  
Healthy Dogs ◽  
Galactomannan Antigen ◽  
Antigen Antibody ◽  
Urine And Serum

ABSTRACTAntigen detection has been reported to be a promising method for rapid diagnosis of coccidioidomycosis in humans.Coccidioidesantigen detection has not been previously reported in dogs with coccidioidomycosis and was evaluated in 60 cases diagnosed based on detection of anti-Coccidioidesantibodies at titers of 1:16 or more in serum. Controls included dogs with presumed histoplasmosis or blastomycosis, other fungal infections, or nonfungal diseases and healthy dogs. Urine and serum specimens were tested using an enzyme immunoassay forCoccidioidesgalactomannan antigen. Antibody testing was performed at commercial veterinary reference laboratories. Antigen was detected in urine or serum of 12 of 60 (20.0%), urine only in 2 of 57 (3.5%), and serum only in 11 of 58 (19.0%) dogs with coccidioidomycosis. Antigen was detected in the urine of 3 of 43 (7.0%) and serum of 1 of 37 (2.7%) dogs with histoplasmosis or blastomycosis but not in 13 dogs with other fungal infections (serum, 9; urine, 13), 41 dogs with nonfungal diseases (urine, 41; serum, 18), or healthy dogs (serum, 21; urine, 21). Detection of antigen was an insensitive method for diagnosis of coccidioidomycosis in dogs in which the diagnosis was based primarily upon detection of antibodies at titers of 1:16 or higher, and the highest sensitivity was in serum.

Application of the APE2-CHN and RITE2-CHN scores for autoimmune epilepsy in Chinese patients: a retrospective study

2020 ◽  
Author(s):  
Wei-ping Liu ◽  
Mian Wang ◽  
Chen Zhang ◽  
Charlie Weige Zhao ◽  
Bo Xiao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Sensitivity And Specificity ◽  
Chinese Patients ◽  
Unknown Etiology ◽  
Thyroid Peroxidase ◽  
Seizure Outcome ◽  
Receptor Antibody ◽  
Autoimmune Epilepsy ◽  
Patients With Epilepsy ◽  
New Onset

Abstract Background : Autoimmune epilepsy is recognized as a distinct entity of epilepsy with underestimated incidence. Our previous study reported that prompt diagnosis and early-initiated immunotherapy led to better outcome. We proposed to assess the feasibility and reasonability of the Antibody Prevalence in Chinese Patients with Epilepsy and Encephalopathy (APE 2 -CHN) and Response to Immunotherapy in Chinese Patients with Epilepsy and Encephalopathy (RITE 2 -CHN) scores in predicting Chinese patients with autoimmune epilepsy. Methods : We conducted a retrospective study of consecutive patients from Xiangya Hospital, Central South University (01/01/2017-02/28/2019) whose serum and/or cerebrospinal fluid (CSF) samples were examined for autoimmune encephalitis antibodies. Of these, patients with new-onset epilepsy or established epilepsy of unknown etiology were selected in our study. An APE 2 -CHN score was assigned to each patient and a RITE 2 -CHN score was calculated for each patient who received immunotherapy. Results : 191 patients meeting the diagnostic criteria for epilepsy were enrolled in our study. 36 were subsequently identified with specific etiologies. The rest of the 155 patients had an unknown etiology. Central nervous system-specific antibodies were detected in 76 (49.0%) of them, after excluding solely thyroid peroxidase antibody or glutamic acid decarboxylase antibody. N-methyl-D-aspartate receptor antibody (48.7%, 37/76) was the most common antibody specificity, followed by γ-aminobutyric acid type B receptor antibody (14.5%, 11/76). Certain clinical features such as new-onset epilepsy, autonomic dysfunction, viral prodrome, facio-brachial dystonic seizures/oral dyskinesia, inflammatory CSF profile, and mesial temporal magnetic resonance imaging abnormalities correlated with positive antibody results. Sensitivity and specificity of an APE 2 -CHN score ≥ 5 to predict the presence of specific neural auto-antibodies in our study were 85.5% and 58.9%, respectively. In the subset of patients who received immunotherapy (n = 112), sensitivity and specificity of a RITE 2 -CHN score ≥ 8 to predict favorable seizure outcome were 98.6% and 63.2% respectively. Conclusion : The APE 2 -CHN and RITE 2 -CHN scores were preferable tools in predicting positive serologic findings and prognosis of autoimmune epilepsy in Chinese patients with epilepsy.

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