RESUMO
BACKGROUND: Coccidioidal meningitis (CM), a common cause of chronic meningitis in endemic area, is usually diagnosed by detection of anti-Coccidioides antibodies in cerebrospinal fluid (CSF), and findings may be negative in up to one-third of cases. CSF cultures and cytology are infrequently positive. Antigen detection has been used for the diagnosis of other forms of coccidioidomycosis and meningitis caused by other mycoses. The purpose of this study was to assess the diagnostic utility of CSF Coccidioides antigen (CAg) detection for the diagnosis of CM. METHODS: The medical records of patients with clinically suspected meningitis, in whom CSF was tested for Coccidioides antibodies and CAg, were retrospectively reviewed, and CSF CAg testing was prospectively conducted in patients with CM. All specimens were submitted for CAg testing. RESULTS: Thirty-six patients with 42 episode of CM were studied. The sensitivity and specificity of CAg were 93% and 100%, respectively. Cultures of CSF were positive in 7%, antibodies were demonstrated by immunodiffusion in 67% and complement fixation in 70%, and immunoglobulin M and G antibodies were demonstrated by enzyme immunoassay in 8% and 85%, respectively. CONCLUSIONS: Testing CSF for CAg is a useful addition to diagnostic methods in suspected CM and complements testing with CSF antibodies and culture.
Assuntos
Antígenos de Fungos/análise , Líquido Cefalorraquidiano/microbiologia , Coccidioides/química , Coccidioidomicose/diagnóstico , Meningite Fúngica/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
We report West Nile virus (WNV) RNA in urine collected from a patient with encephalitis 8 days after symptom onset. Viral RNA was detected by reverse transcriptase-polymerase chain reaction (RT-PCR). Sequence and phylogenetic analysis confirmed the PCR product to have > or = 99% similarity to the WNV strain NY 2000-crow3356.
Assuntos
Febre do Nilo Ocidental/urina , Vírus do Nilo Ocidental/isolamento & purificação , Idoso , Anticorpos Antivirais/sangue , Análise por Conglomerados , Humanos , Masculino , Filogenia , RNA Viral/química , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Alinhamento de Sequência , Análise de Sequência de DNA , Febre do Nilo Ocidental/tratamento farmacológico , Vírus do Nilo Ocidental/genéticaRESUMO
Conventional antifungal therapy was not successful for a critically ill patient who had been hospitalized for 137 days in the intensive care unit with disseminated Coccidioides immitis infection and respiratory failure. The addition of interferon- gamma to the therapeutic regimen resulted in improvement and discharge from the hospital. Adjunctive interferon- gamma used in the successful treatment of severe coccidioidomycosis has not been reported previously.
