Coccidioides Ab, CompF/ImmDiff, S (SCOC), San Joaquin Valley fever, Valley Fever, Cocci
Diagnosis of coccidioidomycosis in serum specimens
Antibodies (both IgM and IgG) may be present after the infection has resolved.
Complement Fixation (CF) Using Coccidioidin: IgG
Immunodiffusion: IgG and IgM
Coccidioidomycosis (valley fever, San Joaquin Valley fever) is a fungal infection found in the southwestern US, Central America, and South America. It is acquired by inhalation of arthroconidia of Coccidioides immitis/posadasii. Usually, it is a mild, self-limiting pulmonary infection. Less commonly, chronic pneumonia may occur, progressing to fibronodular, cavitary disease. A rash often develops within a day or 2, followed by erythema nodosum or multiforme and accompanying arthralgias. About 2 weeks after exposure, symptomatic patients develop fever, cough, malaise, and anorexia; chest pain is often severe. Coccidioidomycosis may disseminate beyond the lungs to involve multiple organs, including the meninges.
IgG antibody is detected by the complement-fixation tests. Precipitating antibodies (IgM and IgG) are detected by immunodiffusion. They are rarely found in cerebrospinal fluid; however, their presence is associated with meningitis. Chronic coccidioidal pulmonary cavities are often accompanied by IgG and IgM precipitating antibodies.
Serologic testing for coccidioidomycosis should be considered when patients exhibit symptoms of pulmonary or meningeal infection and have lived or traveled in areas where C immitis/possadasii is endemic. Any history of exposure to the organism or travel cannot be overemphasized when a diagnosis of coccidioidomycosis is being considered.
If positive, results are titered.
Results are reported as positive, negative, or equivocal.
Titers of 1:2 or higher may suggest active disease; however, titers may persist for months after infection has resolved. Increasing complement fixation (CF) titers in serial specimens are considered diagnostic of active disease.
The presence of IgM antibody may be detectable within 2 weeks after the onset of symptoms; however, antibody may be detected longer than 6 months after infection.
The presence of IgG antibody parallels the CF antibody and may suggest an active or a recent asymptomatic infection with Coccidioides immitis/posadasii; however, antibodies may persist after the infection has resolved.
An equivocal result (a band of nonidentity) cannot be interpreted as significant for a specific diagnosis. However, this may be an indication that a patient should be followed serologically.
Over 90% of primary symptomatic cases will be detected by combined immunodiffusion (ID) and CF testing.