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Original Research: Chest Infections |

CoccidioidomycosisPleural Effusions in Coccidioidomycosis: Adenosine Deaminase Levels, Serologic Parameters, Culture Results, and Polymerase Chain Reaction Testing in Pleural Fluid

George R. Thompson, III, MD; Shobha Sharma, MD; Derek J. Bays, BS; Rachel Pruitt, BS; David M. Engelthaler, BS; Jolene Bowers, PhD; Elizabeth M. Driebe, PhD; Michael Davis, MD, FCCP; Robert Libke, MD; Stuart H. Cohen, MD; Demosthenes Pappagianis, MD, PhD
Author and Funding Information

From the Department of Medical Microbiology and Immunology (Drs Thompson and Pappagianis, Mr Bays, and Ms Pruitt), Coccidioidomycosis Serology Laboratory, University of California-Davis, Davis, CA; Department of Internal Medicine (Drs Thompson and Cohen), Division of Infectious Diseases, University of California Davis Medical Center, Davis, CA; Department of Internal Medicine (Drs Sharma and Libke), Division of Infectious Diseases, University of California at San Francisco-Fresno Medical Center, Fresno, CA; Translational Genomics Research Institute (Mr Engelthaler and Drs Bowers and Driebe), Flagstaff, AZ; and Doctors Hospital of Manteca (Dr Davis), Manteca, CA.

Correspondence to: George R. Thompson III, MD, Coccidioidomycosis Serology Laboratory, Department of Medical Microbiology and Immunology, Department of Medicine, Division of Infectious Diseases, University of California-Davis, Davis, CA 95616; e-mail: grthompson@ucdavis.edu


Funding/Support: This research was funded in part by the US National Institutes of Health [Grant #R21AI076773].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):776-781. doi:10.1378/chest.12-1312
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Background:  In a patient with positive serum serology for coccidioidomycosis, the differential diagnosis of concurrent pleural effusions can be challenging. We, therefore, sought to clarify the performance characteristics of biochemical, serologic, and nucleic-acid-based testing in an attempt to avoid invasive procedures. The utility of adenosine deaminase (ADA), coccidioidal serology, and polymerase chain reaction (PCR) in the evaluation of pleuropulmonary coccidioidomycosis has not been previously reported.

Methods:  Forty consecutive patients evaluated for pleuropulmonary coccidioidomycosis were included. Demographic data, pleural fluid values, culture results, and clinical diagnoses were obtained from patient chart review. ADA testing was performed by ARUP Laboratories, coccidioidal serologic testing was performed by the University of California-Davis coccidioidomycosis serology laboratory, and PCR testing was performed by the Translational Genomics Research Institute using a previously published methodology.

Results:  Fifteen patients were diagnosed with pleuropulmonary coccidioidomycosis by European Organization for the Research and Treatment of Cancer/Mycoses Study Group criteria. Pleural fluid ADA concentrations were <40 IU/L in all patients (range, < 1.0-28.6 IU/L; median, 4.7). The sensitivity and specificity of coccidioidal serologic testing was 100% in this study. The specificity of PCR testing was high (100%), although the overall sensitivity remained low, and was comparable to the experience of others in the clinical use of PCR for coccidioidal diagnostics.

Conclusion:  Contrary to prior speculation, ADA levels in pleuropulmonary coccidioidomycosis were not elevated in this study. The sensitivity and specificity of coccidioidal serologic testing in nonserum samples remained high, but the clinical usefulness of PCR testing in pleural fluid was disappointing and was comparable to pleural fluid culture.

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