PubMed · 6285789
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D A Stevens, P L William, A M Sugar, A Pont. 1982. Ketoconazole effects.. https://doi.org/10.7326/0003-4819-97-2-284_3
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Coccidioidomycosis is an endemic fungal infection of the southwestern United States. Normally a self-limited infection in healthy hosts, coccidioidomycosis can become a serious complication in patients who have had solid organ transplantation. Among patients whose solid organ transplantation was complicated by coccidioidomycosis, the infection has a variety of clinical presentations. Disseminated disease is common and has substantial morbidity. Patients at risk for coccidioidal infection should be identified so that antifungal prophylactic therapy can be initiated. Treatment options include amphotericin B or azoles. Secondary prophylaxis is recommended because relapse is frequent.
Serologic tests are valuable in the management of patients with suspected or confirmed coccidioidomycosis. Qualitative tests (immunodiffusion, enzyme immunoassay, or latex particle agglutination) permit detection in the serum of the major antibody responses-coccidioidal IgM in early coccidioidomycosis, and complement fixing (CF) IgG, which appears later and is more persistent. Quantitation of the level (titer) of coccidioidal IgG is useful in prognosis and diagnosis. The preferable antigen for these tests is coccidioidin from the hyphal phase of Coccidioides immitis. When coccidioidal disease has disseminated to an extrapulmonary site, the corresponding fluid-cerebrospinal, synovial, peritoneal (as well as pleural)-can be tested for coccidioidal antibody provided that the serum is known to be positive. Some immunocompromised patients may have a limited humoral responsiveness; therefore, it will be important to develop a practical method for the detection of coccidioidal antigen.
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