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Test ID: CCOC Coccidioides Antibody, Complement Fixation and Immunodiffusion, Spinal Fluid

Reporting Name

Coccidioides Ab, CompF/ImmDiff, CSF

Useful For

Diagnosing coccidioidomycosis in spinal fluid

Clinical Information

Coccidioidomycosis (Valley fever, San Joaquin Valley fever) is a fungal infection found in the southwestern United States, 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 1 to 2 days, 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.

 

Serologic testing for coccidioidomycosis should be considered when patients exhibit symptoms of meningeal infection and have lived in or traveled to areas where Coccidioides immitis/posadasii is endemic. Any history of exposure to the organism or travel cannot be overemphasized when coccidioidomycosis serologic tests are being considered.

Interpretation

Complement Fixation:

IgG antibody is detected by complement fixation (CF) testing. Any CF titer in cerebrospinal fluid (CSF) should be considered significant. A positive complement fixation test in un-concentrated CSF is diagnostic of meningitis.

 

Immunodiffusion:

IgM and IgG precipitins are rarely found in CSF. However, when present, they are diagnostic of meningitis (100% specific). Since the immunodiffusion test is 100% specific, it is helpful in interpreting CF results.

Testing Algorithm

See Meningitis/Encephalitis Panel Algorithm in Special Instructions.

Analytic Time

3 days

Day(s) and Time(s) Performed

Monday; 6 a.m.

Tuesday through Friday; 9:30 a.m.

Clinical Reference

1. Larone D, Mitchell T, Walsh T: Histoplasma, blastomyces, coccidioides, and other dimorphic fungi causing systemic mycoses. In: Murray PR, Baron EJ, Pfaller MA, et al, eds. Manual of Clinical Microbiology. 7th ed. ASM Press, 1999:1260-1261

2. Ramanan P, Wengenack NL, Theel ES: Laboratory diagnosis for fungal infections. A review of current and future diagnostic assays. Clin Chest Med. 2017 Sep;38(3):535-554. doi: 10.1016/j.ccm.2017.04.013

Method Name

Complement Fixation (CF) Using Coccidioidin: IgG
Immunodiffusion: IgG and IgM

Specimen Type

CSF


Specimen Required


Container/Tube: Sterile vial

Specimen Volume: 2 mL


Specimen Minimum Volume

1.2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
CSF Refrigerated (preferred) 14 days
  Frozen  14 days

Reference Values

COMPLEMENT FIXATION

Negative

If positive, results are titered.

 

IMMUNODIFFUSION

Negative

Results are reported as positive, negative, or equivocal.

Test Classification

This test has been cleared, approved or is exempt by the U.S. Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

86635 x 3

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CCOC Coccidioides Ab, CompF/ImmDiff, CSF 88745-5

 

Result ID Test Result Name Result LOINC Value
81542 Coccidioides Ab, CompF, CSF 13917-0
21002 Coccidioides, IgG, ImmDiff, CSF 94662-4
21001 Coccidioides, IgM, ImmDiff, CSF 94663-2

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.

Mayo Clinic Laboratories | Neurology Catalog Additional Information:

mml-CNS-Infections, mml-Pediatric