Specificity of Enzyme Immunoassay for Serologic Coccidioidomycosis Diagnosis Compared to Immunodiffusion

Persistent Link:
http://hdl.handle.net/10150/183699
Title:
Specificity of Enzyme Immunoassay for Serologic Coccidioidomycosis Diagnosis Compared to Immunodiffusion
Author:
Petein, Nathalie
Affiliation:
The University of Arizona College of Medicine - Phoenix
Issue Date:
Mar-2011
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Collection Information:
This item is part of the College of Medicine - Phoenix Scholarly Projects 2011 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.
Abstract:
BACKGROUND: Serologic testing for coccidioidomycosis challenges clinicians due to conflicting small studies regarding the sensitivity and specificity of newer enzyme immunoassay (EIA) tests and the lack of a true gold standard diagnostic test for comparison. METHODS: We analyzed all Lab Corp coccidioidomycosis serological test results from February 2008 through February 2009 and calculated the sensitivity, specificity, and positive/negative predictive values of EIA immunoglobulin (Ig)M and IgG. Immunodiffusion IgM and IgG (ID), complement fixation titers (CF), and tissue/culture diagnosis were used as tests for comparison. The comparison test (CT) was considered positive if any comparison test was positive the day of EIA collection or if tissue/culture diagnosis occurred during the time period. Cases required EIA IgM and IgG and ≥ 2 comparison tests performed the same day for inclusion. Medical records associated with positive EIA and negative comparison test results were reviewed for coccidioidomycosis symptoms, physician diagnosis, and subsequent positive comparison test results. Sensitivity, specificity, and predictive values were calculated, including those with subsequent positive comparison test results. RESULTS: A total of 1445 laboratory test sets were identified. EIA sensitivity and specificity were 83.8% and 92.6%, respectively. Positive and negative predictive values were 61.5% and 97.6%, respectively. Of 94 “false positive” EIA results, 92 (97.9%) were associated with documented coccidioidomycosis symptoms and 81% with coccidioidomycosis physician diagnosis. CONCLUSION: Based on the largest study of sensitivity and specificity calculated from laboratory surveillance data, EIA sensitivity and specificity for coccidioidomycosis diagnosis are lower than previously reported using only coccidioidomycosis laboratory tests as a comparison. However, association of “false positive” EIA results with coccidioidomycosis symptoms and physician diagnosis suggests that ID and CF laboratory tests alone are not a sufficient confirmation test for diagnosis.
MeSH Subjects:
Coccidioidomycosis; Sunenshine, Rebecca, MD
Description:
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleSpecificity of Enzyme Immunoassay for Serologic Coccidioidomycosis Diagnosis Compared to Immunodiffusionen_US
dc.contributor.authorPetein, Nathalieen_US
dc.contributor.departmentThe University of Arizona College of Medicine - Phoenixen_US
dc.date.issued2011-03-
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.collectioninformationThis item is part of the College of Medicine - Phoenix Scholarly Projects 2011 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.en_US
dc.description.abstractBACKGROUND: Serologic testing for coccidioidomycosis challenges clinicians due to conflicting small studies regarding the sensitivity and specificity of newer enzyme immunoassay (EIA) tests and the lack of a true gold standard diagnostic test for comparison. METHODS: We analyzed all Lab Corp coccidioidomycosis serological test results from February 2008 through February 2009 and calculated the sensitivity, specificity, and positive/negative predictive values of EIA immunoglobulin (Ig)M and IgG. Immunodiffusion IgM and IgG (ID), complement fixation titers (CF), and tissue/culture diagnosis were used as tests for comparison. The comparison test (CT) was considered positive if any comparison test was positive the day of EIA collection or if tissue/culture diagnosis occurred during the time period. Cases required EIA IgM and IgG and ≥ 2 comparison tests performed the same day for inclusion. Medical records associated with positive EIA and negative comparison test results were reviewed for coccidioidomycosis symptoms, physician diagnosis, and subsequent positive comparison test results. Sensitivity, specificity, and predictive values were calculated, including those with subsequent positive comparison test results. RESULTS: A total of 1445 laboratory test sets were identified. EIA sensitivity and specificity were 83.8% and 92.6%, respectively. Positive and negative predictive values were 61.5% and 97.6%, respectively. Of 94 “false positive” EIA results, 92 (97.9%) were associated with documented coccidioidomycosis symptoms and 81% with coccidioidomycosis physician diagnosis. CONCLUSION: Based on the largest study of sensitivity and specificity calculated from laboratory surveillance data, EIA sensitivity and specificity for coccidioidomycosis diagnosis are lower than previously reported using only coccidioidomycosis laboratory tests as a comparison. However, association of “false positive” EIA results with coccidioidomycosis symptoms and physician diagnosis suggests that ID and CF laboratory tests alone are not a sufficient confirmation test for diagnosis.en_US
dc.typeThesisen_US
dc.subject.meshCoccidioidomycosisen_US
dc.subject.meshSunenshine, Rebecca, MDen_US
dc.descriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.en_US
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