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HelpTest ID CCOC Coccidioides Antibody, Complement Fixation and Immunodiffusion, Spinal Fluid
Reporting Name
Coccidioides Ab, CompF/ImmDiff, CSFUseful For
Diagnosing coccidioidomycosis using spinal fluid specimens
Specimen Type
CSFSpecimen Required
Container/Tube: Sterile vial
Specimen Volume: 2 mL
Collection Instructions: Submit specimen from collection vial 2 (preferred), 3, or 4.
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.
Day(s) Performed
Monday through Friday
Test Classification
This test has been cleared, approved, or is exempt by the US 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
Clinical Information
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 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.
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 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 unconcentrated 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.
Cautions
While complement fixation (CF) titers may be present in serum months after the infection has resolved, any CF titer in spinal fluid should be considered significant.
Clinical Reference
1. McHardy IH, Barker B, Thompson GR 3rd. Review of Clinical and Laboratory Diagnostics for Coccidioidomycosis. J Clin Microbiol. 2023;61(5):e0158122. doi:10.1128/jcm.01581-22
2. Ramanan P, Wengenack NL, Theel ES. Laboratory diagnosis for fungal infections. A review of current and future diagnostic assays. Clin Chest Med. 2017;38(3):535-554. doi:10.1016/j.ccm.2017.04.013
Method Description
Complement Fixation:
The immune response of a person to an infection frequently begins with the formation of specific antibody that is capable of combining in vitro with homologous antigen and complement (C'). The complement fixation (CF) test is a 2-stage test based on the ability of antigen-antibody complexes to bind C'. In the first stage, antigen and antibody combine and fix C'. The second stage is an indicator system in which sheep erythrocytes, sensitized by rabbit anti-sheep red cell antibody (hemolysin), are used to demonstrate the presence of unfixed C'. If the patient's serum contains C'-fixing antibody that reacts with the specific antigen (a positive reaction), C' will be fixed and excess C' will not be available to react with and lyse the sensitized sheep erythrocytes. If no antigen-antibody reaction occurs (a negative reaction), C' will be available to lyse the sheep erythrocytes. The CF titer is determined by the greatest dilution of serum (antibody) in which the sheep erythrocytes are not lysed.(Kaufman L, Kovacs JA, Reiss E: Immunomycology. In: Rose NR, de Macario ED, Folds JD, Lane HC, Nakamura RM, eds. Manual of Clinical Laboratory Immunology. 5th ed. ASM Press; 1997:591-592; Pappagianis D, Zimmer BL: Serology of coccidioidomycosis. Clin Microbiol Rev. 1990;3:247-268; Ramanan P, Wengenack NL, Theel ES. Laboratory diagnosis for fungal infections. A review of current and future diagnostic assays. Clin Chest Med. 2017;38[3]:535-554. doi:10.1016/j.ccm.2017.04.013)
Immunodiffusion:
Immunodiffusion (ID) is a qualitative test employed for the detection of precipitating antibodies present in the specimen. Soluble antigens of the fungus are placed in wells of an agarose gel filled Petri dish and the patient's specimen and a control (positive) are placed in adjoining wells. If present, specific precipitate antibody will form precipitin lines between the wells. Their comparison to the control establishes the results. When performing the ID test, only precipitin bands of identity with the reference bands are significant.(Kaufman L, Kovacs JA, Reiss E: Immunomycology. In: Rose NR, de Macario EC, Folds JD, Lane HC, Nakamura RM, eds. Manual of Clinical Laboratory Immunology. 5th ed. ASM Press, 1997:591-593; Ramanan P, Wengenack NL, Theel ES. Laboratory diagnosis for fungal infections. A review of current and future diagnostic assays. Clin Chest Med. 2017;38[3]:535-554)
Report Available
3 to 6 daysReject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
NY State Approved
YesMethod Name
Complement Fixation (CF)/Immunodiffusion (ID)
Forms
If not ordering electronically, complete, print, and send Infectious Disease Serology Test Request (T916) with the specimen.
Disease States
- Coccidioidomycosis
Testing Algorithm
For more information see Meningitis/Encephalitis Panel Algorithm.