660. Early Treatment with Fluconazole May Abrogate the Development of IgG Antibodies in Coccidioidomycosis
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:   We have observed a number of patients with coccidioidomycosis that fail to develop Coccidioidal complement fixing antibodies (IgG) when early antifungal treatment is initiated.  Others have reported a similar lack of antibody production following early treatment in both primary syphilis and primary Lyme disease; likely due to the requirement for the continued presence of antigen to develop a mature humoral response.

Methods:   A retrospective chart review was conducted on all patients with persistently positive IgM antibodies (>3 months).  Patients were excluded from evaluation if they developed IgG antibody.  Chart abstraction was performed to identify demographic variables and risk factors that may be associated with this phenomenon.

Results: Thirty-two patients with persistence of IgM antibodies were identified.  Clinical information was available for thirteen of these patients.  Seven male and 6 female patients ranging in age from 11-70 (mean 41.5) made up this cohort.  Three patients had proven disease (1 meningitis, 2 pulmonary), the remaining 10 (all pulmonary) had probable disease by established EORTC/MSG criteria and improvement after initiation of antifungal therapy.  Early treatment with antifungals (within 2 weeks of symptom onset) was seen in the majority of patients (11/13).  Concurrent corticosteroid therapy was seen in 2/13 patients (both received antifungals as well).  Six patients had repeat serum testing until antibody was no longer detectable (mean time to resolution of IgM antibody 470 days; range 130-1353 days). 

Conclusion: The early initiation of antifungal therapy may abrogate a portion of the immune response, specifically the IgG response to chitinase CTS1.  Although this phenomenon is relatively uncommon, it may complicate serodiagnosis and epidemiologic aspects regarding the timing of onset in this reportable disease.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
George R. Thompson III, MD , Medical Microbiology and Immunology, University of California-Davis, Davis, CA
Suzanne M. Johnson, PhD , Medical Microbiology and Immunology, University of California-Davis, Davis, CA
Stuart H. Cohen, MD, FIDSA , University of California, Davis, Sacramento, CA
Demosthenes Pappagianis, MD, PhD , University of California School of Medicine, Davis, CA

Disclosures:

G. R. Thompson III, None

S. M. Johnson, None

S. H. Cohen, None

D. Pappagianis, None

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