Abstract
To investigate the epidemiology of Coccidioides immitis infection in persons returning to western Canada from C immitis endemic zones in southwestern United States. Review of C immitis serology requests from 1996. Data were based on review of enzyme immunoassay and immunodiffusion results from 1993 to 1996 inclusive. Detailed information on clinical presentation, treatment and outcome of disease process was obtained through questionnaires and interviews with physicians who submitted Coccidioides serology requests in 1996. Positive serology for C immitis increased from 4.7% to 5.2% (between 1993 and 1995 inclusive) to 10.7% in 1996. Enzyme immunoassay for immunoglobulin G and/or immunoglobulin M or immunodiffusion was positive in 25 patients in 1996. The mean age of these patients was 62 years, and the predominant clinical presentation was pulmonary infiltrate with fever. All patients with positive serology were known to have travelled to central or southwestern Arizona or southern California. Travel to a defined coccidioidomycosis endemic zone presents a risk for the older traveller. Serology for C immitis supported the clinical, histological and microbiological diagnoses in patients who had travelled to this defined endemic zone.
Highlights
The patients were attended by many physicians in many different locales, and there is no reason to suspect that physician practices changed during the period of study. If this were the case, we might have expected a significant increase in the number of requests for Coccidioides serology
In 1996, we identified at least 25 new cases of C immitis infection; in one year, almost one-fifth the number reported in Canada over the previous 35 to 40 years [8]
The Premier Coccidioides enzyme immunoassay (EIA) screening test provided laboratory evidence supporting the diagnosis of C immitis infection in this nonendemic population
Summary
Enzyme immunoassay: The Premier Coccidioides enzyme immunoassay (EIA) (Meridian Diagnostics, Inc, Ohio) was used as the screening test. This is a qualitative assay for the detection of immunoglobulin (Ig) M and IgG antibodies directed against the purified tube-precipitating and complement fixing antigens of C immitis in serum and cerebrospinal fluid. Information requested included patient demographics, clinical presentation and diagnosis, travel history, mycology culture results if available and performed in a laboratory other than NCM, types of specimens collected, biopsy and/or histological evidence of disease, use of any antifungals, and patient outcomes. Patients with negative serology but whose laboratory requests indicated that the patients had travelled to a Coccidioides endemic area had clinical information collected using the same format as that for patients with positive serology. In cases with negative serology where there was no travel indicated on the requisition or when the travel indicated was to nonendemic areas such as Idaho or the southeastern United States, no additional clinical information was collected
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