Utility of Anti-WI-1 Serological Testing in the Diagnosis of Blastomycosis in Wisconsin Residents

Abstract

WI-1, a 120-kD protein found in the outer cell wall of Blastomyces dermatitidis, has been purified, labeled with 125I, and used as a target in a radioimmunoassay (RIA). In an assessment of the usefulness of anti-WI-1 serology in the diagnosis of blastomycosis, the RIA was used to test four panels of sera from residents of Wisconsin, a state in which blastomycosis is endemic. Twenty-four (75%) of 32 patients whose blastomycosis had been reported to the Wisconsin Division of Health had at least one serum sample positive for antibody to WI-1; 25 (93%) of 27 serum samples obtained from these patients within 60 days of diagnosis were positive. In an effort to simulate clinical practice, 132 serum samples were assayed from another 107 patients in whom blastomycosis was being considered as a cause of illness. The result was positive for at least one sample from 83% of the 23 patients with confirmed blastomycosis and from 5% of the 84 patients from whom the fungus was not documented. Serum samples from another five patients with blastomycosis identified during investigation of a 1990 outbreak in Oconto Falls, Wisconsin, also gave a positive result, whereas none of the serum specimens from 57 healthy family members or neighbors did so. Only three (0.56%) of 535 serum samples from random blood donors residing in two counties with a high annual incidence of blastomycosis were positive for antibody to WI-1. Modification of the RIA so that IgM rather than IgG antibody was detected did not enhance diagnostic sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)