In:
Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 73, No. 9 ( 2021-11-02), p. e2746-e2753
Abstract:
Coccidioidomycosis (CM) is a common cause of community-acquired pneumonia where CM is endemic. Manifestations include self-limited pulmonary infection, chronic fibrocavitary pulmonary disease, and disseminated coccidioidomycosis. Most infections are identified by serological assays including enzyme-linked immunoassay (EIA), complement fixation, and immunodiffusion. These are time-consuming and take days to result, impeding early diagnosis. A new lateral flow assay (LFA; Sōna; IMMY, Norman, OK) improves time-to-result to 1 hour. Methods We prospectively enrolled 392 patients with suspected CM, compared the LFA with standard EIA and included procalcitonin evaluation. Results Compared with standard EIA, LFA demonstrates 31% sensitivity (95% confidence interval [CI], 20–44%) and 92% specificity (95% CI, 88–95%). Acute pulmonary disease (74%) was the most common clinical syndrome. Hospitalized patients constituted 75% of subjects, and compared with outpatients, they more frequently had ≥3 previous healthcare facility visits (P = .05), received antibacterials (P & lt; .01), and had & gt;3 antibacterial courses (P & lt; .01). Procalcitonin (PCT) was & lt;0.25 ng/mL in 52 (83%) EIA-positive patients, suggesting infection was not bacterial. Conclusions When CM is a possible diagnosis, LFA identified nearly one-third of EIA-positive infections. Combined with PCT & lt;0.25 ng/mL, LFA could reduce unnecessary antibacterial use by 77%.
Type of Medium:
Online Resource
ISSN:
1058-4838
,
1537-6591
DOI:
10.1093/cid/ciaa1205
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2021
detail.hit.zdb_id:
2002229-3
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