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Page 1 Rev. Inst. Med. Trop. São Paulo 29(5):276-283, Setembro-Outubro Rev. Inst- Med. tro|. São paulo 2g(5) t276-2E3, seteñhrò-outubro. lg87 PREDICTIVE VALUE OF SEROTOGIC IESTS IN THE DIAGNOSÍS AND FOLLOI¡V.UP OF PATIENTS W|TH PARAGOCCIDIOIDOMYCOSIS tr) Luz EIeD¡ CIINO & Á[getÐ BESTA,RO SUMMABY A serologic study was undertaken in a gtoup of 4A patients with active pe lacoscidioidomycosis who were treated in the same foÍm (ketoconazole). fo¡ identicaJ. periods of time (6 months), and followed-up for valious periods post. therapy. The tests employed w€re agar gel iÌnrnunodiffusion (.A,GID) and, com: plement fixation (FC). AIso studied were S0 seta from patients ,with proven histoplasmosis and pulmonary aspergilloma, B0 patients rwith culturaly proven tuberculosis as \¡¡¡ell as 92 specimens from healthy individuals, residents in thg endemic a.rea for pamcoccidioidornlrcosis, A single lot of yea,st filtpàte antigen wâs used throwhout the stud¡r, ltre va,lue of each tÆst was measuted acsording to GAIEN a¡rd GAMBINO 6. Both tests v¡ere highly sensi¿ive, gg aÃd. gtVo rcs. tæctively. Regarding their specificity, the AGID was totally specific S¿hile the CI' edúbited 96.6Vo and 97qo specificiþ in front of tuberculosis patients and healthy individuals respectively and. 82% in comperison ï'ith patients with other mJ¡coses. The concElt of predlctive value, that is, Ûre certainty one ha.s in accepting a positive test ås diagnostic of paracoccidioidomycosis, favored tbe ,q.GID proædure (70OVo) ov4-r the CF test. The lattet coutd sort out vnllr- 9t7o ceftainty a patient with patacoccidioidomycosis among a group of healthy indi. viduals a,nd willf, 97.5% in the sase of TB patients; when the group in question was composed by individuals with other deep Í\ycoses, sucTì certBinty was lower (877a). T'he above results indicâte that both the .4,GID and the CF iests fumish results of high sonfidenc€; one should not telay, howevel, in the CF alone as a means to establish the specific diagnosis of pamcoccidioidomycosis. KEI¿ WORD,S: Predictive values; Serologic tests; pamsoccidoidorlycosis; Cros$ rea.ctions; Systemic lr¡ycoses, INIT,ODUGTION ParacoccidÍoidomycosis irs a polylno4lhio This being so, it worrld bs highly deslrâble to disease and its varying clùúcal manifestations attempt standatdization of the various tests oft€n delay promp¿ consideration by the trea- currently available and of the reegents ting physical of its erE, real etiology. In tffs con_ ployed in such tests s,7. text serologic tests play an important role in diagnosist"2,11,u,17,19,25, FΡrthermore and due cenetally, in o¡der to achieve standardlza, to the ch¡onic nature of paracoccidioidoh.vcG tion, it is necessårf,r to r¡ndertake the-statist¡ca¡ sis, such tests are also cruciâl in evatuating anâlysis of the most p¡omising tests 6,2,10. Ihg the patient's 2.as,2,8p4, respo¡ìse to treatme¡;it first step towards this goal is to evaluate tho (') s¿udy ges€ntod durj¡s the rslt¡M rr¡temãtlotrsl cou(ql¡IuE on psrêcocclauoidomycosis, Ileb¡1¡sry t986, M€de¡ü¡, eo- loÍrbiB. cotpo¡ación lnvestlgactones Blológic5s (cIB), qoslitÀt p¿blo !3¡a l¡obóà urtbe, Mectellin, cotombts, south ¡t¡¡rer¡cs. 276 CÁNO, f,. E. & RESTREPO, A. - Èedictive value of se¡orogic tests in the diaglþsis and fotlo\¡¡-u! of pEtionts ìrith pa¡âcoccidìoidomycoE:s. Rev. IDst. M€d. irolr. São P¿u¡o, 29t 276-2A3, 1987. tests results obtained when studying series of were 33 cases with histoplasmosis and 17 vrith patients ând of control individuals. We be- pulmonary aspergilloma. lieve that various points should be empha,si- Group C: patients z,ed here as follqws: Constituted by 30 with culturally-proven tuberculosis by M. tubercu. losls var, hominis. 1. The group(s) ur¡del study should be as homogeneous a,s possible and cons- Group D: Composed by 92 healthy indivi. tituted by p€$ons twith simila¡ charâÆ- duâls, all resident in endemic a¡eas for par€" teristics. Ideauy, Û1 the case of pa. coccldioido[rj¡cosis and v¡ho had been previou& tients - rwho should have been prc. ly skin-tested with paxacoccidioidin and for¡nd perly diagnosed tåey should be acti- reactive æ. ve ât time of filst- testing, be treated with the same drug and for similar Concefnturg group A, tftese patients were periods of time, q'ith bleedings ta,lring exarniried at various periods. All 43 v/ere tes- place at identical pe¡iods during and ted at time of diagnosis, when their disease after therapy. Healthy controls should was active. They v¡¡ere all treated vrith keto- be chosen among persons living in the conazole (200 mg,/dey) for a period of 6 mon- known endemic areas for the disease ths; during this time, 42 patients wet€ bled urder study. Patients with ot¡rer fi¡n- at montl¡ 3 of thempy and 4l at 6 months, gal diseases should also be studied Upon determination of therapy, 31 patients once their diagnosis has been propedy were available for testi.ng 12 months after fi- established. nishir¡g drug inta,he, 16 patients after 24 - 2. Identica'l tÆsts should be applied to aü and I after 36 - months. specimeru! and the methods sl¡ould be Patients with paxa.coccidioidom¡¡cosis wer€ carefully controlled, avoiding modifica, classified as having pulmonary diseas€ with tions to the teshniques during the pe dissemination to othet organs (29, 67 -ïEo, ot Iiod of study7 6. as presenting involsement lestricted to the 3. It would be highly desirable to use a lungs (14, 32-5Vo) - Concwrcîf, pulmona"rJ¡ tu- single lot ot antigen for all tests but berculosis was found in 5 patients (11.07¿). if this is not feasÍble, one should em- Regarding other parameterc, most patients (42) ploy antigens potencyT'16. of comparable wele males and âIl were adults, ages 35-62 yeals. Ihe above steps twould, eliminat€ va,riables and would peamit a more precise statistical Sera were collected before breakfast f¡om evalu&tion. all individuâls (groups A, B, C, D), prese¡ved 1:10.000 meÉhiolate bu.ffer solution 8, IÌ¡ring the pa.st 6 years rwe have had tl¡e \trith in and kept the æfdgerato¡ oppofiunity to perform serologic tests to a in at 4'C until time series of patients and healthy coDtfol groups of testing; this rwas done before 15 days of who present optimal conditions for standardi- collection date. obtained the ba. zation. The results we form The serologic t€sts evaluated ï'ere com. sis of tllis publication. plement fixation (CF), the 50ø¿ hemo$¡sis mi- MATEßIAL ÄND METIIODS crGtest recoûlmeded by the CDC Laboratorl¡ Brar¡ch e, and tfie âgar gel immunodiffusion Sera obtained from 4 grol¡ps of percons techrique (AGID) suggested by the Panameri. were studied" as follows: ca'n Health Organization serolog¡¡ study 8. G¡oup À: Composed ttJr 43 pa,tients \trith grou¡x laboretory proven parasoccidioidornycosls as Both tÆsts employed .a yeast filtrate ánti- described elsewhet e T'n þE, gen obtained according to techniques alleady 23, Group B: Fo'rmed þy 50 patients vrith othe¡ descdbed from P. b¡adliensls isoþte 8339. deep mycoses, lwhose diagnosis had allso been A large batch wâs plElarcd and utilized aU established b¡¡ laboratory þro¿€dures. There throughont tlre study pefiod. 277 c'aNo' L' E & RESTREPo A Pre'lictivs Yslue of serotoglc tests pâEcoccidioidomycos:s. - tn the diasÐosis sn¿r folloey..up of lauênts with Rev. IDst. Med. tlop. São p¿uro, 29: }?6-283. I9B?. For comparison putf)oses, a single ¡ot of 30 TB patients GsVo) as well as B Histoplasl¡La capsulatum of the nor- whole yeast oells a.n mal controls (3.37¿), tumed out positive. tigen \Ã'as prel)âted ¡5 and used in the CI' tests. When the IL capsulatum whole yeast CF results cells werc considered positive when antigen was used in tfìe C¡' test (Fig. the titer was > qrere 1), at¡ 1:8; IDGA results DG histopla.smosis sel6r reâcted; a high proportion Êitive when band 1 either alone or accompa. G7 or 86Eo) of the para,coccidloidomlrcosis ca, nied by bands 2 and g, q'as detected 1?,1s. ses also tecogn¿ed ttre heteÌo,logous antigen. S€ven serum St¿tistical analS¡sis eacompassed thè deter_ samples from aspergilloma pa. tients ( mination of sensitivity, especificitr anal pæatic. þqo), one of the TB patients (8.32¿) and I from the tive velue as defined by GALEN and. GAM- healthy control group (9.8%) g1¡9 werc also positive. o, and ITOZINN and TASCIIDIIÂN r0 (Table 1). Tlre Student test t was used to de_ ïhe sensitivity of botll serologia tests was temine statistical significance. determined in trmtients witf¡ para4occid.ioido- myoGsis, a¿ every one of the study perioals (Fig. ?ÅBLE 1 D€f¡nitioÌì of teIÃls (+) 2). At time of diagnosis both AGID ar¡d CF proved highlt sensitive (Bg ând g0Z¿) æsDecti- Equation ooncePt D€ftnftioE employed to vely. lherapy caused. a certain loss oi sen- meâsure vhtue of test sitivity with â trend towards loweÌ figures ráith time of thempy. At the end yeâ.ß Sensitiyttt percentage of J ot T,P. ' alter cessation of treatment, dlse8se i¡dtir4aluah AEE, of. lhe ca,- ses could still detected qriüh positivo test T.P.+IlN... be by AGID and 85Zo æsults by the CF: IIowever, ¿here were no statistical differences betrween the two tests. Speclftcitj' percenktge of T.N. r.' non-diseased ---_x100 The sf,ecifìcity was determined in the con- individuåls T.N. + P. trol gÎoups (8, C and Ì\¡ith D). .q,s eai] be seen in negative Fig._3 ¿est results.
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