Humoral responses

Both asymptomatic infection and disease are marked in over 90% of all infected persons by an antibody response to C. immitis. Mycelial phase antigens are most useful in serodiagnosis. IgM is detected earliest by precipitation, latex agglutination or immunodiffusion in 75% of infected individuals. Detectable IgM usually disappears within 6 months of infection. In identifying progression of disease, IgG is useful: elevated titers indicate dissemination, and titers will fall with successful therapy in serum and in cerebrospinal fluid (CSF) in patients with meningitis. Antibody to the 33 kDa antigen can be detected in the CSF of patients with Coccidioides meningitis, including about half of those without detectable coccidioidal complement-fixing (CF) antibody. The antibody against the antigen appears to persist longer than detectable CF antibody. For patients who were failing therapy, a significant increase in antibody to the 33 kDa antigen was demonstrated over time; for patients responding to therapy, a significant decrease. Circulating immune complexes are found in up to 70% of patients with active, disseminated disease. Circulating free antigen has also been detected in patients with active disease. Total serum hemolytic complement activity is depressed early in primary infection in some patients but later recovers. Both classic and alternate pathways are probably activated.

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