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Journal of Clinical Microbiology, November 1998, p. 3309-3316, Vol. 36, No. 11
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Antigenemia in Patients with Paracoccidioidomycosis: Detection of the 87-Kilodalton Determinant during and after Antifungal Therapy

B. L. Gómez,1,2,* J. I. Figueroa,2 A. J. Hamilton,2 S. Diez,1 M. Rojas,3 A. M. Tobón,1 R. J. Hay,2 and A. Restrepo1

Corporación para Investigaciones Biológicas,1 and Laboratorio Central de Investigaciones, Facultad de Medicina, Universidad de Antioquia,3 Medellín, Colombia, and St. John's Institute of Dermatology, Guy's Hospital, London, England2

Received 9 June 1998/Returned for modification 1 August 1998/Accepted 19 August 1998

Serological diagnosis and follow-up of paracoccidioidomycosis (PCM) patients have relied mainly on the detection of antibody responses by using techniques such as complement fixation (CF) and immunodiffusion. We recently described a novel inhibition enzyme-linked immunosorbent assay (inh-ELISA) which proved to be useful in the diagnosis of PCM via the detection of an 87-kDa determinant in patient sera (B. L. Gomez, J. I. Figueroa, A. J. Hamilton, B. Ortiz, M. A. Robledo, R. J. Hay, and A. Restrepo, J. Clin. Microbiol. 35:3278-3283, 1997). This test has now been assessed as a means of following up PCM patients. A total of 24 PCM patients, classified according to their clinical presentation (6 with the acute form of the disease, of whom two had AIDS, 12 with the multifocal form of the disease, and 6 with the unifocal form of the disease), were studied. The four human immunodeficiency virus-negative patients with acute PCM showed a statistically significant decrease in circulating antigen levels after the start of antifungal therapy. Antigen levels in this group became negative by our criteria (<= 2.3 µg/ml) before week 20 and remained so in three of four of these patients. In contrast, the two AIDS patients who also presented with the acute form of PCM showed no statistically significant decrease in circulating antigen levels even after 68 weeks of therapy. Taken together as a group, the patients with the multifocal form showed a statistically significant decrease in antigenemia after 28 weeks of therapy. In addition, five of six patients with the unifocal form became antigen negative by week 40. Antigen level decrease mirrored clinical cure in the majority of patients in all clinical groups; in contrast, measurement of anti-PCM antibodies via the CF test showed wide fluctuations in titers during the follow-up period. The inh-ELISA for the detection of the 87-kDa Paracoccidioides brasiliensis determinant would appear to be a valuable additional tool in the follow-up of PCM patients.

* Corresponding author. Mailing address: St John's Institute of Dermatology, Dermatology Laboratory, 5th Floor, Thomas Guy House, Guy's Hospital, London SE1 9RT, United Kingdom. Phone: 0171 955 4663 Fax: 0171 407 6689. E-mail: g.beatriz{at}umds.ac.uk.

Journal of Clinical Microbiology, November 1998, p. 3309-3316, Vol. 36, No. 11
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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