ANTIGENEMIA IN PATIENTS WITH PARACOCCIDIOIDOMYCOSIS - DETECTION OF THE 87-KILODALTON DETERMINANT DURING AND AFTER ANTIFUNGAL THERAPY

Serological diagnosis and follow-up of paracoccidioidomycosis (PCM) pa tients have relied mainly on the detection of antibody responses by us ing techniques such as complement fixation (CF) and immunodiffusion. W e recently described a novel inhibition enzyme-linked immunosorbent as say (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 no w 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 di sease), were studied. The four human immunodeficiency virus-negative p atients with acute PCM showed a statistically significant decrease in circulating antigen levels after the start of antifungal therapy. Anti gen levels in this group became negative by our criteria (less than or equal to 2.3 mu g/ml) before week 20 and remained so in three of four of these patients, In contrast, the two AIDS patients who also presen ted with the acute form of PCM showed no statistically significant dec rease in circulating antigen levels even after 68 weeks of therapy. Ta ken 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 beca me antigen negative by week 40, Antigen level decrease mirrored clinic al cure in the majority of patients in all clinical groups; in contras t, measurement of anti-PCM antibodies via the CF test showed wide fluc tuations in titers during the follow-up period. The inh-ELISA for the detection of the 87-kDa Paracoccidioides brasiliensis determinant woul d appear to be a valuable additional tool in the follow-up of PCM pati ents.