Test ID: CCOC
Coccidioides Antibody, Spinal Fluid
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Serologic testing for coccidioidomycosis should be considered when patients exhibit symptoms of meningeal infection and have lived or traveled in areas where Coccidioides immitis is endemic. Any history of exposure to the organism or travel cannot be overemphasized when coccidioidomycosis serologic tests are being considered.
Method Name A short description of the method used to perform the test
Complement Fixation (CF) Using Coccidioidin: IgG
Immunodiffusion: IgG and IgM
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Coccidioides, Spinal Fluid
San Joaquin Valley Fever
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube: Sterile vial
Specimen Volume: 2 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | Mild OK; Gross OK |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| CSF | Refrigerated (preferred) | 14 days |
| Frozen | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Coccidioidomycosis (valley fever, San Joaquin Valley fever) is a fungal infection found in the southwestern United States, Central America, and South America. It is acquired by inhalation of arthroconidia of Coccidioides immitis. Usually, it is a mild, self-limiting pulmonary infection, often leaving a coin-like lesion. Less commonly, chronic pneumonia may persist or progress to fibronodular, cavitary disease. A rash often develops within 1 to 2 days, followed by erythema nodosum or multiforme and accompanying arthralgias. About 2 weeks after exposure, symptomatic patients develop fever, cough, malaise, and anorexia; chest pain is often severe. Coccidioidomycosis may disseminate beyond the lungs to involve multiple organs including the meninges.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
COMPLEMENT FIXATION
Negative
If positive, results are titered.
IMMUNODIFFUSION
Negative
Results are reported as positive, negative, or equivocal.
Interpretation Provides information to assist in interpretation of the test results
Complement Fixation (CF):
IgG antibody is detected by CF testing. Any CF titer in cerebrospinal fluid (CSF) should be considered significant. A positive complement fixation test in unconcentrated CSF is diagnostic of meningitis.
Immunodiffusion (ID):
IgM and IgG precipitins are rarely found in CSF. However, when present, they are diagnostic of meningitis (100% specific). Since the ID test is 100% specific, it is helpful in interpreting CF results.
Early primary antibody (IgM) found in coccidioidomycosis can be detected by the IgM-specific ID test. IgM precipitins may be detectable within 1 to 4 weeks after the onset of symptoms. The presence of IgG antibody parallels the CF antibody and indicates an active or a recent asymptomatic infection with Coccidioides immitis. Both IgG and IgM antibodies are rarely detected 6 months after infection. However, in some patients having disseminated infection, both IgG and IgM antibodies may be present for several years. IgM and IgG precipitins are not prognostic.
An equivocal result (a band of nonidentity) cannot be interpreted as significant for a specific diagnosis. However, this may be an indication that a patient should be followed serologically.
The sensitivity of serologic testing (CF and ID combined) for coccidioidomycosis is >90% for primary symptomatic cases.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
While complement fixation (CF) titers may be present in serum months after the infection has resolved, any CF titer in spinal fluid should be considered significant.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Larone D, Mitchell T, Walsh T: Histoplasma, blastomyces, coccidioides, and other dimorphic fungi causing systemic mycoses. In Manual of Clinical Microbiology. 7th edition. Edited by PR Murray, EJ Baron, MA Pfaller, et al: Washington, DC, ASM Press, 1999, pp 1260-1261
Method Description Describes how the test is performed and provides a method-specific reference
Antibody in the cerebrospinal fluid (CSF) of a patient to coccidioidin is performed by CF and ID.
Complement Fixation (CF):
The immune response of a person to an infection frequently begins with the formation of specific antibody that is capable of combining in vitro with homologous antigen and complement (C’). The CF test is a 2-stage test based on the ability of antigen-antibody complexes to bind C’. In the first stage, antigen and antibody combine and fix C’. The second stage is an indicator system in which sheep erythrocytes, sensitized by rabbit anti-sheep red cell antibody (hemolysin), are used to demonstrate the presence of unfixed C’. If the patient’s serum contains C’-fixing antibody that reacts with the specific antigen (a positive reaction), C’ will be fixed and excess C’ will not be available to react with and lyse the sensitized sheep erythrocytes. If no antigen-antibody reaction occurs (a negative reaction), C’ will be available to lyse the sheep erythrocytes. The CF titer is determined by the greatest dilution of serum (antibody) in which the sheep erythrocytes are not lysed.
Immunodiffusion:
ID is a qualitative test employed for the detection of precipitating antibodies present in the CSF. Soluble antigens of the fungus are placed in wells of an agarose gel filled Petri dish and the patient’s CSF and a control (positive) CSF are placed in adjoining wells. If present, specific precipitate antibody will form precipitin lines between the wells. Their comparison to the control CSF establishes the results. When performing the ID test, only precipitin bands of identity with the reference bands are significant. (Kaufman L, Kovacs JA, Reiss E: Immunomycology. In Manual of Clinical Laboratory Immunology. 5th edition. Edited by NR Rose, EC de Macario, JD Folds, et al. Washington, DC, ASM Press, 1997, pp 591-593)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday, 9:30 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
86635 x 3
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 81542 | Cocci Ab, CF (CSF) | 30209-1 |
| 21002 | Cocci ID-IgG (CSF) | In Process |
| 21001 | Cocci ID-IgM (CSF) | In Process |
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