Which two assays should be used together for detecting antibodies toward B. dermatitidis, H. capsulatum, and C. immitis?
a. Enzyme-linked immunosorbent assay (ELISA) and direct fluorescent antibody (DFA)
b. Complement fixation and immunodiffu-sion
c. Indirect fluorescent antibody (IFA) and Western blot
d. Enzyme immunoassay (EIA) and latex agglutination
B
Two assays, complement fixation and immunodiffusion, should be used together for the detec-tion of antibodies directed toward B. dermatitidis, H. capsulatum, and C. immitis. In the com-plement fixation assay, titers of 1:8 to 1:16 are suggestive of active infection by B. dermatitidis and H. capsulatum, whereas titers of 1:32 or greater are indicative of active disease. Titers as low as 1:2 to 1:4 have been identified in patients with coccidioidomycosis. Titers greater than 1:16 are usually indicative of active disease. Bands of identity form in the immunodiffusion test among known antisera, known fungal antigen, and the antibodies present in the patient's serum. Specific bands of identity are used for the serologic detection of particular fungi, whereas non-specific bands suggest the possibility of an infection by another fungal pathogen. One or two bands of identity, the H and M bands, may occur in patients with histoplasmosis. The presence of both bands is indicative of active infection. The presence of an M band may indicate early or chronic infection.
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