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During a 9-month study of patients being evaluated for coccidioidomycosis, 1 or more serum samples were obtained from 138 patients with an illness suggestive of recent infection. In this group, standard immunodiffusion tests of unconcentrated sera were positive for 25; 49 additional patients had at least 1 reactive test result by newer enzyme-linked serologic tests. At least 11 of these 49 patients had coccidioidomycosis as determined by culture or subsequent standard serologic tests. Patients with coccidioidomycosis identified only by newer tests had fewer or milder clinical abnormalities than did patients in whom the disease was detected by standard tests. For 31 other patients with illness of a chronic or undetermined duration, newer tests detected only 10 more than the 18 identified by standard tests, suggesting that later in the course of illness, standard testing gains in sensitivity for coccidioidal infection.

The levels of tumor necrosis factor-α (TNF-α) and interleukin (IL)-1β in the cerebrospinal fluid (CSF) of 66 patients with coccidioidal meningitis during therapy with fluconazole were measured by ELISA. The median concentration of TNF-α was 15.2 pg/ml, for 322 samples; for IL-1β, it was 4.7 pg/ml, for 316 samples. There were no significant changes in the level of either cytokine over 24 months of follow-up nor was there an association between the initial CSF concentrations of TNF-α and IL-1β and subsequent fluconazole treatment failure. Over time, concentrations of IL-1β were significantly associated with both clinical symptoms and white blood cell counts in CSF. These results indicate that CSF levels of TNF-α and IL-1β are relatively low compared with those associated with acute bacterial meningitis.