Dinitrochlorobenzene Responsivity: Difference between Patients with Severe Pulmonary Coccidioidomycosis and Patients with Disseminated Coccidioidomycosis

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Abstract
Immunologic responses in 15 patients with severe pulmonary coccidioidomycosis and in 50 patients with disseminated coccidioidomycosis were measured by determination of complement-fixing (CF) antibody titers to coccidioidin in serum, toecidioidin (I: 100) skin tests, and sensitization to dinitrochlorobenzene. Among the patients with disseminated coccidioidomycosis, the nine with CF antibody titers of ⩽ 1:8 had normal responses to dinitrochlorobenzene, but the 41 with titers of ⩾ 1:16 had responses that were significantly lower than those of controls (P < 0.001). In contrast, all patients with severe pulmonary coccidioidomycosis had CF antibody titers of ⩾ 1:16 and had responses to dinitrochlorobenzene that were greater (but not significantly greater) than those of controls. Among subjects with antibody titers of ⩾ 1:16, responsiveness to coccidioidin was found in 27% of those with severe pulmonary disease and in 39% of those with disseminated disease. Thus impaired responsivity to dinitrochlorobenzene in coccidioidomycosis is restricted to patients who have disseminated illness and high titers of CF antibody and is separable from lack of responsiveness to coccidioidin.