Until recently coccidioidin has been the only antigenic preparation available for detecting delayed dermal sensitivity induced by an experience with Coccidioides immitis. It is prepared from autolysates of the mycelial phase (saprophytic) of the fungus. A more sensitive reagent, spherulin, was developed in 1969 from the spherule phase (parasitic) of the organism. Use of spherulin showed that coccidioidin failed to detect approximately 30% of individuals specifically sensitive to C. immitis. However the potential of spherulin to detect cross-sensitivity induced by Histoplasma capsulatum was unknown. This information was considered to be germane because of the capacity of coccidioidin to detect a histoplasmal experience. Accordingly, both reagents as well as paracoccidioidin were compared simultaneously in 365 Colombian soldiers from areas endemic for histoplasmosis but not for coccidioidomycosis. At standard strength both preparations detected nonspecific responses in 0.8% to 3% of the histoplasmin negative and positive subgroups, respectively. At 10-times standard strength both preparations cross-detected histoplasmin sensitivity comparably; 5.1% to 7.1% of histoplasmin-pos'itive subjects reacted with the coccidioidal antigens. No pattern of cross-reactivity was observed between paracoccidioidin sensitivity and sensitivity to the coccidioidal antigens. coccidioidin; histoplasmin; paracoccidioidin; spherulin

Six patients with multisystem paracoccidioidomycosis proven by serology and culture or smear were treated with relatively brief courses of intravenous miconazole. Two had relapsed following prior therapy; 6 had active pulmonary, 4 laryngeal, 2 oropharyngeal, 2 lymphoid, and 1 abdominal disease. Paracoccidioides brasiliensis was highly susceptible to miconazole in vitro; minimal inhibitory concentration was less than or equal to 0.001 microgram/ml. Clinical examination showed a prompt and objective response in all patients, confirmed by smear or culture and X-rays; in 4/6 serological response was shown. Side effects were minor. Two patients relapsed 3--5 mo after therapy; another had a rise in antibody 6 mo after therapy and was given maintenance oral sulfa. One remains in remission 7 mo after treatment; two given oral sulfa after response to miconazole remain in remission 4--6 mo after treatment. Paracoccidioidomycosis responds well to miconazole, but longer courses may be needed to prevent relapse.

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