Coccidioidomycosis, or valley fever (VF), is a fungal infection caused by Coccidioides that is highly endemic in southern Arizona and central California. The antibody response to infection in combination with clinical presentation and radiographic findings are often used to diagnose disease, as a highly sensitive and specific antigen-based assay has yet to be developed and commercialized. In this dissertation, a panel of monoclonal antibodies (mAbs) was generated in an attempt to identify circulating antigen in VF-positive patients. Despite utilizing a mixture of antigens, almost all mAbs obtained were against chitinase 1 (CTS1), a protein previously identified as a main component in serodiagnostic reagents. While CTS1 was undoubtedly a dominant seroreactive antigen, it was not successfully detected in circulation in patient samples prompting a shift toward further understanding the importance of CTS1 in antibody-based diagnostic assays. Interestingly, depletion of this antigen from diagnostic antigen preparations resulted in complete loss of patient IgG reactivity by immunodiffusion. This finding encouraged the development of a rapid, 10-minute point-of-care test in lateral flow assay (LFA) format to exclusively detect anti-CTS1 antibodies from human and non-human animal patients with coccidioidal infection. A CTS1 LFA was developed that demonstrated 92.9% sensitivity and 97.7% specificity when compared to current quantitative serologic assays (complement fixation and immunodiffusion). A commercially available LFA that utilizes a proprietary mixture of antigens was shown to be less sensitive (64.3%) and less specific (79.1%). This result provides evidence that a single antigen can be used to detect antibodies consistently and accurately from patients with VF. The LFA presented here shows promise as a helpful tool to rule-in or rule-out a diagnosis of VF such that patients may avoid unnecessary antibacterial treatments, improving healthcare efficiency.

Coccidioidomycosis or Valley Fever (VF) is an emerging fungal respiratory infection endemic to the southwest region of the United States, and parts of Mexico, Central and South America. Satellite cases have also been reported in Washington and Oregon. It is estimated that in Maricopa County alone, VF accounts for 10-30% of community-acquired pneumonia. Difficulty in diagnosis is largely attributed to lack of antibody reactivity to antigens used in diagnosis, especially early in disease. Serological detection of VF employs mycelial-phase culture filtrates as antigen. While culture filtrates are thought to provide the most specific diagnostic antigen, preparation includes the growth of large volume Coccidioides cultures which require employment of extensive safety precautions in a BSL3 setting. An additional concern with use of culture filtrates as an antigen source is batch variability, as expression of immunogenic proteins within each lot are variable. To address safety and batch variability concerns, this thesis proposes the use of recombinant Coccidioides proteins as a consistent and reliable antigen source. For the purpose of this study, I expressed known antigenic Coccidioides proteins in a eukaryotic, recombinant protein expression system. Recombinant endochitinase-1 (rCTS1) and recombinant heat-labile antigen (rHL-Ag) were evaluated for serologic reactivity by ELISA, using a sample set of 55 known serologically positive and 55 known negative human sera specimens, previously tested in Mayo Clinic Arizona (MCA) serologic laboratories. Evaluation by ELISA demonstrated 94.55% sensitivity and 92.72% specificity using combined rCTS1 and rHL-Ag as an antigen source, indicating promising diagnostic utility.

Antibiotic resistance is a very important issue that threatens mankind. As bacteria

are becoming resistant to multiple antibiotics, many common antibiotics will soon

become ineective. The ineciency of current methods for diagnostics is an important

cause of antibiotic resistance, since due to their relative slowness, treatment plans

are often based on physician's experience rather than on test results, having a high

chance of being inaccurate or not optimal. This leads to a need of faster, pointof-

care (POC) methods, which can provide results in a few hours. Motivated by

recent advances on computer vision methods, three projects have been developed

for bacteria identication and antibiotic susceptibility tests (AST), with the goal of

speeding up the diagnostics process. The rst two projects focus on obtaining features

from optical microscopy such as bacteria shape and motion patterns to distinguish

active and inactive cells. The results show their potential as novel methods for AST,

being able to obtain results within a window of 30 min to 3 hours, a much faster

time frame than the gold standard approach based on cell culture, which takes at

least half a day to be completed. The last project focus on the identication task,

combining large volume light scattering microscopy (LVM) and deep learning to

distinguish bacteria from urine particles. The developed setup is suitable for pointof-

care applications, as a large volume can be viewed at a time, avoiding the need

for cell culturing or enrichment. This is a signicant gain compared to cell culturing

methods. The accuracy performance of the deep learning system is higher than chance

and outperforms a traditional machine learning system by up to 20%.

Valley Fever, also known as coccidioidomycosis, is a respiratory disease that affects 10,000 people annually, primarily in Arizona and California. Due to a lack of gene annotation, diagnosis and treatment of Valley Fever is severely limited. In turn, gene annotation efforts are also hampered by incomplete genome sequencing. We intend to use proteogenomic analysis to reannotate the Coccidioides posadasii str. Silveira genome from protein-level data. Protein samples extracted from both phases of Silveira were fragmented into peptides, sequenced, and compared against databases of known and predicted proteins sequences, as well as a de novo six-frame translation of the genome. 288 unique peptides were located that did not match a known Silveira annotation, and of those 169 were associated with another Coccidioides strain. Additionally, 17 peptides were found at the boundary of, or outside of, the current gene annotation comprising four distinct clusters. For one of these clusters, we were able to calculate a lower bound and an estimate for the size of the gap between two Silveira contigs using the Coccidioides immitis RS transcript associated with that cluster's peptides \u2014 these predictions were consistent with the current annotation's scaffold structure. Three peptides were associated with an actively translated transposon, and a putative active site was located within an intact LTR retrotransposon. We note that gene annotation is necessarily hindered by the quality and level of detail in prior genome sequencing efforts, and recommend that future studies involving reannotation include additional sequencing as well as gene annotation via proteogenomics or other methods.

Background: Coccidioidomycosis (Valley Fever) is a respiratory disease that is caused by the soil-dwelling fungi Coccidioides immitis and Coccidioides posadasii. Because fungal glycosylation patterns are distinct from mammalian glycosylation patterns, we hypothesized that certain lectins (carbohydrate-binding proteins) might have differential binding properties to coccidioidal glycoproteins, and therefore serve as a tool for the purification and characterization of these glycoproteins from patient specimens. Materials and Methods: To identify potential Coccidioides-binding lectins, lectin-based immunohistochemistry was performed using a panel of 21 lectins on lung tissue from human patients infected with Coccidioides. Enzyme-Linked Immunosorbent Assays (ELISAs) were used to confirm and test candidate Coccidioides-binding lectins for their ability to bind to proteins from antigen preparations of laboratory-grown Coccidioides. Inhibition IHC and ELISAs were used to confirm binding properties of these lectins. SDS-PAGE and mass spectrometry were performed on eluates from coccidioidal antigen preparations run through lectin-affinity chromatography columns to characterize and identify lectin-binding coccidioidal glycoproteins. Results: Two GlcNAc-binding lectins, GSLII and sWGA, bound specifically to spherules and endospores in infected human lung tissue, and not to adjacent lung tissue. The binding of these lectins to both Coccidioides proteins in lung tissue and to coccidioidal antigen preparations was confirmed to have lectin-like characteristics. SDS-PAGE analysis of eluates from lectin-affinity chromatography demonstrated that GSLII and sWGA bind to coccidioidal glycoproteins. Mass spectrometric identification of the top ten lectin affinity-purified glycoproteins demonstrated that GSLII and sWGA share affinity to a common set of coccidioidal glycoproteins. Conclusion: This is the first report of lectins that bind specifically to Coccidioides spherules and endospores in infected humans. These lectins may have the potential to serve as tools for a better method of detection and diagnosis of Valley Fever.