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Mold infections range in spectrum from colonization to hypersensitivity reactions. In addition, opportunistic molds have become increasingly recognized as a cause of life-threatening invasive infection in severely ill or immunocompromised patients.
Tests generally appear in the order most useful for common clinical situations
| Test name: Aspergillus Antibodies by CF & ID |
| ARUP #: 0050101 |
| Methodology: Semi-Quantitative Complement Fixation/Qualitative Immunodiffusion |
| Use: Detect presence of Aspergillus antibodies |
| Test name: Allergen, Fungi and Molds, Aspergillus niger IgE |
| ARUP #: 0092598 |
| Methodology: Quantitative ImmunoCAP® |
| Use: Use to measure IgE |
| Test name: Aspergillus Galactomannan Antigen by EIA, Serum |
| ARUP #: 0060068 |
| Methodology: Semi-quantitative Enzyme Immunoassay |
| Use: Diagnose Aspergillus infection |
| Limitations: Negative results do not rule out invasive aspergillosis Single positive test result (index greater than or equal to 0.5) should be confirmed by separate serum specimen; many agents may cross-react with the assay (food, antibiotics, etc) |
| Follow-up: Recommend serial sampling for high-risk patients if suspicion is high |
| Test name: Aspergillus Galactomannan Antigen by EIA, Bronchoscopy |
| ARUP #: 2003150 |
| Methodology: Semi-quantitative Enzyme Immunoassay |
| Use: Diagnose Aspergillus infection |
| Test name: Fungal Culture |
| ARUP #: 0060149 |
| Methodology: Standard reference procedures for fungal culture. Standard reference procedures for identification and/or ITS rDNA Sequencing. DNA probes available for Histoplasma, Coccidioides, and Blastomyces |
| Use: Gold standard test for diagnosing fungi as agent of infection in pus, sputum, tissue or urine |
| Test name: Fungal Culture, Skin, Hair or Nails |
| ARUP #: 0060728 |
| Methodology: Standard reference procedures for fungal culture. Standard reference procedures for identification and/or ITS rDNA Sequencing. |
| Use: Gold standard test for diagnosing fungi as agent of infection in skin, hair or nails |
| Test name: Fungal Stain, KOH with Calcofluor White |
| ARUP #: 2004589 |
| Methodology: KOH with Calcofluor White Stain |
| Use: Identify fungus from fungal smear |
| Limitations: Difficult to identify type of fungus from a smear |
| Test name: Fungal (Mould/Yeast) Identification |
| ARUP #: 0060163 |
| Methodology: Standard reference procedures for identification, DNA probes and/or ITS rDNA Sequencing |
| Use: Identify fungal agent |
| Limitations: Testing to differentiate between Candida albicans and C. dubliniensis performed by request only Cryptococcus gattii is ruled out when routine biochemical testing identifies organism as C. neoformans |
| Test name: Blood Culture, Fungal |
| ARUP #: 0060070 |
| Methodology: BACTEC® Continuous Monitoring System. Standard reference procedures for identification and/or DNA Sequencing |
| Use: Gold standard test for diagnosing fungi as agent of infection in blood |
| Limitations: Poor sensitivity for Aspergillus spp, Zygomycetes and dematiaceous fungi |
| Test name: Aspergillus fumigatus Antibody, IgG by ELISA |
| ARUP #: 0097771 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Use: Diagnose antibody response to A. fumigatus |
| Test name: (1,3)-Beta-D-Glucan (Fungitell®) |
| ARUP #: 2002434 |
| Methodology: Semi-quantitative Colorimetric Assay |
| Use: Diagnosis of fungal infection Use in conjunction with other diagnostic procedures |
| Limitations: Does not detect fungal species that produce very low levels of (1,3)-beta-D-glucan (eg, Cryptococcus) Does not detect zygomycetes spp, which are not known to produce (1,3)-beta-D-glucan (eg, Absidia, Mucor, Rhizopus) |
| Test name: Antimicrobial Susceptibility - Mould Susceptibility |
| ARUP #: 0060227 |
| Methodology: Broth Microdilution |
| Use: Test for level of antifungal agent required for treatment of identified mold spp Agents tested - amphotericin B, anidulafungin, caspofungin, fluconazole, 5-fluorocytosine, griseofulvin, itraconazole, micafungin, posaconazole, terbinafine, and voriconazole Selective reporting by organism |
| Limitations: Assay does not test for environmental molds |
| Test name: Fungal Antibodies by ID |
| ARUP #: 0050164 |
| Methodology: Qualitative Immunodiffusion |
| Comments: |
| Test name: Aspergillus Antibody by CF |
| ARUP #: 0050100 |
| Methodology: Semi-Quantitative Complement Fixation |
| Comments: Use with paired sera taken 3 weeks apart to detect a rise in titer against a single antigen |
| Test name: Aspergillus Antibody by ID |
| ARUP #: 0050171 |
| Methodology: Qualitative Immunodiffusion |
| Comments: Use to measure IgG and precipitins |
| Test name: Fungal Antibodies by CF, CSF |
| ARUP #: 0050750 |
| Methodology: Semi-Quantitative Complement Fixation |
| Comments: |
| Test name: Fungal Antibodies by CF, Serum |
| ARUP #: 0050605 |
| Methodology: Semi-Quantitative Complement Fixation |
| Comments: |
| Test name: Candida albicans Antibodies, IgA, IgG, & IgM by ELISA |
| ARUP #: 0095200 |
| Methodology: Semi-Quantitative Enzyme-Linked Immunosorbent Assay |
| Comments: Antibody testing has limited utility in immunocompromised patients Best evidence for infection is significant change on two appropriately timed specimens where both tests are done in the same laboratory at the same time; however, low levels of IgM may occasionally persist for >12 months |
| Test name: Histoplasma capsulatum Identification by DNA Probe |
| ARUP #: 0062226 |
| Methodology: Nucleic Acid Probe |
| Comments: |
| Test name: Coccidioides immitis Identification by DNA Probe |
| ARUP #: 0062225 |
| Methodology: Nucleic Acid Probe |
| Comments: |
| Test name: Blastomyces dermatitidis Identification by DNA Probe |
| ARUP #: 0062224 |
| Methodology: Nucleic Acid Probe |
| Comments: |
| Test name: Fungal Identification by ITS rDNA Sequencing |
| ARUP #: 0060756 |
| Methodology: ITS rDNA Sequencing |
| Comments: |