Yeast-Associated Infections

Yeasts cause a spectrum of diseases that range from colonization to uniformly fatal invasive disease. Invasive fungal disease may occur in immunocompromised patients, patients on immunomodulatory therapy or with indwelling devices, and critically ill patients. The species most likely to cause disease include cryptococcus neoformans and candida spp. Manifestations of infections may occur in one or more body sites, and often present with symptoms related to the site of involvement. For more information on fungal diseases, visit the CDC’s fungal diseases site.

Diagnosis

Indications for Testing

At-risk patients with suspected yeast-associated disease

Laboratory Testing

Background

Pulmonary Symptoms

Nonpulmonary Symptoms

ARUP Lab Tests

Gold standard test to diagnose fungi as agent of infection

Notify laboratory if Malassezia furfur is suspected

Identify fungus from fungal smear (eg, yeast, aseptate hyphae, septate hyphae)

Gold standard test to diagnosis fungi as agent of infection in blood

Identify fungi from culture

For the direct detection and identification of fungi in tissue

Aid in diagnosis of histoplasmosis

Recommend testing in conjunction with combined complement fixation and immunodiffusion antibody and urine galactomannan antigen tests

Crossreactivity with Blastomyces dermatiditis, Coccidioides immitis, and possibly Talaromyces marneffei have been observed

Aid in diagnosis of histoplasmosis

Recommend testing in conjunction with combined complement fixation and immunodiffusion antibody and serum antigen tests

Rapid test for identifying H. capsulatum (yeast or mold form) from pure isolate

Identify C. neoformans as the infectious agent of invasive cryptococcal disease

Identify Cryptococcus as an etiological agent of meningitis

CAP requires confirmation by culture for this test; order with CSF culture and gram stain

When test is ordered by the University of Utah Hospital, Huntsman Cancer Hospital, or VA Hospital of SLC, CSF culture will be ordered automatically; other clients should order culture separately

Aid in diagnosis of invasive/disseminated fungal infections (eg, P. jirovecii, Aspergillus, or Candida)

Does not detect fungal species that produce very low levels of (1-3) beta-D-glucan (eg, Cryptococcus)

Does not detect Zygomycetes (ie, AbsidiaMucor, and Rhizopus)

Yeast phase of Blastomyces dermatitidis may not be detected

Use to detect common vaginal pathogens associated with vaginitis/vaginosis

Not recommended as stand-alone test for sexually transmitted infection testing or screening

Panel includes testing for Candida species, Gardnerella vaginalis, and Trichomonas vaginalis

Preferred serology test to detect coccidioidomycosis (Valley fever)

Panel includes Coccidioides antibody IgG and IgM, Coccidiodes immitus antibodies, and coccidiode titer

Aid in diagnosis of coccidioidal meningitis (Valley fever)

Rapid test for identifying C. immitis (yeast or mold form) from a pure isolate

Rapid test for identifying B. dermatitidis (yeast or mold form) from a pure isolate

Diagnose and monitor B. dermatitidis

For urine specimens, refer to Blastomyces antigen quantitative by EIA, urine

Diagnose and monitor B. dermatitidis

For serum specimens, refer to Blastomyces antigen quantitative by EIA

Recommended test if serology is used to aid in diagnosis of blastomycosis

Recommended test if serology is used to aid in the diagnosis of cerebral blastomycosis

Detect respiratory pathogens in patients with pneumonia

Related Tests

Not recommended

Refer to individual fungus-related tests appropriate to patient exposure

Identify fungi from culture

Determine in vitro susceptibility to antifungal agents for fungal organisms

Agents tested – amphotericin B, anidulafungin, caspofungin, fluconazole, 5-fluorocytosine, itraconazole, micafungin, posaconazole, and voriconazole

Not recommended as a stand-alone test

Refer to combined complement fixation and immunodiffusion test 

Limited clinical utility

Best evidence for infection is significant change on 2 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

Preferred test for establishment of diagnosis is Coccidioides Antibody Reflexive Panel

Panel includes coccidioides antibody by CF; coccidioides immitis antibodies by immunodiffusion; coccidioides antibody, IgG and IgM by ELISA

May aid in diagnosis of coccidioidomycosis (Valley fever)

Preferred test for establishment of diagnosis is Coccidioides Antibody Reflexive Panel

Aid in diagnosis of coccidioidal meningitis (Valley fever)

Aid in diagnosis of coccidiodomycosis (Valley fever)

Titers may aid in monitoring coccidioidomycosis (Valley fever) and treatment response

Preferred test for establishment of diagnosis is Coccidioides Antibody Reflexive Panel

Titers may aid in monitoring coccidioidal meningitis (Valley fever) and treatment response

Not recommended

Preferred test for establishment of diagnosis is Coccidioides Antibody Reflexive Panel

Not recommended

Not recommended as a stand-alone test

Preferred test for establishment of diagnosis is Coccidioides Antibody Reflexive Panel

Not recommended as a stand-alone test

Aid in diagnosis of histoplasmosis

Recommend testing in conjunction with serum antigen and urine galactomannan antigen tests

Medical Experts

Contributor

Couturier

Marc Roger Couturier, PhD, D(ABMM)
Associate Professor of Clinical Pathology, University of Utah
Medical Director, Parasitology/Fecal Testing, Infectious Disease Antigen Testing, Bacteriology, and Molecular Amplified Detection, ARUP Laboratories
Contributor

References

Additional Resources
Resources from the ARUP Institute for Clinical and Experimental Pathology®