Yeast-Associated Infections

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Topics

Indications for Testing

  • At-risk patients with suspected yeast-associated disease

Laboratory Testing

Yeasts cause a spectrum of diseases that range from colonization to uniformly fatal invasive disease.

  • Invasive fungal disease occurs in at-risk patient populations
    • Immunocompromised patients
    • Patients on immunomodulatory therapy
    • Patients with indwelling devices
    • Critically ill patients
  • Species most likely to cause disease include the following
    • Yeasts – Cryptococcus neoformans, Candida spp
      • Emerging infectious yeast agents such as Rhodotorula spp and Trichosporon spp
    • Dimorphic fungi – Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis
    • See CDC for information on fungal diseases
  • Manifestations of infection may occur in one or more body sites
    • Often presents with symptoms related to site of involvement

Yeast-Associated Signs and Symptoms – Pulmonary

Yeast-Associated Signs and Symptoms – Sites Other than Pulmonary

Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Fungal Culture 0060149
Method: Culture/Identification

Limitations 

Notify laboratory if Malassezia furfur is suspected

Fungal Stain, KOH with Calcofluor White 2004589
Method: Microscopy

Limitations 

Difficult to classify type of fungus from a smear

India Ink Stain 2004593
Method: Microscopy

Blood Culture, Fungal 0060070
Method: Continuous Monitoring Blood Culture/Identification

Limitations 

Wide range of reported sensitivity for yeast (40-90%)

Fungal (Mold/Yeast) Identification 0060163
Method: Identification. Methods may include biochemical, mass spectrometry, or sequencing.

Histoplasma Antigen by EIA, Serum 0092522
Method: Semi-quantitative Enzyme Immunoassay

Limitations 

Rarely positive in chronic disease

Histoplasma Galactomannan Antigen Quantitative by EIA, Urine 2009418
Method: Quantitative Enzyme Immunoassay

Histoplasma capsulatum Identification by DNA Probe 0062226
Method: Nucleic Acid Probe

Limitations 

Chrysosporium anamorph Nannizziopsis vriesii may cross-react with H. capsulatum AccuProbe

Cryptococcus Antigen, Serum 0050196
Method: Semi-quantitative Enzyme Immunoassay

Cryptococcus Antigen, CSF 0050195
Method: Semi-Quantitative Enzyme Immunoassay

(1,3)-Beta-D-Glucan (Fungitell) 2002434
Method: Semi-Quantitative Colorimetry

Limitations 

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

Does not detect Zygomycetes (ie, Absidia, Mucor, and Rhizopus)

Yeast phase of Blastomyces dermatitidis may not be detected

Vaginal Pathogen Panel by DNA Probe 0065153
Method: Qualitative Nucleic Acid Probe

Limitations 

Poor clinical specificity; cannot distinguish colonization from active infection

Coccidioides Antibodies Panel, CSF by CF, ID, ELISA 0050710
Method: Semi-Quantitative Complement Fixation/Qualitative Immunodiffusion/Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Coccidioides Antibodies Panel, Serum by CF, ID, ELISA 0050588
Method: Semi-Quantitative Complement Fixation/Qualitative Immunodiffusion/Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Limitations 

Negative fungal serology does not rule out possibility of current infection

Coccidioides immitis Identification by DNA Probe 0062225
Method: Nucleic Acid Probe

Blastomyces dermatitidis Identification by DNA Probe 0062224
Method: Nucleic Acid Probe

Limitations 

Gymmascella hyalinospora, a member of the Ascomycetes order, may cross-react with B. dermatitidis probes

Blastomyces dermatitidis Antigen Quantitative by EIA 2002926
Method: Quantitative Enzyme Immunoassay

Blastomyces Antibodies by CF and ID 0050626
Method: Semi-Quantitative Complement Fixation/Qualitative Immunodiffusion

Guidelines

De Rosa FG, Garazzino S, Pasero D, Di Perri G, Ranieri VM. Invasive candidiasis and candidemia: new guidelines. Minerva Anestesiol. 2009; 75(7-8): 453-8. PubMed

Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, Filler SG, Fisher JF, Kullberg B, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD, Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009; 48(5): 503-35. PubMed

Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen M, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010; 50(3): 291-322. PubMed

General References

Chagas-Neto TC, Chaves GM, Colombo AL. Update on the genus Trichosporon Mycopathologia. 2008; 166(3): 121-32. PubMed

Cornely OA. Aspergillus to Zygomycetes: causes, risk factors, prevention, and treatment of invasive fungal infections. Infection. 2008; 36(4): 296-313. PubMed

Couturier MR, Graf EH, Griffin AT. Urine antigen tests for the diagnosis of respiratory infections: legionellosis, histoplasmosis, pneumococcal pneumonia. Clin Lab Med. 2014; 34(2): 219-36. PubMed

Durkin M, Connolly P, Kuberski T, Myers R, Kubak BM, Bruckner D, Pegues D, Wheat J. Diagnosis of coccidioidomycosis with use of the Coccidioides antigen enzyme immunoassay. Clin Infect Dis. 2008; 47(8): e69-73. PubMed

Fischer GB, Mocelin H, Severo CB, Oliveira Fd, Xavier MO, Severo LC. Histoplasmosis in children. Paediatr Respir Rev. 2009; 10(4): 172-7. PubMed

Huston SM, Mody CH. Cryptococcosis: an emerging respiratory mycosis. Clin Chest Med. 2009; 30(2): 253-64, vi. PubMed

Kauffman CA. Histoplasmosis. Clin Chest Med. 2009; 30(2): 217-25, v. PubMed

Montenegro BL, Arnold JC. North American dimorphic fungal infections in children. Pediatr Rev. 2010; 31(6): e40-8. PubMed

Parish JM, Blair JE. Coccidioidomycosis. Mayo Clin Proc. 2008; 83(3): 343-48; quiz 348-9. PubMed

Perfect JR. Cryptococcus neoformans: the yeast that likes it hot. FEMS Yeast Res. 2006; 6(4): 463-8. PubMed

Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007; 45(4): 321-46. PubMed

Saccente M, Woods GL. Clinical and laboratory update on blastomycosis. Clin Microbiol Rev. 2010; 23(2): 367-81. PubMed

Tuon FF, Costa SF. Rhodotorula infection. A systematic review of 128 cases from literature. Rev Iberoam Micol. 2008; 25(3): 135-40. PubMed

Wheat J. Approach to the diagnosis of the endemic mycoses. Clin Chest Med. 2009; 30(2): 379-89, viii. PubMed

Wheat J. Improvements in diagnosis of histoplasmosis. Expert Opin Biol Ther. 2006; 6(11): 1207-21. PubMed

References from the ARUP Institute for Clinical and Experimental Pathology®

Cloud JL, Bauman SK, Neary BP, Ludwig KG, Ashwood ER. Performance characteristics of a polyclonal enzyme immunoassay for the quantitation of Histoplasma antigen in human urine samples. Am J Clin Pathol. 2007; 128(1): 18-22. PubMed

Cloud JL, Bauman SK, Pelfrey JM, Ashwood ER. Biased report on the IMMY ALPHA Histoplasma antigen enzyme immunoassay for diagnosis of histoplasmosis. Clin Vaccine Immunol. 2007; 14(10): 1389-90; author reply 1390-1. PubMed

Crockett DK, Kushnir MM, Cloud JL, Ashwood ER, Rockwood AL. Identification of histoplasma-specific peptides in human urine. Int J Pept. 2012; 2012: 621329. PubMed

Erali M, Pounder JI, Woods GL, Petti CA, Wittwer CT. Multiplex single-color PCR with amplicon melting analysis for identification of Aspergillus species. Clin Chem. 2006; 52(7): 1443-5. PubMed

Hansen J, Slechta S, Gates-Hollingsworth MA, Neary B, Barker AP, Bauman S, Kozel TR, Hanson KE. Large-scale evaluation of the immuno-mycologics lateral flow and enzyme-linked immunoassays for detection of cryptococcal antigen in serum and cerebrospinal fluid. Clin Vaccine Immunol. 2013; 20(1): 52-5. PubMed

Hanson KE, Pfeiffer CD, Lease ED, Balch AH, Zaas AK, Perfect JR, Alexander BD. β-D-glucan surveillance with preemptive anidulafungin for invasive candidiasis in intensive care unit patients: a randomized pilot study. PLoS One. 2012; 7(8): e42282. PubMed

Kushnir MM, Crockett DK, Cloud JL, Ashwood ER, Rockwood AL. Exploratory study of proteins in urine of patients with histoplasma antigenuria. J Chromatogr B Analyt Technol Biomed Life Sci. 2012; 883-884: 147-54. PubMed

Powers AE, Bender JM, Kumánovics A, Ampofo K, Augustine N, Pavia AT, Hill HR. Coccidioides immitis meningitis in a patient with hyperimmunoglobulin E syndrome due to a novel mutation in signal transducer and activator of transcription. Pediatr Infect Dis J. 2009; 28(7): 664-6. PubMed

Rickerts V, Khot PD, Ko DL, Fredricks DN. Enhanced fungal DNA-extraction from formalin-fixed, paraffin-embedded tissue specimens by application of thermal energy. Med Mycol. 2012; 50(6): 667-72. PubMed

Slechta S, Hohmann SL, Simmon K, Hanson KE. Internal transcribed spacer region sequence analysis using SmartGene IDNS software for the identification of unusual clinical yeast isolates. Med Mycol. 2012; 50(5): 458-66. PubMed

Yu MK, Rodgers GM. Immune-mediated thrombocytopenia associated with valley fever. Am J Hematol. 2002; 70(1): 81-2. PubMed

Medical Reviewers

Last Update: August 2016