Yeast-Associated Infections

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Content

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

Indications for Laboratory Testing

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

Additional Tests Available

Coccidioides Antibodies, IgG & IgM by ELISA 0050137
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Fungal Antibodies by Immunodiffusion 0050164
Method: Qualitative Immunodiffusion

Fungal Antibodies by CF, Serum 0050605
Method: Semi-Quantitative Complement Fixation

Fungal Identification by ITS rDNA Sequencing 0060756
Method: Sequencing

Comments

Identify clinically significant isolates

Antimicrobial Susceptibility - Fungal (Yeasts and Molds) 2009257
Method: Broth Microdilution

Comments

Determine minimum inhibitory antifungal agent concentration to treat identified Candida, Cryptococcus, Geotrichum, and Trichosporon species

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

Blastomyces Antibody by CF 0050130
Method: Semi-Quantitative Complement Fixation

Comments

Use with paired sera taken 3 weeks apart to detect a rise in titer against a single antigen

Blastomyces dermatitidis Antibodies by Immunodiffusion 0050172
Method: Qualitative Immunodiffusion

Comments

Measure IgG antibodies

Candida Antibody by ID 0055565
Method: Qualitative Immunodiffusion

Candida albicans Antibodies IgA, IgG, and IgM by ELISA 0095200
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Comments

Measure IgG, IgM and IgA antibodies

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

Coccidioides Antigen by EIA 2011075
Method: Quantitative Enzyme Immunoassay

Coccidioides Antibody by CF 0050170
Method: Semi-Quantitative Complement Fixation

Comments

Detect current or past infection

Monitor response to therapy

Least sensitive in pulmonary cavitary disease

Coccidioides immitis Antibodies by Immunodiffusion 0050183
Method: Qualitative Immunodiffusion

Comments

Detect current or past infection

Monitor response to therapy

Coccidioides Antibody, IgG by ELISA 0050179
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Comments

Detect current or past infection

Negative fungal serology does not rule out possibility of current infection

Coccidioides Antibody, IgM by ELISA 0050178
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Comments

Detect current or past infection

Negative fungal serology does not rule out possibility of current infection

For equivocal results, repeat test in 10-14 days 

Histoplasma Antibodies by CF 0050625
Method: Semi-Quantitative Complement Fixation

Comments

Detect current or past Histoplasma infection

Histoplasma Antibodies by CF & ID 0050627
Method: Semi-Quantitative Complement Fixation/Qualitative Immunodiffusion

Comments

Detect current or past Histoplasma infection

Negative fungal serology does not rule out possibility of current infection

Histoplasma spp. Antibodies by Immunodiffusion 0050174
Method: Qualitative Immunodiffusion

Comments

Identify Histoplasma as causative agent in disease

Negative fungal serology does not rule out possibility of current infection

Fungal Antibodies by CF, CSF 0050750
Method: Semi-Quantitative Complement Fixation

Guidelines

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

Pappas P, Kauffman C, Andes D, Benjamin D, Calandra T, Edwards J, Filler S, Fisher J, Kullberg B, Ostrosky-Zeichner L, Reboli A, Rex J, Walsh T, Sobel J, 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 J, Dismukes W, Dromer F, Goldman D, Graybill J, Hamill R, Harrison T, Larsen R, Lortholary O, Nguyen M, Pappas P, Powderly W, Singh N, Sobel J, Sorrell T. 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 T, Chaves G, Colombo A. Update on the genus Trichosporon Mycopathologia. 2008; 166(3): 121-32. PubMed

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

Couturier M, Graf E, Griffin A. 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 B, 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 G, Mocelin H, Severo C, Oliveira F, Xavier M, Severo L. Histoplasmosis in children. Paediatr Respir Rev. 2009; 10(4): 172-7. PubMed

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

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

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

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

Perfect J. 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 G. Clinical and laboratory update on blastomycosis. Clin Microbiol Rev. 2010; 23(2): 367-81. PubMed

Tuon F, Costa S. 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 J, Bauman S, Neary B, Ludwig K, Ashwood E. 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 J, Bauman S, Pelfrey J, Ashwood E. 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 D, Kushnir M, Cloud J, Ashwood E, Rockwood A. Identification of histoplasma-specific peptides in human urine. Int J Pept. 2012; 2012: 621329. PubMed

Erali M, Pounder J, Woods G, Petti C, Wittwer C. 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 M, Neary B, Barker A, Bauman S, Kozel T, Hanson K. 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 K, Pfeiffer C, Lease E, Balch A, Zaas A, Perfect J, Alexander B. 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 M, Crockett D, Cloud J, Ashwood E, Rockwood A. 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 A, Bender J, Kumánovics A, Ampofo K, Augustine N, Pavia A, Hill H. 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 P, Ko D, Fredricks D. 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 S, Simmon K, Hanson K. 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 M, Rodgers G. Immune-mediated thrombocytopenia associated with valley fever. Am J Hematol. 2002; 70(1): 81-2. PubMed

Medical Reviewers

Last Update: December 2015