Used to aid in the diagnosis of fungal infections.

Out of the large number and variety of fungi in our environment, only a small number have the innate ability to invade and cause human disease.  The fungi that are able to cause disease seem to do so because of some peculiar trait of metabolism not shared by taxonomically similar species.  The survival and growth at elevated body temperature, in reduced oxidation-reduction environment of tissue, and the ability to overcome host defense mechanisms set apart a few species.

The advent of cytotoxic drugs, long-term steroid treatment, organ transplant, and immunosuppressive agents has markedly increased the number and severity of diseases caused by the ever growing list of opportunistic fungi. For this reason, many fungi are of potential significance and should be scrutinized with respect to the patient's condition and underlying disease on an individual basis.  Communication between the physician and the Mycology Section is crucial for the proper evaluation of an isolate.

The incidence of serious candidiasis has risen sharply and often follows use of broad-spectrum antibiotics, steroids, and other immunosuppressive drugs.  As a group Candida spp. is one of the most frequent opportunistic pathogens in patients with Acquired Immunodeficiency Syndrome (AIDS) and in other patients with immune defects. 

Culture of bronchial, ETS, or sputum specimen is not conclusive for opportunistic infections (Aspergillus, Candida, and zygomycetes.) Lung biopsy for histopathology and culture are recommended. 

CSF fluid is screened for cell count (<=5 WBC/cubic mm, newborns <20 WBC/cubic mm). A normal CSF will not be cultured except from immunocompromised patients.

Culture of bone marrow is recommended by many authorities for diagnosis of systemic histoplasmosis and other fungus infections.

Susceptibility testing (Minimal Inhibitory Concentration Methodology) may be useful in serious fungal infections due to organisms with unpredictable susceptibility profiles, especially if standard regimens are inapplicable or have proven ineffective.  Testing is available at additional charge(s) for Candida, or Cryptococcus neoformans to amphotericin B, fluconazole, micafungin, caspofungin, and voriconazole.  Testing is not available for molds (e.g., Aspergillus, Rhizopus).  Susceptibility results are reported in mcg/mL.  The interpretative category ("susceptible", "intermediate", "susceptible dependent on dose," or "resistant") is included, if established for the yeast species/antifungal agent tested. Testing requires 3-5 days to complete.  Consultation with the Infectious Diseases Service is required prior to testing.

Communication with Clinical Microbiology is recommended when infection with Histoplasma, Blastomyces, or Coccidioides is suspected.

KOH-Calcofluor-White Preparation is reported with culture results.

Fungal Culture.

Includes identification of fungi for an additional charge. 

Includes KOH-Calcofluor-White Preparation on all tissues, abscesses, eye, and sinuses, and on other specimens from immunocompromised patients at additional charge.

Includes Cryptococcal Antigen on CSF specimens that meet culture criteria at additional charges. 

CPT coding cannot be determined before culture is completed.

Order CULTURE, FUNGUS, DERMATOPHYTES for skin scraping, hair, or nail specimens. Order KOH PREPARATION, SKIN, HAIR, NAIL if needed.