Fungal Tests

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Also known as: KOH Prep; Fungal Smear; Mycology Tests; Fungal Molecular Tests
Formal name: Potassium Hydroxide Preparation; Fungal Culture; Fungal Antigen and Antibody Tests; Calcofluor White Stain

At a Glance

Why Get Tested?

To detect a fungal infection, to determine which specific fungus or fungi are present, and to help guide treatment

When to Get Tested?

When a doctor suspects that you have a skin, lung, or systemic fungal infection; sometimes after treatment to monitor its effectiveness

Sample Required?

The sample collected depends upon the suspected location(s) of the infection. Some examples include: scrapings of the skin, nail and hair samples, body fluids, blood, and/or a tissue biopsy.

Test Preparation Needed?

None

The Test Sample

What is being tested?

Fungi are microorganisms that exist in nature as one-celled yeasts or as branching filamentous molds (also may be spelled "moulds"). There are more than 50,000 species of fungi in the environment, but less than 200 species are associated with human disease. Of these, only about 20 to 25 species are common causes of infection. Fungal tests detect infections and sometimes identify the fungus and help guide treatment. 

Fungal infections represent the invasion of tissues by one or more species of fungi and range from superficial skin infections to serious deep tissue, blood, lung or systemic diseases.

  • Superficial fungal infections are very common. They may cause nail infections or itchy red scaly skin infections such as those commonly known as athlete's foot, jock itch, and ringworm, or yeast infections that cause white patches in the mouth (thrush) or vaginal itching and discharge. According to the Centers for Disease Control and Prevention (CDC), almost 75% of women will have at least one yeast infection in their lifetime.
  • Deep, systemic infections: less commonly, fungi may spread from their original location to penetrate to deeper tissues or may cause serious lung infections, septicemia, or systemic infections that can affect any organ in the body. Fungal lung infections typically start with the accidental inhalation of microscopic fungal spores. While anyone can get a serious lung or systemic fungal infection, most affected people will only experience mild to moderate flu-like symptoms. However, people who are immunocompromised, such as those with HIV/AIDS, organ transplant recipients, and people with an underlying condition such as diabetes or lung disease are at an increased risk of having a severe fungal infection, a systemic infection, and/or recurrent infections.

Fungal tests are used to detect and identify fungi in order to diagnose infections and help guide treatment. Fungal testing typically includes a microscopic examination of the sample on a slide, sometimes using a preparation or stain to aid in detection of fungal elements. This may be sufficient to determine that the infection is due to a fungus and, with superficial infections, no further testing may be required. However, in cases of persistent, deep, or systemic infections when a more definitive diagnosis is needed, it may be followed by additional tests such as culture and susceptibility testing, antigen or antibody tests, or molecular tests that detect fungal genetic material.

How is the sample collected for testing?

The sample collected depends upon the suspected location(s) of the infection. For superficial infections, the sample may include scrapings of the skin, clipped or shaved nail or hair, vaginal secretions collected with a swab, or a urine sample. For deeper tissue, organ or systemic infections, the sample may involve the collection of urine, blood from a vein, sputum from the lungs, bone marrow, and/or the collection of a tissue biopsy. If meningitis is suspected, a sample of cerebrospinal fluid is collected.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

(March 2011) Mandanas R. Fungal Pneumonia. Medscape Reference Article. Available online at http://emedicine.medscape.com/article/300341-overview through http://emedicine.medscape.com. Accessed October 2012.

(May 21 2012) Hidalgo J. Candidiasis, Medscape Reference. Available online at http://emedicine.medscape.com/article/213853-overview through http://emedicine.medscape.com. Accessed October 2012.

(October 1, 2012) King J. Cryptococcocus, Medscape Reference. Available online at http://emedicine.medscape.com/article/215354-overview through http://emedicine.medscape.com. Accessed October 2012.

American Thoracic Society. Fungal Lung Disease. PDF available for download at http://www.thoracic.org/education/breathing-in-america/resources/chapter-9-fungal-lung-disease.pdf through http://www.thoracic.org. Accessed October 2012.

(January 5, 2012) Centers for Disease Control and Prevention. Fungal Infections. Available online at http://www.cdc.gov/fungal/ through http://www.cdc.gov. Accessed October 2012.

(March 9, 2011) Rashid M. Tinea in Emergency Medicine. Medscape Reference. Available online at http://emedicine.medscape.com/article/787217-overview through http://emedicine.medscape.com. Accessed October 2012.

Sources Used in Previous Reviews

Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1569, 1570, 1532, 1616.

Forbes, B. et. al. (© 2007). Bailey & Scott's Diagnostic Microbiology, Twelfth Edition: Mosby Elsevier Press, St. Louis, Missouri. Pp 629-716.

(2008 March 27, Modified). Candidiasis. CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/candidiasis_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

(2008 March 27, Modified). Aspergillosis (Aspergillus). CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/aspergillosis_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

(2008 March 27, Modified). Blastomycosis. CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/blastomycosis_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

(2008 March 27, Modified). Coccidioidomycosis. CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/coccidioidomycosis_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

(2008 March 27, Modified). Cryptococcus. CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/cryptococcus_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

(2008 March 27, Modified). Dermatophytes (Ringworm). CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/dermatophytes_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

(2008 March 27, Modified). Histoplasmosis. CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/histoplasmosis_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

(2008 March 27, Modified). Sporotrichosis. CDC, Division of Foodborne, Bacterial, and Mycotic Diseases [On-line information]. Available online at http://www.cdc.gov/nczved/dfbmd/disease_listing/sporotrichosis_gi.html through http://www.cdc.gov. Accessed on 8-14-08.

Lehrer, M. (2006 October 26, Updated). Fungal nail infection. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001330.htm. Accessed on 8-14-08.

Lehrer, M. (2006 October 16, Updated). Tinea Corporis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000877.htm. Accessed on 8-14-08.

Berman, K. (2007 April 12, Updated). Athlete's Foot. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000875.htm. Accessed on 8-14-08.

Lehrer, M. (2006 October 16, Updated). Tinea capitis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000878.htm. Accessed on 8-14-08.

Berman, K. (2007 April 12, Updated). Jock itch. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000876.htm. Accessed on 8-14-08.

Lehrer, M. (2007 April 12, Updated). Skin lesion KOH exam. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003761.htm. Accessed on 8-14-08.

Berman, K. (2006 October 13, Updated). Wood's lamp. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003386.htm. Accessed on 8-14-08.

Stokowski, L. (2007 November 20). Fungal Skin and Nail Infections: Practical Advice for Advanced Practice Clinicians. Medscape Nursing Perspectives [On-line information]. Available online at http://www.medscape.com/viewarticle/566002 through http://www.medscape.com. Accessed on 8-16-08.

Pappas, P. (2007 May 31). Invasive Fungal Infections: Diagnosis, Treatment, and Prophylaxis CME/CE. Medscape [On-line information]. Available online at http://www.medscape.com/viewarticle/556373 through http://www.medscape.com. Accessed on 8-13-08.

(2005 November, Revision). Fungi. The Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec14/ch180/ch180a.html?qt=fungal%20infection&alt=sh#sec14-ch180-ch180a-1521 through http://www.merck.com. Accessed on 8-13-08.

(2005 November, Revision). Fungal Skin Infections. The Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec10/ch120/ch120a.html through http://www.merck.com. Accessed on 8-13-08.

(© 2006-2008). Yeast-Associated Syndromes. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/InfectiousDz/Fungi/Yeasts.html through http://www.arupconsult.com. Accessed on 8-16-08.

(© 2006-2008). Mold-Associated Syndromes. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/InfectiousDz/Fungi/Molds.html through http://www.arupconsult.com. Accessed on 8-16-08.

Ellis, D. (2008 February 7, Modified). Calcofluor White with 10% KOH. Mycology Online [On-line information]. Available online at http://www.mycology.adelaide.edu.au/Laboratory_Methods/Microscopy_Techniques_and_Stains/calcofluor.html through http://www.mycology.adelaide.edu.au. Accessed on 8-16-08.