Tests & diagnoses

The set of tests required to make a proven, probably or possible diagnosis of a fungal infection or allergy is usually set out in the guidelines for that disease, and will depend on patient factors as well as local availability.

Generally multiple tests will be required because there are often many conditions in the differential diagnosis, and fungal infections may co-exists with other infections (e.g. influenza with aspergillosis) or diagnoses (e.g. bronchiectasis and aspergillosis).

Laboratory tests explained, including current suppliers

AntibodyAntigen & β-D-glucanCulture
Fungal microscopyHistopathologyMolecular

Imaging & examinations

Imaging / radiology
– Choosing an appropriate modality
– CT
– MRI
Specialist clinical examinations
Dermoscopy
– Opthalmoscopy
– Skin testing for endemic mycoses

In addition to making or confirming the diagnosis of fungal infection, full mycological testing has several advantages:

  • Knowing which fungus is involved guides appropriate antifungal choice, dose and duration of therapy. It may also indicate the source of infection.
  • Additional or dual infections can be identified (i.e. 3-5% of Candida bloodstream infections).
  • Severity of infection may be revealed from the extent of involvement on skin or scans, the number or load of organisms visible on microscopy or histology or the strength of signal on antigen or PCR tests. These factors may assist in determining whether additional therapy should be added and in following response to therapy.
  • Assessing whether antifungal resistance is present, and whether an alternative antifungal agent is required.

Some samples are easy to take and process, blood and urine being the obvious examples. Others are harder, including fingernail or toenail clippings, tissue biopsies and respiratory samples. Additional guidance may be required beyond what is given on this website.

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