Fungus Stain

CPT: 87206
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Test Details

Synonyms

  • Calcofluor
  • KOH

Use

Determine the presence or absence of fungal forms in clinical specimens submitted for direct microscopic exam

Additional Information

KOH/calcofluor: Microscopic examination of nails does not have the sensitivity of culture. KOH alone can be difficult to read and time-consuming. KOH plus the whitener calcofluor increases the sensitivity of the smear. The KOH/calcofluor requires a fluorescence microscope for reading but is superior to KOH alone and replaces the PAS stain for detection capabilities. Positive smears using KOH/calcofluor can be expected in about 60% of positive cultures. If the smear is positive then the likelihood that the culture will grow a dermatophyte is greater than if the smear is negative. See table for retrospective recovery data.

Fungi Grown From

Smear-positive Nails

Fungi Grown From

Smear-negative Nails

T rubrum (54%)

Various “saprophytes” (50%)

Various “saprophytes” (23%)

Yeasts (19%)

Yeasts (12%)

T rubrum (12%)

T mentagrophytes (6%)

T mentagrophytes (6%)

Fusarium sp (2%)

Fusarium sp (5%)

Scopulariopsis sp (2%)

T tonsurans (2%)

Aspergillus sp (2%)

Chrysosporium sp (2%)

Paecilomyces sp (2%)

Specimen Requirements

Specimen

Biopsy, body fluid, aspirates, bronchoalveolar lavage (BAL), skin, nails, hair, sinus, sputum, stool, swab of conjunctiva, throat, tissue, urine, or vaginal

Volume

50 mL BAL, 5 mL fluid, 2 mL tissue

Container

Sterile leakproof container or swab

Patient Preparation

Usual sterile preparation (see Blood Culture, Routine [008300]).

Collection

Biopsy: Surgical specimen in sterile container. A small amount of sterile nonbacteriostatic water should be used to prevent drying.

Body fluid, aspirates: Aspirated material in sterile container.

Skin and nails: Cleanse the area with 70% alcohol prior to specimen collection. Nail scraping should be from a subsurface portion of the infected nail. Skin should be taken from the active border of the lesion.

Hair: Epilate 10 to 12 hairs and place them in a sterile container.

Stool: Random sample in sterile container.

Swabs of throat, nose, nasopharynx, ear, vagina: Swab affected area or visible lesion.

Urine: Clean catch midstream sample in sterile container.

Wound: Purulent material, fluid, scraping of lesion border, or swab (least preferred) in sterile transport container. Swabs cannot be split for other tests.

Avoid contamination of the specimen with commensal organism as much as possible. Specify the source of the specimen and include any pertinent clinical information.

Storage Instructions

Maintain specimen at room temperature.

Causes for Rejection

Swab without evidence of specimen present; leaking specimen; inappropriate specimen transport device including syringe with needle; unlabeled specimen or name discrepancy between specimen and request label; specimen received after prolonged delay (usually more than 72 hours); specimen received in expired transport; fungal stain (KOH/Calcofluor) cannot be performed on blood

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
008136 Fungus Stain 21003-9 008136 Fungus Stain 21003-9
Reflex Table for Fungus Stain
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 080086 Result 080087 Result 1 N/A
Reflex Table for Fungus Stain
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 080086 Result 080088 Result 2 N/A
Reflex Table for Fungus Stain
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 080086 Result 080089 Result 3 N/A
Reflex Table for Fungus Stain
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 080086 Result 080090 Result 4 N/A
Reflex Table for Fungus Stain
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 080086 Result 080091 Antimicrobial Susceptibility N/A

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