33468/33519 - Histoplasma qPCR (Lower respiratory) & Histoplasma qPCR (CSF)
Histoplasma infections are caused by inhalation of spores of the fungus Histoplasma capsulatum. This infection primarily affects the lungs but can spread to other organs and historically was thought to be endemic to the Ohio and Mississippi River valleys of the United States. However, Histoplasma infections are now detected across the United States and this is suspected due to climate change and the travel habits of people. Histoplasmosis, blastomycosis, and coccidioidomycosis are often underrecognized and frequently misdiagnosed fungal infections as the can clinically resemble bacterial and viral community-acquired pneumonia (CAP). The utility of PCR (using a BAL, sputum or CSF specimen) has brought on advances in the detection and therapeutic monitoring, leading to increased survival rates and increased quality of care.
ProcedureExtraction of fungal DNA from BAL, CSF, or sputum specimens followed by PCR amplification of targets using real-time PCR methods. An internal control is added to ensure that extraction was performed correctly and that the PCR reaction was not inhibited.
SpecificityAll specimens were positive for UIC, with CT values ≤35.
No signal was detected in the following off-target fungal, bacterial, and viral pathogens:
| Aspergillus fumigatus | Escherichia coli 11775 | Parainfluenza 4B VR-1377 |
| Adenovirus strain 24 | Enterococcus faecalis ATCC 35550 | Rhinovirus VR-1645 |
| Burkholderia cepacia 13945 | Haemophilus influenzae 8142 | RSV A VR-26 |
| Blastomyces parvus ATCC 10785 | Human Coronavirus ATCC 25238 | RSV B VR-1794 |
| Candida albicans ATCC 18804 | Influenza A H1N1 A/New Jersey/8/76 | Staphylococcus aureus 12600 |
| Candida auris MYA-5002 | Influenza B VR-295 | Staphylococcus epidermidis 35547 |
| Candida glabrata ATCC 66032 | Klebsiella pneumoniae 35555 | Serratia marcescens 264 |
| Candida krusei ATCC 6258 | Mycobacteroides abscessus | Streptococcus pneumoniae Z 022 |
| Candida parapsilosis ATCC 22019 | Moraxella catarrhalis ATCC 25238 | Streptococcus pyogenes ATCC BAA-947 |
| Candida tropicalis ATCC 750 | Mucor racemosus ATCC 42647 | SARS CoV-2 |
| Coxsackievirus B4 0810075CF | Pseudomonas aeruginosa 35422 | Swine Flu VR-1737 |
| Enterobacter cloacae ATCC 35549 | Paracoccidioides brasiliensis ATCC 10237 |
Same day (< 24 hours from receipt of specimen), Monday through Saturday.
| Specimen Type | Test Code | CPT Code | NY Approved | Volume | Assay Range | Special Instructions |
|---|---|---|---|---|---|---|
| Lower respiratory | 33468 | 87798 | No | 5 mL (min. 0.5 mL)* |
1000 copies/mL to 1.25E+09 copies/mL |
• If reflex NGS testing is being considered, please submit at least 5.0 mL of BAL.* |
| CSF | 33519 | 87798 | No | 2 mL (min. 0.5 mL) |
250 copies/mL to 1.25E+09 copies/mL |
• Collect in a sterile, screw top tube. |
Ship Monday through Friday. Friday shipments must be labeled for Saturday delivery. All specimens must be labeled with patient's name and collection date. A Eurofins Viracor test requisition form must accompany each specimen. Multiple tests can be run on one specimen. Ship specimens FedEx Priority Overnight® to: Eurofins Viracor, 18000 W 99th St. Ste, #10, Lenexa, KS 66219.
Causes for RejectionRespiratory sample received in trap, specimen received outside stability, insufficient specimen volume and specimen types other than those listed.
Specimens are approved for testing in New York only when indicated in the Specimen Information field above. The CPT codes provided are based on Eurofins Viracor’s interpretation of the American Medical Association's Current Procedural Terminology (CPT) codes and are provided for informational purposes only. CPT coding is the sole responsibility of the billing party. Questions regarding coding should be addressed to your local Medicare carrier. Eurofins Viracor assumes no responsibility for billing errors due to reliance on the CPT codes illustrated in this material.
References1. Buitrago MJ and Martín-Gómez MT (2020) Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge. Front. Microbiol. 11:467. doi: 10.3389/fmicb.2020.00467Comparison of PCR protocols for detecting Histoplasma capsulatum DNA through a multicenter study. http://dx.doi.org/10.1016/j.riam.2013.03.004
2. Buitrago MJ and Martín-Gómez MT (2020) Timely Diagnosis of Histoplasmosis in Non-endemic Countries: A Laboratory Challenge. Front. Microbiol. 11:467. doi: 10.3389/fmicb.2020.00467
3. Validation and Clinical Application of a Molecular Method for Identification of Histoplasma capsulatum in Human Specimens in Colombia, South America. CLINICAL AND VACCINE IMMUNOLOGY, Jan. 2010, p. 62–67 Vol. 17, No. 1 1556-6811/10 doi:10.1128/CVI.00332-09.
4. Bialek R, Feucht A, Aepinus C, Just-Nubling G, Robertson VJ, Knobloch J, et al. Evaluation of two nested PCR assays for detection of Histoplasma capsulatum DNA in human tissue. J Clin Microbiol. 2002;40:1644–7.
5. Buitrago MJ, Berenguer J, Mellado E, Rodriguez-Tudela JL, Cuenca-Estrella M. Detection of imported histoplasmosis in serum of HIV-infected patients using a real-time PCR-based assay. Eur J Clin Microbiol Infect Dis. 2006;25:665–8.
6. Buitrago MJ, Bernal-Martinez L, Castelli MV, Rodriguez-Tudela JL, Cuenca-Estrella M. Histoplasmosis and paracoccidioidomycosis in a non-endemic area: a review of cases and diagnosis. J Travel Med. 2011;18:26–33.
7. Colombo LA, Tobon A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol. 2011;49:785–98.
8. Frias De Leon MG, Arenas LG, Taylor ML, Acosta AG, Reyes-Montes MR. Development of specific sequence-characterized amplified region markers for detecting Histoplasma capsulatum in clinical and environmental samples. J Clin Microbiol. 2012;50:673–9.
9. Martagon-Villamil J, Shrestha N, Sholtis M, Isada CM, Hall GS, Bryne T, et al. Identification of Histoplasma capsulatum from culture extracts by real-time PCR. J Clin Microbiol. 2003;41:1295–8. Wheat LJ. Approach to the diagnosis of the endemic mycoses. Clin Chest Med. 2009;30:379–89, viii.
10. Wheat LJ, Knox KS, Hage CA. Approach to the diagnosis of histoplasmosis, blastomycosis and coccidioidomycosis. Curr Treat Options Infect Dis 2014;6:337–51. https://doi.org/10.1007/ s40506-014-0020-6