33470/33523 - Coccidioides qPCR (Lower respiratory) & Coccidioides qPCR (CSF)
Coccidioides infections are caused by inhalation of spores of the fungi Coccidioides immitis or Coccidioides posadasii. This infection primarily affects the lungs but can spread to other organs and the geographic distribution: While both are found in the southwestern US, C. posadassii has a wider geographic range, extending into Mexico and Central America. However, Coccidioides infections are now detected across the United States and this is suspected due to climate change and the travel habits of people. Coccidioidomycosis, blastomycosis, an histoplasmosis, 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 | 33470 | 87798 | No | 5 mL (min. 0.5 mL)* |
250 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 | 33523 | 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. https://fightfungus.org/diagnositic-testing/
2. Dallas J. Smith, PharmD 1,2; Samantha L. Williams, MPH2; Endemic Mycoses State Partners Group; Kaitlin M. Benedict, MPH2; Brendan R. Jackson, MD2; Mitsuru Toda, PhD2 (1 Epidemic Intelligence Service; 2 Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, CDC). MMWR Surveill Summ 2022;71 No. 7
3. Galgiani JN, Ampel NM, Blair JE, et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis 2016;63:e112–46. PMID:27470238 https://doi.org/10.1093/cid/ciw360
4. Blair JE, Logan JL. Coccidioidomycosis in solid organ transplantation. Clin Infect Dis 2001;33:1536–44. PMID:11588699 https://doi. org/10.1086/323463
5. 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
6. McCotter OZ, Benedict K, Engelthaler DM, et al. Update on the epidemiology of coccidioidomycosis in the United States. Med Mycol 2019;57(Suppl_1):S30–40. PMID:30690599 https://doi.org/10.1093/ mmy/myy095
7. Head JR, Sondermeyer-Cooksey G, Heaney AK, et al. Influence of meteorological factors and drought on coccidioidomycosis incidence in California, 2000–2020. Preprint published online February 4, 2022. https://doi.org/10.1101/2022.02.03.22270412
8. Benedict K, Molinari NAM, Jackson BR. Public awareness of invasive fungal diseases—United States, 2019. MMWR Morb Mortal Wkly Rep 2020;69:1343–6. PMID:32970658 https://doi.org/10.15585/mmwr. mm6938a2