Test Id : HBRP
Histoplasma capsulatum/Blastomyces species, Molecular Detection, PCR, Varies
Useful For
Suggests clinical disorders or settings where the test may be helpful
Rapid detection of Histoplasma capsulatum and Blastomyces dermatitidis DNA
Aiding in the rapid diagnosis of histoplasmosis and blastomycosis
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For more information see Meningitis/Encephalitis Panel Algorithm
Method Name
A short description of the method used to perform the test
Real-Time Polymerase Chain Reaction (PCR)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For more information see Meningitis/Encephalitis Panel Algorithm
Specimen Type
Describes the specimen type validated for testing
Varies
Ordering Guidance
Urine is not an acceptable source for this assay. Studies indicate that Histoplasma DNA is not routinely found in the urine of patients with disseminated histoplasmosis. The recommended test for urine specimens is UHBAG / Histoplasma and Blastomyces Antigen, Enzyme Immunoassay, Urine.
Shipping Instructions
Specimen must arrive within 7 days of collection; specimens received after 7 days will be rejected.
N-acetyl-l-cysteine-sodium hydroxide (NALC/NaOH)-digested specimen must arrive within 7 days of digestion.
Necessary Information
Specimen source is required.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| SRC78 | Histo/Blasto Source |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
The high sensitivity of amplification by polymerase chain reaction requires the specimen to be processed in an environment in which contamination of the specimen by Histoplasma or Blastomyces species DNA is not likely.
Submit only 1 of the following specimens:
Specimen Type: Body fluid
Sources: Body, spinal fluid, bone marrow
Container/Tube: Sterile container
Specimen Volume: 1 mL
Specimen Type: Respiratory
Sources: Bronchoalveolar lavage, bronchial washing, sputum
Container/Tube: Sterile container
Specimen Volume: 1 mL
Specimen Type: Tissue or bone
Container/Tube: Sterile container
Specimen Volume: 5-10 mm
Collection Instructions: Collect a fresh tissue or bone specimen.
Acceptable:
Specimen Type: N-acetyl-l-cysteine-sodium hydroxide (NALC/NaOH)-digested respiratory specimens
Sources: Lavage fluid, bronchial washing, gastric washing, respiratory fluid, sputum, or tracheal secretion
Container/Tube: Sterile container
Specimen Volume: 2 mL
Collection Instructions:
1. Submit digested specimen treated with NALC/NaOH.
2. Clearly indicate on container and order form that specimen is a digested specimen.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
Body fluid or respiratory specimen: 0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Specimen in anaerobe vial or viral transport medium (including but not limited to M4, M5, BD viral transport media, thioglycolate broth) Feces Swab Tissue in formalin fluid Urine | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Refrigerated (preferred) | 7 days | |
| Ambient | 7 days | ||
| Frozen | 7 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Rapid detection of Histoplasma capsulatum and Blastomyces dermatitidis DNA
Aiding in the rapid diagnosis of histoplasmosis and blastomycosis
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For more information see Meningitis/Encephalitis Panel Algorithm
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Infections with Blastomyces dermatitidis and Histoplasma capsulatum cause a variety of clinical manifestations ranging from self-limited, mild pulmonary illness to potentially life-threatening, disseminated disease. Primary infections are acquired through inhalation of conidia that are present in the environment. In the United States, most cases of blastomycosis and histoplasmosis occur along the Ohio and Mississippi River valleys, although recent studies suggest the geographic area of endemicity may be expanding.
The gold standard for diagnosis of blastomycosis and histoplasmosis remains isolation of the organisms in culture. Although sensitive, recovery in culture and subsequent identification may require days to weeks. This polymerase chain reaction assay can provide rapid and specific detection and differentiation of B dermatitidis/gilchristii and H capsulatum directly from clinical specimens.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Not applicable
Interpretation
Provides information to assist in interpretation of the test results
A positive result for Histoplasma capsulatum indicates presence of Histoplasma DNA; a positive result for Blastomyces dermatitidis/gilchristii indicates presence of Blastomyces DNA.
A negative result indicates absence of detectable H capsulatum and B dermatitidis/gilchristii DNA. Fungal culture has increased sensitivity over this polymerase chain reaction (PCR) assay and should always be performed when the PCR is negative.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This rapid polymerase chain reaction (PCR) assay detects Histoplasma capsulatum and Blastomyces dermatitidis nucleic acid and, therefore, does not distinguish between the presence of viable, disease-related organisms and nucleic acid persisting from previous, treated disease. Test results should be correlated with patient symptoms and clinical presentation before a definitive diagnosis is made.
A negative result does not rule out the presence of H capsulatum or B dermatitidis/gilchristii because the organism may be present at levels below the limit of detection for this assay.
The sensitivity of the PCR assay from bronchoalveolar lavage fluid is low, and a negative result does not rule out infection.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1.Wheat LJ, Azar MM, Bahr NC, Spec A, Relich RF, Hage C: Histoplasmosis. Infect Dis Clin North Am. 2016 Mar;30(1):207-227. doi: 10.1016/j.idc.2015.10.009
2.Azar MM, Loyd JL, Relich RF, Wheat LJ, Hage CA: Current concepts in the epidemiology, diagnosis, and management of Histoplasmosis syndromes. Semin Respir Crit Care Med. 2020 Feb;41(1):13-30. doi: 10.1055/s-0039-1698429
3.Linder KA, Kauffman CA, Miceli MH: Blastomycosis: A review of mycological and clinical aspects. J Fungi (Basel). 2023 Jan 14;9(1):117. doi: 10.3390/jof9010117
4.Smith DJ, Williams SL; Endemic Mycoses State Partners Group; Benedict KM, Jackson BR, Toda M: Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis - United States, 2019. MMWR Surveill Summ. 2022 Aug 19;71(7):1-14. doi: 10.15585/mmwr.ss7107a1
Method Description
Describes how the test is performed and provides a method-specific reference
Following specimen processing, nucleic acids are extracted using the MagNA Pure instrument (Roche Applied Sciences). The extract is then amplified using the LightCycler real-time polymerase chain reaction (PCR) platform (Roche Applied Sciences). The presence of the specific organism nucleic acid is confirmed by performing a melting curve analysis of the amplicon. Primers and fluorescence resonance energy transfer (FRET) hybridization probes were designed to target a 174-base pair (bp) region of the histidine kinase (DRK-1) gene of Blastomyces dermatitidis/gilchristii and a 192-bp region of the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) gene of Histoplasma capsulatum, respectively. The acceptor probe for B dermatitidis/gilchristii was labeled with a Red-705 dye, while the acceptor probe for H capsulatum was labeled with a Red-640 dye. Labeling the acceptor probes with 2 different dyes allows for simultaneous detection and differentiation of B dermatitidis/gilchristii and H capsulatum within a single PCR assay.(Babady NE, Buckwalter SP, Hall L, Le Febre KM, Binnicker MJ, Wengenack NL: Detection of Blastomyces dermatitidis and Histoplasma capsulatum from culture isolates and clinical specimens by use of real-time PCR. J Clin Microbiol. 2011;49:3204-3208)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Sunday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
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- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
87798
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| HBRP | Histoplasma/Blastomyces PCR | 81653-8 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| SRC78 | Histo/Blasto Source | 31208-2 |
| 32457 | Histo/Blasto Result | 81653-8 |