Table 2:

Diagnostic Tests for Invasive Yeast

Organism	Clinical Manifestations	Gold Standard	Culture	Antigen Testing	Molecular Testing	Comments
Candida spp.1	Blood stream infection Deep tissue infection	Blood or deep tissue culture [6]	Blood Urine Tissue	Serum BDG Mannan/ antimannan IgG	T2Candida panel	BDG may help rule out IC but lacks the specificity to be used as a stand-alone diagnostic test. Mannan/ anti-mannan IgG is not widely used in the US. T2Candida panel is not widely available.
		Limitations Blood cultures only positive during candidemia; May require invasive biopsy	Limitations Prolonged time to positivity [31]	Limitations BDG is non-specific, should not be used in isolation to make diagnosis [6] Mannan/ anti-mannan have low sensitivity, but specific [32]	Limitations Only for Candidemia; may remain positive for several days after Candidemia has cleared [31]
Cryptococcus spp.	Pneumonia Meningoencephalitis	Culture Direct visualization of narrow budding, encapsulated yeast	Sputum BAL CSF Tissue	Latex agglutination EIA Lateral flow immunoassay *Can be tested on sputum, BAL, serum, CSF, urine, pleural fluid	Currently unavailable for clinical use	Antigen testing on serum or CSF is used most to make the diagnosis. Evaluate for CNS disease in immunocompetent patients with neurologic findings and high serum titer Evaluate for CNS disease in all immunocompromised patients
		Limitations Delayed time to positivity [36]	Limitations Sensitivity dependent upon culture specimen [40]	Limitations False positive RF or other infections [35]

Abbreviations: BDG- β-1,3-D glucan, CSF- Cerebrospinal Fluid, EIA- Enzyme Immunoassay, IC- Invasive Candidiasis, RF- Rheumatoid factor, US- United States, CNS- Central Nervous System

¹Tests are referring to the diagnostic tests used for IC, which includes candidemia and deep-seated tissue infections