Table 2

Rapid and histology stains available for fungal examination and identification7 25–30

StainUseComments
Calcofluor/Blankophor whiteDetection of all fungiRapid. Alone or in combination with 10–20% KOH. Need for fluorescence microscope at 420 nm
Fontana–Masson stainHistological stain for melaninStains the cell wall of Cryptococcus neoformans. Especially useful for differentiation of capsule-deficient C neoformans. Confirmation of melanin in lightly pigmented cells of dematiaceous (dark coloured) fungi. Cell walls stain brown/black
GiemsaStaining of bone marrow and peripheral blood smears or sputum and BALUseful for Histoplasma and Pneumocystis species identification
Grocott-Gomori methenamine silver stain (GMS)Histological stainProvides optimal contrast for the detection of fungi in tissue. Specific for fungal cell walls. Fungi stain black, dark brown or grey. Stains old and non-viable fungal elements most effectively. Erythrocytes can mimic yeasts
H&EGeneral purpose histological stainStains most fungi. Allows demonstration of host tissue reaction. Demonstrates natural pigment in dematiaceous fungi. Not a specific fungal stain and fungal elements are easily missed. Cartilage and calcium deposits dark blue, cytoplasm and other components shades of red
India inkNegative staining. Especially useful in CSFRapid. Detection of Cryptococcus species (encapsulated)
KOHClearing of specimen to allow improved visibility of fungal elements. Mostly with solid specimensRapid. With or without incubation at 56°C. May produce artefacts due to crystallisation of the KOH especially on drying
LactophenolLactophenol: preserves fungal structures and kills the fungus. Cotton blue: stains the fungal elementsRapid. Clear and specific images of fungal elements. Mostly used at the identification steps
Lactophenol-cotton blue
Mayer's mucicarmine stainHistological stainSpecifically stains mucopolysaccharide capsular material of several fungi. May help in confirmation of cryptococcal infection
Papanicolaou stainCytological stain mainly used to detect malignant cellsStains most fungal elements
Periodic acid-Schiff stainHistological stainStains yeasts and hyphae. Possible artefacts with yeasts. Fungi appear red-purple. Zygomycete hyphae may stain poorly