Microbiology - Mycology
Specimens for isolation and identification of medically important fungi from body tissues and fluids are accepted from public and private health care providers. Reference cultures are also accepted for identification of yeasts, molds, and aerobic actinomycetes. Fungal specimens for "routine" culture are not accepted; limit cultures to those actually implicated in fungal disease. Except for specimens to be examined for agents of superficial or cutaneous mycoses, clinical material should not be mailed to the State Laboratory for primary isolation without special arrangement. Telephone the Microbiology Branch, at (919) 733-7367, to make these arrangements. Routine antimicrobial susceptibility testing is not performed in this laboratory. Consultation and bench training in mycology are provided upon request.
Specimen Collection
Specimens should be inoculated to isolation media within 24 hours of collection. Viability of most fungal pathogens decreases significantly with delay in processing specimens; for example, viability of Histoplasma capsulatum is lost after 24 hours regardless of how the specimen is handled. For this reason, it is preferable to initiate primary isolation at the local level. It is not recommended, however, that primary isolation of systemic fungi be attempted without using a biological safety cabinet for specimen processing. Appropriate culture media are available commercially; consult reference manuals for recommended isolation methods.
Blood, bone marrow, spinal fluid, biopsy material, aspirates, and other clinical specimens should be collected aseptically. Sputum for fungus culture should be an early morning specimen collected after rinsing the mouth with water. Bronchial washing and brusing and other body fluids should be submitted in the centrifuge tubes found in the sputum mailer for TB. Tissue from fungal lesions should be obtained from the center and the wall of the lesion. Skin, hair, and nails are no longer accepted.
Label specimen with patient's name, date of birth or Social Security Number and, if isolated organism, local laboratory number. Unlabeled specimens will not be tested. It is particularly important that pertinent clinical information be sent with each specimen since it is used in selecting appropriate isolation procedures. For safety reasons, please do not submit a single clinical specimen for primary isolation of both fungi and Mycobacterium tuberculosis; however, please indicate if tuberculosis is suspected in addition to fungal disease.
Place properly completed DHHS Form #2010 (PDF, 216 KB; one form for each specimen) in the outer container to avoid contamination in case of breakage or leakage. Place caps on securely to avoid leakage. Leaking specimens constitute a biological hazard and may not be tested.
Lab records are computerized and the following data are required: patient name, patient Social Security Number (or assigned number), date of birth, patient Medicaid number (if applicable), submitter Federal Tax Number (Employer Identification Number), submitter return address, specimen collection date and specimen source. Without these data, specimen records cannot be entered into the computer, nor can a report of results be printed. Other data are helpful for epidemiological follow-up and for statistical purposes.
Note: CLIA regulations require the following information on all test requisitions:
- Patient name or identifier
- Name and address of submitting agency
- Test requested
- Date specimen collected
To submit reference cultures, isolated pure colonies from primary culture media should be subcultured to fresh media, and incubated until visible growth appears before shipment. If necessary, initial cultures believed to be clinically significant may be submitted on primary isolation media.Culture plates should not be submitted. Each specimen should be clearly labeled with the patient's name and accompanied by DHHS form #2010 (PDF, 216 KB). Note: Specimens received without the submitter's return address are subject to rejection!
Specimen Shipment
Always use double-walled shipping containers, or equivalent that meets safety requirements. Several types are available from the Laboratory Mailroom. Multiple tubes or specimens should be wrapped individually in absorbent cushioning material and securely packaged in a leak-proof container. Mailers or packages not supplied by the State Laboratory should have "Mycology" plainly marked on the outside of the package. This ensures that packages and mail will be delivered directly to the Mycology Unit, eliminating needless and possibly hazardous exposure of non-technical staff.
Ship specimens as soon as possible after collection. Use first class postage on U.S. mail. Be sure to place return address on outside of container, regardless of shipping method. When large numbers of specimens, unusual specimens, or potentially hazardous specimens are being submitted, telephone the Microbiology Unit at (919)733-7367 prior to shipping.
Reference cultures may be submitted on any appropriate fungal culture medium slants after growth is visible. Use Microbiology Reference Culture mailer or equivalent for shipping. Please telephone the Microbiology Branch before mailing clinical material or cultures of Histoplasma capsulatum, Blastomyces dermatitidis, or Coccidioides immitis. Known cultures of these organisms must be shipped according to Federal Regulations for Diagnostic or Infectious substances. Be aware: Coccidiodes immitis is considered a Selec Agent and shipment must comply with Federal Regulations.
Reporting Procedure and Interpretation
Yeasts and some other fungi may be identified and reported within three to ten working days, while others may require a longer time. Cultures are held four weeks before being reported as negative. Preliminary reports are sent out on all clinical specimens.
Medically important fungi ordinarily are identified to the species level (e.g., Microsporum gypseum, Trichophyton mentagrophytes). Genus and species designations are those consistent with designations in the Manual of Clinical Microbiology. Most saprophytic fungi are identified to genus level only.
Computer generated final reports are returned to the submitting agency only; therefore, the submitter is responsible for sending copies and/or making reports to any other agency. The submitting agency is responsible for maintaining reports to any other agency. The submitting agency is responsible for maintaining reports in the patient's file. Results are also availabe via the secure website, http://slph.ncpublichealth.com.
See also:
- About Microbiology
- Botulism
- Bordetella Pertussis
- Enteric Bacteriology
- Foodborne Illness
- Cholera
- Legionella
- Mycobacteriology
- Mycology
- Neisseria Gonorrhoeae
- Norovirus
- Parasitology
- Special & Atypical Bacteriology
