Test Code LAB7009 Mycology (fungal) culture
Infectious
Methodology
Note:
1. For Cerebrospinal fluid (CSF), order LAB7380. For CSF samples, Cryptococcal Antigen, CSF (LAB927) will also be performed at an additional charge.
2. Refer to Candida (yeast) Culture (LAB925) if looking for yeast only on the following specimen types: cervical, endocervical, lesion, ulcer, penile, urethra, vaginal, oral, throat, skin scraping, esophageal brush, or urine.
3. For hair, nail, and superficial skin specimens, refer to Mycology (fungal) culture, hair, skin, and nails (LAB7007)
Testing Algorithm:
Identification of fungi is based on colonial and microscopic morphology, Matrix Assisted Laser Desorption Ionization – Time of Flight Mass Spectrometry (MALDI-TOF MS), and physiologic or biochemical tests, when applicable. Suspicious isolates resembling dimorphic fungi are sent to the Mayo Clinic for molecular confirmation, when applicable. When requested, fungal isolates difficult to identify are sent to the University of Texas Science Center at San Antonio, San Antonio, Texas 78229-3900 for identification by combined phenotypic characterization and DNA sequencing of the following targets: ITS,D1/D2. Isolates suspected of being Nocardia are sent to the University of Texas Health Center at Tyler for identification by both 16S rRNA and secA1 gene sequencing.
Performing Laboratory
Barnes-Jewish Hospital Laboratory
Specimen Requirements
Acceptable Specimens:
Note: Swabs are not optimal for fungal culture; tissue and fluids in sterile containers are preferred.
Abscess, aspirate, drainage, or wound: ≥1 mL in a leakproof screw-capped, sterile container or 1 ESwab per test request in sterile collection tube.
Tissue or lymph node: ≥1 g in a leakproof screw-capped, sterile container
Bronchial, tracheal: ≥5 mL in a leakproof screw-capped, sterile container
Ocular swab: 1 ESwab Minitip Collection Kit
Ocular fluid (anterior chamber, aqueous humor, vitreous): ≥0.5 mL in a leakproof screw-capped, sterile container or Anerobic Transport media
Sterile Fluids (CSF, pericardial, pleural, synovial, etc.): ≥1 mL in a leakproof screw-capped, sterile container
Sputum: ≥5 mL in a leakproof screw-capped, sterile container
Unacceptable Specimens:
Stool
Specimen collected with ESwab Collection Kit is unacceptable if received without fluid or swab in the transport tube.
Collection Procedure:
Note: Specimen source is required.
Abscess, Aspirate, Drainage, or Wound
1. Disinfect surface of abscess or wound.
2. Aseptically collect purulent material by aspiration (≥1 mL) or by using an ESwab. Frequently, viable organisms are only associated with abscess wall, so adequately sample this area. If material is aspirated, aseptically inject specimen into a leakproof screw-capped, sterile container or a plain, red-top tube.
3. If ESwab is used, return ESwab into transport tube following instructions on kit.
4. Maintain sterility and forward promptly.
5. If transport is delayed, keep specimen at room temperature.
Tissue or Lymph node
1. Aseptically collect ≥1 g of tissue. Because there may be only a few viable organisms, specimen must be large enough to permit their recovery.
2. Place specimen in a leakproof screw-capped, sterile container.
3. Maintain sterility and forward promptly.
4. If transport is delayed, keep specimen at room temperature.
Bronchial or Tracheal
1. Aseptically collect ≥5 mL.
2. Place specimen in a leakproof screw-capped, sterile container.
3. Maintain sterility and forward promptly.
4. If transport is delayed, refrigerate specimen.
Ocular swab
Call Barnes-Jewish Hospital Laboratory Customer Service at 314-362-1470 to obtain ESwab Minitip Collection Kit.
1. Collect specimen before application of topical anesthetics because topical anesthetics possess antimicrobial activity.
2. Cleanse skin around eye with mild antiseptic.
3. Gently remove makeup and ointment with sterile cotton and saline.
4. Collect specimen by passing ESwab 2 times over lower conjunctiva or over cornea. Avoid eyelid border and lashes (culture these separately in a similar fashion, if indicated).
5. Place ESwab in transport tube following instructions on kit.
6. Maintain sterility and forward promptly.
7. If transport is delayed, keep specimen at room temperature.
Ocular fluid (anterior chamber, aqueous humor, vitreous)
1. Aseptically collect ≥0.5 mL of fluid.
2. Place specimen in a leakproof screw-capped or sterile container.
3. Maintain sterility and forward promptly.
4. If transport is delayed, keep specimen at room temperature.
Additional information on ocular specimen collection requirements can be found here.
Fluid (CSF, Joint, Pericardial, Synovial, etc.)
1. Aseptically collect ≥1 mL of fluid.
2. Place specimen in a leakproof screw-capped, sterile container.
3. Maintain sterility and forward promptly.
4. If transport is delayed, keep specimen at room temperature.
Sputum
1. Aseptically collect early-morning specimen in a leakproof screw-capped, sterile container. It is optimal to collect a specimen each day for 3 consecutive days. (Saliva is not acceptable.)
2. Instruct patient to brush his/her teeth and rinse mouth well with water.
3. Have patient remove dentures.
4. Instruct patient to take a deep breath, hold it momentarily, and then cough deeply and vigorously into container. Collect ≥5 mL of discharged material.
5. Maintain sterility and forward promptly.
6. If transport is delayed, refrigerate specimen.
Specimen Transport Temperature
Ambient/Refrigerate OK
Reference Values
No growth of fungi after 28 days
Literature Reference:
Westblade, Lars F. Larone's Medically important fungi - a guide to identification. 7th ed. Washington, DC: American Society for Microbiology; 2023
Day(s) Test Set Up
Monday through Sunday
Turnaround Time:
STAT: not available
Routine: final negative report available after 28 days of incubation
Test Classification and CPT Coding
87102-Culture, fungi other
Additional Information
For BJH Laboratory Use Only
Minimum Volume:
Abscess, aspirate, drainage, or wound: 0.5 mL in a leakproof screw-capped, sterile container or 1 ESwab per test request in a sterile collection tube.
Tissue or lymph node : any amount in a leakproof screw-capped, sterile container
Bronchial, tracheal, or sputum: 0.5 mL in a leakproof screw-capped, sterile container
Ocular swab: 1 ESwab Minitip Collection Kit
Ocular fluid (anterior chamber, aqueous humor, vitreous): any amount in a leakproof screw-capped, sterile container
Sterile Fluids (CSF, pericardial, pleural, synovial, etc.): 0.5 mL in a leakproof screw-capped, sterile container
Laboratory Processing Instructions:
Test performed in BJH Microbiology.