Lab Dept:

Microbiology/Virology

Test Name:

FUNGAL CULTURE (NON-BLOOD)

General Information

Lab Order Codes:

FUNG

Synonyms:

Culture, Fungus

CPT Codes:

87102 – Culture, fungi isolation, with presumptive identification of isolates; other source, except blood

The following testing may be added if appropriate based on findings for organism identification (multiple additions are possible if more than one organism is identified) and to aid in patient treatment management.

87106 – Culture, fungi definitive identification, each organism; yeast (if appropriate)
87107 – Culture, fungi definitive identification, each organism; mold (if appropriate)
87077 – Aerobic isolate, additional methods required for definitive identification, each isolate (if appropriate)
87184 – Susceptibility studies, disk method, per plate (if appropriate)
87186 – Susceptibility studies, microdilution or agar dilution, each multi-antimicrobial, per plate (if appropriate)

Test Includes:

Culture for yeast and filamentous fungi, identification and antifungal susceptibility testing as required. Physician or nursing unit will be notified of systemic fungal isolates from significant body sites.

Logistics

Lab Testing Sections:

Microbiology

Referred to:

Fairview University Diagnostic Laboratories

Phone Numbers:

Minneapolis:

Saint Paul:

612-813-5866

651-220-6555

Test Availability:

Daily, 24 hours

Turnaround Time:

Preliminary reports are available at 1, 2 and 3 weeks; negative results are reported within 4 weeks.

Special Instructions:

● Specimen site and date/time of collection are required for processing.

● Indicate organism suspected or relevant clinical history on requisition.

● This procedure does not include blood or bone marrow specimens. Refer to separate listings Blood Culture, Fungus and Bone Marrow Culture, Fungus.

Specimen

Specimen Type:

Respiratory sources, tissue, pus, granules, hair, skin, nails, genital sources, corneal scrapings, CSF, or other body fluids. For blood or bone marrow specimens, see separate listings.

Container:

Sterile container or swab transport system

Volume:

Visible material, 1.0 mL of body fluid, 10.0 mL of urine

Collection:

Swabs are not encouraged; however certain body sites, such as the ear canal, nasopharynx, throat and vagina are not readily collected by other means.

Body fluids:

1. Collect aseptically and place in sterile container.

Bronchoscopy:

1. Specimen obtained by physician through the biopsy channel of the bronchoscope.

2. Transfer specimen into a luki tube.

Bronchial brush:

1. Place brush into a sterile container with 1.0 mL of saline.

Corneal scraping:

1. Procedure performed by ophthalmologist.

2. Contact Microbiology for media for direct inoculation.

3. Direct culture inoculation: BHI with 10% sheep blood, Chocolate agar, and SABS.

4. Deliver to lab ≤15 min at room temperature.

Pus, Exudate or Drainage:

1. Using a sterile needle and syringe, aspirate material from undrained abscesses.

2. Place in a sterile container.

Sputum (expectorate):

1. Collect early morning specimen under the direct supervision of a nurse or a physician.

2. Have patient rinse or gargle with water to remove superficial flora.

3. Instruct patient to cough deeply to produce a lower respiratory specimen.

4. Exam specimen to make sure it contains thick mucus. Do not submit saliva.

Sputum (induced):

1. Have patient rinse mouth with water after brushing gums and tongue.

2. With the aid of a nebulizer, have patients inhale ~25 mL of 3 to 10% sterile saline.

3. Collect the induced sputum in a sterile container.

4. Do not submit saliva.

Tissue:

1. Submit in sterile container.

2. For small samples, add a few drops of sterile saline to keep moist.

3. Do not allow tissue to dry out.

4. The portion of the biopsy specimen submitted for culture should be separated from the portion submitted for histopathology by the surgeon or pathologist.

Urine:

1. Submit a catherized specimen.

2. Collect early-morning specimen in a sterile container.

3. 24 hour specimens are unacceptable.

Hair:

1. With forceps, collect at least 10 - 12 affected hairs with the base of the shaft intact.

2. Place in sterile container.

Nails:

1. Remove nail polish.

2. Wipe nail with 70% alcohol using gauze (not cotton).

3. Clip a generous portion of the affected area and collect scrapings of the excess keratin produced under the nail.

4. Place in sterile container.

Skin:

1. Cleanse the affected area with 70% alcohol.

2. Gently scrape the surface of the skin at the active margin of the lesion. Do NOT draw blood.

3. Place scrapings between two clean glass slides.

Transport/Storage:

Transport to the Microbiology Laboratory immediately at room temperature.

Special Processing:

If processing is to be delayed, store specimens as follows:

● CSF: Room temperature (4°C, if Cryptococcal antigen is requested)

● Dermatological specimens: Room temperature

● Tissue: 4°C, do not store more than 8 hours until processing

● Urine: 4°C, may be stored 12 - 14 hours

● All other specimens: 4°C

Process specimens as soon as possible after collection. Viability can be significantly decreased for Histoplasma capsulatum, Coccidiodes immitis, Blastomyces dermatitidis, Rhizopus sp., and Aspergillus fumigatus when stored at RT or 4°C, especially if the specimens harbor relatively few fungal cells.

Sample Rejection:

Specimen with a transit time exceeding 2 hours after collection; specimen not submitted in appropriate transport container; specimen received in fixative; improperly labeled specimen; insufficient volume; external contamination. If an unacceptable specimen is received, the physician or nursing station will be notified and another specimen will be requested before the specimen is discarded.

Interpretive

Reference Range:

No fungus isolated

Critical Values:

Isolation of Cryptococcus neoformans, Coccidiodes immitis, Histoplasma capsulatum, Blastomyces dermatitidis, Sporothrix schenkii, and other fungi in significant body sites and clinical situations. The physician or patient’s nurse will be notified if a systemic fungus is isolated.

Limitations:

A negative culture does not rule out the presence of a fungal infection.

Methodology:

Culture

References:

University of Minnesota Physicians, Outreach Laboratories 2002 – 2003 Guide, p 125

Cook, JH, and M Pezzlo (1992). Specimen receipt and accessioning. Section 1. Aerobic bacteriology, 1.2.1-4. In HD Isenberg (ed) Clinical Microbiology Procedures Handbook. American Society for Microbiology, Washington DC

Miller, J Michael (1999) A Guide To Specimen Management in Clinical Microbiology, American Society for Microbiology, Washington DC

Miller, J Michael, and HT Holmes (1999) Specimen Collection, Transport, and Storage In PR Murray et al, (ed), Manual of Clinical Microbiology, 7^th edition, American Society for Microbiology, Washington DC, pp 33-104

Updates:

3/24/2010: CPT Updates