Culture, Fungus Other source

CXFUN

Specimen(s) Highlights:  Collect specimens aseptically, place them in sterile containers, deliver the containers to the laboratory within 2 hours, process the specimens, and then inoculate them to primary isolation media within a few hours of collection. Viability may decrease with prolonged specimen storage.
Swab specimens are not encouraged; however, may be accepted from certain body sites such as the ear canal, nasopharynx, throat, vagina, and cervix.    Swab collections from open wounds or draining lesions are frequently contaminated with environmental microorganisms and are not the specimen of choice. 

Specific collection information by Specimen Type:

1. Sputum (tracheal lavage, bronchial lavage, and aerosol collection)
   1. Sputum should be fresh. Collect in the early morning.
   2. Have patient remove dentures and rinse mouth.
   3. Sputum should be the result of a deep cough (not saliva) or should be induced by an aqueous aerosol.
   4. Collect 5 to 10 ml in sterile container.
2. Respiratory specimens other than sputum
   1. These specimens include tracheal aspirates, lung biopsy material, and bronchoscopy specimens. 
   2. Collect aseptically by physicians.
   3. Immediately send to the laboratory.
3. Blood – Refer to CXFNB:  Culture Fungus Blood
4. Pus, exudate, and drainage
   1. Use a sterile needle and syringe to aspirate material from undrained abscesses. 
   2. Place the material in a sterile container and send to laboratory.
5. Vaginal material
   1. Using several sterile swabs, collect material from the vagina. 
   2. Insert swabs into a sterile tube and send to laboratory.
6. Tissue
   1. Collect tissue aseptically from the center and edge of the lesion.
   2. Place specimen between moist gauze squares and add a small amount of sterile water or 0.85% NaCl to keep tissue from drying out. Place tissue and gauze into sterile container.
   3.  Send immediately to the laboratory. Specimen may be refrigerated up to 8 hours at 4^oC until processed.
7. Bone Marrow
   1. Aspirate approximately 3 to 5 ml of bone marrow and place it in a sterile container.
   2. SPS or heparin can be added as an anticoagulant. 
   3. Send to laboratory immediately.
8. CSF
   1. Collect as much spinal fluid as possible and place it in a sterile CSF container. 
   2. Generally, the number three (3) CSF Collection Tube is used for microbiology.
   3. Send to laboratory.
   4. NOTE:  Perform Cryptococcal Antigen testing if ordered. Remote sites (ie, CCMC) may Perform gram stain on centrifuged sediment before transport to CRMC.
9. Urine
   1. The urine specimen most suitable for making a diagnosis of mycoses of the urinary tract is a catherized specimen. Collect a clean-catch midstream specimen when aspiration or cystoscopy cannot be done.
   2. Collect early-morning specimens aseptically in sterile containers.
   3. Twenty-four-hour urine collections are not accepted. 
   4. Urine specimens may be stored at 4^oC for 12 to 14 hours.
   5. Send to laboratory.
10. Body fluids (pleural, synovial, and peritoneal)
    1. Collect specimens aseptically.
    2. Place fluids into sterile containers.
    3. Send to laboratory.
11. Hair
    1. Select infected areas and with forceps, epilate at least 10 hairs. (Note:  Cleaning of scalp is NOT needed.)
    2. For hairs broken off at the scalp level, use a scalpel or a blade knife to collect.
    3. Place hairs in a sterile dry container for transport, or in a clean envelope labeled with the patient’s information. 
    4. Send to laboratory.
12. Nail
    1. Clean nail with 70% alcohol.
    2. For a specimens from the dorsal plate, scrape the outer surface and discard the scrapings. Then scrape the deeper portion for a specimen.
    3. Remove a portion of debris form under the nail with a scalpel.
    4. Collect the whole nail or nail clippings.
    5. Place all material in a clean envelope labeled with the patient information.
    6. Send to laboratory.
13. Skin and Interspaces  (Refer to CXFNS Fungus, Skin)
    1. Wipe lesions and interspaces between the toes with alcohol sponges or sterile water.
    2. Scrape the entire lesion(s) and both sides of interspaces with a sterile scalpel.
    3. Place scrapings in a sterile dry container or in a clean envelope labeled with the patient information.
    4. Send to laboratory.
14. Eye
    1. Corneal Scrapings:  Obtain Fungal Media from the laboratory.  Have physician collect corneal scrapings and directly inoculate the media.  Label and send to laboratory.
    2. Intraocular Fluid:  Collect intraocular fluid with syringe.
       1. Place fluid into a sterile transport tube.  Note: The collecting syringe may be sent directly to the laboratory if handled correctly (ie, remove needle) and taken immediately to the laboratory.
       2. Fluid may be stored at 25^oC (room temperature) if there is a delay in processing.

If processing is to be delayed for more than 4 hours, store the specimens according to the following guidelines:

• Store/Transport dermatological specimens (hair, nails, skin scrapings) in a dry container at 15-30^o C (Room Temperature).
• Store/Transport blood and CSF at 30-37^oC (Incubator temp)
• Store/Transport all other specimens at 4^o C (Refrigerator temperature).

24x7

Negative
Critical Results:

• CSF Specimens:  Positive Cryptococcal Antigen test, positive India Ink, or gram stain showing organisms.
• Joint Fluids: Fungal elements in joint fluid specimens
• Blood Culture: Fungal elements in blood cultures.

Identification of pathogenic fungi causing infections in various body fluids or wounds.