2 specimen collection
DESCRIPTION
MYCVIR1TRANSCRIPT
MYCOLOGY
SPECIMEN COLLECTION &
HANDLING
Important considerations:
Proper collection
Rapid delivery to the laboratory
Prompt and correct processing
Inoculation into proper and appropriate medium
Incubation at a suitable temperature
Specimen collection & transport
Transport of Specimen:
Antibiotics may be incorporated in body fluid specimens to prevent proliferation of bacteria:
50, 000 units of Penicillin
100,000 units of Streptomycin
0.2 mg of Chloramphenicol
Specimen collection & transport
Transport of Specimen:
Storage temperature of specimen for fungal culture:
Blood & CSF: 30 – 37 OC
Dermatological: 15 – 30 OC
Others: 4 OC
Specimen collection & transport
SPUTUM first early morning sample
Deep cough specimen; may be induced by:
Aqueous aerosol
Bronchial tap
Volume: 5 – 10 ml
Specimen collection & transport
BLOOD and BONE MARROW
Transport medium: at 1:10 proportion
TSB or TSA (biphasic agar or broth)
BHI transport medium
Thioglycollate broth
Volume: 10 ml
Specimen collection & transport
CEREBROSPINAL:
Transport immediately. Do NOT refrigerate.
For suspected Cryptococcus, Coccidioides infections, containers must be leak proof and lab manipulations should be done under a hood
Specimen collection & transport
DERMATOLOGICAL SPECIMENSSKIN LESIONS
Sterilized area with 70% alcohol or sterile water
Collect at the the active border
Specimen collection & transport
NAILS
Clean with 70% alcoholIf: Dorsal plate:
scrape the deeper portion
Nail plate:
scrape beneath the nail plate
Whole nail or clippings
Specimen collection & transport
HAIR Collect from:
Areas of scaling
Alopecia
Hair that fluoresce under Wood’s lamp
Specimen collection & transport
EXUDATES & PUS
Undrained or unruptured abscess
Aspirate using sterile syringe, recap needle and transport to lab immediately
Failed aspiration, do skin biopsy
Specimen collection & transport
URINE First early morning
Transport and perform test ASAP within 2 hours
If not possible, refrigerate specimen.
Specimen collection & transport
VAGINAL SECRETIONS
Sterile swabs Put in transport medium or
primary isolation broth immediately (ex: TSB)
Specimen collection & transport
TISSUES & Biopsy specimens:
Collect aseptically at the center and edge of the lesion
Place in between sterile gauze wet with sterile NSS or transport medium.
Specimen collection & transport
MYCOLOGY
METHODS OF IDENTIFICATION
A. DIRECT FUNGAL MICROSCOPY
Clinical significance: Provide an immediate presumptive
diagnosis Aid in the selection of appropriate
culture media Aid in decision of what’s best
inoculation technique to use It will provide evidence of infection despite
negative culture
Macroscopic Examination (physical exam): Note for:
caseous material Purulent exudate Necrotic material Granules Punch biopsies Layers of skin that are broken vertically
(fissures) Obtain specimens for microscopy and culture
fro
A. DIRECT FUNGAL MICROSCOPY
Preparation for Microscopic examination: Mince or grind hard specimens Centrifuge for 3-5 minutes fluid specimens Pulvorize nail clippings Volume for fluid specimens: 0.5 ml Assemble a wet chamber for incubation
A. DIRECT FUNGAL MICROSCOPY
REAGENTS used for DIRECT MICROSCOPIC STUDY KOH 10-20%
Routinely used 10% = skin and soft tissues, body fluids 20% = nail and hard tissues
Calcoflour white Green flourescense
India ink “Dark field” microscopy for Cryptococcus
neoformans
A. DIRECT FUNGAL MICROSCOPY
STAINS for MICROSCOPIC STUDIES: Lactophenol Blue
very popular for quick evaluation of fungal structures stains the chitin in cell walls of fungi blue Use for following up fungal culture growths
Wright’s/Giemsa stain (Diff quick) For rapid staining of blood and bone marrow fungi (ex:
Histoplasma capsulatum) Modified Acid-Fast Stain
used to differentiate the acid-fast Nocardia from other aerobic Actinomyces
Gram Stain generally fungi are gram positive Actinomyces and Nocardia are gram variable
A. DIRECT FUNGAL MICROSCOPY
STAINS for MICROSCOPIC STUDIES:Stains for tissue mycoses: Periodic Acid - Schiff Stain (PAS)
stains certain polysaccharide in the cell walls of fungi Fungi stain pink-red with blue nuclei.
Gomori Methenamine Silver Stain silver nitrate outlines fungi in black due to the silver
precipitating on the fungi cell wall. The internal parts of hyphae are deep rose to black, and the background is light green.
Gridley Stain Hyphae and yeast stain dark blue or rose. Tissues stain
deep blue and background is yellow.
A. DIRECT FUNGAL MICROSCOPY
Stains for tissue mycoses … Fluorescent Antibody Stain
simple, sensitive, and extremely specific method of detecting fungi in tissues or fluids. Applications for many different fungal organisms.
Mayer Mucicarmine Stain will stain capsules of Cryptococcus neoformans
deep rose. Papanicolaou Stain
good for initial differentiation of dimorphic fungi Works well on sputum smears also
A. DIRECT FUNGAL MICROSCOPY
KOH Wet Mounts Principle:
KOH softens most tissues, dissolves fat droplets, bleaches many pigments and dissolves the “cement” that holds keratinized cells together; glycerine clears tissue debris, thus making it easier to demonstrate presence of fungal elements.
Reagents: 10 – 20 % KOH:
KOH pellets 10 – 20 grams Glycerine (optional) 10 ml Distilled water 90 ml
KOH Wet Mounts Procedure:
Place a small amount of specimen on a clean glass slide place 1-2 drops of KOH on the specimen and overlay a cover
slip Allow the preparation to stand for 10-30 minutes in a wet
chamber. You can gently heat preparation to hasten the action of
KOH Do not over heat for it may crystallize the KOH
Examine preparation under low then high magnification. Take note for the presence of fungal elements (hyphae and/or spores)
INDIA INK PREPARATION aka: Nigrosin stain Principle:
Specimen placed in a drop of India ink becomes darkly colored because of the carbon particle in the ink. Hyaline structures such as capsules and cell walls will be highlighted against a dark background of inked colored specimen creating an illusion of darkfield microscopy.
Reagent: 1:1 dilution of the ink
India Ink Preparation Procedure:
Place a drop of the specimen (body fluid or from culture) on a clean glass
Put a drop of India Ink, mix and overlay a cover slip Examine under low power and high power with a bright
field microscope Result:
India ink creates a dark background against which hyaline fungal cell wall and capsules can se seen
Limitation: wbc may be confused as fungi
Lactophenol Cotton Blue Principle:
The morphology of fungal elements are preserved and stained better.
Reagents: Lactic acid & Phenol
Kills the organism Glycerin
Prevents easy dehydration Cotton blue
Dye or stain
DIAGNOSIS OF MYCOSES by UNSTAINED & STAINED
MICROSCOPY
A. SKIN or DERMATOMYCOSIS
KOH for superficial involvement, look for:
Spaghetti & meat balls (lung aspirate) Malassezia furfur
Pseudohyphae and yeasts (vaginal secretions) Candida species
A. SKIN or DERMATOMYCOSIS
KOH & LPCB for superficial involvement, look for:
Hyaline septate hyphaeex: Dermatophytes
Dematiaceous septate hyphaeex: Tinea nigra
Alternaria
A. SKIN or DERMATOMYCOSIS
H & E stain for Oral Candidiasis on Skin biopsy of tongue, look for: Pseudohyphae yeasts
B. DRAINING SINUS for MYCETOMAS & ACTINOMYCOSIS
KOH, look for Various colored
granulesActinomycosis/
Nocardiosis
GMS stain, look for Various granules
Mycetoma
C. EYE SCRAPINGS & ASPIRATE for KERATOMYCOSIS
KOH & LPCB, look for Septate hyaline hyphae
Aspergillus species Fusarium species
Coenocytic hyaline hyphae Mucor species
Pseudohyphae and yeasts Candida species
D. NASOPHARYGNEAL ASPIRATES f for RHINOSPORIDIOSIS
KOH, look for
Large sporangium with spores (lacrimal gland aspirate) Rhinosporidium
species
E. HAIR for DERMATOMYCOSES & ALOPECIA
KOH, look for Endothrix spores/hyphae
Trichophyton
Ectothrix spores/hyphae Trichophyton
mentsgrophytes
E. HAIR for PIEDRA
KOH, look for:
Hard, brown, compact nodules (Black piedra) Piedraia hortae
Soft, off-white, concretions/nodules(White piedra) Trichosporon beigeli
F. NAILS for ONYCHOMYCOSIS KOH & LPCB, look for
Septate, hyaline hyphae Dermatophytes
Epidermophyton Trichophyton Microsporon
Pseudohyphae and yeast cells Candida species
G. SYSTEMIC MYCOSESSpecimens: blood, CSF, sputum, other body fluids
KOH & Mucicarmine stain systemic involvement, look for: Pseudohyphae and yeast
cells (CSF) Candida species
Broad based buds(brain and CSF) Blastomyces species
SYSTEMIC MYCOSES
GMS for systemic involvement, look for: Spherules/sporangia
(CSF)Coccidioides immitis
PAS stain for systemic involvement, look for: Dematiaceous septate
hyphae (brain tissue)
SYSTEMIC MYCOSES
H & E stain for systemic involvement, look for:
Endospores (CSF brain tissue) Coccidioides species
Fission/sclerotic bodies Chromomyces species
SYSTEMIC MYCOSES
Wright’s/Giemsa stain (Diff quick) & LPCB for systemic involvement, look for: Small, intracellular budding
yeast (CSF) Histoplasma species
Small, intracellular yeast dividing by fission (CSF) Penicillin species
SYSTEMIC MYCOSES
Mucicarmine stain & India Ink for systemic involvement, look for: Encapsulate yeast
(CSF) Cryptococcus
neoformans
SYSTEMIC MYCOSES
LPCB & Fluorescent Antibody stain for systemic involvement, look for Large yeast with multiple
buds called “mariner’s wheel” Paracoccidioides
braziliensis
SYSTEMIC MYCOSES Calcoflour mounts for
systemic mycoses , look for (flourescence) Pseudohyphae and
yeasts (blood) Candida species
Septate, hyaline at right degrees angle (bronchial lavage) Aspergillus species
Interpretation of Direct Microscopic Findings (Summary)
Observation Diagnostic Possibility
Yeast and pseudohyphae Candidiasis
Fine, hyaline, septate hyphae Dermatomycosis
Clear, hyaline, septate, branching hyphae
Aspergillosis
Clear, hyaline, coenocytic, branching hyphae
Mucor or Phycomycosis
Dematiaceous, septate hyphae
Tinea nigra or Phaeohypomycosis
Spaghetti and meatballs (spores and hyphae)
Tinea versicolor (Malassezia furfur)
Observation Diagnostic Possibility
Large sporangia (>300 microns) and spores
Rhinosporidiosis
Granules: varied shapes, colors, shapes and sizes
Mycetomas; Actinomycosis
Brown fission bodies Chromomycosis
Broad-based yeast cells with thick walls
Blastomycosis
Large, thick-walled yeast with multiple small buds (“mariner’s wheel)
Paracoccidioidomycosis
Spherules and releasing endospores Coccidioidomycosis