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Mycology

I would like to use Chromagar Candida from BBL to ID Candida albicans. Larone Davis' book indicates it is a definitive ID using the CAC with no other tests necessary. What do you think? What CPT code would you use?
(answered 03/04/2005)
Should yeast isolated on routine urine cultures be given a quantity or is this not relevant to this group of microorganisms? Is quantitating yeasts in this situation misleading information? Thanks
(answered 02/28/2005)
On 9-24-2004 a question was answered indicating that pneumocystis positive control slides were available from BioRad (Cat# 72731) When I attempted to order these I was told they aren't available in the U.S. We currently use Meridian's Merifluor assay and are also at a loss as to where to go to get positive qc materials.
(answered 01/28/2005)
Should we or should we NOT be reporting growth of Candida albicans in routine sputum cultures? Our laboratory has always reported "yeast" or "Candida albicans" in sputum cultures in addition to a "growth of upper respiratory flora" report. I believe that patients are being overtreated with antifungals based on this practice. All evidence points to Candida albicans not being a significant sputum isolate except in rare instances, and even then not proven to cause disease. Should we stop reporting yeasts isolated from sputum cultures? What if it is NOT a Candida albicans and is in predominance? Thanks in advance.
(answered 01/24/2005)
Where can I find the most recently updated charts for the identification of Candida species?
(answered 11/24/2004)
Some of our microbiologists, who also work at other laboratories, state that yeast that are isolated with significant colony counts in urines need only be identified as C. albicans or "Not C. albicans". Is this an acceptable practice?
(answered 11/17/2004)
What is the best way to process maxillary and ethmoid sinus cultures for fungus? We use a digestant procedure but have not seen an increase in recovery. Thank you
(answered 11/17/2004)
When performing media viability testing on 100ml vials of TSB, is it possible that Aspergillus niger growth could be inhibited by lack of oxygen in the vial?
(answered 11/04/2004)
Is there a set standard for how frequently one must examine fungal cultures?
(answered 10/29/2004)
Is identification of yeast important?
(answered 10/26/2004)
Could you point me to a good procedure or flowchart for the identification of molds and yeast? I have the ASM resources that describe the fungi and the sites of the body where they can be found. What I'm looking for is a procedure that says to do a germ tube, if negative and respiratory source do urea, if positive call it "X", etc. Or for molds, do a lactophenol cotton blue. If no identifiable stuctures, continue ID based on source. If respiratory, set up "X" media and do "X" tests. Rule out following possible pathogens. Does something like that exist?
(answered 10/21/2004)
We are using the Periodic Acid Schiff for fungus cultures (non-dermal). Could you tell me what the correct CPT code would be for this stain?
(answered 10/15/2004)
Is there a Wright-Giemsa Fungal smear procedure in use and/or available for routine, microbiology specimens?
(answered 10/06/2004)
We use Remel's Germ Tube Solution and have been running positive (C. albicans) and negative (Cr. neoformans)controls with each new batch. We can't find CAP requirements for frequency of QC, and Remel's technical folks couldn't help, either. Is batch (or even lot) QC frequent enough?
(answered 10/01/2004)
We have had requests for fungal cultures on stool specimens. Should these be performed or rejected?
(answered 09/24/2004)
For quality control, a positive pneumocystis smear should be done each time the test is performed. However, I cannot find anywhere to purchase positive control smears for fluorescent procedures. I have checked with the kit manufacturer, and they do not have any recommendations. I have spoken with a variety of clinical labs in my area and no one has any sample that they can share. We have been using smears that we made internally from a positive patient, but those are almost gone (three left). Are there any alternatives that can be used in place of a "real" pcp positive control smear? Any other ideas or suggestions would be appreciated. Thank you.
(answered 09/24/2004)
LOOKING FOR A PROCEDURE TO IDENTIFY TRICHOPHYTON SPECIES USING TRICHOPYTON AGARS, ETC
 
WHEN YEAST OR A MOLD IS ISOLATED FROM A BACTERIAL CULTURE AND A DEFINITIVE ID IS PERFORMED, WHAT CPT CODES ARE APPROPRIATE FOR BILLING FOR THESE ORGANISMS? SINCE THESE ISOLATES ORIGINATED FROM A BACTERIAL CULTURE RATHER THAN A FUNGAL CULTURE, ARE 87106 AND 87107 STILL ACCEPTABLE?
(answered 08/10/2004)
We would like some input regarding our yeast identification procedures. We are a rather small lab and must run our microbiology department cost-effectively. We have recently checked NCCLS 2002 Abbreviated Identification of Bacteria and Yeast; Approved Guideline. This source lists the germ tube as >95 specific for C. Albicans, and therefore concludes that C. Albicans need not be reported as presumptive when this test is positive. What we found more interesting is that this NCCLS document also mentions that after confirming microscopically that the colony is yeast, C. Albicans may be reported (not presumptively) based on colony morphology alone. We would like to begin using colony morphology to identify C. Albicans but are a bit reluctant because we have not been able to find information in our textbooks in support of the NCCLS information. We would also like good pictures or better descriptions for “mycelial projections into the agar” (listed as a positive id) versus a “fringed type” colony that may be mistaken for the mycelial projections. The 1998 edition of Bailey and Scott states that a positive germ tube test is a definitive identification, while the 1999 edition of the Manual of Clinical Microbiology says that it is a presumptive id with both false positives and false negatives. Neither source mentions identification based on colony morphology. Any suggestions on how we should proceed would be appreciated.
(answered 07/30/2004)
I am trying to find a source of blood-glucose-cysteine agar as recommended in the ASM manual for mould-to-yeast conversion of Histoplasma capsulatum. I have contacted several culture media distributors, but without success in finding a source for this particular medium.
(answered 07/21/2004)
what are the recommend ed standards for fungus culture stains? should every specimen submitted for fungal studies have a PAS smear?
(answered 07/09/2004)
What is the significance for candida in stool specimen?
(answered 07/08/2004)
At our institution there is a need to differentiate Candida dublinensis from Candida albicans. Is there a relatively rapid way to do this?
(answered 06/23/2004)
Is there any advantage in using EIA based tests for Cryptococcal antigen on CSF and serum versus using Latex based agglutination tests? Which are more sensitive and specific? Thanks
(answered 06/23/2004)
We have a patient who has had CSF cultures positive for C.neoformans and has been treated for it. Now his India Ink preps are still positive, as are the Cryptococcal antigen tests, but the cultures are no growth. The I.D. doc wants to be sure the organism is "dead", and that we are doing everything we can to optimize growth, because the patient is going for surgery. We have the CSF cultured onto SAB, IMA, and Mycosel agars, plus have the blood agar and chocolate agar plates from the routine C&S. The ASM manual says a lipid supplement may enhance growth for some yeasts - would this help Cryptococcus? If so, what specific supplement or media would you use? Also, ASM says that C.neoformans is inhibited by cyclohexamide. Any suggestions of how to be sure we're not missing Cryptococcus growth would be very welcome. (answered 05/28/2004)
I have one lady who came to me at the clinic complaining of vaginal discharge. The discharge was watery and colorless. I collected a high vaginal swab and send it for c/s. I found that she had a heavy growth of saccharomyces cerviciae. Is this a pathogen and should I treat it? How? 
(answered 04/05/2004)
Are data collected for fluconazole resistance? If so, can you direct me to this data?
(answered 04/01/2004)
All candida species comes under which risk group and which biosafety level I should use ? Can I take colony picture under the microscope outside safety hood?
(answered 03/23/2004)
Why Candida develops "Pseudohyphae" in Corn Meal Agar ? Any references ?
(answered 03/22/2004)

The NCCLS guidlines have been published in the M44-P for susceptibility testing of Candida species against Diflucan, but what vendor can the disc be purchased from.
(answered 02/12/2004)
Is it appropriate to use fungal smears on stool such calcafluor white or KOH? My understanding is that a gram stain for WBC's and/or yeast would be appropriate but how about the need for other stains?
(answered 11/12/2003)
What new treatments are there for fungal pneumonia for cancer chemotherapy patients?
(answered 10/22/2003)
Can anyone tell me where I can go to study and learn how to identify Actinomyces, Nocardia and Rapid-growing Mycobacteria? Looking for workshops, etc.
(answered 10/21/2003)
Is there any advantage in identification turnover time if Potato Dextrose Agar with Cyloheximide and Chloramphenicol is used verses Mycosel for suspected dermatophyte infections? Along this line, is there any significant difference in performance between PDA and Potato Flakes agar? 
(answered 10/21/2003)
Can anyone tell me where I can go to study and learn how to identify Actinomyces, Nocardia and Rapid-growing Mycobacteria? Looking for workshops, etc.
(answered 10/21/2003)
Does anyone know if the antifungal Voriconazole is FDA approved? Are there any interpretive guidelines?If it is on a panel for testing how should one report results?
(answered 10/20/2003)
I need your assistance in interpreting the following, "All other isolated organisms are probably laboratory contaminants unless KOH or microscopy indicates they have the atypical frondlike hyphae associated with non-dermatophyte molds..." (found in the CMR Vol.11 No.3 1998 p.421 by Elewski). What book or website can one find this frondlike hyphae illustrated, and to what genus does this morphology correspond to? 
(answered 10/17/2003)
Can you recommend reliable sources for purchase of teaching slides stained with either lacto-phenol aniline blue or fuchsin? 
(answered 07/18/2003)
I know CAP now requires us to report Blastocystis hominis when seen in surveys. Should it ALWAYS be reported when seen in patients regardless of how many you see
(answered 05/28/2003)
What is the average growth rate for Blastomyces dermatitidis mold form?
(answered 05/28/2003)
I have read that very rarely does yeast cause lower respiratory tract infection, it should only be reported when it is tissue invasive which is better seen in pathology preps. When is it appropriate to report yeast in sputum culture
(answered 05/28/2003)
Sorry - I clicked too soon. My question is, to what extent is it necessary to speciate clinically significant yeast? I am considering eliminating the current protocol (full speciation, when the organism is significant), to just using the germ tube to screen for C. albicans (reporting as presumptive, since we don't plan to rule out C. dubliniensis); and the urea agar to screen for Crypto, which we would then refer for speciation. We have previously used the Vitek YBC card, but have not been too pleased with the Vitek 2 ID-YST; We are a 150 bed hospital lab with a sizable population of ESRD patients. 
(answered 05/09/2003)
We get requests for fungal cultures from the eye. The physician submits a slide and ask for Giemsa stain. What is the appropriate way to handle a fungal culture from the eye. And what are general guidelines on eye cultures?
(answered 04/17/2003)
We have routinely performed KOH preps on bronchial washings and sputum ordered for fungal culture. This involves centrifugation of the specimen. Is this still a recommended procedure, especially now that we (particularly in Canada) are faced with the challenge of SARS?
(answered 04/10/2003)
Oidiodendron has been recovered in several clinical isolates. Is this significant or a likely contaminant?
(answered 04/02/2003)
What are the safety guidelines for reading Mycology cultures? Can mycology cultures be read in the open laboratory if they are sealed? or should they be read under the hood, expecially if they are respiratory in orgin?
(answered 03/18/2003)
How can we identify the species level of Nocardia.
(answered 02/21/2003)
We would like to start performing serological testing for Coccidiodes immitus. What are the recommended methodologies and their sensitiviteis and specificities for the detection of IgM and IgG antibody? It is necessary to perform IgG antibody testing when you do not have paired sera available?
(answered 08/24/2002)
How long should mold be decontaminated in and autoclave? Could bleach be used as a substitute?
(answered 07/15/2002)

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