Mycology

Clinical Services

We provide telephonic advice to ensure selection of the most appropriate test or specimen types for particular patients and assist with the interpretation of results.  We also provide guidance on the clinical management of individual cases.

Reference Services

Identification

• Moulds
• Yeasts
• Dimorphic fungic

Reference antifungal drug susceptibility testing of yeasts and moulds

These tests are performed on all yeasts and moulds (excluding dermatophytes). Anidulafungin, amphotericin, caspofungin, fluconazole, flucytosine, isavuconazole, itraconazole, micafungin, posaconazole, voriconazole

Historical Examination

Histopathology of specimens and slides along with special fungal stains

Molecular Assays

Pneumocystis jiroveci (PJP/PCP) PCR must be done on respiratory samples. Preferably BAL and induced sputum

Serological Tests

Beta 1-3 Glucan antigen detection for invasive fungal infections.

(NB: this test has a very high negative predictive value)

Cryptococcal antigen test Serum/CSF

Histoplasma urinary antigen

Test Type TAT (hours)

• Aspergillus antigen (galactomannan)  100
• Aspergillus PCR - 48
• Beta 1-3 Glucan 60
• Cryptococcus antigen 24
• Histoplasma antigen testing - 60
• Isavuconazole HPLC - one week
• Itraconazole assay 120
• Mould antifungal susceptibilities 120
• Mould identificationvariable  >15 days
• PJP PCR 24
• Posaconazole assay 120
• Voriconazole assay 120
• Yeast antifungal susceptibilities 72
• Yeast identification  48

How to make the best use of our service?

Please use and complete fully the standard request forms, available on the web site under the heading above.

• Form: Fungal Identification/Susceptibility testing.
• Preferably send slopes of cultures and not plates.

 

Serological tests:

• Please supply 5ml of blood in a yellow top/red top tube.

 

Antifungal assays:

• Please supply 4 ml blood in EDTA tube (purple top) 15 mins prior to next dose.

If the sample cannot reach the lab within 2 hours of collection, please separate the plasma in a microfuge tube and transport on dry ice. Do not use serum separator tubes with a gel plug for azole drug.

Itraconazole Pre-dose after 7 days

Posaconazole Pre-dose after 7 days

Voriconazole Pre-dose after 7 days

ITRACONAZOLE

• The trough level should stay above 0.5 mg/L.
• Less than 0.5mg/L is a low concentration.
• There may be toxicity issues at higher concentrations (>4 mg/L). Liver function tests should be monitored during prolonged courses.

VORICONAZOLE

• The absorption and metabolism of voriconazole will vary from patient to patient. The voriconazole trough concentration should be maintained above 1.0 mg/L. Outcomes for disseminated infections are better when levels are >2.0 mg/L.
• Levels above 6.0 mg/L are more likely to lead to liver toxicity. Levels above 10.0 mg/L should be avoided.

POSACONAZOLE

• The absorption and metabolism of posaconazole will vary from patient to patient. Recommended trough concentrations are: 0.7 mg/L for prophylaxis and >1.0 mg/L for invasive disease.

Training Courses

We organise regular training courses on the identification of pathogenic fungi. Full details are available on request.

External Quality Assurance Schemes In Mycology

We participate in two EQAS schemes. One from the College of American Pathologists and the other from PGI Chandigarh.

Fungal Identification

Kindly download the form, fill and submit it along with the sample. Click here to download form.

Guidelines for sending fungal cultures

• If you are sending multiple isolates, separate form should be filled for each isolate.
• Culture should be sent in the plastic tube containing thick agar slants and a plate containing thick agar base, both properly sealed with parafilm.
• Please send all cultures by speed post or courier and ensure they are well packed to avoid breakage of tubes or plates.
• Each isolate should preferably be sent in duplicates after proper labelling.
• Ensure purity of cultures before sending.

• INDIA INK
• REFERRAL ID FOR MOLDS BY MALDI TOF MS
• REFERRAL ISOLATE ID FOR YEAST BY MALDI TOF
• SENSITITRE MIC FOR FUNGAL SUSCEPTIBILITY (This is for yeasts including Cryptococcus)
• SMEAR FUNGAL
• AFST- BROTH MICRO DILUTION (This is for molds and Trichosporon spp)
• ANTIFUNGAL SUSCEPTIBILITY YEAST (This is done on VITEK, only for the common Candida spp)
• CULTURE FUNGUS
• ID YEASTVITEK
• PJP RT PCR

• ASPERGILLUS GALACTOMANNAN
• BD GLUCAN
• CRYPTOCOCCUS ANTIGEN -CSF
• CRYPTOCOCCUS ANTIGEN - SERUM
• ITRACONAZOLE HPLC
• VORICONAZOLE HPLC
• POSACONAZOLE HPLC

 

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Postal Address:

Dr. Anjali Shetty

P. D. Hinduja National Hospital and MRC, Microbiology Department 9, Takandas Kataria Marg, Mahim West Mumbai- 400016. Maharashtra.

For further information please contact : 022-24447793

Confidentiality:

We will carry out the identification on a strictly confidential basis. Strains sent for identification will normally be destroyed after completion of the task. However strains of interest will be accessed.