Specimen Requirements

1. Skin, nails, hair: Wash the affected site with 70% isopropanol or sterile distilled water and allow to dry. Scrape the peripheral growing margin of typical "ringworm" lesions using a scalpel blade or the side of a glass microscope slide into a sterile Petri plate. If the skin is reddened and not scaly the skin is cleaned with sterile water and swabbed with a Culturette swab. Infected nails should be sampled from beneath the nail plate to obtain softened material from the nail bed. If this is not possible, scrape away the surface of the nail before collecting shavings from the deeper portions. Hairs should be collected from areas of scaling, and any hairs that fluoresce under a Wood's UV lamp should also be sampled. The specimens obtained are placed in sterile wide- mouth specimen cups or sterile envelopes for transport, or may be placed directly onto the culture media. Specimens collected on swabs with transport media are also acceptable.  
    
2. Respiratory secretions: All specimens from the respiratory tract are collected in sterile wide-mouth specimen cups. The patient should thoroughly rinse his/her mouth, including brushing his/her teeth and removing dentures before collecting sputum for fungus. A first morning expectorated sputum specimen is optimal. Sputa induced by respiratory therapy or from a transtracheal aspiration are also acceptable.  Bronchoscopy specimen are also acceptable.  Specimens should be transported to the laboratory as soon as possible to ensure maximal recovery. If culturing is delayed, the specimen may be refrigerated.
    
3. Cerebrospinal fluid: As much CSF as possible (at least 2 ml) should be sent to the laboratory in a tightly sealed tube as soon as possible after collection. If a delay is unavoidable, CSF should not be refrigerated, since it is an excellent culture medium for fungi and they will continue to grow at room temperature, and some systemic fungi may not survive refrigeration.
    
4. Blood: Blood cultures for fungi are collected into the Isolator 10 tube using aseptic collection technique. Specimens are processed as soon as possible. (See Funal Blood culture procedure.)
    
5. Urine: Meticulous technique must be used in preparing to collect a urine specimen for fungal culture, as some yeast are commensal in the lower urinary tract and genitalia. A first morning clean catch midstream specimen is optimal, and urine samples collected for fungal culture are processed as soon as possible after collection. Twenty-four hour urine samples or samples from indwelling catheter bags are unacceptable, because of the potential for overgrowth of saprophytic yeasts and bacteria. If specimens cannot be cultured within an hour after receipt, they may be refrigerated at 4° C for up to 12 hours.
    
6. Tissues, bone marrow, and other sterile body fluids: These specimens are collected by the physician and submitted to the laboratory in sterile tubes, cups or syringes. All specimens are cultured as soon as they are received in the laboratory, as some agents of systemic mycoses may not survive refrigeration. If the amount of the specimen is small, nutrient broth or saline without preservatives may be added to allow more than one medium to be inoculated.
    
7. Ocular specimens: Material from patients with suspected mycotic keratitis is collected by an ophthalmologist by scraping areas of ulceration or suppuration with a Kimera spatula. These scrapings are inoculated by the physician at the bedside onto appropriate media and sent to the lab.
    
8. Miscellaneous specimens: Draining lesions, abscesses or sinus tracts are collected by the physician. They are submitted to the laboratory in sterile culture tubes, wide mouth containers with leak-proof screw cap lids or in syringes. They should be set up promptly, as agents of systemic mycoses may not survive refrigeration.