Fungal culture - Dermal (hair, skin and nail)
Test Mnemonic
ACFSC
CPT Codes
- 87101 - QTY (1)
- 87176 - QTY (1)
- 87118 - QTY (1)
- 87077 - QTY (1)
- 87106 - QTY (1)
- 87107 - QTY (1)
- 87153 - QTY (1)
- 87181 - QTY (1)
- 87184 - QTY (1)
- 87185 - QTY (1)
- 87186 - QTY (1)
- 87186 - QTY (1)
- 87186 - QTY (1)
- 87186 - QTY (1)
LOINC ®
580-1
Aliases
- Dermatophyte Culture
- Fungal Culture Dermal
- Mold Culture
- Yeast Culture
- Ringworm
- Tinea
Includes
- Specimens may include some pre-processing steps to aid in recovery of fungal organisms.
Performing Laboratory
Cleveland Clinic Laboratories
Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| Entire collection | Hair | Sterile container | Ambient | Hair root is essential for the recovery of fungal organisms so plucking or pulling hair with intact hair shaft is ideal. Cutting hair is not recommended. In cases of alopecia (hair loss), hair can be collected from the region by using a soft bristle toothbrush and rubbing in circular motions over the margins or patches. Collected specimens should be sent in a sterile container or dry paper envelope. Ensure that the specimen is secured within the container to prevent loss of specimen. Specimen should be transported dry in ambient temperatures for optimal recovery. | |
| Entire collection | Skin | Sterile container | Ambient | The affected area should be cleaned with 70% alcohol and allowed to dry. Skin should be scraped with a dull edged object or vigorously brushed in a circular motion with a toothbrush. Be careful to not draw blood. Leading edge of the skin lesion is the preferred sample for optimal recovery of fungal organisms. Ensure that the specimen is secured within the container to prevent loss of specimen. Specimen should be transported dry in ambient temperatures for optimal recovery. | |
| Entire collection | Nails | Sterile container | Ambient | Nails should be cleaned with 70% alcohol and then clipped or scraped with a scalpel. Clip generous portion of the affected area and place in sterile container along with any material or debris from under the nail/nailbed. Ensure that the specimen is secured within the container to prevent loss of specimen. Specimen should be transported dry in ambient temperatures for optimal recovery. |
Stability
| Environmental Condition | Description |
|---|---|
| Ambient | 7 days |
| Refrigerated | 7 days |
| Frozen | Unacceptable |
Days Performed
Sun - Sat
Turnaround Time
6 weeks
Methodology
| Name | Description |
|---|---|
| Culture |
Reference Range
| Fungal Culture | |||||
|---|---|---|---|---|---|
| Sex | Age From | Age To | Type | Range | Range Unit |
| No fungal growth |
Special Info
Fungal smears - direct detection of fungi from clinical specimens will NOT be performed. Please order FHSNSM if fungal smears are needed. Clinical specimens for dermal fungal cultures are processed and plated on selective fungal media to optimize recovery of fungal organisms. Cultures are incubated for 28 days; negative results are auto-updated daily. Any fungal organisms recovered will be isolated and identified by various methods. Additional CPT codes may be applicable for recovery and identification of fungal organisms, 87106 - ID by MALDI-TOF Mass Spec for yeast, 87107 - ID by MALDI-TOF Mass Spec for Mold, 87153 - DNA sequencing. Fungal susceptibility testing for yeast and filamentous mold recovered is ONLY performed by request when clinically relevant (CPT 87186). Yeast susceptibility testing is performed in-house by colorimetric microdilution broth. A standardized inoculation of test organism is incubated with appropriate dilutions of antifungal agents; minimum inhibitory concentration (MIC) are determined by inhibition of growth at the lowest antifungal concentration. MIC are determined and interpreted according to CLSI standards. Filamentous mold susceptibility testing is a send-out test and can be requested by contacting the lab.
Clinical Info
Aseptic technique should be utilized to minimize contamination and for optimal recovery of organisms. Specimen should be transported immediately to the microbiology laboratory in dry conditions at ambient temperatures. Refrigeration may impact recovery of dermatophytes. Isolation and identification of fungi from keratinized tissue such as hair, skin and nails are commonly due to dermatophytic fungi. Opportunistic superficial infections caused by other fungal organisms and yeasts resembling dermatophytoses will also be identified and reported. However, normally saprophytic or environmental fungi are often recovered from these sites. Clinical correlation with patient symptoms is necessary to determine significance of recovered organism. If specific fungi are suspected the "rule out" feature in Epic can be utilised. If fungal smears are needed order FCULSM; for fungal blood cultures HISTCL; for CSF order FUNCSF; for dermal samples of hair, skin and nail order ACFSC or FHSNSM (with smear); for candidiasis on vaginal and oral samples order fungal screen FUNGSC. Fungal smear is not included. If desired, order Fungal Culture and Smear - Dermal (hair, skin and nail) (FHSNSM).
Clinical Limitation
Not all fungal organisms recovered in cultures may be significant; clinical correlation needed to determine significance.
Clinical Reference
Westblade et. al. Larone’s Medically Important Fungi, 7th edition, ASM press, Washington DC., 2024. Leber et al., Clinical Microbiology Procedures Handbook, 5th edition, ASM press, Washington, DC. 2023. Carroll, et al. Manual of Clinical Microbiology, 13th Edition, Volume 3, ASM Press, Washington, DC. 2024.