Culture for Nocardia

CERNER / EPIC MNEMONIC: C FUNGUSSM
POE DESCRIPTION: CU FUNGUS W SMEAR (NON-SKIN); C FUNGUSSM (NON-SKIN)
CPT CODE: 87102; 87206
TEST INFORMATION: Test includes a culture for fungi and performance of a direct fungal smear. All fungal isolates will be identified. Other isolated organisms (i.e. aerobes, mycobacteria, etc.) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily, 24 hours
TURNAROUND TIME: Smear results: same day if the specimen is received in the laboratory no later than 1400. Preliminary culture reports are available after 1 week or when a fungal isolate is detected. Cultures will be finalized after 4 weeks.
SPECIAL INSTRUCTIONS: The specific anatomic site of the specimen MUST be specified on the order or the requisition. The order or the requisition MUST be labeled to rule out the presence of Nocardia spp.
CONTAINER TYPE: Copan Swab® II, sterile sputum container, sterile Leuken`s tube, sterile container, no preservative
COLLECTION: The specimen of choice is an aspirate or tissue, NOT a swab. Specimens are to be collected from a site prepared utilizing aseptic technique. Overlying and adjacent areas must be carefully prepared to eliminate surface (normal flora) anaerobes. Ideally, material is obtained by needle aspiration through an intact surface, which has been cleaned with antiseptic, then placed directly into a sealed sterile container. Sampling of open lesions is enhanced by deep aspiration using a sterile plastic catheter. Curetting of the base of an open lesion is optimal. If irrigation is necessary, nonbacteriostatic sterile saline may be used. When a syringe is used to obtain the specimen, ALL air should be expelled after which the specimen should be injected into a sealed, sterile container. Swabs should be used as a last resort due to the small volume of specimen obtainable by this method. If a swab must be used, sample the advancing margin of the lesion and abscess walls firmly. Do NOT sample pus or exudate ONLY. Contamination with normal flora from skin or other body sources MUST be avoided since colonizing bacteria and/or saprophytic fungi not involved in the infectious process may be introduced into the sample. The sputum and Leuken`s specimens should be first morning specimens. Nonbacteriostatic saline should be used when irrigation is necessary
SPECIMEN REQUIREMENTS: Purulent fluid material appropriately obtained from a wound, sputum, bronchial, sterile body fluids
REJECTION CRITERIA: Inappropriate specimen container, insufficient specimen volume.
MINIMUM VOLUME: 0.5 mL
HANDLING INSTRUCTIONS: Specimen should be transported as soon as possible. When transportation is delayed, leave at room temperature.
REFERENCE RANGE: No Nocardia isolated/observed
LIMITATIONS OF TEST: A single negative culture does NOT rule out the presence of nocardial infection. Swabs should be submitted ONLY when aspirated purulent fluid, exudate, or biopsy material cannot be obtained.
METHODOLOGY: Smear: modified acid-fast stain. Culture: Conventional culture utilizing media specifically formulated for fungal isolation.
ADDITIONAL INFORMATION: Specimens from lesions suspected of containing Nocardia species should also be examined for Actinomyces species. A separate specimen should be submitted for Actinomycosis Special Anaerobe Culture. The portion of the surgical specimen submitted to the Clinical Microbiology Laboratory should be aseptically separated from the portion submitted to the Pathology Department.