Blastomyces (Please notify laboratory if suspected)

Alternative Names/Synonyms	Identification of Blastomyces species (Blastomycosis)
Laboratory	Microbiology
Sub-section	Mycology
Specimen Type	Fungal culture: ○ Blood ○ Tissue/biopsy ○ BAL ○ Any other specimen submitted for routine fungal culture Antigen detection: ○ Plasma, serum ○ BAL, CSF, other body fluids ○ Urine

Other Information

○ Ensure laboratory is notified
○ For Blastomyces serology, see Fungal serology

Specimen Requirements (Tube Type)

Fungal culture:
○ Blood: SPS vacutainer tube
○ BAL or Tissue/biopsy: sterile container

Antigen detection
○ Serum: serum separator tube or red top tube (min volume 5mL)
○ Plasma: EDTA, heparin or sodium citrate tube (5 mL)
○ Urine: sterile container (0,5 mL)
○ BAL/other body fluids: sterile container (0,5mL)
○ CSF: sterile container (0,8 mL)

Collection Requirements

Fungal culture:
Blood
○ Collect 8 mL of blood into a clean, sterile syringe with aseptic technique. Transfer the blood into an SPS tube. Transport to the laboratory immediately for processing.

Tissue/biopsy
○ Collect 5-10 mm3 tissue aseptically using surgical technique/punch biopsy. Place in a clean, sterile container with a small amount of sterile saline.

BAL
○ Pass bronchoscope transnasally or transorally (if patient is not intubated) or via endotracheal tube (if patient is intubated). Instill a large volume of 0.85% sterile saline (nonbacteriostatic) into the airway lumen. Discard the initial fluid recovered (likely contaminated). Collect remaining fluid in a clean, sterile container via suction.

Antigen detection:
Whole blood/serum/plasma:
○ Decontaminate skin with 70% alcohol followed by iodine or chlorhexidine, collect at least 5 mL of blood.

Urine:
○ Collect urine into a clean, sterile container. Transport to the microbiology laboratory ASAP.

CSF by lumbar puncture:
Decontaminate skin, collect at least 1mL of CSF by lumbar puncture into a sterile container; collect more CSF if additional cultures are requested (AFB, fungal, etc.). If more than one tube can be successfully collected, the microbiology laboratory should receive the second or third tubes (whichever is less bloody) to avoid contamination by skin flora or blood.

Sample Stability

Refer to section Sample Processing / Delivery

Referral Laboratory

Culture In-house Quantitative Antigen EIA
MIRAVISTA

Routine Turnaround Time

○ Culture/confirmation: Up to 21 days
○ Antigen detection: Up to 3 days after receipt of specimen

Laboratory Contact Information

416-586-4800 extension 4458

Approval Required

○ YES; laboratory should be notified of any specimen where Blastomyces or other related dimorphic fungal organisms are suspected

Sample Processing / Delivery

○ Label specimen container. Place specimens in biohazard bag and seal..

○ Blood, CSF and skin should be stored at room temperature (20-25˚C) after collection and submitted to the UHN/SH Microbiology Laboratory ASAP. Other specimens should be stored at refrigeration temperature if a delay of more than 2h is expected.

○ The specimen will be referred to the Public Health Ontario Laboratory for testing if there is fungal growth suggestive of Blastomyces species.

○ The specimen will be referred to MiraVista Diagnostics for antigen detection testing.