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for Microbiology Improving the stability of microbiology Improving the stability of microbiology EQA specimens: Fungal spore suspensions 12 th October 2010 EQALM Microbiology Working Group Overview Overview Part 1 - Mycology Fungi /


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for Microbiology

Improving the stability of microbiology Improving the stability of microbiology EQA specimens: Fungal spore suspensions

12th October 2010 EQALM Microbiology Working Group

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Overview Overview

Part 1 - Mycology

Fungi / specimens distributed

New specimen format development

New specimen format development Results from pilot distribution Experience to date Experience to date

Part 2 - Bacteriology gy

EQA specimen design Stability results – lyophilised bacteriology specimens Open discussion

12th October 2010 EQALM Microbiology Working Group

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UK NEQAS Mycology Schemes UK NEQAS Mycology Schemes

Mycology Identification

Identification of filamentous fungi and yeasts, Identification of filamentous fungi and yeasts, including dermatophytes and fungi associated with infection in the immuno-compromised i di ib d 3 i 4 specimens distributed 3 times per year

Antifungal susceptibility

Id tifi ti d t f tif l Identification and assessment of antifungal susceptibility testing including: Amphotericin B, Fluconazole, Flucytosine, Itraconazole, , y , , Voriconazole and Caspofungin 2 specimens distributed 3 times per year

12th October 2010 EQALM Microbiology Working Group

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Filamentous fungi distributed g

12th October 2010 EQALM Microbiology Working Group

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Participant performance (% correct) – p p ( ) mycology EQA non-dermatophyte fungi

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Participant performance (% correct) p p ( ) mycology EQA dermatophyte fungi

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Participant performance (% correct) p p ( ) mycology EQA antifungal susceptibility

Organism Amphotericin B Fluconazole Flucytosine Itraconazole Voriconazole

  • C. parapsilosis

91 93 94 74 87

  • C. parapsilosis

91 93 94 74 87

  • C. tropicalis

90 93 96 30 91 C krusei 90 61 23 44 100

  • C. krusei

90 61 23 44 100

  • R. mucilaginosa

95 100 97 91 22 C neoformans 100 86 44 89 100

  • C. neoformans

100 86 44 89 100

  • C. albicans

93 98 98 98 96 Overall (%) concordance by agent

93 89 75 71 83

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Participant performance – mycology p p y gy EQA antifungal susceptibility

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Developing new specimens Developing new specimens

M gypseum

  • M. gypseum
  • A. versicolor

12th October 2010 EQALM Microbiology Working Group

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Review of specimen options Review of specimen options

Lyophilisation Under mineral oil Drying on silica gel

Soil sto age

Soil storage Spore suspensions in water Spore suspensions in water

12th October 2010 EQALM Microbiology Working Group

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Evaluation of the viability of pathogenic filamentous fungi after prolonged storage in sterile water & review of recent published studies p g g p

  • n storage methods

Borman et al. Mycopathologia (16) June 2006

  • Evaluation of the survival and potential morphological alterations of

45 species of pathogenic filamentous fungi that had been stored in sterile water following Castellani's method in the National Collection f P th i F i (NCPF) UK

  • f Pathogenic Fungi (NCPF), UK
  • Storage duration varied from 2 months to over 21 years

Ni t t f t d i h t b i bl

  • Ninety percent of stored organisms were shown to be viable
  • Viability was largely independent of the duration of storage, but did

apparently vary to some degree in an organism-specific manner

  • This was especially marked for several isolates of dermatophytes,

where storage resulted in loss of recognisable colonial features, and

  • verproduction of sterile mycelium with aberrant or no conidia
  • These findings suggest that while Castellani's method remains an

easy and inexpensive method for long-term preservation of most fungi, water storage should be supplemented by a second storage th d t i th h f t i i b th i bilit d method to increase the chances of retaining both viability and morphological stability over long periods

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Pilot - Dermatophytes selected p y

Trichophyton rubrum Trichophyton tonsurans

12th October 2010 EQALM Microbiology Working Group

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Pilot Dermatophytes selected Pilot - Dermatophytes selected

Trichopyton interdigitale

Epidermophyton floccosum

12th October 2010 EQALM Microbiology Working Group

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Preparation of spore suspensions Preparation of spore suspensions

Fl d i l l th

  • Flood a single colony on the

SABM plate with 5mL distilled water

  • Scrape the surface of the colony
  • Scrape the surface of the colony

to release the spores

  • Take up the water from the plate,

now containing the released spores and transfer to a 5mL spores and transfer to a 5mL bijou

  • Vortex the spore suspension for
  • ne minute to break any
  • e

ute to b ea a y mycelium fragments

  • Inoculate 100µL of the

suspension onto five SABM plates Spread the inoculum

  • plates. Spread the inoculum

around the surface of the agar plate using a plastic spreader

  • Incubate the SABM plates for 14

12th October 2010 EQALM Microbiology Working Group

p days.

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Bulk preparation Bulk preparation

  • After incubation confirm the purity of the
  • rganism

g

  • Perform a spore count using a counting

chamber The numbers of spores/ mycelial chamber The numbers of spores/ mycelial fragments found should concur by species with the guidelines provided by the with the guidelines provided by the Mycology Reference Laboratory on spore forming filamentous fungi

  • Prepare a bulk specimen

12th October 2010 EQALM Microbiology Working Group

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Spore production characteristics of p p some common fungi

12th October 2010 EQALM Microbiology Working Group

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12th October 2010 EQALM Microbiology Working Group

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Pilot specimens results Pilot specimens - results

Trichophyton rubrum, T. interdigitale T. tonsurans, Microsporum canis, M audounii to su a s, c ospo u ca s, audou

Every vial in the pilot batch (n= 400)

produced viable fungal colonies p g demonstrating typical morphology Epidermophyton floccosum

First batch 50% failed to grow; second First batch 50% failed to grow; second

batch revealed 100% viability with typical morphology

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Acknowledgements Acknowledgements

Staff and participants of UK NEQAS for Special thanks to: Students Q Microbiology Students Anita Marwaha Kalana Patabendige Nita Patel Malti nakrani A D h G h Kalana Patabendige Dr Elizabeth Johnson & staff Ana Deheer Graham Mousoumi Daschowdhury Mycology Reference Laboratory Daschowdhury Martha Valencia Bristol

12th October 2010 EQALM Microbiology Working Group

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Bacteriology specimens – gy p homogenity and stability

EQALM Microbiology Working Group Discussion Discussion

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What are the design criteria for EQA g schemes?

Clinically relevant

Homogeneous specimens

Homogeneous specimens No matrix effect Stable specimens Adequately characterised Adequately characterised Measurement and assessment of

performance is possible performance is possible

12th October 2010 EQALM Microbiology Working Group

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6 4 5 6 2 3 1 … Plate 1 Plate 2 coccus aureus scherichia coli scherichia coli a pneumoniae coccus aureus as aeruginosa haemolyticus

  • ccus faecalis

as aeruginosa scherichia coli coccus aureus coccus aureus scherichia coli scherichia coli a pneumoniae coccus aureus coccus aureus a marcescens scherichia coli as aeruginosa scherichia coli cter baumanii (serotype 10) as maltophilia a marcescens

  • ccus group B

lla catarrhalis gonorrhoeae tella pertussis Negative ella enteritidis coccus aureus

  • cholerae O1

s pneumoniae ergillus flavus us & Group A… llus paracasei Plate 3 Plate 4 Plate 5 Staphyloc Es Es Klebsiella Staphyloc Pseudomona aphylococcus Enteroco Pseudomona Es Staphyloc Staphyloc Es Es Klebsiella Staphyloc Staphyloc Serratia Es Pseudomona Es Acinetobac higella boydii ( notrophomona Serratia lytic streptoco Moraxel Neisseria Bordet eri & Salmone Staphyloc Vibrio Streptococcus Aspe lococcus aure Lactobacil Sta Sh Sten Beta-haemol Shigella flexne S Staphy

12th October 2010 EQALM Microbiology Working Group

S

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6 5 3 4 1 2 plate 1 plate 2 plate 3 plate 4 plate 5

12th October 2010 EQALM Microbiology Working Group