Mycology Reference Laboratory

The Mycology Laboratory at Statens Serum Institut is the national reference laboratory for mycology. It hosts the EUCAST development laboratory for fungi and plays an important role in the EUCAST antifungal susceptibility testing subcommittee work focused on susceptibility test methods and clinical breakpoint development.

Introduction

The laboratory provides a range of diagnostic tests for the detection of superficial and invasive fungal infections and advices on the diagnostic options and clinical management of patients in Denmark. The laboratory receives approximately 12-13.000 samples per year including both clinical samples and fungal cultures sent for species ID, EUCAST reference susceptibility testing and molecular characterisation. It is responsible for the national surveillance of fungaemia and azole resistance i A. fumigatus (established in 2003 and 2008, respectively) and perform in vitro testing of new antifungal compounds.

Analyses

Routine tests

  • Rapid detection of dermatophyte infection in skin, hair and nails by PCR
  • Microscopy (with fluorescent brightener for increased speed and sensitivity) and culture of yeast, moulds and dermatophytes in clinical specimens
  • Susceptibility testing of yeast, moulds and dermatophytes following the EUCAST reference methods (E.Def 7.3, E.Def 9.3, E.Def 10.0 and E.Def 11.1).
  • Antigen detection tests for Aspergillus, Cryptococcus and Candida, and antibody detection against Candida, Aspergillus, Coccidioides and Histoplasma
  • Aspergillus PCR with species identification and direct detection of the two most common environmental resistance methods TR34/L98H and TR46/Y121F/T289A in A. fumigatus 
  • Therapeutic drug concentration determinations of voriconazole, isavuconazole, itraconazole, posaconazole and flucytosine

Additional analyses

  • Diagnostic PCRs in a panfungal format (ITS and microbiome-PCR for fungi, parasites and bacteria). 
  • Genus and species-specific diagnostic PCRs for Mucorales, Fusarium and Candida.
  • Identification of fungal isolates using classical techniques as well as ITS, TEF, beta-tubulin and calmodulin sequencing and MALDI-TOF
  • Typing of A. fumigatus in outbreak investigations
  • Detection of echinocandin resistance mutations in Candida and Aspergillus
  • Detection of azole resistance mutations in Aspergillus
  • Detection of terbinafine resistance mutations in Trichophyton

Reference laboratory tasks

Nationwide surveillance of fungaemia and azole resistance in A. fumigatus.

Consultancy

The reference laboratory provide advice to doctors and authorities regarding all aspects of the clinical management of fungal infections and regularly hosts academics in training.

Network

In Denmark

The Danish fungaemia network constituted of a representative from every single department of clinical microbiology in Denmark.

The Head of the department is also a professor at the dept of clinical microbiology at Rigshospitalet and dept of clinical medicine at the Copenhagen University thereby contributing to a close collaboration between the three organisations. The laboratory also has a close collaboration with the Institute for Agro-ecology at Århus University. 

Internationally

The laboratory host the EUCAST development laboratory for fungi. The head of the department is currently chairman for the EUCAST AFST steering committee. Other network relations include the Nordic Society for Medical Mycology (NSMM), the European Fungal Infection Study Group (EFISG) and the European confederation for Medical Mycology (ECMM).