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 comprehensive range of diagnostic services for the detection of superficial and invasive fungal infections and offer expert advice on diagnostic strategies and the clinical management of patients with fungal diseases in Denmark. The laboratory receives approximately 11.000 samples annually, including both clinical samples and fungal isolates submitted for species identification, EUCAST reference antifungal susceptibility testing and molecular characterisation.
It is responsible for the national surveillance programmes of fungaemia, azole resistant A. fumigatus and C. auris (established in 2003, 2008 and 2024, respectively) and also 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 7.4, E.Def 9.4, and E.Def 11.0).
  • Antigen detection tests for Aspergillus, Cryptococcus and Candida, and antibody detection against 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
  • Candida PCR for the detection of the following species: Candida albicans, C. dubliniensis, C. glabrata, C. krusei, C. parapsilosis (including the cryptic species C. orthopsilosis and C. metapsilosis), and C. tropicalis. In addition, PCR for C. auris is available upon specific request.
  • Mucorales and Fusarium PCRs. Detects the most common human pathogenic species including: Rhizopus microspores, Rhizopus arrhizus, Mucor spp., Lichtheimia spp. and Rhizomucor spp., and Fusarium solani, Fusarium dimerum and Fusarium oxysporum/ fujikuroi species complexes, respectively.
  • Therapeutic drug concentration determinations of fluconazole, voriconazole, isavuconazole, itraconazole, posaconazole and flucytosine
     

Additional specialised analyses

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

Reference laboratory tasks

Nationwide surveillance of fungaemia, azole resistance in A. fumigatus and of C. auris.

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 laboratory coordinates the Danish Fungaemia Network and the Danish Aspergillus Network, each comprising a representative from every Department of Clinical Microbiology in Denmark.

The Head of the department also holds a professorship at the dept of clinical microbiology at Rigshospitalet and Dept of Clinical Medicine at the Copenhagen University fostering close collaboration between the three institutions. In addition, the laboratory has established close collaborations with DTU Bioengineering, Technical University of Denmark and with the Department of the Built Environment, Aalborg University.
 

Internationally

The laboratory hosts the EUCAST Antifungal Susceptibility Testing Development Laboratory For Fungi (AFST EDL). The head of the laboratory is currently the immediate Past Chair for the EUCAST steering committee for Antifungal Susceptibility testing (AFST).

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).