Dermatophyte mycology I have always found a bit of a mystery, and even as a clinical microbiologist it has never really ignited my passion. All those microconidia and macroconidia are completely lost on me. I am comforted however by the fact that there are people within my laboratory who are excited by this subject and take pride in being good at it.
The thing which intrigues me about this area of microbiology is how long it takes to get a culture result from the skin scrapings and nail clippings….Nothing to do with the lab staff of course, that is just the way it is for this branch of microbiology, which has not changed much in decades.
Two weeks, three weeks and counting, with no real sign of this turnaround time coming down. (Maldi-tof of filamentous fungi may help a little in the future with regards to this.)
Having said this, I have never ever had a complaint from a clinician about the length of time it takes to produce a mycology result from a skin scraping or nail clipping, and this in itself says a few things to me about mycological culture and its clinical implications. In a smallish proportion of cases the culture result does have an impact on diagnosis and subsequent management of the patient, but this cohort of patients is small and generally as a group are not “sick” in the more traditional sense of the word.
As Bacteriology Automation systems begin to become commonplace, dermatophyte mycology is starting to become an increasingly isolated sub-speciality, requiring a different skill set from most of the other samples.
I sometimes wonder if all the skin scrapings and nail clippings in the country (what a thought!) should be packaged up and processed at the one laboratory. To be frank, a day transporting the samples makes little difference when your average turnaround time is three weeks…..
But then again, maybe not. I go back to my first paragraph, “some people are excited by this area”, and all clinical microbiology laboratories need people that are impassioned by their work…..