KOH Wet Mount Preparation: Introduction, Principle, Test Requirements, Procedure, Result Interpretation, Uses, Keynotes, and Collection of KOH Mount Footages

Potassium hydroxide (KOH) Wet Mount Introduction

Table of Contents

The KOH Wet Mount is a very simple and important technique in mycology for presumptive diagnosis of the type of fungal infections whether ringworm, aspergillosis, dermatomycosis, blastomycosis, mucormycosis, otomycosis, etc. It is the most common assay ordered by clinicians, particularly by dermatologists. It is also helpful in the selection of appropriate culture media for the isolation of etiological fungal agents. Here you can see in the image fungal elements (hyphae-septate/aseptate, yeast cells, budding, and pseudohyphae) from a variety of clinical specimens like skin scraping, aural discharge, blood sputum, and urine.

KOH Wet Mount Preparation: Introduction, Principle, Test Requirements, Procedure, Result Interpretation, Uses, Keynotes, and Collection of KOH Mount Footages
Fig. A variety of clinical samples KOH Wet Mount Preparation footage

Principle of KOH Wet Mount Preparation

As you know, potassium hydroxide (KOH) is a strong alkali. When clinical samples such as pus, skin, hair, nails, or sputum mix, it softens, digests, and clears the tissues i.e. keratin present in the skin surrounding the fungi so that the fungal elements (yeast, a cell with pseudohyphae, budding, hyphae-septate/aseptate, granules, conidia, etc.) of fungi can be observed under a microscope.

Sputum KOH Mount Microscopy
Fig. Sputum KOH Mount Microscopy

Requirements for KOH Wet Mount Preparation

1.  Equipment

  • Compound Microscope

2. Reagent and laboratory wares

  • Glass Petri dishes
  • clean and grease-free glass slide
  • Cove slip
  • Straight wire or bent wire
  • Needle
  • Bunsen burner
  • Potassium hydroxide (Generally 20% KOH but depending on the nature specimen its concentration can be decreased or increased)
  • Tissue paper roll

3. Clinical Specimen/sample-It may vary according to the site of infections such as pus from draining sinus, aspirate from nasal sinuses, respiratory specimen, skin scrapings, nail clipping, hair, corneal scraping, material from ear discharge, etc.

Procedure of KOH Wet Mount Preparation

  1.  Emulsify the specimen in a drop of 20% KOH on a glass slide applying inoculating loop. To assist in clearing, hairs should not be more than 5 mm long, and skin scales, crusts, and nail snips should not be more than 2 mm across.
  2. Use gentle heat by passing the slide over a Bunsen burner 3-4 times in case of 10% KOH or hard specimens like nail clipping or hair. (Note: This step can exclude by using a high concentration of KOH or KOH with Dimethylsulfoxide(DMSO) or treating the specimen with KOH for a longer duration.)
  3. Cover the smear with the coverslip and leave for 5-10 minutes. (generally, but when using nail clipping or hair, there is a need for a longer duration.)
  4. As soon as the specimen has cleared, examine the preparation microscopically focusing the 10X and finally observation using 40X objectives with the condenser iris diaphragm closed sufficiently to give a good contrast. If you are using too intense a light source the contrast will not be adequate and the unstained fungi will not be seen. Examine the preparation carefully for the demonstration of shining fungal elements as shown above image.

Quality control (QC)

Quality control can maintain using the following points-

  •  The right concentration of  20% KOH should be prepared.
  • Emulsification of the specimen should be homogenous in potassium hydroxide (KOH) preparation.

Observation of KOH Mount Footage

Observe fungal elements in microscopy of the clinical samples.

Result and Interpretation of KOH Wet Mount 

If there is the presence of any fungal elements either yeast cells, cells with pseudohyphae, budding, septate hyphae, aseptate hyphae, branching hyphae, conidia, or granules, etc. during the examination, KOH mount is positive i.e. fungal elements seen.

No fungal elements were seen during in microscopy of the clinical specimen, and KOH preparation is negative.

Interpretation of results should do by critical analysis of the type, size, and color of the fungal elements that will be different for different fungi. A fungal culture is necessary for the isolation of etiological fungal agents while conformation biochemical tests and molecular tests are needed.

Uses of KOH Wet Mount Preparation

The applications of KOH wet mount preparation are as follows-

  1. KOH Mount is used for the rapid detection of fungal elements in clinical specimens, as it clears the specimen making fungal elements more visible during direct microscopic examination.
  2. It is very useful for the presumptive diagnosis of type-fungal infections.
  3. The recommendation of KOH wet mount preparation is very useful in the following suspected clinical conditions as shown in this table.
Suspected ConditionsEtiological AgentsSpecimensDiagnostic Characteristics
MucormycosisMucor speciesSamples from infected tissue or lesionAseptate hyphae
AspergillosisAspergillus flavus, A. fumigatus,
A.niger
, etc
According to the site of infection e.g.
respiratory system-sputum while
in ear-aural discharge
Septate hyphae with V-shaped/acute-angle/dichotomous branching
BlastomycosisBlastomyces dermatitidis
(Dimorphic fungus)
Sputum, pus, or skinLarge budding yeast cells have a distinct broad base and due to being a dimorphic fungus, it may be with yeast cells in tissue
RingwormDermatophytes (Trichophyton,
Microsporum, Epidermophyton
)
Skin, hair, and nailSeptate hyphae or spores (microconidia or macroconidia) depending on the nature of the etiological agent involved

Keynotes on KOH  Mount 

  1.  Potassium hydroxide(KOH) reagent is highly corrosive therefore handle it with great care.
  2. Experience is necessary for reporting because background artifacts are often confusing.
  3. Clearing off some specimens such as nail clipping, and hair may require an extended time.

Collection of KOH Mount Footages

KOH preparation of a skin scale, showing ringworm-causing fungus structures

KOH preparation of a skin scale, showing ringworm causing fungus structures
Fig. KOH preparation of a skin scale, showing ringworm-causing fungus structures

Nail Dermatophytes in Nail Clipping KOH mount and Growth on SDA

Nail Dermatophytes in Nail Clipping KOH mount and Growth on SDA
Fig. Nail Dermatophytes in Nail Clipping KOH mount and Growth on SDA

KOH Mount of Sputum Showing Fungal Elements-Hyphae and yeast cells

KOH Mount of Sputum Showing Fungal Elements-Hyphae and yeast cells
Fig. KOH Mount of Sputum Showing Fungal Elements-Hyphae and yeast cells

Fungal pseudohyphae, yeast cells, and budding in KOH mount of Sputum Microscopy

Fungal pseudohyphae, yeast cells and budding in KOH mount of Sputum Microscopy
Fig. Fungal pseudohyphae, yeast cells, and budding in KOH mount of Sputum Microscopy

KOH mount of aural discharge showing fungal elements-Septate hyphae with V-shaped or acute-angle or dichotomous branching

KOH mount of aural discharge showing fungal elements-Septate hyphae with V-shaped or acute-angle or dichotomous branching
Fig. KOH mount of aural discharge showing fungal elements-Septate hyphae with V-shaped or acute-angle or dichotomous branching

Fungal hyphae in KOH mount of Ear discharge of CSOM Patient showing septate hyphae with dichotomous branching-Tentative organism-Aspergillus

Fungal hyphae in KOH mount of Ear discharge of CSOM Patient showing septate hyphae with dichotomous branching-Tentative organism-Aspergillus
Fig. Fungal hyphae in KOH mount of Ear discharge of CSOM Patient showing septate hyphae with dichotomous branching-Tentative organism-Aspergillus

Nail Dermatophytes in Nail Clipping KOH mount showing thin-walled macroconidia in the cluster and lacking microconidia

Nail Dermatophytes in Nail Clipping KOH mount showing thin-walled macroconidia in the cluster and lacking microconidia
Fig. Nail Dermatophytes in Nail Clipping KOH mount showing thin-walled macroconidia in the cluster and lacking microconidia

Skin scrapping in KOH mount showing yeast cells and an elongated cigar-shaped morphology

Skin scrapping in KOH mount showing yeast cells and an elongated cigar-shaped morphology
Fig. Skin scrapping in KOH mount showing yeast cells and an elongated cigar-shaped morphology

KOH mount of ear discharge showing fungal elements-Septate hyphae with V-shaped or acute-angle or dichotomous branching

KOH mount of ear discharge showing fungal elements-Septate hyphae with V-shaped or acute-angle or dichotomous branching
Fig. KOH mount of ear discharge showing fungal elements-Septate hyphae with V-shaped or acute-angle or dichotomous branching

Aspergillus fumigatus fungal elements in KOH mount of aural discharge microscopic footage

Aspergillus fumigatus fungal elements in KOH mount of aural discharge microscopic footage
Fig. Aspergillus fumigatus fungal elements in KOH mount of aural discharge microscopic footage

Fungal hyphae and conidia in KOH mount of ear discharge

Fungal hyphae and conidia in KOH mount of ear discharge
Fig. Fungal hyphae and conidia in KOH mount of ear discharge

Ochroconis gallopava in 0.05% Tween 80 wet mount of culture microscopy exhibiting conidia, conidiophores, hyphae, and hyphae are brown with relatively thick walls

Ochroconis gallopava in 0.05% Tween 80 wet mount of culture microscopy exhibiting conidia, conidiophores, hyphae, and hyphae are brown with relatively thick walls.
Fig. Ochroconis gallopava in 0.05% Tween 80 wet mount of culture microscopy exhibiting conidia, conidiophores, hyphae, and hyphae are brown with relatively thick walls

Urine under the Microscope showing hyphae indicates Fungal UTI

Urine under the Microscope showing hyphae indicates Fungal UTI
Fig. Urine under the Microscope showing hyphae indicates Fungal UTI

Fungal Hyphae in Urine Microscopy

Fungal Hyphae in Urine Microscopy
Fig. Fungal Hyphae in Urine Microscopy

Heavy load of fungal elements in KOH mount of Sputum sample

Heavy load of fungal elements in KOH mount of Sputum sample
Fig. Heavy load of fungal elements in KOH mount of Sputum sample

KOH mount of sputum under the Microscope showing fungal elements- yeast cells and fungal hyphae

KOH mount of sputum under the Microscope showing fungal elements- yeast cells and fungal hyphae
Fig. KOH mount of sputum under the Microscope showing fungal elements- yeast cells and fungal hyphae

Further Readings

  1. Medical Mycology. Editors:  Emmons and Binford, 2nd ed 1970, Publisher Lea and Febiger, Philadelphia.
  2. Rippon’s JW: Medical Microbiology. The pathogenic fungi and the Pathogenic Actinomycetes. 3rd ed 1988 Publisher WB Saunder co, Philadelphia.
  3. Clinical Microbiology Procedure Handbook, Chief in editor H.D. Isenberg, Albert Einstein College of Medicine, New York, Publisher ASM (American Society for Microbiology), Washington DC.
  4. A Textbook of Medical Mycology. Editor: Jagdish Chander.  Publication Mehata, India.
  5.  Practical Laboratory Mycology. Editors: Koneman E.W. and G.D. Roberts, 3rd ed 1985, Publisher Williams and Wilkins, Baltimore.

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    其次,人工智能(AI)在娛樂城中的應用也達到了新高度。AI技術不僅用於增強遊戲的公平性和透明度,還在個性化玩家體驗方面發揮著重要作用。從個性化遊戲推薦到智能客服,AI的應用使得娛樂城更能滿足玩家的個別需求。

    此外,線上娛樂城的安全性和隱私保護也獲得了顯著加強。隨著技術的進步,更加先進的加密技術和安全措施被用來保護玩家的資料和交易,從而確保一個安全可靠的遊戲環境。

    2024年的娛樂城還強調負責任的賭博。許多平台採用了各種工具和資源來幫助玩家控制他們的賭博行為,如設置賭注限制、自我排除措施等,體現了對可持續賭博的承諾。

    總之,2024年的娛樂城呈現出一個高度融合了技術、安全和負責任賭博的行業新面貌,為玩家提供了前所未有的娛樂體驗。隨著這些趨勢的持續發展,我們可以預見,娛樂城將不斷地創新和進步,為玩家帶來更多精彩和安全的娛樂選擇。

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  34. Деревянные дома под ключ
    Дома АВС – Ваш уютный уголок

    Мы строим не просто дома, мы создаем пространство, где каждый уголок будет наполнен комфортом и радостью жизни. Наш приоритет – не просто предоставить место для проживания, а создать настоящий дом, где вы будете чувствовать себя счастливыми и уютно.

    В нашем информационном разделе “ПРОЕКТЫ” вы всегда найдете вдохновение и новые идеи для строительства вашего будущего дома. Мы постоянно работаем над тем, чтобы предложить вам самые инновационные и стильные проекты.

    Мы убеждены, что основа хорошего дома – это его дизайн. Поэтому мы предоставляем услуги опытных дизайнеров-архитекторов, которые помогут вам воплотить все ваши идеи в жизнь. Наши архитекторы и персональные консультанты всегда готовы поделиться своим опытом и предложить функциональные и комфортные решения для вашего будущего дома.

    Мы стремимся сделать весь процесс строительства максимально комфортным для вас. Наша команда предоставляет детализированные сметы, разрабатывает четкие этапы строительства и осуществляет контроль качества на каждом этапе.

    Для тех, кто ценит экологичность и близость к природе, мы предлагаем деревянные дома премиум-класса. Используя клееный брус и оцилиндрованное бревно, мы создаем уникальные и здоровые условия для вашего проживания.

    Тем, кто предпочитает надежность и многообразие форм, мы предлагаем дома из камня, блоков и кирпичной кладки.

    Для практичных и ценящих свое время людей у нас есть быстровозводимые каркасные дома и эконом-класса. Эти решения обеспечат вас комфортным проживанием в кратчайшие сроки.

    С Домами АВС создайте свой уютный уголок, где каждый момент жизни будет наполнен радостью и удовлетворением

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  35. Дома АВС – Ваш уютный уголок

    Мы строим не просто дома, мы создаем пространство, где каждый уголок будет наполнен комфортом и радостью жизни. Наш приоритет – не просто предоставить место для проживания, а создать настоящий дом, где вы будете чувствовать себя счастливыми и уютно.

    В нашем информационном разделе “ПРОЕКТЫ” вы всегда найдете вдохновение и новые идеи для строительства вашего будущего дома. Мы постоянно работаем над тем, чтобы предложить вам самые инновационные и стильные проекты.

    Мы убеждены, что основа хорошего дома – это его дизайн. Поэтому мы предоставляем услуги опытных дизайнеров-архитекторов, которые помогут вам воплотить все ваши идеи в жизнь. Наши архитекторы и персональные консультанты всегда готовы поделиться своим опытом и предложить функциональные и комфортные решения для вашего будущего дома.

    Мы стремимся сделать весь процесс строительства максимально комфортным для вас. Наша команда предоставляет детализированные сметы, разрабатывает четкие этапы строительства и осуществляет контроль качества на каждом этапе.

    Для тех, кто ценит экологичность и близость к природе, мы предлагаем деревянные дома премиум-класса. Используя клееный брус и оцилиндрованное бревно, мы создаем уникальные и здоровые условия для вашего проживания.

    Тем, кто предпочитает надежность и многообразие форм, мы предлагаем дома из камня, блоков и кирпичной кладки.

    Для практичных и ценящих свое время людей у нас есть быстровозводимые каркасные дома и эконом-класса. Эти решения обеспечат вас комфортным проживанием в кратчайшие сроки.

    С Домами АВС создайте свой уютный уголок, где каждый момент жизни будет наполнен радостью и удовлетворением

    Reply
  36. Understanding the processes and protocols within a Professional Tenure Committee (PTC) is crucial for faculty members. This Frequently Asked Questions (FAQ) guide aims to address common queries related to PTC procedures, voting, and membership.

    1. Why should members of the PTC fill out vote justification forms explaining their votes?
    Vote justification forms provide transparency in decision-making. Members articulate their reasoning, fostering a culture of openness and ensuring that decisions are well-founded and understood by the academic community.

    2. How can absentee ballots be cast?
    To accommodate absentee voting, PTCs may implement secure electronic methods or designated proxy voters. This ensures that faculty members who cannot physically attend meetings can still contribute to decision-making processes.

    3. How will additional members of PTCs be elected in departments with fewer than four tenured faculty members?
    In smaller departments, creative solutions like rotating roles or involving faculty from related disciplines can be explored. Flexibility in election procedures ensures representation even in departments with fewer tenured faculty members.

    4. Can a faculty member on OCSA or FML serve on a PTC?
    Faculty members involved in other committees like the Organization of Committee on Student Affairs (OCSA) or Family and Medical Leave (FML) can serve on a PTC, but potential conflicts of interest should be carefully considered and managed.

    5. Can an abstention vote be cast at a PTC meeting?
    Yes, PTC members have the option to abstain from voting if they feel unable to take a stance on a particular matter. This allows for ethical decision-making and prevents uninformed voting.

    6. What constitutes a positive or negative vote in PTCs?
    A positive vote typically indicates approval or agreement, while a negative vote signifies disapproval or disagreement. Clear definitions and guidelines within each PTC help members interpret and cast their votes accurately.

    7. What constitutes a quorum in a PTC?
    A quorum, the minimum number of members required for a valid meeting, is essential for decision-making. Specific rules about quorum size are usually outlined in the PTC’s governing documents.

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  37. 外送茶是什麼?禁忌、價格、茶妹等級、術語等..老司機告訴你!

    外送茶是什麼?
    外送茶、外約、叫小姐是一樣的東西。簡單來說就是在通訊軟體與茶莊聯絡,選好自己喜歡的妹子後,茶莊會像送飲料這樣把妹子派送到您指定的汽車旅館、酒店、飯店等交易地點。您只需要在您指定的地點等待,妹妹到達後,就可以開心的開始一場美麗的約會。

    外送茶種類

    學生兼職的稱為清新書香茶
    日本女孩稱為清涼綠茶
    俄羅斯女孩被稱為金酥麻茶
    韓國女孩稱為超細滑人參茶

    外送茶價格

    外送茶的客戶相當廣泛,包括中小企業主、自營商、醫生和各行業的精英,像是工程師等等。在台北和新北地區,他們的消費指數大約在 7000 到 10000 元之間,而在中南部則通常在 4000 到 8000 元之間。

    對於一般上班族和藍領階層的客人來說,建議可以考慮稍微低消一點,比如在北部約 6000 元左右,中南部約 4000 元左右。這個價位的茶妹大多是新手兼職,但有潛力。

    不同地區的客人可以根據自己的經濟能力和喜好選擇適合自己的價位範圍,以免感到不滿意。物價上漲是一個普遍現象,受到地區和經濟情況等因素的影響,茶莊的成本也在上升,因此價格調整是合理的。

    外送茶外約流程

    加入LINE:加入外送茶官方LINE,客服隨時為你服務。茶莊一般在中午 12 點到凌晨 3 點營業。
    告知所在地區:聯絡客服後,告訴他們約會地點,他們會幫你快速找到附近的茶妹。
    溝通閒聊:有任何約妹問題或需要查看妹妹資訊,都能得到詳盡的幫助。
    提供預算:告訴客服你的預算,他們會找到最適合你的茶妹。
    提早預約:提早預約比較好配合你的空檔時間,也不用怕到時候約不到你想要的茶妹。

    外送茶術語

    喝茶術語就像是進入茶道的第一步,就像是蓋房子打地基一樣。在這裡,我們將這些外送茶入門術語分類,讓大家能夠清楚地理解,讓喝茶變得更加容易上手。

    魚:指的自行接客的小姐,不屬於任何茶莊。
    茶:就是指「小姐」的意思,由茶莊安排接客。
    定點茶:指由茶莊提供地點,客人再前往指定地點與小姐交易。
    外送茶:指的是到小姐到客人指定地點接客。
    個工:指的是有專屬工作室自己接客的小姐。
    GTO:指雞頭也就是飯店大姊三七茶莊的意思。
    摳客妹:只負責找客人請茶莊或代調找美眉。
    內機:盤商應召站提供茶園的人。
    經紀人:幫內機找美眉的人。
    馬伕:外送茶司機又稱教練。
    代調:收取固定代調費用的人(只針對同業)。
    阿六茶:中國籍女子,賣春的大陸妹。
    熱茶、熟茶:年齡比較大、年長、熟女級賣春者(或稱阿姨)。
    燙口 / 高溫茶:賣春者年齡過高。
    台茶:從事此職業的台灣小姐。
    本妹:從事此職業的日本籍小姐。
    金絲貓:西方國家的小姐(歐美的、金髮碧眼的那種)。
    青茶、青魚:20 歲以下的賣春者。
    乳牛:胸部很大的小姐(D 罩杯以上)。
    龍、小叮噹、小叮鈴:體型比較肥、胖、臃腫、大隻的小姐。

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