Introduction
The disk diffusion assay for molds is a standardized antifungal susceptibility testing (AFST) method that evaluates the sensitivity or resistance of filamentous fungi to antifungal agents. While primarily standardized for yeasts (e.g., CLSI M44-A2), disk diffusion has also been adapted for molds, particularly Aspergillus and Fusarium species, to provide a rapid, inexpensive, and simple screening method in clinical mycology laboratories.
Principle
The test is based on the diffusion of antifungal drugs from impregnated paper disks into an agar medium seeded with the test mold.
- As the antifungal diffuses radially, it creates a concentration gradient.
- Mold inoculum growth is inhibited around the disk if the organism is susceptible, forming a zone of inhibition (ZOI).
- The size of the ZOI correlates with susceptibility or resistance, interpreted against reference guidelines or established cutoff values.
Methods
- Inoculum Preparation
- Conidia or hyphal fragments are harvested from a fresh mold culture.
- Adjusted to a standardized turbidity.
- Spread evenly over the surface of agar medium (commonly Mueller-Hinton agar with glucose and methylene blue, or RPMI agar).
- Disk Placement
- Commercially available antifungal disks (e.g., amphotericin B, voriconazole, itraconazole, posaconazole, caspofungin) are placed on the inoculated agar surface.
- Incubation
- Plates are incubated at 35–37 °C for 24–48 hours, sometimes longer for slow-growing molds.
- Zone Measurement
- Measure the diameter of the clear inhibition zone around each disk.
- Compare values with reference breakpoints (where available).
Clinical Significance
- Provides a screening tool for antifungal resistance in molds.
- Useful in resource-limited settings where broth microdilution (CLSI M38-A2 or EUCAST standards) is not available.
- Helps guide antifungal therapy in invasive mold infections such as aspergillosis, mucormycosis, and fusariosis.
- Early detection of resistance (e.g., azole resistance in Aspergillus fumigatus) improves patient outcomes.
- However, it is considered a supplementary test, not a definitive method—broth microdilution remains the gold standard.
Keynotes
- Disk diffusion is simple, low-cost, and rapid, but less standardized for molds compared to yeasts.
- Zone sizes may vary depending on media, inoculum preparation, and incubation conditions.
- CLSI and EUCAST do not yet provide official interpretive breakpoints for all molds; local validation is essential.
- It can be applied in screening for resistance trends in epidemiological surveillance studies.
- It should always be followed by broth dilution testing in critical clinical cases.
Further Readings
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10305799/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1426461
- https://pmc.ncbi.nlm.nih.gov/articles/PMC1933077/
- https://www.sciencedirect.com/topics/immunology-and-microbiology/disk-diffusion
- https://link.springer.com/chapter/10.1007/978-981-96-7047-5_6
- https://clsi.org/shop/standards/m44/
- https://www.fwdamr-reflabcap.eu/-/media/arkiv/projekt-sites/fwdamrreflabcap/events/salmonella/determination-of-antimicrobial-resistance-by-disk-diffusion_final.pdf
