{"id":292,"date":"2023-09-16T22:20:28","date_gmt":"2023-09-16T21:20:28","guid":{"rendered":"https:\/\/microregistrar.com\/?p=292"},"modified":"2023-09-16T22:20:28","modified_gmt":"2023-09-16T21:20:28","slug":"smi-investigation-of-throat-related-specimens","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=292","title":{"rendered":"SMI: Investigation of Throat-Related Specimens"},"content":{"rendered":"\n

Specimens<\/h3>\n\n\n\n

Throat swab, posterior pharyngeal swab, nasopharyngeal swab, pharyngeal washings, pus aspirate, oropharyngeal swab, throat gargle.<\/p>\n\n\n\n

Why<\/h3>\n\n\n\n

To investigate upper respiratory tract infection \u2013 Pharyngitis, Tonsillitis, Epiglottitis, and Laryngitis.<\/p>\n\n\n\n

Condition<\/strong><\/td>Target organisms<\/strong><\/td><\/tr>
Pharyngitis
(sore throat)<\/td>		1. Viral (commonest),
2. Group A Streptococcus\/ Streptococcus pyogenes,
3. Group C\/G Streptococcus \u2013 Streptococcus dysgalactiae subspecies equisimilis,
4. Streptococcus anginosus group,
5. Corynebacterium \u2013 C diphtheriae, C. ulcerans,
6. Vincent\u2019s angina \u2013 Borrelia vincentii and Fusobacterium species,
7. Arcanobacterium haemolyticum,
8. Fusobacterium necrophorum.
9. Neisseria gonorrhoeae.

Rare:<\/strong>
Francisella tularensis, Yersinia enterocolitica, Mycoplasma pneumoniae and Chlamydophila pneumoniae.

Other:<\/strong>
To test for carriage \u2013<\/strong> Neisseria meningitidis, Staph aureus.<\/td><\/tr>
Epiglottitis<\/td>1. H. influenzae type b,
2. Group A Streptococcus\/ Streptococcus pyogenes,
3. Pseudomonas species and
4. Mycobacterium tuberculosis.

In immunocompromised patients:<\/strong>
Candida species and
Aspergillus<\/td><\/tr>
Tonsillitis<\/td>1. Viral infection,
2. Some bacterial infection \u2013 Group A Streptococcus.
Quinsy (peritonsillar abscess):
1. Streptococcus anginosus group,
2. Group A Streptococci,
3. Fusobacterium necrophorum and Fusobacterium nucleatum,
4. Anaerobes (Prevotella, Porphyromonas and Peptostreptococcus species),
5. S. aureus<\/td><\/tr>
Laryngitis<\/td>1. Viral infection,
2. Corynebacterium diphtheriae (rare),
3. MRSA,
4. Group A streptococci,
5. Streptococcus pneumoniae,
6. Haemophilus influenzae and
7. Mycobacterium tuberculosis or
8. fungal (Candida species, Blastomyces species)
9. parasite infections.

Non-infectious aetiology:
<\/strong>smoking, alcohol misuse, voice overuse, gastroesophageal reflux disease (GERD), allergies, inhalation of irritants or chemicals.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
When to test for Corynebacterium diptheriae\/ Corynebacterium ulcerans?<\/h5>\n\n\n\n
    \n
  1. Membranous or pseudomembranous pharyngitis\/tonsillitis<\/li>\n\n\n\n
  2. Contact with a confirmed case within the last 10 days<\/li>\n\n\n\n
  3. Travel abroad to high-risk area within the last 10 days<\/li>\n\n\n\n
  4. Contact with someone who has been to a high-risk area within the last 10 days<\/li>\n\n\n\n
  5. Contact with any animals (including household pets, visiting a farm or petting zoo) within the last 10 days<\/li>\n\n\n\n
  6. Recent consumption of any unpasteurised milk or dairy products<\/li>\n\n\n\n
  7. The patient works in a clinical microbiology laboratory, or similar occupation, where Corynebacterium species may be handled<\/li>\n<\/ol>\n\n\n\n
    \"Map
    Reported diphtheria cases 2019 (WHO)
    https:\/\/apps.who.int\/immunization_monitoring\/globalsummary\/timeseries\/tsincidencediphtheria.html<\/a><\/em><\/figcaption><\/figure>\n\n\n\n

    Gram stain<\/h2>\n\n\n\n

    Stain for Vincent\u2019s organisms: report on Vincent\u2019s organisms detected.<\/p>\n\n\n\n

    Plate selection<\/h2>\n\n\n\n
    CONDITION<\/th>PLATE<\/th>TARGET ORGANISM<\/th><\/tr><\/thead>
    Default<\/td>Blood agar<\/td><\/td><\/tr>
    Membrane formation or membranous pharyngitis\/tonsillitis
    Foreign travel to high-risk areas<\/td>    		Hoyle\u2019s tellurite agar<\/td>Corynebacterium diphtheriae,
    Corynebacterium ulcerans<\/td><\/tr>
    Test for MSSA carriage<\/td>Blood agar,
    Chromogenic agar<\/td>    		Staph aureus<\/td><\/tr>
    GUM clinic, gonorrhoea, N. meningitidis case or contact<\/td>GC selective agar<\/td>N. gonorrhoeae, N. meningitidis<\/td><\/tr>
    Epiglottitis<\/td>Chocolate agar<\/td>H influenzae<\/td><\/tr>
    Diabetes, Immunosuppressed, Oral candidiasis<\/td>Sabouraud agar
    OR
    Chromogenic aga<\/td>    		Yeast
    Mould<\/td><\/tr>
    Persistent sore throat or Quinsy<\/td>Fastidious Anaerobic Agar (FAA)
    containing nalidixic acid and vancomycin<\/td>    		Fusobacterium necrophorum<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    Organisms should be isolated up to the species level, except yeast \u2013 which can be left at the yeast level. Beta-haemolytic Streptococcus should be tested by Lancefield grouping. Any C diphtheriae\/ C ulcerans should be referred to the reference lab for a toxigenicity test ASAP. H influenza should be referred to the reference lab for grouping if it is epiglottitis.<\/p>\n\n\n\n

    \"Corynebacterium
    C diphtheriae on telluride agar (http:\/\/www.medical-labs.net\/corynebacterium-diphtheriae-on-tellurite-agar-2180\/<\/a>)<\/figcaption><\/figure>\n\n\n\n

    Safety, infection control and public health<\/h2>\n\n\n\n
    ORGANISM<\/th>ACTION<\/th><\/tr><\/thead>
    Corynebacterium diphtheriae,
    Corynebacterium ulcerans<\/td>    		C. diphtheriae and C. ulcerans are in Hazard Group 2. Suspected and known isolates
    of C. diphtheriae \/C. ulcerans should always be handled in a microbiological safety
    cabinet. Sometimes the nature of the work may dictate that full containment Level 3
    conditions should be used, e.g. for the propagation of C. diphtheriae\/C. ulcerans to comply with COSHH 2004 Schedule 3 (4e).

    Diphtheria is a notifiable disease in the UK.
    \u2013 Lab should immediately inform microbiologists
    \u2013 The infection control team should be notified ASAP.
    \u2013 PHE should be notified on suspicion, on an urgent basis, for management of case, contact and outbreak.
    \u2013 In the healthcare setting, appropriate infection control measures should be taken.
    \u2013 All isolates should be referred to the reference lab for toxigenicity test.<\/td><\/tr>
    Group A Streptococcus<\/td>The microbiologist and the infection control team should be notified.
    Isolate the patient for 24 \u2013 48 h after the commencement of appropriate antibiotic therapy.
    Follow appropriate infection control measures as per local\/national guidelines<\/a>.
    Notify public health about any invasive group A Streptococcal infection.
    Ensure the isolate is sent for typing.<\/td><\/tr>
    N meningitidis<\/td>C. diphtheriae and C. ulcerans are in Hazard Group 2. Suspected and known isolates
    of C. diphtheriae \/C. ulcerans should always be handled in a microbiological safety
    cabinet. Sometimes the nature of the work may dictate that full containment Level 3
    conditions should be used, e.g. for the propagation of C. diphtheriae\/C. ulcerans to comply with COSHH 2004 Schedule 3 (4e).

    Diphtheria is a notifiable disease in the UK.
    \u2013 Lab should immediately inform microbiologists
    \u2013 The infection control team should be notified ASAP.
    \u2013 PHE should be notified on suspicion, on an urgent basis, for management of case, contact and outbreak.
    \u2013 In the healthcare setting, appropriate infection control measures should be taken.
    \u2013 All isolates should be referred to the reference lab for toxigenicity tests.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    F tularensis is a HG3 organism.<\/p>\n\n\n\n

    Reference<\/h2>\n\n\n\n

    https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/423204\/B_9i9.pdf<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    Specimens Throat swab, posterior pharyngeal swab, nasopharyngeal swab, pharyngeal washings, pus aspirate, oropharyngeal swab, throat gargle. Why To investigate upper […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[60],"tags":[64,63,66],"class_list":["post-292","post","type-post","status-publish","format-standard","hentry","category-laboratory","tag-laboratory","tag-smi","tag-throat-swab"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/292","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=292"}],"version-history":[{"count":1,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/292\/revisions"}],"predecessor-version":[{"id":293,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/292\/revisions\/293"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=292"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=292"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=292"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}