Upper Respiratory Culture, Routine

Thrush, oral candidiasis, and Candida esophagitis frequently complicate antineoplastic therapy, hyperalimentation, transplantation immunosuppression, pregnancy, and the acquired immunodeficiency syndrome (AIDS). In addition to a fungal culture, a saline wet preparation, Gram stain, or KOH preparation demonstrating yeast cells or pseudohyphae may also be useful in rapidly establishing the diagnosis of oral or mucocutaneous candidiasis.

Streptococcus pyogenes: Group A β-hemolytic strep) and other β-hemolytic streptococci in groups B, C, D, and G are generally susceptible to penicillin and its derivatives. Therefore, susceptibility need not be routinely determined. The principal reason for considering an alternative drug for individual patients is allergy to penicillin. Erythromycin, a cephalosporin, or clindamycin might be substituted in these cases. Patients allergic to penicillins may also be allergic to cephalosporins.

In the late 1980s, a resurgence of serious Streptococcus pyogenes infection was observed. Complications including rheumatic fever, sepsis, severe soft tissue invasion,and toxic shock-like syndrome (TSLS) are reported to be most common with the M1 serotype and a unique invasive clone has become the predominant cause of severe streptococcal infections.³

Ear: Normal flora of the skin of the healthy ear includes Staphylococcus epidermidis, Corynebacterium sp, and Staphylococcus aureus. Correlation of nasopharyngeal cultures with results of tympanocentesis culture is poor and lacks predictive value in identification of the causative agent of otitis media. In decreasing order of frequency, the following organisms have been recovered from tympanocentesis: S pneumoniae (50 to 75 percent), H influenzae (10 to 30 percent), Moraxella (Branhamella) catarrhalis (5 to 10 percent), Streptococcus pyogenes (5 to 10 percent), Staphylococcus aureus (1 to 5 percent), Pseudomonas aeruginosa (0.1 to 1 percent). E coli, Klebsiella pneumoniae, Pseudomonas aeruginosa may be isolated from neonates. In therapeutic failures, S aureus, and P aeruginosa are most frequently recovered. Tympanocentesis is not usually performed in primary infections. It is to be considered in treatment failures and neonates. Candida superinfection may complicate therapy for recurring ear infections and may be a cause of persistent otorrhea. Otitis externa is frequently caused by P aeruginosa and less frequently by Candida sp, Proteus sp, S aureus, and Trichophyton sp.

Footnotes

1. Bibler MR, Rouan GW. Cryptogenic group A streptococcal bacteremia: Experience at an urban general hospital and review of the literature. Rev Infect Dis. 1986 Nov-Dec; 8(6):941-951. PubMed 3541128
2. Lang SD, Singh K. The sore throat. When to investigate and when to prescribe. Drugs. 1990 Dec; 40(6):854-862. PubMed 2079000
3. Cleary PP, Kaplan EL, Handley JP, et al. Clonal basis for resurgence of serious Streptococcus pyogenes disease in the 1980s. Lancet. 1992 Feb 29; 339(8792):518-521. PubMed 1346879

References

• Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989 Dec; 36(6):1551-1569. PubMed 2685730
• Brook I. The clinical microbiology of Waldeyer’s ring. Otolaryngol Clin North Am. 1987 May; 20(2):259-273. PubMed 3299209
• Epstein JB, Truelove EL, Izutzu KT. Oral candidiasis: Pathogenic and host defense. Rev Infect Dis. 1984 Jan-Feb; 6(1):96-106. PubMed 6369482
• Givner LB. Abramson JS, Wasilauskas B. Apparent increase in the incidence of invasive group A beta-hemolytic streptococcal disease in children. J Pediatr. 1991 Mar; 118(3):341-346. PubMed 1999773
• Gregory DW. Saturday Conference: Candida infections. South Med J. 1982 Mar; 75(3):339-345. PubMed 7038888
• Kaplan EL. The rapid identification of group A beta-hemolytic Streptococci in the upper respiratory tract. Current status. Pediatr Clin North Am. 1988 Jun; 35(3):535-542. PubMed 3287313
• Meyer RD. Cutaneous and mucosal manifestations of the deep mycotic infections. Acta Derm Venereol Suppl (Stockh). 1986; 121:57-72. PubMed 3521177
• Wheeler MC, Roe MH, Kaplan EL, Schlievert PM, Todd JK. Outbreak of group A Streptococcus septicemia in children: Clinical, epidemiologic, and microbiological correlates. JAMA. 1991 Jul 24-31; 266(4):533-537. PubMed 2061980
• Wright JM, Taylor PP, Allen EP, Byrd RL. A review of the oral manifestations of infections in pediatric patients. Pediatr Infect Dis. 1984 Jan-Feb; 3(1):80-88. PubMed 6366773

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Throat: Depress tongue and rub swab vigorously over each tonsillar area and posterior pharynx. Any exudate should be touched, and care should be taken to avoid the tongue and uvula. Place the used swab in a transport tube.

Nasopharynx: With the patient’s head immobilized, insert a flexible wire swab into the patient’s nostril until it reaches the posterior nares. Leave the swab in place for 15 to 30 seconds. Rotate and remove the swab; then, place it in a transport tube.

Container/Tube: Bacterial culture transport swab

Sample Volume: One swab or aspirated material

Storage: Store specimens at room temperature.

Rejection Criteria:

• Unlabeled specimen or name discrepancy between specimen and request label
• Inappropriate specimen transport device
• Leaking specimen
• Specimen received after prolonged delay (usually more than 72 hours)
• Expired transport

This test is used to:

• Isolate and identify potentially pathogenic organisms from a patient’s throat, sinus, etc.
• Evaluate pharyngitis
• Evaluate nares for staph

Limitations

Interpretation requires a significant level of experience and technical proficiency in order to avoid false-positives and false-negatives.¹ Many other etiologic agents can be responsible for pharyngitis.²

Note: This procedure does not include screening for Neisseria gonorrhoeae or Corynebacterium diphtheriae. Anaerobic organisms that are frequently implicated in chronic infection of the tonsils and adenoids are not recovered by aerobic culture methods.