Guidelines for workup of Throat and Genital Cultures
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1 Guidelines for workup of Throat and Genital Cultures 1
2 Acute Pharyngitis By far the most common infection of the upper respiratory tract Viral infection is by far the most common cause of pharyngitis The most important bacterial pathogen in pharyngitis is Streptococcus pyogenes (GAS) 20-30% children / 5-15% in adults 2
3 Group A Streptococcus Pharyngitis Group A Streptococcus (GAS) is the only common cause of acute pharyngotonsillitis that routinely requires antibiotic treatment Accounts for 15% to 30% of sore throats in children and 5% to 10% in adults Highest rates of infection are in children aged 5 to 11 years 3
4 Streptococcal Pharyngitis Other b-haemolytic streptococci produce symptoms similar to, but more mild than those of GAS These other strains are usually NOT associated with rheumatic fever as a noninfectious sequela GAS can occasionally colonize the oropharynx in small numbers, However Groups C & G streptococci are regular colonizers Therefore difficult to determine clinical significance If in pure culture or as a predominating organism, might be reasonable to report their presence 4
5 Pharyngitis (cont d) Arcanobacterium haemolyticum Formerly known as Corynebacterium haemolyticum (small GPB), cat -, b hem. Rarely causes pharyngitis Symptoms closely mimics GAS pharyngitis Exudative pharyngitis Lymphadenopathy Scarlatiniform rash frequent (scarlet fever?) Primarily affects teenagers and young adults year old groups 5
6 6
7 Pharyngitis (cont d) Arcanobacterium haemolyticum Reverse CAMP positive The b-hemolysin of S.aureus on blood agar is inhibited by the phospholipase of A.haemolyticum Appears as an arrow-head-shaped nonhemolyzed area between S.aureus and A.haemolyticum streaked at right angles to each other Additional ID tests: LAP + 7
8 Reverse CAMP CAMP 8
9 Throat cultures: So what to do? 9
10 Throat Culture Inspect blood plates for b- hemolytic colonies after overnight incubation No b colonies b colonies Colony count of b- hemolytic colonies b colonies Reincubate plates overnight No b colonies Report as negative for Group A Strep Perform Streptex A latex agglutination test Negative Are b colonies greater than oral flora? Yes Perform smear and cat Positive No Perform Cat (=) and smear (gpc) Report as negative for Group A Strep Smear not gpb or gpc OR organism is cat + gpb cat = gpc cat = Report as positive for Group A Strep Perform reverse camp test Report b streptococcus, not group A Negative Positive Report as negative for Group A Strep Arcanobacterium hemolyticum 10
11 11
12 12
13 13
14 MALDI 14
15 Throat cultures: Summary Report any amount of GAS If > oral flora, report presence of: Arcanobacterium haemolyticum b-streptococci, not GAS (may group/report C or G) Do not report: Neisseria spp Haemophilus spp. S.pneumoniae S.aureus No indication that growing these in tht cultures means anything in pharyngitis. 15
16 Rapid GAS antigen detection - appropriate utilization Children/Adolescents negative RADT results should be confirmed with a throat culture result Adults low incidence of streptococcal infection extremely low risk of rheumatic fever negative RADT results do not need culture confirmation Clin Infect Dis. 2002;35(2): doi: /
17 GAS Pharyngitis - Diagnosis Rapid testing & when to back up with culture Shulman et al, CID Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the IDSA. In children and adolescents, negative RADT tests should be backed up by a throat culture. In adults, negative RADT tests do not need to be backed up by a throat culture. The risk of acute rheumatic fever is exceptionally low in adults Abbott et al, CID Reflexive Culture in Adolescents and Adults With Group A Streptococcal Pharyngitis. Culturing samples from adults with negative rapid antigen detection tests identified additional individuals who can benefit from treatment Felsenstein et al, JCM Molecular and Clinical Diagnosis of Group A Streptococcal Pharyngitis in Children. (illumigene assay) Rapid molecular assays are far superior to a RADT and culture for the detection of GAS, when testing is limited to patients presenting with clinical symptoms. 17
18 Molecular detection for GAS (POC) (culture back up necessary?) 3 rd Q
19 DISCUSSION 19
20 Genital cultures What is Vaginitis? By definition, vaginitis refers to vaginal irritation and discharge Causes of vaginitis 3 agents cause > 90% of cases Cervicitis Trichomonas Yeast Bacterial vaginosis (BV) Neisseria gonorrhoeae molecular Chlamydia trachomatis molecular Herpes Simplex virus culture or molecular Cytomegalovirus culture or molecular Wet prep Antigen detection NAAT There really is no place for a routine vaginal culture. 20
21 Vaginal cultures OK That being said We are all pressured to do routine vaginal cultures There is no clinical studies to show that other organisms cause vaginitis So, what should we do? 21
22 Vaginal cultures Look for growth of any organism in quantities > the amount of normal vaginal flora present in the culture. Note: Gardnerella spp. is considered normal vaginal flora. Quantitate and report the amount of normal vaginal flora (VF) present. If there is growth of the following in quantities > VF: Yeast quantitate and report yeast GBS (β or γ) quantitate and report Group B streptococci Enterics quantitate and report enteric gram negative bacilli If there is overgrowth of any other organism consult Do not perform susceptibilities on any organism. Consult all cultures on patients < 15 y.o. 22
23 DISCUSSION 23
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