Upper Respiratory Culture, Routine w/ Reflex*

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Category:

Turnaround Time: 2 - 4 days
CPT Code:

87070

Test Type: One swab or aspirated material
Reference Range:

Routine respiratory flora present or no growth

Overview:

Isolate and identify potentially pathogenic organisms from throat, sinus etc; evaluate pharyngitis; evaluate nares for staph.

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.

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%), H influenzae (10% to 30%), Moraxella (Branhamella) catarrhalis (5% to 10%), Streptococcus pyogenes (5% to 10%), Staphylococcus aureus (1% to 5%), Pseudomonas aeruginosa (0.1% to 1%). 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.

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

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

Collection Details:

Collection Instructions:

Sterile specimens (eg, sinus aspirates or tympanocentesis fluid), collected by invasive procedures, should be submitted as sterile body fluid cultures. If the amount of material aspirated is small, it may be advisable to inject it into an anaerobic transport or absorb it onto the swab of the bacterial swab collection kit and use the bacterial transport. For throat specimens submitted for isolation of Neisseria gonorrhoeae, use GC (Neisseria gonorrhoeae) Culture Only [008128] and include inoculated Jembec® transport. Specimens from other sources, such as genital, stool, urine, upper and lower respiratory specimens, cannot be cultured under the aerobic bacterial culture test number. If specimens are incorrectly submitted with an order for aerobic bacterial culture, the laboratory will process the specimen for the test based on the source listed on the test request form. The client will not be telephoned to approve this change, but the change will be indicated on the report. Check expiration date of transport; do not use expired device.

Bacterial culture transport swab.

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 swab in transport.

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

Maintain specimen at room temperature.