Indications Of Throat Swab

INDICATIONS OF THROAT SWAB Pharyngitis And Tonsillitis Clinically Suggested By Observing An Inflamed And Edematous mucosa. Pharyngeal Mucosa In A Patient Who Complains Of Throat Pain Difficulty In Swallowing And Secondary Symptoms Such As Fever Headache And Occasionally A Scarletiniform Rash. Purulent Exudates Over The Posterior Pharynx And Tonsillar Area May Also Be Observed.

OBTAINING

A Bright Light Should Be Focussed In To The Oral Cavity So That The Swab Can Be Guided Into The Posterior Pharynx. The Patient Is Instruted To Tilt His Or Her Head Back And Breathe Deeply. The Tongue Is Depressed With A Tongue Blade To Visualize The Tonsillar Fossae And Posterior Pharynx. The Swab Is Extended Between The Tonsillar Pillars And Behind The Uvula.

Care Should Be Taken Not To Touch The Lateral Walls Of The Buccal Cavity Or The Tongue To Minimize Contamination With The Commensal Bacteria.

Having The Patient Phonate A Long “Ah “ Serves To Lift The Uvula And Helps Prevent Gagging.

The Tonsillar Area And The Posterior Pharynx Should Be Firmly Rubbed With The Swab . Any Purulent Exudate Should Also Be Sampled.

After Collection The Swab Should Be

Placed

Immediately Into A Sterile Tube Or Other Suitable Container For Transport To The Laboratory. If The Recovery Of Only Group A Organisms Is Desired Swabs May Be Allowed To Dry During Transport Without Compromising The Recovery Of The Viable Organisms. While Transporting Care Should Be Taken To Avoid Conditions That Are Suboptimal For The Survival Of Streptococci Such A High Temperature And Swabs That Remain Moist For Long Periods.

GRAM STAINING

Devised By Histologists Christian Gram As A Method Of Staining Bacteria In Tissues. Steps In Gram Staining , Smearing The Slide With A Swab. Primary Staining With The Gentian Violet and wait for 2 minute.

Application Of A Dilute Solution Of Iodine (1 min) Decolourisation With An Organic Solvent.Acetone Counterstaining With The Dye Of Contrasting Colour Such As Carbol Fuschin ( 30 secs)

Group A streptococci is demonstrated by gram staining which is B haemolytic when produce pharyngitis cause rheumatic fever and rheumatic heart disease as a nonsuppurative complications because of the delayed immune response.

Rheumatic heart disease is a problem in all parts of the world especially the developing countries. the reported prevalence rates in school age children in various parts of the world range from very low to high as 33 cases /1000 most common cause of heart disease in 5-30 years of age group is rheumatic heart disease Major public health problem among children and young aduls in developing countries.

Group A streptococci are the most common bacterial cause of pharyngitis with A peak incidence of children 5-15 years. Presence of group A streptococci in the URT may reflect either true infection or A carrier state . only in the case of true infection patients show A rising antibody response

.

The prevalance of RF & RHD & the mortality& Morbidity rates varied widely b/w countries & b/w population groups. In india 1.0-5.0 /1000

school children .

FACTORS WHICH PLAY AN IMPORTANT ROLE IN THE EMERGANCE OF RHEUMATIC FEVER AND

RHEUMATIC HEART DISEASE

Socioeconomic & environmental factors play an indirect but Important role in the magnitude and severity of RF and RHD. Such factors are shortage of resources for providing quality health care. inadequate expedition of health care providers . lower level of awareness in the community Crowding.

Inadequate diagnosis and treatment of Streptococcal pharyngitis . mis diagnosis or late diagnosis of acute rheumatic fever inadequate secondary prophylaxis or non compliance with secondary prophylaxis Patient unaware about the first RF episode Higher incidence of acute RF and its recurrence. Untimely intiation or lack of secondary prophylaxis

rheumatic heart disease comprises, - mitral regurgitation which is the most

common among the school going age group.

- Then mitral stenosis is the common among all age group.

- Aortic stenosis and aortic regurgitation is next to the above

- Tricuspid regurgitation and tricuspid stenosis frequency among RHD is very rare

CLINICAL PRESENTATION Involves

chest pain .

-breathlessness. -palpitations. -syncopial attacks. -features of infective endocarditis. -or with the features of CCF

DIAGNOSIS OF RHEUMATIC HEART DISEASE Clinical examination is the basis of diagnosis of RF & RHD . role of echocardiography should be considered supportive. Echodoppler examination should be Performed if the facilities are available . endomyocardial biopsy & radionucleide imaging are the other methods of diagnosis but these are considered as mainly as the research tools .

Treatment benzathine pencillin as life long prophylaxis. treatment of infective endocarditis if occurs because of its higher incidence to develop in the damaged valves. anti-failure measures by prescribing digoxin & diuretics in case of mild to moderate PHT surgery is the best mode of treatment -valvotomy open closed - balloon valvuloplasty

REFERENCES Parks textbook of social and preventive medicine 17th edition. Who technical report series 923: rheumatic fever and rheumatic heart disease. Davidson textbook of medicine 19 th edition. Anantha narayans text book of microbiology ;17th edition. Www.Allreferhealth.Com