Lab Guide
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Test ID: Respiratory Upper Culture
Respiratory Upper Culture
Culture of upper respiratory tract specimens by conventional culture
Useful For

The identification of etiological agents of bacterial pharyngitis, epiglottitis, sinusitis and oral infections.

Method name and description

Conventional Culture Technique

Note: For mouth swabs, microscopy only (no culture) 

Reporting name

Upper Respiratory culture

Clinical information

Pharyngitis is inflammation of the pharynx. It is also known as “sore throat”. This infection may be acute or chronic. Most cases are caused by viruses but it can also be caused by bacteria. Clinically, it is difficult to differentiate between bacterial and viral cause of pharyngitis based on symptoms alone. 

The most common cause of bacterial pharyngitis is the Lancefield Group A, Streptococcus (S. pyogenes).

Diphtheria is an acute infectious disease of the upper respiratory tract and occasionally the skin. It is caused by toxigenic strains of Corynebacterium diphtheriae (of which there are 4 biotypes - gravis, mitis, intermedius and belfanti) and some toxigenic strains of Corynebacterium ulcerans and Corynebacterium pseudotuberculosis

Vincent’s angina Borrelia vincentii and Fusobacterium species are associated with the infection known as Vincent's angina.

Fusobacterium necrophorum infection may be characterised by acute pharyngitis and fever, sometimes accompanied by membranous tonsillitis. In the absence of therapy, a small number of these patients may develop bacteraemia and metastatic infection characteristic of Lemièrre’s disease, which can be life threatening

Aliases
  • Respiratory Upper Culture
  • Upper Respiratory culture
  • Throat Culture
  • Nasal Culture 
  • Sinus Culture
  • C upper respiratory
  • Nasopharygeal Culture 
Specimen type / Specimen volume / Specimen container

Specimen type

  • Mouth swab ( for Candida, Borrelia vincentii and Fusobacterium species)
  • Throat swab 
  • Pus swab from nose (accepted only in case of vestibulitis and nasal abscess). Note: this request should ideally be placed as Pus culture with site of infection stated as 'nose'. 
  • Sinus aspirate

Specimen container

  • Amie's transport medium for swabs
  • Sterile leak proof container for aspirate

           

Collection instructions / Special Precautions / Timing of collection

Collection instructions

Mouth swab: 

  • Swab any lesions, inflamed areas or pus if present by using sterile swab ·
  • A tongue depressor or spatula may be helpful to aid vision and avoid · contamination from other parts of the mouth.

Throat swab:

  • Ask the patient to open his/her mouth and stick out their tongue.
  • Use a wooden spatula to press the tongue downward to the floor of the mouth. ·
  • Firmly swab both of the tonsillar arches and the posterior naso-oropharynx, without touching the sides of the mouth.
  • The swab should be thoroughly wet with throat secretions.
  • Swab the tonsillar beds and the back of the throat, avoiding the tongue

Note: Throat culture should not be taken if the epiglottis is inflamed as sampling may cause serious respiratory obstruction.

Sinus aspirate:

The washout should be collected by a specialist ENT surgeon.

Note: aspirates are preferable to swab specimens

Pus swab from nose: see under Pus culture

Special precautions

Avoid contamination with normal flora

Timing of collection

Prior to antimicrobial therapy (where possible)

Relevant clinical information to be provided
  • Patient clinical condition
  • Antimicrobial therapy

 

Storage and transport instructions

<2 hrs. at room temperature

Specimen Rejection Criteria
  • Duplicate specimen in 72 hrs.
  • Improper container
  • Unlabelled/mislabelled specimen
  • No relevant clinical details provided with the request. (Please note that where applicable, the relevant clinical details should reflect those on the patient’s electronic record at the time the order was placed).

 

Biological reference intervals and clinical decision values

Microscopy negative report (mouth swabs only)

  • Absence of yeast cells and pseudohyphae (For Oral candidiasis)
  • Absence of spirochetes and fusiform bacilli (For Vincent’s angina)

Microscopy positive report (mouth swabs only)

Yeast-like cells seen (For Oral candidiasis)

Spirochetes and/or fusiform bacilli seen (For Vincent’s angina)

Culture negative report

  • No growth or normal upper respiratory flora

Culture positive report

  • Significant isolates reported along with antimicrobial susceptibility results 
Factors affecting test performance and result interpretation
  • Improper container and collection technique
  • If patient is on antimicrobial therapy

 

Turnaround time / Days and times test performed / Specimen retention time

Turnaround time

48-72 hrs

Days and times test performed

Sunday to Friday 7am-3pm at HGH microbiology laboratory; 24/7 at AAH, AWH and TCH microbiology laboratories

Specimen retention time

48 hrs. after final report