Nasal Throat Swab
How to Take a Throat Culture
Most of the time a common cold or sore throat will go away after a few days. Sometimes, however, it could be more serious and not go away so easily. This is when your patient should decide to visit a clinic or doctor to check for a bacterial infection. In order to identify the pathogen, you will need to perform a throat culture.
Understanding When to Take a Throat Culture
Recognize the symptoms.In general, the signs and symptoms of a throat infection include: pain, difficulty swallowing, red and swollen tonsils with patches of white pus streaks, swollen and tender lymph glands, fever, and rashes.
- A person could have many of these symptoms and still not have strep throat because viruses can also have the same symptoms as bacterial infections.
- Be aware that it is still possible to have bacteria that cause strep without having a sore throat, which makes the person a “carrier.” Carriers have bacteria in their mouths, but it does not make them sick yet. They can unknowingly pass the bacteria to others through sharing utensils, cups, etc.
Be familiar with the purpose of a throat culture.The primary purpose of performing a throat culture is to determine whether a throat infection is viral or bacterial. The bacteria that cause strep throat,Streptococcus pyogenes(also known as group AStreptococcus) is highly contagious and are easily passed between people.
Understand possible complications.Although strep is not generally considered dangerous, some more serious complications could occur even with treatment. The spread of infection to the sinuses, tonsils, skin, blood, or middle ear is perhaps the biggest concern.
- Group AStreptococcus. This bacterium is responsible for many conditions, including scarlet fever, strep throat, or rheumatic fever.
- Candida albicans.Candida albicansis a fungus, which can cause thrush, an infection appearing in the mouth and in the surface of the tongue. It sometimes can travel to the throat (or other locations), causing infection and can occur after treatment of strep throat.
- Bacterial meningitis.Streptococcus pneumoniaeand group BStreptococcuscan cause meningitis, a serious and potentially deadly disease that causes inflammation in the brain.People can reduce the chances of getting meningitis by getting vaccinated.
- If bacteria are identified, you can perform a sensitivity or susceptibility test, which is a test that will show you what antibiotic will be more efficient against the pathogen.
Taking a Throat Culture
Ask if your patient used mouthwash or antibiotics.If you are preparing a patient for a throat swab you should ask him if he used mouthwash or antibiotics because either one could influence an inaccurate culture from removing bacteria.
- If the patient is confused why it is not a good idea to remove bacteria from the infected area explain to him that removal from the immediate area does not mean that the infection is cured. Indeed, he may still be a carrier and failure to detect the infection will prolong the period of infection, possibly infecting others.
- Inform the patient that this is a relatively painless procedure and does not require any special instructions once the tests are concluded.
- Other questions you can ask your patient are: “What symptoms have you noticed, and how severe are they?”, "For how many days?", "When did it start?", "How has it progressed?", “Have you experienced a fever the last couple of days?”, and “Have you been in contact with anybody who has had strep throat recently?”
Use a tongue depressor.In order to check for redness, swelling, and especially for white streaks or pus on the tonsils, you must use a tongue depressor to get a good look at the tonsils and throat.
- You should also try to detect signs of a strep throat: fever, white or yellow spots that coat the lining of the throat, bright and dark red spots near the throat, and swollen tonsils.
- A visual exam of the throat and tonsils cannot determine whether the signs and symptoms are bacterial or viral; therefore, further testing will be needed.
Perform a throat swab.Once signs and symptoms have been detected, you will have to perform a throat swab to check for the presence of bacteria, including streptococcal bacteria. A throat swab is done to collect any bacteria that exist for a throat culture to determine if the infection is caused by a virus or by bacteria. The result will determine the treatment.
- Using a sterile cotton swab, touch the infected area with the swab with several strokes to collect any pathogenic or bacteria for a microbiologist to analyze.
- Be careful not to touch the tongue, uvula, or lips due to possible contamination.
- This should not be a painful procedure but expect your patient to gag since you will touch the back of her throat.
- Prepare the swab for transportation to the laboratory for analysis. Always label the sample with patient name, date of birth, and patient ID.
Administer a rapid antigen test.This test is usually only performed in an emergency or with children because it can provide immediate feedback on the swab sample.
- This test detects strep bacteria within a few minutes by revealing substances (antigens) from the throat. Once located, antibiotic treatment can begin immediately.
- The downside to this test is that due to its rapid analysis some strep throat infections are misdiagnosed; therefore, it is a good idea to proceed with a culture, especially if the antigen test shows a negative result.
Prepare swab for the laboratory.Inoculate the culture with the sterile swab and carefully place it into a collection container. If you need a quick strep test or a strep screen, use a red Duo-Swab in transport media. Otherwise, place the culture in a blue Amies transport media for a throat culture.
- Make sure you label the transport media correctly or there could be confusion over the proper procedures for treatment, leading to serious complications.
- The collection container should arrive at the laboratory within 24 hours for proper analysis.
Analyze the culture.The culture should be placed in a candle jar and incubated at 35–37° C (95–98° F). You should leave the jar in the incubator for at least 18 hours.
- After 18–20 hours, take out the jar and examine the bacteria (content beta hemolytic) colonies. If you find any trace of a colony, the test is positive, and the patient suffers from a bacterial infection. It will need further examination to determine just what bacteria are present.
- If nothing will grow in the container, the test is negative. If the test results are negative, the patient might suffer from a viral infection, caused by pathogens like Enterovirus, the Herpes simplex virus, Epstein-Barr virus, or RSV (respiratory syncytial virus). Chemical tests or microscope exams will need to be performed in order to find what type of infection is affecting the patient. Remember, viral infections are not treatable with antibiotics. Viral infections require time and rest for the body to fight infection using its own immune response.
Treating and Preventing Further Symptoms
Prescribe antibiotics to cure strep throat.Antibiotics are the most common treatment for strep throat. Antibiotics will reduce the duration of the symptoms and help prevent the spread of the infection to others.
- Penicillin is the most common. It can be injected or taken orally.
- Similar to penicillin is Amoxicillin. This drug is more often given to children because it is readily available as chewable tablet or liquid suspension.
- If your patient is allergic to penicillin some alternatives are: cephalexin (Keflex), clarithromycin (Biaxin), Azithromycin (Zithromax, Zmax), or Clindamycin.
- The patient should feel much better and no longer be contagious between 24 and 48 hours.
- Make sure the patient understands that, even if he feels better, it isessentialthat he complete the full course of antibiotics. He should take the pills as directed until they are all gone. This prevents a resurgence of the infection and/or developing an antibiotic-resistant bacteria.
Encourage patients to embrace home remedies.In most cases, antibiotics will effectively remove the bacteria causing discomfort. At the same time, lifestyle adaptations and home remedies can alleviate the symptoms.
- Rest and relaxation will help fight the infection. Advise your patient not go to work or school for 24 hours after starting treatment, since strep throat is highly contagious. After 24 hours a patient being treated with antibiotics should not be contagious.
- Drinking lots of water will keep a sore throat lubricated and ease swallowing. It will prevent dehydration from the antibiotics as well.
- Gargling with warm salt water relieves throat pain. Make sure the patient does not swallow. She can also gargle hydrogen peroxide (dilute one capful of hydrogen peroxide in a cup of warm water).
- A humidifier will add moisture to the air easing discomfort from dried out mucous membranes.
Prevent further strep infection.Remember strep infections are caused by mobile bacteria from coughs, sneezes, or even touching infected surfaces. Advise your patient to do the following:
- Wash hands to eliminate the transfer of bacteria from surfaces to the eyes, mouth, and nose. Make sure to use warm soap and water for about fifteen to twenty seconds, or use an alcohol-based hand sanitizer.
- Cover his mouth and nose with his elbow when sneezing or coughing.
- Avoid touching his face, especially his nose, mouth, and eyes.
- Avoid sharing drinking glasses, eating utensils, or toys with children who have strep throat.
After brushing my teeth how long afterward can I get an accurate throat culture?
Do we need to fast before taking throat swab for culture?
- Untreated strep throat can lead to serious complications such as rheumatic fever and glomerulonephritis (kidney inflammation).
- You should always visit a doctor or health clinic to get a throat culture — this is not something that should be attempted at home or by an untrained person.
Sources and Citations
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