INDICATIONS OF THROAT SWABINDICATIONS OF THROAT SWAB

PharyngitisPharyngitis And TonsillitisAnd TonsillitisClinically Suggested By ObservingClinically Suggested By ObservingAn Inflamed And Edematous mucosa.An Inflamed And Edematous mucosa.

Pharyngeal Mucosa In A PatientPharyngeal Mucosa In A PatientWho Complains Of Throat PainWho Complains Of Throat PainDifficulty In Swallowing AndDifficulty In Swallowing AndSecondary Symptoms Such As Secondary Symptoms Such As Fever Headache And Occasionally A Fever Headache And Occasionally A ScarletiniformScarletiniform Rash.Rash.

Purulent Exudates Over The Purulent Exudates Over The Posterior Pharynx And Posterior Pharynx And TonsillarTonsillarArea May Also Be Observed.Area May Also Be Observed.

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OBTAININGOBTAINING ����������

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A Bright Light Should Be A Bright Light Should Be FocussedFocussed In To In To

The Oral Cavity So That The Swab Can Be The Oral Cavity So That The Swab Can Be Guided Into The Posterior Pharynx.Guided Into The Posterior Pharynx.

The Patient Is The Patient Is InstrutedInstruted To Tilt His Or To Tilt His Or Her Head Back And Breathe Deeply.Her Head Back And Breathe Deeply.

The Tongue Is Depressed With A Tongue The Tongue Is Depressed With A Tongue Blade To Visualize The Blade To Visualize The TonsillarTonsillar FossaeFossaeAnd Posterior Pharynx.And Posterior Pharynx.

The Swab Is Extended Between The The Swab Is Extended Between The TonsillarTonsillar Pillars And Behind The Uvula.Pillars And Behind The Uvula.

����������������Care Should Be Taken Not To Care Should Be Taken Not To

Touch The Lateral Walls Of The Touch The Lateral Walls Of The Buccal Cavity Or The Tongue To Buccal Cavity Or The Tongue To Minimize Contamination With TheMinimize Contamination With TheCommensalCommensal Bacteria.Bacteria.

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

Gagging.Gagging.

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

After Collection The Swab Should Be Placed After Collection The Swab Should Be Placed

Immediately Into A Sterile Tube Or Other Immediately Into A Sterile Tube Or Other

Suitable Container For Transport To The Suitable Container For Transport To The

Laboratory.Laboratory.

If The Recovery Of Only Group A Organisms Is If The Recovery Of Only Group A Organisms Is

Desired Swabs May Be Allowed To Dry During Desired Swabs May Be Allowed To Dry During

Transport Without Compromising The Recovery Transport Without Compromising The Recovery

Of The Viable Organisms.Of The Viable Organisms.

While Transporting Care Should Be Taken To While Transporting Care Should Be Taken To

Avoid Conditions That Are Suboptimal For The Avoid Conditions That Are Suboptimal For The

Survival Of Streptococci Such A High Survival Of Streptococci Such A High

Temperature And Swabs That Remain Moist For Temperature And Swabs That Remain Moist For

Long Periods.Long Periods.

GRAM STAININGGRAM STAININGDevised By Histologists Christian Gram Devised By Histologists Christian Gram

As A Method Of Staining Bacteria In As A Method Of Staining Bacteria In Tissues.Tissues.

Steps In Gram Staining ,Steps In Gram Staining ,

Smearing The Slide With A Swab.Smearing The Slide With A Swab.

Primary Staining With The Gentian Violet and Primary Staining With The Gentian Violet and wait for 2 minute.wait for 2 minute.

Application Of A DiluteApplication Of A DiluteSolution Of Iodine (1 min)Solution Of Iodine (1 min)

DecolourisationDecolourisation With An With An Organic Organic Solvent.AcetoneSolvent.Acetone

Counterstaining With TheCounterstaining With TheDye Of Contrasting Dye Of Contrasting Colour Such As Colour Such As CarbolCarbolFuschinFuschin ( 30 ( 30 secssecs))

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

Rheumatic heart disease is a problem in all parts ofRheumatic heart disease is a problem in all parts of

the world especially the developing countries.the world especially the developing countries.

the reported prevalence rates in school age children in the reported prevalence rates in school age children in

various parts of the world range from very low to high various parts of the world range from very low to high

as 33 cases /1000as 33 cases /1000

most common cause of heart disease in 5most common cause of heart disease in 5--30 years of 30 years of

age group is rheumatic heart diseaseage group is rheumatic heart disease

Major public health problem among children and Major public health problem among children and

young young adulsaduls in developing countries.in developing countries.

Group A streptococci are the most common Group A streptococci are the most common bacterial cause of bacterial cause of pharyngitispharyngitis with A peak with A peak incidence of children 5incidence of children 5--15 years.15 years.

Presence of group A streptococci Presence of group A streptococci in the URT may reflect either true in the URT may reflect either true infection or A carrier state .infection or A carrier state .

only in the case of true infection patients only in the case of true infection patients

show A rising antibody responseshow A rising antibody response ..

The The prevalanceprevalance of RF & RHD & the mortality& of RF & RHD & the mortality& Morbidity rates varied widely b/w countries Morbidity rates varied widely b/w countries

& b/w population groups.& b/w population groups.

In In indiaindia 1.01.0--5.0 /1000 school children .5.0 /1000 school children .

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

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

Inadequate diagnosis and treatment ofInadequate diagnosis and treatment ofStreptococcal Streptococcal pharyngitispharyngitis ..

mismis diagnosis or late diagnosis of diagnosis or late diagnosis of acute rheumatic fever acute rheumatic fever

inadequate secondary prophylaxis or inadequate secondary prophylaxis or non compliance with secondary prophylaxisnon compliance with secondary prophylaxis

Patient unaware about the first RF episodePatient unaware about the first RF episode

Higher incidence of acute RF and its recurrence.Higher incidence of acute RF and its recurrence.

Untimely Untimely intiationintiation or lack of secondary or lack of secondary prophylaxisprophylaxis

rheumatic heart disease comprises,rheumatic heart disease comprises,rheumatic heart disease comprises,rheumatic heart disease comprises,rheumatic heart disease comprises,rheumatic heart disease comprises,rheumatic heart disease comprises,rheumatic heart disease comprises,

-- mitralmitral regurgitation which is the most regurgitation which is the most common among the school going age common among the school going age group.group.

-- Then Then mitralmitral stenosisstenosis is the common among all is the common among all age group.age group.

-- Aortic Aortic stenosisstenosis and aortic regurgitation is and aortic regurgitation is next to the abovenext to the above

-- Tricuspid regurgitation and tricuspid Tricuspid regurgitation and tricuspid stenosisstenosisfrequency among RHD is very rarefrequency among RHD is very rare

CLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONCLINICAL PRESENTATIONInvolvesInvolvesInvolvesInvolvesInvolvesInvolvesInvolvesInvolves��chest pain . chest pain .

--breathlessness.breathlessness.

--palpitations.palpitations.

--syncopialsyncopial attacks.attacks.

--features of infective features of infective endocarditisendocarditis..

--or with the features of CCFor with the features of CCF

DIAGNOSIS OF RHEUMATIC DIAGNOSIS OF RHEUMATIC HEART DISEASEHEART DISEASEClinical examination is the basis of Clinical examination is the basis of diagnosis of RF & RHD .diagnosis of RF & RHD .

role of echocardiography should role of echocardiography should be considered supportive.be considered supportive.

EchodopplerEchodoppler examination should beexamination should bePerformed if the facilities are Performed if the facilities are available .available .

endomyocardialendomyocardial biopsy & biopsy & radionucleideradionucleideimaging are the other methods of diagnosis but these are imaging are the other methods of diagnosis but these are considered as mainly as the research tools .considered as mainly as the research tools .

Treatment Treatment Treatment Treatment Treatment Treatment Treatment Treatment benzathinebenzathine pencillinpencillin as life as life long prophylaxis.long prophylaxis.

treatment of infective treatment of infective endocarditisendocarditis ififoccurs because of its higher incidence to occurs because of its higher incidence to develop in the damaged valves.develop in the damaged valves.

antianti--failure measures by prescribing failure measures by prescribing digoxin & diureticsdigoxin & diuretics

in case of mild to moderate PHT surgery in case of mild to moderate PHT surgery is the best mode of treatment is the best mode of treatment

--valvotomyvalvotomyopenopenclosedclosed

-- balloon balloon valvuloplastyvalvuloplasty

REFERENCESREFERENCESParks textbook of social and preventive Parks textbook of social and preventive medicine 17medicine 17thth edition.edition.Who technical report series 923: Who technical report series 923: rheumatic fever and rheumatic heart rheumatic fever and rheumatic heart disease.disease.Davidson textbook of medicine 19 Davidson textbook of medicine 19 ththedition.edition.AnanthaAnantha narayansnarayans text book of text book of microbiology ;17microbiology ;17thth edition.edition.Www.AllreferWww.Allreferhealth.Comhealth.Com