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Laboratory Diagnosis of Respiratory Infections

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Laboratory diagnosis of respiratory infections

In our laboratory, we offer tests for the diagnosis of upper respiratory tract infections-pharyngitis, sinusitis, ocular and ear infections, and lower tract infections including pneumonia and bronchitis. Today we will focus on the diagnosis of common bacterial causes of pharyngitis and lower respiratory tract infections. Dr Miller will cover mycobacterial, fungal, and viral causes of lower respiratory tract infections with a special emphasis on the use of molecular methods to detect these organisms.

Upper respiratory tract infections

Pharyngitis- Group A streptococci is the most important bacterial cause of pharyngitis. Although pharyngitis is typically a self-limited disease, the diagnosis of group A streptococci may be attempted. The reasons may be to prevent the overuse of antimicrobials to treat pharyngitis (GAS negative patients are not treated) and to prevent ping-ponging of GAS in family with susceptible children. 1. GAS diagnostic strategy- Rapid Antigen Detection Test (RADT)- can be used in adults; test has high specificity (99%+) but sensitivity ranging from 80-90% (dependent upon test used and quality of specimen collection). Antigen positive patients would be treated but antigen negative patients would not. a. What about back-up culture- pro-can detect other agents of pharyngitis including Group C and G strep which is a common cause of bacterial pharyngitis as well as Arcanobacterium. i. Arcanobacterium-weakly beta hemolytic, gram positive rod can be confused with group F streptococci-seen in adults causes a scarlet fever like syndrome with a scarlantiform-like rash b. Con- culture adds expense and positive cultures require follow up; cases of rheumatic fever are vanishing rare in adult-ED rarely does back up culture 2. Neisseria gonorrhoeae is the other...

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