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Streptococcus pyogenes

Corynebacterium diphtheriae

Arcanobacterium haemolyticum

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Sterile throat swab, nasal swab, nasopharyngeal swab, nasal washings, sinus aspirates, typanocentesis fluids, and oral cultures can be submitted for detection of upper respiratory tract pathogens.

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Set up BAP (blood agar plate), CHOC (chocolate plate), and MAC (McConkey plate) from specimen received. Do not need to perform direct smear from a URT specimen due to too much normal flora being present, it would be hard to differentiate between normal flora and pathogen.

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Haemophilus influenzae

Haemophilus parainfluenzae

Neisseria sp.

Bordetella pertussis

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runny/stuffy nose

sore throat

cough

fever

headache

fatigue

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Main pathogen

Also known as Strep A.

Gram positive cocci in chains

Beta hemolytic on BAP (large zone)

Catalase negative

A disc (Bacitracin) susceptible

PYR positive

LAP positive

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Pleomorphic gram negative rods (may find intracellularly)

Tan, translucent colony on CHOC agar (will not grow on MAC or BAP)

Has a distinct bleach-like or mousy odor

Contains a capsule which will make it appear mucoid

Oxidase positive, Spot Indole positive, requires both x and v factor, ALA porphyrin test negative

If suspected, use ID system to identify (Vitek, rapid NH, MALDI)

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Hyaluronidase

-spreading factor

M protein

-resist phagocytosis

Streptolysin S

-oxygen stable hemolysin

Streptolysin O

-oxygen labile hemolysin

Streptococcal pyrogenic exotoxin

-superantigen (cause scarlet fever, toxic shock, and necrotizing fasciitis)

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Pleomorphic gram negative bacilli. Diphtheroid (palisading and letter formation)

Cystine-tellurite blood agar (CTBA) is selective and differential plate for this pathogen

Catalase positive

Urease negative

Nitrate positive

ELEK (immunodiffusion) test for toxin detection

Reportable disease

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Pleomorphic gram negative rods

Translucent tan colony on CHOC agar (no growth on BAP or MAC)

Oxidase positive, Spot Indole negative, requires v factor but can make its own x factor, ALA porphyrin test positive

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Respiratory disease caused by diphtheria toxin

-kills tissue locally leading to necrosis

Not all C. diphtheria are positive for the toxin

-bacteria must be infected by a beta-phage that carries the tox gene (ELEK test to identify toxin production)

Treatment is to neutralize toxin

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Infection presents like strep throat

Gram positive bacillus of many shapes

Translucent, beta hemolytic colony on BAP

-black dot can be left behind on agar after colony is scraped away

Catalase negative

Reverse CAMP test positive (arrow-shaped zone of hemolysis)

Intrinsically resistant to penicillin

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Nasopharynx swab not throat swab

Small gram negative coccobacilli that stain faintly - use carbolfuschin instead of safranin will help

Strict aerobe and very fastidious

Regan Lowe or Bordet-Gengou Agar (drops of mercury) with charcoal

Often not identified with culture, direct fluorescent antibody or PCR is usually used

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Neisseria gonnorrheae:

Gram negative dipplococci (coffee beans)

tan/gray flat colonies on CHOC plate

Oxidase positive

Catarrhalis disc test negative

Typically use ID system to identify (rapid NH, Vitek, MALDI)

Upper respiratory tract infection with Neisseria gonorrheae isn't common but can occur