INDICATIONS OF THROAT SWAB

Pharyngitis And Tonsillitis

Clinically Suggested By Observing
An Inflamed And Edematous mucosa.

Pharyngeal Mucosa In A Patient

Who Complains Of Throat Pain
Difficulty In Swallowing And
Secondary Symptoms Such As
Fever Headache And Occasionally A
Scarletiniform Rash.

Purulent Exudates Over The

Posterior Pharynx And Tonsillar
Area May Also Be Observed.
 OBTAINING

A Bright Light Should Be Focussed In To

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

The Patient Is Instruted To Tilt His Or

Her Head Back And Breathe Deeply.

The Tongue Is Depressed With A Tongue

Blade To Visualize The Tonsillar Fossae
And Posterior Pharynx.

The Swab Is Extended Between The

Tonsillar Pillars And Behind The Uvula.
 Care Should Be Taken Not To
Touch The Lateral Walls Of The
Buccal Cavity Or The Tongue To
Minimize Contamination With The
Commensal Bacteria.

Having The Patient Phonate A

Long “Ah “ Serves To Lift The
Uvula And Helps Prevent
Gagging.

The Tonsillar Area And The

Posterior Pharynx Should Be
Firmly Rubbed With The Swab .
Any Purulent Exudate
Should Also Be Sampled.
After Collection The Swab Should Be Placed

Immediately Into A Sterile Tube Or Other

Suitable Container For Transport To The

Laboratory.

If The Recovery Of Only Group A Organisms Is

Desired Swabs May Be Allowed To Dry During

Transport Without Compromising The Recovery

Of The Viable Organisms.

While Transporting Care Should Be Taken To

Avoid Conditions That Are Suboptimal For The

Survival Of Streptococci Such A High

Temperature And Swabs That Remain Moist For

Long Periods.
 GRAM STAINING
Devised By Histologists Christian Gram
As A Method Of Staining Bacteria In
Tissues.

Steps In Gram Staining ,

Smearing The Slide With A Swab.

Primary Staining With The Gentian Violet and

wait for 2 minute.
Application Of A Dilute
Solution Of Iodine (1 min)

Decolourisation With An
Organic Solvent.Acetone

Counterstaining With The

Dye Of Contrasting
Colour Such As Carbol
Fuschin ( 30 secs)
Group A streptococci is demonstrated
by gram staining which is B haemolytic
when produce pharyngitis cause
rheumatic fever and rheumatic heart
disease as a nonsuppurative
complications because of the delayed
immune response.
Rheumatic heart disease is a problem in all parts of

the world especially the developing countries.

the reported prevalence rates in school age children in

various parts of the world range from very low to high

as 33 cases /1000

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

age group is rheumatic heart disease

Major public health problem among children and

young aduls in developing countries.

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

Presence of group A streptococci

in the URT may reflect either true
infection or A carrier state .

only in the case of true infection patients

show A rising antibody response .
The prevalance of RF & RHD & the mortality&
Morbidity rates varied widely b/w countries
& b/w population groups.

In india 1.0-5.0 /1000 school children .

FACTORS WHICH PLAY AN IMPORTANT ROLE IN
THE EMERGANCE OF RHEUMATIC FEVER AND
RHEUMATIC HEART DISEASE
Socioeconomic & environmental factors
play an indirect but Important role in the
magnitude and severity of RF and RHD.
Such factors are
shortage of resources for providing quality
health care.
inadequate expedition of health care providers .
lower level of awareness in the community
Crowding.
Inadequate diagnosis and treatment of
Streptococcal pharyngitis .

mis diagnosis or late diagnosis of

acute rheumatic fever

inadequate secondary prophylaxis or

non compliance with secondary prophylaxis

Patient unaware about the first RF episode

Higher incidence of acute RF and its recurrence.

Untimely intiation or lack of secondary

prophylaxis
rheumatic heart disease comprises,

- mitral regurgitation which is the most

common among the school going age
group.

- Then mitral stenosis is the common among all

age group.

- Aortic stenosis and aortic regurgitation is

next to the above

- Tricuspid regurgitation and tricuspid stenosis

frequency among RHD is very rare
CLINICAL PRESENTATION
Involves
chest pain .

-breathlessness.

-palpitations.

-syncopial attacks.

-features of infective endocarditis.

-or with the features of CCF

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

role of echocardiography should

be considered supportive.

Echodoppler examination should be

Performed if the facilities are
available .

endomyocardial biopsy & radionucleide

imaging are the other methods of diagnosis but these are
considered as mainly as the research tools .
Treatment
benzathine pencillin as life
long prophylaxis.

treatment of infective endocarditis if

occurs because of its higher incidence to
develop in the damaged valves.

anti-failure measures by prescribing

digoxin & diuretics

in case of mild to moderate PHT surgery

is the best mode of treatment
-valvotomy
open
closed
- balloon valvuloplasty
 REFERENCES
Parks textbook of social and preventive
medicine 17th edition.
Who technical report series 923:
rheumatic fever and rheumatic heart
disease.
Davidson textbook of medicine 19 th
edition.
Anantha narayans text book of
microbiology ;17th edition.
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