CLIA and Strep throat
2 tests that are NOT CLIA-waived
-*Microscopic UA* and *wet prep* (KOH or vaginal exam) -anything you have to look in a microscope for -must be performed by provider & are more complex
alpha hemolytic vs beta hemolytic
-Alpha - mild, less toxic -Beta - severe, very toxic
List of CLIA waived procedures
-CBC -CMP -Lipid panel -Strep antigen -Flu swab -*macroscopic* UA -urine preg. -glucometer/glucose -microalbumin -mono -occult blood -PT/INR -RSV -TSH
Signs & Tx of acute post-strep glomerulonephritis
-Hematuria, proteinuria -Swollen feet -HTN -low grade fever -headache -Tx: hydration, supportive
How to treat acute Rheumatic Fever
-IV antibiotics -cardiovascular support -ICU admission
Kissing tonsils
-If tonsils are touching each other. -Makes it hard to breathe and swallow. -concerning -due to strep pharyngitis
Thrush & a cause in adults
-oral candidiasis (yeast infection) -painful, burning -baby won't eat/drink -ADULTS: could be caused by *steroids* or HIV or Diabetes
PE for strep throat
-palpate abdomen (r/o splenomegaly) -look in nose -sinus exam -ear exam
Reasons you get false positive strep results
-pt may be a carrier -misidentification of B-hemolytic strep belonging to other strep groups
*Fusobacterium necrophorum (F-throat)* -demographics -cause -type of bacteria -sx -tx
-MC in college-age kids/adults -potentially fatal if misdiagnosed or untreated -not detected in routine cultures -*Gram neg bacilli* that's part of normal flora -Causes *Lemierre's syndrome* (septic thrombosis in internal jugular vein of neck) -severe sore throat doesn't improve -fever, night sweats, chills -itchy throat -cervical lymphadenopathy -unilateral neck swelling -*RESISTANT to Z-pack* -Tx w/ PCN, clindamycin, or Flagyl
CLIA-waived
-The Clinical Laboratory Improvement Amendment of 1988 established that some clinical tests be exempted from certain laboratory requirements -*simple tests* -*No legally required audits* -don't have to be a trained lab tech to do them
Reasons you get false negative strep results
-bad culture technique -faulty bacteriologic methods -occult antibiotic use
ASO titer & what causes false pos & false neg
-detects prior infection of GABHS, Strep C, or Strep G -measures *level of antistreptolysin O antibodies in blood plasma* -can also indicate a URI, TSS, or scarlet fever -*False neg*: antibiotic use -*False pos*: liver disease, TB, Elevated B-lipoprotein levels
GABHS
-group A beta hemolytic strep (strep pyogenes) -*gram pos cocci* usually in *chains* -smear on blood agar to classify type of hemolysis -beta = *clear zone of hemolysis*
Gonorrhea pharyngitis throat appearance
-just red
CLIA moderate complexity labs
-more complex tests -requires higher level of operator training/education -audits are *legally required* and are more frequent
sore throat differential diagnoses
-thrush -diphtheria -gonorrhea -strep throat -mono
Diphtheria throat
-uncommon acute bacterial infection -gray nastiness in back of throat
Workup if a pt is young & has cardiac/hematuria sx
ASO titer to detect prior strep infection
CLIA
Clinical Laboratory Improvement Amendments
How to do intranasal swab
Pass the swab *STRAIGHT BACK* should cause pt. discomfort & runny eyes
Tx of strep throat
amoxicillin..... if mono is true dx, this will cause a rash
