THE DIAGNOSIS OF BACTERIAL INFECTIONS AT DIFFERENT BODY SITES:

SITE OF INFECTION Respiratory tract

PRESENTING SIGNS AND SYMPTOMS

SPECIMENS TO CULTURE

BACTERIAL SPECIES POTENTIALLY ASSOCIATED WITH INFECTIONS

Upper tract nose and sinuses: Headache Pain and redness over malar area Rhinitis Radiograph :sinus consolidation, fluid levels, or membrane thickness. Upper tract- throat and pharynx: Redness and edema of mucosa Exudation of tonsils
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Acute: Nasopharyngeal swabs Sinus washings Chronic: Sinus washings Surgical biopsy specimen

Streptococcus pneumoniae Streptococcus, betahemolytic group A Staphylococcus aureus Haemophilus influenzae Klebsiella spp. And other Enerobacteriaceae Bacteroides spp. And other anaerobes (sinus)

Swabs of posterior pharynx Streptococcus, betaSwabs of tonsils(abscess) hemolytic group A Nasopharyngeal swabs Corynebacterium diphtheriae Neisseria gonorrhea Bordetella pertusis

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Pseudomembrane formation Edema of uvula Gray coating of tongue :"strawberry tongue" Enlargement of cervical nodes Lower tract- lungs and bronchi: Cough :bloody or profuse Chest pain Dyspenia Consolidation of lungs: Rales and and rhonchidiminished breath sounds Dullness to percussion Radiographic infiltration Cavity lesions Empyema
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sputum(poor return) blood bronchoscopy secretions transtracheal aspirate lung aspirate or biopsy

Streptococcus pneumoniae Haemophilus influenza Staphylococcus aureus Klebsiella pneumoniae and other Enerobacteriaceae Moraxella catarhalis Legionella spp Mycobacterium spp Fusobacterium nucleatum; Prevotella melaninogenicus and other anaerobes Bordetella species

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Middle ear

Serous or purulent drainage Deep pain in ear and jaw Throbbing headache Red bulging tympanic membrane

Acute: no culture Nasopharyngeal swab Tympanic membrane aspirate Chronic: Drainage of external meatus

Acute: Streptococcus pneumoniae and other streotococci Haemophilus influenza Chronic: Pseudomonas aeroginosa Proteus spp. Anaerobic bacteria Helicobacter pylori

Gastrointestin al tract

Upper- stomach and duodenum Gastritis and peptic ulcer disease Lower- small and large intestine Diarrhea Dysentery Purulent Mucous
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Gastric or duodenal biopsy

Campylobacter jejunum and Stool specimen other Campylobacter spp Rectal swab or rectal mucus Salmonella spp. blood culture (typhoid Shigella spp. fever) Escherichia coli (toxigenic strains) Vibrio cholera and other Vibrio spp.
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Bloody Cramping abdominal pain

Urinary tract

Genital tract

Urinary bladder infection : Pyuria Dysuria Hematuria Pain and tenderness; suprapubic or lower abdomen Kidney infection: Back pain Tenderness: costovertebral angle (CVA) Males: Urethral discharge serous or purulent Burning on urination Terminal hematuria Females: Purulent vaginal
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Clean-catch midstream urine Catheterized urine Suprapubic aspiration of urine

Yersinia species Clostridium difficile ( demonstration of toxin) Enerobacteriaceae Escherichia coli Klebsiella Proteus spp. Enterococcus spp. Pseudomonas aeroginosa Staphylococcus aureus, S. epidemidis, and S. saprophyticus

Urethral discharge Prostatic secretions

Uterine cervix
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Neisseria. gonorrhoeae (N. meningitis) Haemophilus ducreyi Treponema pallidium (syphilis) Mebiluncus spp. and other anaerobes Gardnerella vaginalis

discharge Burning on urination Lower abdominal pain, spasm and tenderness Mucous membrane chancre or chancroid
Central nervous system

Rectum (anal sphincter swab) Urethral swab Dark field examination

Nonbacterial: Trichomonas vaginalis Candida albicans Mycoplasma spp. Chlamydia trachomatis Herpes simplex virus Neisseria .meningitis Haemophilus influenza Streptococcus pneumoniae Streptococcus, betahemolytic groups A and B(group B infants) Enterobacteraceae: debilitated patients, infants and posteraniotomy Listeria monocytogenes Haemophilus spp. Moraxella spp. Neisseria.gonorrhoeae Staphylococcus aureus Streptococcus pneumoniae

Headache Pain in neck and back Stiff neck Straight -leg raising :positive Kernig's sign Nausea and vomiting Stupor to coma Petechial rash

Spinal fluid Subdural aspirate Blood culture Throat or sputum culture

Eye

Conjunctival discharge :serous Purulent discharge or purulent Lower cul-de-sac Conjunctival redness Inner canthus (hyperemia) :pink eye Ocular pain and tenderness
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Streptococcus pyogenes Pseudomonas aeroginosa (report stat)

Blood

Spiking fever Chills Cardiac murmur (endocarditis) Petechiae: skin and mucous membranes "Splinter hemorrhages" of nails Malaise

Wounds

Discharge: serous or purulent

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Blood: three or four cultures Streptococcus spp. per day at 1-h intervals or Group A- all ages longer S.viridans(endocarditis) Any suspected primary site Groups A,B,D- neonates of infection: Streptococcus Cerebrospinal fluid pneumoniae Respiratory tract Staphylococcus aureus Skin- umbilicus Listeria monocytogenes Skin- ear Corynebacterium jekium Wounds Haemophilus influenza Urinary tract HACEK group Escherichia coli and other "coliforms" Salmonella typhi Pseudomonas aeroginosa Bacteroides fragilis and other anaerobic bacteria Aspirate of drainage Staphylococcus aureus
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Abscess: subcutaneous or submucosal Redness and edema Crepitation (gas formation) Pain Ulceration or sinus formation
Bones and joints

Deep swab of purulent drainage Tissue biopsy

Joint swelling Redness and heat Pain and motion tenderness on palpation Radiograph: synovitis or osteomyelitis

Joint aspirate Synovial biopsy Bone spicules or bone marrow aspirate

Streptococcus pyogenes Clostridium spp., Bacteroides spp., and other anaerobic bacteria Enterobacteraceae Pseudomonas aeroginosa Entreococcus species Staphylococcus aureus Haemophilus influenza Streptococcus pyogenes Neisseria.gonorrhoeae Streptococcus pneumonae Enterobacteraceae Mycobacterium species

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