Karuna Thapar, Sandeep Aggarwal, Naresh Jindal
Govt medical college, Amritsar Email: drsandeep222@yahoo.co.in

In lower respiratory tract infections in children it is important to identify pathogens in lower airways for effective antibiotic therapy. Except sputum collection, other techniqueslike bronchoalveolar lavage (BAL) fluid, and lung aspirates are invasive. In addition, young children cannot expectorate. This study demonstrates the importance of throat swab and oropharyngeal secretions in diagnosing micro-organisms in small children with lower respiratory tract infections especially after physiotherapy. Early detection of causative pathogen is our necessity and to develop the methods within the available resources is our compulsion, satisfaction and invention.
Design : A prospective hospital based study.
Setting and Methods : 15 out of 65 children aged 2 months-1.5 years admitted with respiratory distress in the Pediatrics Department of Government Medical College Amritsar from January 2006 to March 2006were the subjects of the study after excluding cases with recurrent attacks and cases receiving antibiotics just before admission. Throat swab was collected by gently rubbing a sterile swab stick over pharyngeal wall and replacing the same in sterile vials. Oropharyngeal secretions was collected by gentle suctioning by sterile and disposable neonatal mucus sucker attached to gentle suction machine to avoid contamination. For samples after physiotherapy, child was given chest physiotherapy and samples were collected thereafter.
Results : During the study period, a total of 60 samples from 15 patients were collected, 46% (28/60 samples) were positive for pathogens. Mean age of patients was 5.6 months. Out of positive cultures 39% (11/28 samples) were of Streptococcus pneumoniae, 28.5% for Klebsiella pneumoniae, 21% for Enterobacter, 10% for Staphylococcus aureus and 7% for Pseudomonas aeruginosa. Out of positive cultures, 67.8% (19/28 samples) were after physiotherapy as compared to 32% (9/28 samples) before physiotherapy.
Conclusion: We conclude that throat swab and oropharyngeal secretions after physiotherapy can be used reliably for identification of lower airway pathogens. . Physiotherapy helps in loosening up of secretions in the lower airways and facilitates the movement of the same towards upper airway.

Last updated: 1-12-2007

Thapar K, Aggarwal S, Jindal N. Comparison of Throat Swab / Oropharyngeal Secretions with and without Chest Physiotherapy in Small Children Unable to Expectorate in Absence of Invasive Methods in Lower Respiratory Infections. Pediatric Oncall [serial online] 2007 [cited 2007 December 1];4. Available from:
http://www.pediatriconcall.com/fordoctor/viewersChoice/
comparison_ofthroat_swab.asp