Investigation of ear swabs

Microbiology

Infections of the ear can be divided into otitis externa and otitis media.

Otitis externa: In general, infection of the external auditory canal resembles infection of skin and soft tissue elsewhere. However, there are some notable differences. The canal is narrow and, as a result, foreign materials and fluid that enter can become trapped, causing irritation and maceration of the superficial tissues. Otitis externa can be subdivided into categories: acute localised; acute diffuse; chronic; and invasive (‘malignant’). However, except for invasive, they are rarely differentiated as such in clinical practice.

Otitis media: Acute otitis media is defined by the co-existence of fluid in the middle ear and signs and symptoms of acute illness. It can occur when oropharyngeal flora ascends the Eustachian tube and are not eliminated by the defence mechanisms of the middle ear. Otitis media is a common disease in children with frequent recurrence of infections. It is important to treat otitis media because possible complications include the loss of hearing. This could have adverse effects on the development of speech and behaviour in children. Symptomatic relief is suggested as the initial form of treatment with antibiotic therapy prescribed only upon reoccurrence of infection. The role of antibiotic treatment at the

first presentation of infection is a contentious issue as most infections are of viral origin. However, common bacteria causing otitis media, such as Streptococcus pneumoniae and Haemophilus influenzae can be isolated from ear swabs if the tympanic membrane has perforated. Other less common causes include S. aureus, S. pyogenes and Moraxella catarrhalis. Although uncommon in adults, the causative organisms and treatment of otitis media are the same as in children. An external ear swab is not useful in the investigation of otitis media unless there is perforation of the eardrum. Tympanocentesis, to sample middle ear effusion, is rarely justified.

PLEASE NOTE: Samples and accompanying relevant patient/ isolate data maybe referred for confirmatory or further laboratory testing to Reference laboratories. Relevant Public Health departments may also be notified IF a notifiable disease is identified under the Infectious Diseases (Amendment) Regulations 2020 (S.I. No. 53/2020).

Sample Type:

Unless otherwise stated, swabs for bacterial and fungal culture should be placed in Amies transport medium with charcoal.

Temperature: 2-8°C

Turnaround Time:

48h for a negative result.

72h for a positive result.

*Excludes Sundays and Bank Holidays

Sample Stability:

2 days @ 2-8ºC

Instrument / Procedure:

Manual Culture

Units:
Reference Range:
Precautions:

Preparation of patient: Collect specimens before antimicrobial therapy where possible.

Precautions: For investigation of fungal infection, scrapings of material from the ear canal are preferred although swabs can also be used. If processing is delayed, refrigeration is preferable to storage at ambient temperature. Delays of over 48hr are undesirable.

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SAMPLE REQUIREMENTS FOR COAGULATION TESTS

PROCEDURE

Sample Requirements and Collection

  • Patients should be relaxed pre-venepuncture. Excessive stress and exercise will increase FVIII, vWF antigen and fibrinolysis. Venous occlusion should be avoided.  
  • Difficult venepuncture with trauma may lead to platelet activation with release of PF4 from alpha granules.
  • Venous blood should be collected into coagulation tubes containing Sodium Citrate 3.2%, 0.105M.
  • Specimens must be mixed immediately post venepuncture to avoid clot activation, by GENTLY inverting the tubes 5 to 10 times.
  • The ratio of whole blood to anticoagulant is crucial to clotting times. A target blood to anticoagulant ratio of 9:1 is optimal.  Under- or over- filled specimens will not be processed this can adversely affect results.  
  • Any warfarin treatment should be mentioned on the request form.
  • Sample rejection Criteria: Clotted sample, grossly hemolyzed sample, underfilled/overfilled specimen, unlabeled sample, mismatched patient ID, aged samples, wrong sample tube (citrate tube only).

Transportation and Storage

  • PT/INR specimens should be transported to the laboratory at room temperature.
  • Coagulation specimens should ideally be analysed within 4 hours of collection. Where this is not possible, centrifuge specimens at room temperature (RT) @ 1500RCF for at least 15 minutes, and then carefully remove the plasma from the cells, transfer to a fresh plastic plain tube and freeze at -20oC.  
  • Non-frozen coagulation specimens should be transported at RT ASAP to avoid deterioration of labile factors V and VIII.
  • Collection of blood through intravenous lines that have been previously flushed with heparin should be avoided. In the event blood is drawn from an indwelling catheter, the line should be flushed with 5ml of saline, and the first 5ml of blood or 6 times the line volume be drawn off and discarded before coagulation tube is filled.
  • Effect of freezing on Coagulation Specimens.
  • A 14days in-house study on the effect of freezing, on coagulation specimens at -20oC, showed that there was negligible and clinically non-significant effect of freezing on coagulation specimen results. Therefore frozen citrated coagulation samples are stable for 14 days at -20oC, post centrifugation. This study is available in-house for reference.
ESR Ref Ranges
Units of Measurement
MALE
FEMALE
>50 Years
mm/hr
0 - ≤12
0 - ≤15
<50 Years
mm/hr
0 - ≤8
0 - ≤10
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Analyte
Units of Measurement
MALE
FEMALE
WBC
10^9/L
4.0–10.0
4.0 - 10.0
RBC
10^12/L
5.0 ± 0.5
4.3 ± 0.5
HB
g/dL
15.0 ± 2.0
13.5 ± 1.5
HCT
L/L
0.45 ± 0.05
0.41 ± 0.05
MCV
fL
92 ± 9
92 ± 9
MCH
pg
29.5 ± 2.5
29.5 ± 2.5
MCHC
g/dL
33.0 ± 1.5
33.0 ± 1.5
PLT
10^9/L
280 ± 130
280 ± 130
MPV
fL
N/A
N/A
RDW
%
11.6 - 14.0
11.6 - 14.0
#Neut
10^9/L
2.0 – 7.0
(40 - 80%)
#Lymph
10^9/L
1.0 – 3.0
(20 - 40%)
#Mono
10^9/L
0.2 – 1.0
(2 - 10%)
#Eos
10^9/L
0.02 – 0.5
(1 - 6%)
#Baso
10^9/L
0.02 – 0.1
(<1 - 2%)
Analyte
Units of Measurement
MALE & FEMALE
WBC
10^9/L
Birth: 18 ± 8
Day 3: 15 ± 8
Day 7: 14 ± 8
Day 14: 14 ± 8
1 Month: 12 ± 7
2 Months: 10 ± 5
3–6 Months: 12 ± 6
1 Year: 11 ± 5
2–6 Years: 10 ± 5
6–12 Years: 9 ± 4
RBC
10^12/L
Birth: 6.0 ± 1.0
Day 3: 5.3 ± 1.3
Day 7: 5.1 ± 1.2
Day 14: 4.9 ± 1.3
1 Month: 4.2 ± 1.2
2 Months: 3.7 ± 0.6
3–6 Months: 4.7 ± 0.6
1 Year: 4.5 ± 0.6
2–6 Years: 4.6 ± 0.6
6–12 Years: 4.6 ± 0.6
HB
g/dL
Birth: 18.0 ± 4.0
Day 3: 18.0 ± 3.0
Day 7: 17.5 ± 4.0
Day 14: 16.5 ± 4.0
1 Month: 14.0 ± 2.5
2 Months: 11.2± 1.8
3–6 Months: 12.6 ± 1.5
1 Year: 12.6 ± 1.5
2–6 Years: 12.5 ± 1.5
6–12 Years: 13.5 ± 2.0
HCT
L/L
Birth: 0.60 ± 0.15
Day 3: 0.56 ± 0.11
Day 7: 0.54 ± 0.12
Day 14: 0.51 ± 0.12
1 Month: 0.43 ± 0.10
2 Months: 0.35 ± 0.07
3–6 Months: 0.35 ± 0.08
1 Year: 0.34 ± 0.04
2–6 Years: 0.37 ± 0.03
6–12 Years: 0.40 ± 0.05
MCV
fL
Birth: 110 ± 10
Day 3: 105 ± 13
Day 7: 107 ± 19
Day 14: 105 ± 19
1 Month: 104 ± 12
2 Months: 95 ± 8
3–6 Months: 76 ± 8
1 Year: 78 ± 6
2–6 Years: 81 ± 6
6–12 Years: 86 ± 9
MCH
pg
Birth: 34 ± 3
Day 3: 34 ± 3
Day 7: 34 ± 3
Day 14: 34 ± 3
1 Month: 33 ± 3
2 Months: 30 ± 3
3–6 Months: 27 ± 3
1 Year: 27 ± 2
2–6 Years: 27 ± 3
6–12 Years: 29 ± 4
MCHC
g/dL
Birth: 33.0 ± 3.0
Day 3: 33.0 ± 4.0
Day 7: 33.0 ± 5.0
Day 14: 33.0 ± 5.0
1 Month: 33.0 ± 4.0
2 Months: 32.0 ± 3.5
3–6 Months: 33.0 ± 3.0
1 Year: 34.0 ± 2.0
2–6 Years: 34.0 ± 3.0
6–12 Years: 34.0 ± 3.0
PLT
10^9/L
Birth: 100 – 450
Day 3: 210 – 500
Day 7: 160 – 500
Day 14: 170 – 500
1 Month: 200 – 500
2 Months: 210 – 650
3–6 Months: 200 – 550
1 Year: 200 – 550
2–6 Years: 200 – 490
6–12 Years: 170 – 450
Reticulocytes
10^9/L
Birth: 120 – 400
Day 3: 50 – 350
Day 7: 50 – 100
Day 14: 50 - 100
1 Month: 20 – 60
2 Months: 30 – 50
3–6 Months: 40 – 100
1 Year: 30 – 100
2–6 Years: 30 – 100
6–12 Years: 30 – 100
#Neut
10^9/L
Birth: 4 – 14
Day 3: 3 – 5
Day 7: 3 – 6
Day 14: 3 – 7
1 Month: 3 – 9
2 Months: 1.0 – 5
3–6 Months: 1 – 6
1 Year: 1 – 7
2–6 Years: 1.5 – 8
6–12 Years: 2 – 8
#Lymph
10^9/L
Birth: 3 – 8
Day 3: 2 – 8
Day 7: 3 – 9
Day 14: 3 – 9
1 Month: 3 – 16
2 Months: 4 – 10
3–6 Months: 4 – 12
1 Year: 3.5 – 11
2–6 Years: 6 - 9
6–12 Years: 1 - 5
#Mono
10^9/L
Birth: 0.5 – 2.0
Day 3: 0.5 – 1.0
Day 7: 0.1 – 1.7
Day 14: 0.1 – 1.7
1 Month: 0.3 – 1.0
2 Months: 0.4 – 1.2
3–6 Months: 0.2 – 1.2
1 Year: 0.2 – 1.0
2–6 Years: 0.2 – 1.0
6–12 Years: 0.2 – 1.0
#Eos
10^9/L
Birth: 0.1 – 1.0
Day 3: 0.1 – 2.0
Day 7: 0.1 – 0.8
Day 14: 0.1 – 0.9
1 Month: 0.2 – 1.0
2 Months: 0.1 – 1.0
3–6 Months: 0.1 – 1.0
1 Year: 0.1 – 1.0
2–6 Years: 0.1 – 1.0
6–12 Years: 0.1 – 1.0
Reference Ranges:
Age
Absolute Reference Range
Age
% Reference Range
0 - 1 day
324 - 617 x109/L
0 - 1 day
1.72 - 8.62%
1 - 5 days
85 - 400 x109/L
1 - 5 days
1.9 - 9.1%
5 days - 1 mth
34.2 - 724 x109/L
5 days - 1 mth
0.1 - 6.9%
1 - 3 mths
21.3 - 205 x109/L
1 - 3 mths
0.1 - 6.27%
3 - 12 mths
8.0 - 171 x109/L
3 - 12 mths
0.1 - 4.7%
1 - 3 yrs
55.6 - 120 x109/L
1 - 3 yrs
0.35 - 2.95%
3 - 7yrs
16.4 - 120.7 x109/L
3 - 7yrs
0.25 - 2.57%
Adult
35.2 - 122.8 x109/L
Adult
0.75 - 2.7%
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