If the amount of material aspirated is small, it may be advisable to inject it into an anaerobic transport or absorb it onto the swab of the bacterial swab collection kit and use the bacterial transport. [QxMD MEDLINE Link]. However, the plates tell a different story. 2nd edition. Anaerobic organisms that are frequently implicated in chronic infection of the tonsils and adenoids are not recovered by aerobic culture methods. 2021 Mar;70(1):25-32. doi: 10.33073/pjm-2021-013. The effect of saline on specimen quality will vary depending on transport time, processing and culture methods. Turnaround time: Cultures are examined for at least 48 hours. This will help your body make more sputum. 2019 Feb;71(2):152-165. doi: 10.1002/iub.1969. eCollection 2014. If the patient aspirates these bacteria, they may cause infection within the lungs. Doctoral Degree. In this case, no predominant pathogen was identified in culture. Most cases in children now are in those who are unvaccinated or under-vaccinated. The clinical microbiology of Waldeyer's ring. Meyer RD. The normal flora of the respiratory tract is made up of the following: Common residents (>50% of the healthy general population): Oral . The profiles of respiratory flora in the occurrence and development of chronic respiratory. Can persist for weeks to months at this site. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. Theyre resistant to most available antibiotics and can find new ways to fight off attacks. Your treatment plan will vary, depending on your diagnosis. Haemophilus influenzae symptoms in babies and children depend on the specific disease that it causes. Positive: Because common causes of pararespiratory infections are usually derived from upper respiratory tract endogenous flora, positive culture must be interpreted in the context of quantity or bacterial growth, purity of culture, Gram stain findings, and clinical signs and symptoms. Symptoms depend on site of infection. The quality of sputum samples is determined by the minimum number of squamous epithelial cells and polymorphonuclear leukocytes per low power field. upper respiratory tract flora: Microbiology Bacteria that are normally located in the upper respiratory tract Nearly one-third of adults are colonized with Staphylococcus aureus in their respiratory tracts. The best way to prevent these types of infections is through vaccination. If you cant cough up enough sputum, try breathing steam in from boiling water, or take a hot steamy shower. In addition to a fungal culture, a saline wet preparation, Gram stain, or KOH preparation demonstrating yeast cells or pseudohyphae may also be useful in rapidly establishing the diagnosis of oral or mucocutaneous candidiasis. Normal respiratory flora (NRF). The soil samples were collected from Iasi's urban area to determine the heavy metal concentrations, obtain maps of sensitive land, and determine the content of . Normal Respiratory Microbiota in Health and Disease, 2023. If you have trouble, they may give you a breathing treatment to help loosen the sputum in your airways. An E.coli outbreak that has caused 29 illnesses and 9 hospitalizations in Michigan and Ohio is being investigated by the CDC. Brook I. Haemophilus influenzae Disease (Including Hib). A purulent specimen that contains many intracellular gram-negative diplococci and yields heavy growth ofM. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Available from: Lab Tests Online [Internet]. New York: About, Inc.; c2020. Scientists believe that Hib cant survive on non-living surfaces or in the environment. The specimen was plated on blood, chocolate and MacConkey agars. All rights reserved. They may ask you to avoid taking medicines that raise your risk of bleeding, such as aspirin and warfarin, the day before your procedure. Abstract. Cultures of Mycoplasma are infrequently done; diagnosis is usually confirmed by a rise in antibody titer. Gram stains should be routinely performed to determine specimen acceptability and used as a guide for culture workup. Your provider may need to do more tests to find the specific type of infection you have. Expert Review of Anti-Infective Therapy. A large white colony is growing into the fourth quadrant, making it the predominant organism with heavy growth. Also, because polymicrobial lower respiratory tract infections are rare, it is more likely that the true pathogen has been identified if there is heavy growth of a single organism than if there is mixed growth. Susceptibility If the patient is taking an antibiotic to which the bacteria are reported as resistant (R) or You can learn more about how we ensure our content is accurate and current by reading our. The client should be instructed to avoid adding saliva or nasopharyngeal secretions to the sputum sample. [Guideline] Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC. this information and the choices you have about how we use such information. In fact, pneumonia is the second most common nosocomial infection affecting critically ill patients in the ICU. There are six subtypes of H. influenzae type a through type f. Other types of H. influenzae are classified as non-typeable. 2,010 satisfied customers. 2020 Aug. 61 (4):420-5. A child who develops a viral upper respiratory tract infection while colonized may develop acute otitis media or sinusitis. Brown. Specimen collection after antibiotic therapy has been initiated may result in inhibited or no growth of organisms. Note any current antibiotic therapy on the laboratory slip. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. The test is sometimes called a Grams stain of sputum. The Gram stain looks for bacteria in the sample and determines the type of bacteria causing a condition. Contact a health care provider if you have questions about your health. Then, theyll complete the series with a booster dose between 12 months old and 15 months old. catarrhalis is part of the normal upper respiratory tract flora, only adequately screened sputum samples provide useful diagnostic information. Cutaneous and mucosal manifestations of the deep mycotic infections. As these secretions pool in the oropharynx, bacteria that live in the respiratory tract can begin to accumulate along the endotracheal tube. This is also true for other Gram-negative rods including the Enterobacterales. Some strains of MRSA cause infections that are acquired outside of a health care facility (called community-acquired infection), including mild abscesses and skin infections. For example, little to no growth might indicate something odd going on if you haven't been taking antibiotics. Then breathe deeply and cough hard until sputum comes up. Several days are required for isolation and identification, susceptibility testing, and further characterization of isolates. It is important to understand how some of the most common causes of pneumonia transition from colonizers to opportunistic pathogens. Bacteria with thick cell walls will produce a Gram-positive result. Symptoms depend on the specific. However, H. influenzae can be resistant to antibiotics. Am J Respir Crit Care Med. The relationships between humans and bacteria are immensely complex. Epub 2019 Apr 8. The rapid identification of group A beta-hemolytic Streptococci in the upper respiratory tract. Lung inflammation and disease: A perspective on microbial homeostasis and metabolism. Prompt diagnosis and treatment are essential for these types of bacterial infections. The impact of PM2.5 on the host defense of respiratory system. If you still cant cough up enough sputum, your doctor will likely do a bronchoscopy to collect sputum directly from your lungs. 1752 N St. NW Erythromycin, a cephalosporin, or clindamycin might be substituted in these cases. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Many organisms are susceptible to temperature changes or delays in testing. Available from: UW Health [Internet]. They might also give you a sedative to help you relax, or medication to put you to sleep, but general anesthesia isnt required. Clonal basis for resurgence of serious. A sputum culture is often done with another test called a Gram stain. Diagnosis is clinical combined with Gram stain and anaerobic cultures. Examination of a Gram-stained smear of the specimen frequently reveals whether the specimen is satisfactory or not. Epub 2018 Nov 22. Bethesda (MD): U.S. Department of Health and Human Services; Bronchoscopy: Overview; [cited 2020 Jun 30]; [about 3 screens]. Daviss Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications. Your doctor may order a sputum Grams stain to help identify the cause of pneumonia. Available from: American Lung Association [Internet]. Check expiration date of transport; do not use expired device. So I was looking at my test results and it seems that the times I feel the worst are when my normal upper respiratory flora levels are reported to be "heavy growth" (HEAVY GROWTH NORMAL UPPER RESPIRATORY FLORA ISOLATED). Common bacteria likely to cause pneumonias include: Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis. Sputum can be one of several different colors. Majd Ibrahim, MD is a member of the following medical societies: American College of Physicians, American Medical AssociationDisclosure: Nothing to disclose. Lippincott Williams & Wilkins: 2004. However, these are growing in insignificant amounts, are not predominant and were not seen in the Gram stain. sharing sensitive information, make sure youre on a federal [Full Text]. Zhu SF, Wu XX, Guo Y, Li PF, Wang JR, Liu M, Luo CW, Yuan XZ, Li SW. Front Med (Lausanne). Refrigeration slows other bacterial growth. This looks like normal respiratory microbiota without the presence of a predominant pathogen. I just had a throat culture and the results came back chryseobacterium indolence very heavy growth and normal respiratory flora moderate growth . Chicago: American Lung Association; c2020. and transmitted securely. (Press Enter or Space to Go to Landing Page or Press Down to expand Menu), Reflex Table for Upper Respiratory Culture, Federally Qualified Health Centers (FQHCs), GC (Neisseria gonorrhoeae) Culture Only [008128], Combatting Modern Slavery and Human Trafficking Statement. Logistics Lab Testing Sections: Microbiology Phone Numbers: MIN Lab: 612 -813 5866 STP Lab: 651-220-6555 Test Availability: Daily, 24 hours Turnaround Time: Preliminary report available at 1 day, final report within 2 - 5 days. It can also affect people who have weakened immune systems (are immunocompromised), such as those with: The Hib vaccine can help protect against Haemophilus influenzae type b infections. If P. aeruginosa is the predominant organism growing in a tracheal aspirate culture from a ventilated patient with symptoms of pneumonia, it is likely the causative pathogen. 2019 Aug;156(2):376-382. doi: 10.1016/j.chest.2019.05.011. The in-line suction technique collects mucus from the closed tracheal tube system that has been connected to the patient since they were hooked up to the ventilator. This site needs JavaScript to work properly. If the organism is fully identified and reported, should susceptibility testing be performed? Invasive diseases usually require hospital treatment and can sometimes be fatal. Epub 2022 Jul 22. de Fays C, Carlier FM, Gohy S, Pilette C. Cells. Sometimes, severe cases of pneumonia can lead to: Early diagnosis can help your doctor prescribe a treatment plan, which may help improve your outlook. If the test results from your sputum Grams stain are abnormal, it means that bacteria and white blood cells have been detected. Like Lyme disease, anaplasmosis is spread by tick bites. Currently, there are no standards for laboratory workup of tracheal aspirate cultures. This test can determine if you have TB or another infection. It is mostly made up of white blood . FOIA Antibody or complement deficiency syndromes. S. aureus carriage in the upper airways may be occasional or persistent, 12 and its success as a component of the respiratory flora is determined by its ability to scavenge iron and coordinate gene expression, as well as the horizontal acquisition of useful genetic elements. Real-life Examples of Challenging Tracheal Aspirate Cultures. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. eCollection 2022. This allows cilia (tiny hairs) in the airways to push it through the mouth and be coughed out. The most common type of H. influenzae is Haemophilus influenzae type b (Hib). Understanding that a single organism may be either normal microbiota or a pathogen encourages the microbiologist and clinician to consider other key factors when making a VAP diagnosis such as which organisms constitute normal respiratory flora and what makes some members of the respiratory microbiota more pathogenic than others. Organisms that normally live within the respiratory tract may end up being the same organisms that cause pneumonia in these patients. It's often caused by microorganisms, like bacteria, viruses, or fungi. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjExOTIzMi1vdmVydmlldw==. Available from: American Lung Association [Internet]. Available from: Lab Tests Online [Internet]. colonization can lead to bacteremia, meningitis or septic arthritis. Your childs provider may give the Hib vaccine as a stand-alone vaccine [PRP-T (ActHIB), PRP-T (Hiberix) or PRP-OMP (Pedvax HIB)] or as part of a combination vaccine [DTap-IPV-Hib (pentacel) or DTap-IPV-Hib-Hep B (Vaxelis)] A combination vaccine combines more than one vaccine into one shot. While suffering from chronic respiratory diseases, the microbial population in the airway changes and the proportion of Proteobacteria is increased in patients with asthma. The American Society for Microbiology, Growth of these organisms from a culture of the oropharynx/nasopharynx is of no significance. This often shows up in people who smoke. But if staphylococci enter the body, they can cause serious infections.. If immediate transportation is not possible, specimens should be refrigerated in order to improve pathogen isolation. The sooner your child receives treatment, the better their chances for survival. To be safe, you should have someone drive you home afterward. These bacterial infections can range from mild, such as ear infections, to severe, such as bloodstream infections. Current status. URL of this page: https://medlineplus.gov/lab-tests/sputum-culture/. Your doctor may also ask you to avoid eating and drinking anything the night before your procedure. To prevent other H. influenzae infections, you should keep your childs hands clean and keep them away from people who are sick. Your doctor may ask you to collect a sample of your own sputum, but if you cant they may collect one using a bronchoscopy. (https://www.cdc.gov/hi-disease/index.html). Candida is an opportunistic pathogen and the most commonly isolated fungal genus in humans. doi: 10.1371/journal.pone.0109710. Clin Infect Dis. Chicago: American Lung Association; c2020. We do not endorse non-Cleveland Clinic products or services. The diversity of airway microorganisms in cystic fibrosis (CF) patients is decreased, while pathogenic bacteria and conditional pathogenic bacteria are proliferated in large numbers. The most common types of harmful bacteria found in a sputum culture include those that cause: An abnormal sputum culture result may also mean a flare-up of a chronic condition, such as cystic fibrosis or chronic obstructive pulmonary disease (COPD). All terms are correct, but sputum and phlegm only refer to the mucus made in the respiratory system (lungs and airways). The colors can help identify the type of infection you may have or if a chronic illness has become worse: Other names: respiratory culture, bacterial sputum culture, routine sputum culture. This will probably be enough to treat your infection if you have a healthy immune system. The American Society for Microbiology, Mechanical ventilation is a life-saving measure used on thousands of patients in the United States each year, the second-most common hospital-acquired infection in intensive care units (ICUs), most common reason for empiric antibiotic use, correlated with the emergence and spread of antibiotic-resistant organisms, The rate of positive cultures is significantly greater, Saline has been shown to damage or kill certain bacteria over time, empiric antimicrobial therapy may be started, Privacy Policy, Terms of Use and State Disclosures. The infections typically affect children younger than 5 years old. confidence and trust with respect to the information we collect from you on Two studies performed in the 1990s proposed Gram stain rejection criteria for tracheal aspirate specimens with >10 squamous epithelial cells or no organisms detected on the Gram stain for, Tracheal Aspirate Cultures: The Challenges. | Privacy Policy, Terms of Use and State Disclosures. Mixed anaerobic infections can include both single anaerobic species or multiple anaerobic species with any number of nonanaerobic isolates. [Full Text]. However, even with antibiotic treatment, some H. influenzae infections can cause long-term complications. The information on this site should not be used as a substitute for professional medical care or advice. Careers. The test can also help the laboratory technician detect the presence of fungi in your sputum. Before beginning collection, ask the client to rinse the mouth with plain water. Lab results indicate my routine genital flora has "heavy. Cleveland Clinic is a non-profit academic medical center. Positive: Because common causes of pararespiratory infections are usually derived from upper respiratory tract endogenous flora, positive culture must be interpreted in the context of quantity or bacterial growth, purity of culture, Gram stain findings, and clinical signs and symptoms. Privacy Policy sets forth the information we collect about you, how we use Sputum is not the same as spit or saliva. Developing standards and guidelines around specimen collection, transport, rejection criteria and culture reporting for trachael aspirate cultures will lead to more meaningful interpretation of results and decrease poor patient outcomes. Turnaround time is defined as the usual number of days from the date of pickup of a specimen for Structures adjacent to the respiratory tract, like the sinuses, are usually sterile or only transiently contaminated. People undergoing chemotherapy, radiation or who have had a, Breathing support through face mask oxygen or. Sputum (phlegm) is a type of mucus. Additionally, fastidious (but important) organisms may be overgrown by non-fastidious organisms within the specimen before it is ever cultured in the laboratory, resulting in misleading culture results. Due to this fact, it is likely that the organism will be fully identified and reported. If your results were not normal, it may mean you have some kind of bacterial or fungal infection. Cryptogenic group A streptococcal bacteremia: Experience at an urban general hospital and review of the literature. 2012;2(3):225232. This is a soft, narrow tube with a light and magnifying glass on the end. The World Health Organization (WHO) estimates that this organism is responsible for killing half a million children worldwide each year. Encapsulated means the bacteria have an outer protective covering. Complications related to mechanical ventilation (such as VAP) will likely increase in frequency across the world as SARS-CoV-2 continues to spread. Epub 2019 May 30. Any exudate should be touched, and care should be taken to avoid the tongue and uvula. 2014 Oct 16;9(10):e109710. Under a Gram stain, bacteria changes to one of two sets of colors (pink to red or purple to blue). There is a significant amount of polymorphonuclear cells, which could suggest infection. Youll be monitored until youre fully awake. If you will be getting a bronchoscopy, you may be asked to fast (not eat or drink) for one to two hours before the test. Knowing that the reporting of gram-negative rods tends to prompt clinicians to treat, should these be mentioned at all? The World Health Organization (WHO) estimates that this organism is responsible for killing half a million children worldwide each year. The most common diseases and infections caused by H. influenzae include: The Hib vaccine is part of the routine childhood immunization schedule. 2022 Apr 13;11(8):1324. doi: 10.3390/cells11081324. government site. A Gram stain is a test that checks for bacteria at the site of a suspected infection or in body fluids such as blood or urine. American Heart Association [Internet]. Severe Hib disease cases have dropped by more than 99% since 1991. -, Lanaspa M., Bassat Q., Medeiros M. M., Munoz-Almagro C. Respiratory microbiota and lower respiratory tract disease. The significance of specific organisms detected in the lower respiratory tract is shown in Table 1. Brodsky L. Modern assessment of tonsils and adenoids. Theyll get their second dose at 4 months old. Before the introduction, about 20,000 children younger than 5 had a severe Hib disease each year and about 1,000 died. Ear: Normal flora of the skin of the healthy ear includes Staphylococcus epidermidis, Corynebacterium sp, and Staphylococcus aureus. From what I read so far (correct me if I'm wrong please) the normal upper respiratory flora can be a number of different . That said, in patients with confirmed VAP, P. aeruginosa is the most common bacterial cause. If tuberculosis is suspected, an acid-fast stain should be performed immediately, and the sputum cultured on special media, which are incubated for at least 6 weeks. Available from: UF Health: University of Florida Health [Internet]. Your provider may tap you on the chest to help loosen sputum from your lungs. Coal Worker's Pneumoconiosis (Black Lung Disease); [cited 2020 May 31]; [about 3 screens]. It is to be considered in treatment failures and neonates. A doctor typically orders a sputum stain to determine if a person has tuberculosis (TB) or another type of mycobacterial infection. These are categorized as gram-negative or gram-positive. Microbiota: A Missing Link in The Pathogenesis of Chronic Lung Inflammatory Diseases. Pediatr Neonatol. Serotypes O1 and O2 are less common and are associated with higher mortality. -, Sato S., Kiyono H. The mucosal immune system of the respiratory tract. 2010. Review of Medical Microbiology and Immunology, 11e, Warren Levinson. A large range (6% to 100%) of infants and toddlers are colonized. Collect your sample first thing in the morning, before eating or drinking anything. Sputum is a thick mucus produced in the lungs. While these numbers are frightening, it is important to remember that a large portion of the population is colonized with this organism, and the presence of it in culture does not immediately suggest infection. Thrush, oral candidiasis, and Candida esophagitis frequently complicate antineoplastic therapy, hyperalimentation, transplantation immunosuppression, pregnancy, and the acquired immunodeficiency syndrome (AIDS). Cultures may be considered in patients who present with unusually severe signs and symptoms consistent with sinusitis, otitis media, or other pararespiratory infection, or when symptoms persist for more than 7 days. Anaerobes can infect normal hosts and hosts with compromised resistance or damaged tissues. 2005-2023 Healthline Media a Red Ventures Company. The first test theyll use is called Gram staining. Since the introduction of the vaccine, the rate of Hib infections has dropped dramatically. Heres why knowing whether. Kaplan EL. They also affect people who are immunocompromised, such as those with certain medical conditions. Pneumonia caused by potential pathogens such as as Streptococcus mitis and Streptococcus anginosus group that may be part of the NRF. Large quantities of bacteria, including Firmicutes, Actinobacteria, and Bacteroidetes, colonize the surface of the respiratory mucosa of healthy people. catarrhalis is highly suggestive of true pneumonia. But it doesnt prevent infections caused by other types of H. influenzae. COPD is a lung disease that makes it hard to breathe. E coli, Klebsiella pneumoniae, Pseudomonas aeruginosa may be isolated from neonates. Saudi J Biol Sci. Secretory Immunoglobulin A Immunity in Chronic Obstructive Respiratory Diseases. Available from: Kids Health from Nemours [Internet]. [6], Severe obstructive or structural lung disease, Positive urine antigen test for pneumococcus, Positive urine antigen test for Legionella (special culture media for Legionella needed), Updated IDSA/ATS guidelines from 2019 state that, with regard to CAP, sputum culture is recommended not only for adult patients with severe disease but also for all adult inpatients who have received empirical treatment for methicillin-resistant S aureus and Pseudomonas aeruginosa. Normal flora of Respiratory tract Respiratory tracts includes both upper respiratory tract (URT) and lower respiratory tract (LRT). Specimens are typically inoculated onto SBA and chocolate and MacConkey agar. Cystic fibrosis is an inherited disease that causes mucus to build up in the lungs and other organs. -, Dai W., Wang H., Zhou Q., et al. Streptococcus pyogenes: (group A -hemolytic strep) and other -hemolytic streptococci in groups B, C, D, and G are generally susceptible to penicillin and its derivatives, therefore, susceptibility need not be routinely determined. The .gov means its official. What makes these seemingly normal bacteria so dangerous, and how can they live within humans and not cause disease most of the time, but occasionally cause lethal infections? Common pitfall: Noninvasively collected specimens, which are more likely to represent endogenous rather than pathogenic flora, are often submitted for patient evaluation. The bacteria found will be Gram-positive or Gram-negative. GigaScience. URT is inhabited by a diverse group of commensal bacteria and fungi species. 2022 Aug 10;13:937666. doi: 10.3389/fmicb.2022.937666. Based on the original Gram stain, should this specimen have been set up for culture at all? Testing schedules may vary. doi: 10.1016/j.coviro.2012.03.009. allowed for additional confirmatory or additional reflex tests. Normally, they exist on our skin and mucous membranes without causing problems. For many reasons, mechanically ventilated patients are especially susceptible to developing pneumonia. The proportion of Firmicutes and Proteobacteria is increased in patients with upper airway cough syndrome (UACS), which replaces the dominance of Streptococcus and Neisseria in the pharynx of a normal population. Variations in upper respiratory tract bacterial flora in patients with acute upper respiratory tract infection and healthy subjects and variations by subject age May 2006 Journal of Infection and . In some cases, bacterial pneumonia can be more severe and even life-threatening. Unable to load your collection due to an error, Unable to load your delegates due to an error. Obtaining an early-morning expectorated specimen is most desirable. You are being redirected to Leave swab in place for 15 to 30 seconds. An acid-fast stain test is a lab test performed on a sample of body fluid or skin tissue. Patients are at most at risk of developing ventilator-associated pneumonia (VAP) in the first 48 hours after an endotracheal tube has been placed. Mucus can also be made elsewhere in the body, such as the urinary or genital tract. Take the sample to the clinic or laboratory, following your doctors instruction. If the gram-negative rods are reported, should susceptibility testing be performed? Gram-negative bacteria have a hard outer shell that protects them and makes them harder to kill. Rochester (NY): University of Rochester Medical Center; c2020. Dont use antiseptic mouthwash. Your doctor will feed a bronchoscope through your nose or mouth into your lungs. The effect P. aeruginosa has on an intubated patient will differ depending on serotype: The pathogenicity of P. aeruginosa is very complex, and the organism uses several mechanisms to adhere to living and nonliving surfaces. If the culture results are reported as mixed normal upper respiratory flora, clinicians may be more likely to de-escalate empiric treatment and search for other causes of the patients symptoms. The first morning specimen is most concentrated and is less likely to be contaminated with saliva and nasopharyngeal secretions. Collect the expectorated sputum in a leak-proof sterile container. Yes. Past, Present, and Future Research on the Lung Microbiome in Inflammatory AirwayDisease. "Mixed upper respiratory tract flora" is normal and does not usually need treatment. websites owned and operated by ASM ("ASM Web Sites") and other sources. Treating all organisms identified from respiratory tract cultures can lead to antibiotic overuse and encourage the development of antibiotic resistant organisms. Sputum is a mixture of saliva and mucus that you cough up from your respiratory tract. Clipboard, Search History, and several other advanced features are temporarily unavailable. Apparent increase in the incidence of invasive group A beta-hemolytic streptococcal disease in children. Approximately 95% to 100% of children develop protective antibody levels of Hib after the primary series. heavy growth of normal upper respiratory flora. The 2007 Infectious Diseases Society of America and American Thoracic Society (IDSA/ATS) consensus guidelines on community-acquired pneumonia (CAP) in adults recommend expectorated sputum specimens for hospitalized patients with signs and symptoms of pneumonia and any of the following conditions: