Sputum

Last updated
Abnormal sputum
Other namesMucus
Enterococcus histological pneumonia 01.png
Cocci-shaped Enterococcus sp. bacteria taken from a pneumonia patient
Pronunciation
  • /'spju:təm/
Specialty Pulmonology

Sputum is mucus that is coughed up from the lower airways (the trachea and bronchi). In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigations of respiratory systems.

Contents

A naked eye exam of the sputum can be done at home by a patient in order to note the various colors (see below). Any hint of yellow or green color (pus) suggests an airway infection (but does not indicate the type of organism causing it). Such color hints are best detected when the sputum is viewed on a very white background such as white paper, a white pot or a white sink surface.

Having green, yellow, or thickened phlegm (sputum) does not always indicate the presence of an infection. Also, if an infection is present, the color of the phlegm (sputum) does not determine whether a virus, a bacterium or another pathogen has caused it. Simple allergies can also cause changes in the color of the mucus. [1]

Description

The best sputum samples contain very little saliva, [2] as saliva contaminates the sample with oral bacteria. This is especially true for samples for laboratory testing in cytology or microbiology. Specimen adequacy is assessed by the laboratory technologists by examining a Gram stain or cytology stain of the sputum. More than 25 squamous epithelial cells at low power magnification exam under the microscope strongly suggest salivary contamination. [3] Sputum samples have been used to quantify the degree of airway inflammation in human diseases such as asthma. Specifically, this work has demonstrated that a subgroup of severe asthma patients has airway inflammation that is resistant to treatment with corticosteroids. [4]

When a sputum specimen is plated out in microbiology, it is best to get the portion of the sample that almost looks like yellow pus onto the swab. If there is any blood in the sputum, this should also be on the swab.[ citation needed ] Microbiological sputum samples are used to look for infections, such as Moraxella catarrhalis , Mycobacterium tuberculosis , Streptococcus pneumoniae , and Haemophilus influenzae . Other pathogens can also be found.

Purulent sputum [5] contains pus, composed of white blood cells, cellular debris, dead tissue, serous fluid, and viscous liquid (mucus). Purulent sputum is typically yellow or green. It is seen in cases of pneumonia, bronchiectasis, lung abscess, or an advanced stage of bronchitis. [6]

Interpretation

Sputum can be (when examined by the naked eye):[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Cough</span> Sudden expulsion of air from the lungs as a reflex to clear irritants

A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.

<span class="mw-page-title-main">Hemoptysis</span> Medical symptom consisting of bloody mucus from coughing

Hemoptysis or haemoptysis is the discharge of blood or blood-stained mucus through the mouth coming from the bronchi, larynx, trachea, or lungs. It does not necessarily involve coughing. In other words, it is the airway bleeding. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions. Hemoptysis is considered massive at 300 mL. In such cases, there are always severe injuries. The primary danger comes from choking, rather than blood loss.

<span class="mw-page-title-main">Respiratory tract</span> Organs involved in transmission of air to and from the point where gases diffuse into tissue

The respiratory tract is the subdivision of the respiratory system involved with the process of conducting air to the alveoli for the purposes of gas exchange in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa.

<span class="mw-page-title-main">Acute bronchitis</span> Medical condition

Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi of the lungs. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort. The infection may last from a few to ten days. The cough may persist for several weeks afterward with the total duration of symptoms usually around three weeks. Some have symptoms for up to six weeks.

<span class="mw-page-title-main">Phlegm</span> Mucus produced by the respiratory system (excluding the nasal passages)

Phlegm is mucus produced by the respiratory system, excluding that produced by the throat nasal passages. It often refers to respiratory mucus expelled by coughing, otherwise known as sputum. Phlegm, and mucus as a whole, is in essence a water-based gel consisting of glycoproteins, immunoglobulins, lipids and other substances. Its composition varies depending on climate, genetics, and state of the immune system. Its color can vary from transparent to pale or dark yellow and green, from light to dark brown, and even to dark grey depending on the contents. The body naturally produces about 1 quart of phlegm every day to capture and clear substances in the air and bacteria from the nose and throat.

<span class="mw-page-title-main">Bronchiole</span> Passageways by which air passes through the nose or mouth to the alveoli of the lungs

The bronchioles are the smaller branches of the bronchial airways in the lower respiratory tract. They include the terminal bronchioles, and finally the respiratory bronchioles that mark the start of the respiratory zone delivering air to the gas exchanging units of the alveoli. The bronchioles no longer contain the cartilage that is found in the bronchi, or glands in their submucosa.

<span class="mw-page-title-main">Bronchiectasis</span> Permanent enlargement of the lung airways

Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest pain. Wheezing and nail clubbing may also occur. Those with the disease often get lung infections.

<span class="mw-page-title-main">Atelectasis</span> Partial collapse of a lung causing reduced gas exchange

Atelectasis is the partial collapse or closure of a lung resulting in reduced or absence in gas exchange. It is usually unilateral, affecting part or all of one lung. It is a condition where the alveoli are deflated down to little or no volume, as distinct from pulmonary consolidation, in which they are filled with liquid. It is often referred to informally as a collapsed lung, although more accurately it usually involves only a partial collapse, and that ambiguous term is also informally used for a fully collapsed lung caused by a pneumothorax.

Tracheobronchitis is inflammation of the trachea and bronchi. It is characterised by a cough, fever, and purulent sputum and is therefore suggestive of pneumonia. It is classified as a respiratory tract infection.

<span class="mw-page-title-main">Respiratory disease</span> Disease of the respiratory system

Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.

<span class="mw-page-title-main">Airway obstruction</span> Blockage in the respiratory system

Airway obstruction is a blockage of respiration in the airway that hinders the free flow of air. Airway obstructions can occur either in the upper airway or lower airway. The upper airway consists of the nose, throat, and larynx. The lower airway comprises the trachea, bronchi, and bronchioles.

<span class="mw-page-title-main">Chest physiotherapy</span> Treatments to improve breathing by indirect removal of mucus from breathing passage

Chest physiotherapy (CPT) are treatments generally performed by physical therapists and respiratory therapists, whereby breathing is improved by the indirect removal of mucus from the breathing passages of a patient. Other terms include respiratory or cardio-thoracic physiotherapy.

<span class="mw-page-title-main">Allergic bronchopulmonary aspergillosis</span> Medical condition

Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterised by an exaggerated response of the immune system to the fungus Aspergillus. It occurs most often in people with asthma or cystic fibrosis. Aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals. A. fumigatus is responsible for a spectrum of lung diseases known as aspergilloses.

<span class="mw-page-title-main">Bronchitis</span> Inflammation of the large airways in the lungs

Bronchitis is inflammation of the bronchi in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. Symptoms include coughing up sputum, wheezing, shortness of breath, and chest pain. Bronchitis can be acute or chronic.

<span class="mw-page-title-main">Obstructive lung disease</span> Category of respiratory disease characterized by airway obstruction

Obstructive lung disease is a category of respiratory disease characterized by airway obstruction. Many obstructive diseases of the lung result from narrowing (obstruction) of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself. It is generally characterized by inflamed and easily collapsible airways, obstruction to airflow, problems exhaling, and frequent medical clinic visits and hospitalizations. Types of obstructive lung disease include asthma, bronchiectasis, bronchitis and chronic obstructive pulmonary disease (COPD). Although COPD shares similar characteristics with all other obstructive lung diseases, such as the signs of coughing and wheezing, they are distinct conditions in terms of disease onset, frequency of symptoms, and reversibility of airway obstruction. Cystic fibrosis is also sometimes included in obstructive pulmonary disease.

<span class="mw-page-title-main">Diffuse panbronchiolitis</span> Inflammatory lung disease

Diffuse panbronchiolitis (DPB) is an inflammatory lung disease of unknown cause. It is a severe, progressive form of bronchiolitis, an inflammatory condition of the bronchioles. The term diffuse signifies that lesions appear throughout both lungs, while panbronchiolitis refers to inflammation found in all layers of the respiratory bronchioles. DPB causes severe inflammation and nodule-like lesions of terminal bronchioles, chronic sinusitis, and intense coughing with large amounts of sputum production.

<span class="mw-page-title-main">Geotrichosis</span> Medical condition

Geotrichosis is a mycosis caused by Geotrichum candidum.

<span class="mw-page-title-main">Acute exacerbation of chronic obstructive pulmonary disease</span> Medical condition

An acute exacerbation of chronic obstructive pulmonary disease, or acute exacerbations of chronic bronchitis (AECB), is a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.

<span class="mw-page-title-main">Eosinophilic bronchitis</span> Medical condition

Eosinophilic bronchitis (EB) is a type of airway inflammation due to excessive mast cell recruitment and activation in the superficial airways as opposed to the smooth muscles of the airways as seen in asthma. It often results in a chronic cough. Lung function tests are usually normal. Inhaled corticosteroids are often an effective treatment.

In clinical guidelines chronic cough is defined as a cough lasting more than 8 weeks in adults and more than 4 weeks in children. there are studies suggest that a chronic cough must persist upwards of three months. The prevalence of chronic cough is about 10% although the prevalence may differ depending on definition and geographic area. Chronic cough is a common symptom in several different respiratory diseases like COPD or pulmonary fibrosis but in non-smokers with a normal chest x-ray chronic cough are often associated with asthma, rhinosinusitis, and gastroesophageal reflux disease or could be idiopathic. Generally, a cough, for example after an upper respiratory tract infection, lasts around one to two weeks; however, chronic cough can persist for an extended period of time, several years in some cases. The current theory about the cause of chronic cough, independent of associated condition, is that it is caused by a hypersensitivity in the cough sensory nerves, called cough hypersensitivity syndrome. There are a number of treatments available, depending on the associated disease but the clinical management of the patients remains a challenge. Risk factors include exposure to cigarette smoke, and exposure to pollution, especially particulates.

References

  1. "Green phlegm and snot 'not always a sign of an infection needing antibiotics'". GOV.UK. 18 November 2013. Retrieved 2022-04-17.
  2. Clinical Microbiology procedures handbook, American Society for Microbiology 2nd Ed. 2007 update
  3. Gershman, Neil H.; Liu, Hong; Wong, Hofer H.; Liu, Jane T.; Fahy, John V. (August 1999). "Fractional analysis of sequential induced sputum samples during sputum induction: Evidence that different lung compartments are sampled at different time points". Journal of Allergy and Clinical Immunology. 104 (2): 322–328. doi: 10.1016/S0091-6749(99)70374-X . PMID   10452752.
  4. Peters, Michael C.; Kerr, Sheena; Dunican, Eleanor M.; Woodruff, Prescott G.; Fajt, Merritt L.; Levy, Bruce D.; Israel, Elliot; Phillips, Brenda R.; Mauger, David T.; Comhair, Suzy A.; Erzurum, Serpil C.; Johansson, Mats W.; Jarjour, Nizar N.; Coverstone, Andrea M.; Castro, Mario; Hastie, Annette T.; Bleecker, Eugene R.; Wenzel, Sally E.; Fahy, John V. (March 2018). "Refractory airway type 2 inflammation in a large subgroup of asthmatic patients treated with inhaled corticosteroids". Journal of Allergy and Clinical Immunology. 143 (1): 104–113.e14. doi:10.1016/j.jaci.2017.12.1009. PMC   6128784 . PMID   29524537.
  5. 1 2 Richard F. LeBlond; Richard L. DeGowin; Donald E. Brown (2004). DeGowin's diagnostic examination. New York: McGraw-Hill. ISBN   0-07-140923-8.
  6. What can sputum tell us?
  7. Altiner A, Wilm S, Däubener W, Bormann C, Pentzek M, Abholz HH, Scherer M (2009). "Sputum color for diagnosis of a bacterial infection in patients with acute cough". Scand J Prim Health Care. 27 (2): 70–3. doi:10.1080/02813430902759663. PMC   3410464 . PMID   19242860.
  8. Sputum Color is the Key to Treating Acute COPD Exacerbations