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 naked eye exam, microbiological investigations of respiratory infections and cytological investigations of respiratory systems. It is critical that the patient not give a specimen that includes any mucoid material from the interior of the nose.

Contents

Naked eye exam of sputum can be done at home by a patient in order to note the various colors (see below). Any hint of yellow 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. The more intense the yellow color, the more likely it is a bacterial infection (bronchitis, bronchopneumonia or pneumonia).

Description

The best sputum samples contain very little saliva, [1] as saliva contaminates the sample with oral bacteria. This is especially true for samples for lab 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 with the microscope strongly suggests salivary contamination. [2] 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 sub group of severe asthma patients have airway inflammation that is resistant to treatment with corticosteroids. [3]

When a sputum specimen is plated out in microbiology, it is best to get the portion of the sample that most 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 [4] 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 bronchiectasis, lung abscess, or an advanced stage of bronchitis. [5]

Interpretation

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

See also

Related Research Articles

Cough 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 that 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.

Hemoptysis Medical symptom consisting of bloody mucus from coughing

Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. 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.

Respiratory tract 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 respiration in mammals. The respiratory tract is lined with respiratory mucosa or respiratory epithelium.

Acute bronchitis 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.

Bronchiectasis Disease of the lungs

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 frequent lung infections.

Atelectasis Collapse or closure of a lung resulting in reduced or absent gas exchange

Atelectasis is the collapse or closure of a lung resulting in reduced or absent 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 called a collapsed lung, although that term may also refer to 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.

Respiratory disease 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.

Lobar pneumonia Medical condition

Lobular pneumonia is a form of pneumonia characterized by inflammatory exudate within the intra-alveolar space resulting in consolidation that affects a large and continuous area of the lobe of a lung.

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.

Erdosteine Chemical to treat chronic bronchitis

Erdosteine is a molecule with mucolytic activity. Structurally is a thiol derivative characterized by the presence of two thiol groups. These two functional sulfhydryl groups contained in the molecule are released following first-pass metabolism with the conversion of erdosteine into its pharmacologically active metabolite Met-I.

Bronchitis Inflammation of the large airways in the lungs

Bronchitis is inflammation of the bronchi in the lungs that causes coughing. Symptoms include coughing up sputum, wheezing, shortness of breath, and chest pain. Bronchitis can be acute or chronic.

Obstructive lung disease 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.

Diffuse panbronchiolitis 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.

Geotrichosis Medical condition

Geotrichosis is a mycosis caused by Geotrichum candidum.

Acute exacerbation of chronic obstructive pulmonary disease 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.

Eosinophilic bronchitis 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.

Chronic cough is long-term coughing, sometimes defined as more than several weeks or months. The term can be used to describe the different causes related to coughing, the 3 main ones being; upper airway cough syndrome, asthma and gastroesophageal reflux disease. It occurs in the upper airway of the respiratory system. Generally, a cough lasts around 1–2 weeks, however, chronic cough can persist for an extended period of time defined as 6 weeks or longer. People with chronic cough often experience more than one cause present. Due to the nature of the syndrome the treatments that are used are similar however there is a subsequent number of treatments available, and the clinical management of the patients remains a challenge.

Francesco Blasi is an Italian Medical scientist and professor. His domain of research is respiratory medicine. He has been the president of European Respiratory Society (ERS) during 2012-13. He has served as the president of Italian Respiratory Society during 2015-17. He is presently serving as one of the board of directors of University of Milan and is the professor of respiratory medicine in department pathophysiology and transplantation in University of Milan.

References

  1. Clinical Microbiology procedures handbook, American Society for Microbiology 2nd Ed. 2007 update
  2. 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.
  3. 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.
  4. 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.
  5. What can sputum tell us?
  6. 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.
  7. Sputum Color is the Key to Treating Acute COPD Exacerbations
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