SPUTUM
*Mixture of Tracheibranchial Secretions
(TBS)
-Cellular Exfoliations
-Nasal and salivary glands secretions
-Normal bacterial flora of the oral cavity
(PRINCIPAL SOURCES OF TBS)
1. Surface Epithelium
-Serous Cells
-Club Cells (Clara cells)- protect bronchile lining
-Goblet Cells- numerous in the upper respiratory tract
-Thick mucin type secretion
2. Submucous Glands
-serous mixture of gylcoprotein, sialoproteins,
sulfoprotein.
(PROPERTIES OF SPUTUM)
1. Viscoelastic -Consistency of sputum depends on
A. Molecular structure of glycoprotein
B. Degree of hydration
*Sialic Acid- most important single component of
sputum viscosity.
2. Chemical Composition
- 95% water, 5% solids (CHO, protein, lipids & DNA)
Increased Solids = Increase Inflammation
(SPECIMEN COLLECTION)
1. Pre-rinsing of the mouth.
2. First morning specimen- best specimen.
24 Hr Collection- For volume measurement
-Rinse the mouth with water before sputum is collected
-Take several deep breaths
-Cough hard from inside the chest.
-Spit the sputum into the container carefully
-Replace the cap tightly
(PEDIATRIC COLLECTION METHODS)
A. Nasopharyngeal swab
B. Cough Plate
C. Cough Swab
-Recommended method
-Gives most representative, non-contaminated samples.
-Epiglottis is touch with a swab to induce cough.
*Sputum Inductions-For uncooperative patients and
those who can’t produce sputum.
*Inductants
1. 10% NaCl
2. Sterile Distilled Water
3. Aerosols
*Trachael Aspiration- For patients with pneumonia and
those who cannot produce specimen.
*Sputum Containers
Sterile, Disposable, with screw cap or tightly fitting cap.
(SPUTUM EXAMINATION)
-Examine under biosafety hood.
A. Gross/Macroscopic
-Examine on petri dish (against dark background)
-Spread it using sterile disposable wooden applicator
stick.
1. Consistency And Appearance
Normal: Clear and Watery; (slightly opaque)
a) Liquid/serous
b) Mucoid
c) Bloody(sanguinous)
d) Purulent
e) Mucopurulent
2. Volume
Gives idea on the prognosis
Poor Prognosis- Vol. Increases w/ treatment
Good Prognosis- Vol. Decreases w/ treatment
3. Color
Normal: Colorless
a) Yellow- pus & epithelial cells
b) Greenish Tint- Pseudomonas, release of
verdoperoxidase.
c) Rust- Pneumococcal pneumonia, Pulmonary
gangrene.
d) Bright Red- Recent Hemorrhage, Acute cardiac
failure, Pulmonary infractions, Far advance Tb,
Neoplasm.
(CAUSES OF BLOOD SPUTUM)
APPEARANCE
USUAL CAUSE
Uniform rusty, with pus
Pneumococcal Pneumonia
Uniform rusty, no pus
CHF, Mitral valve disease
Bright streaks in viscid
Klebsiella Pneumonia
sputum
Scant but persistent streaks Bronchogenic Carcinoma
in mucoid sputum
Episodic occurences of
Tubercolosis
small hemorrhages
Episodes of large
Cavitary Tb,
hemorrhages
Pulmonary Infraction,
Fungal Pneumonia
Spurious Hemoptysis
Bleeding in nose,
nasopharynx
4. Odor
Putrid- Lung Abscess
Fruity- Pseudomonas
(MISCELLANEOUS FINDINGS)
1. Cheesy Masses
-Fragments of necrotic pulmonary tissue.
-Seen in Pulmonary gangrene or PTb.
2. Bronchial Casts
-Branching Tree-like casts of the bronchi.
3. Broncholith
-(Lung stones) calcification of necrotic or infected tissue
with a larger bronchus or cavity.
-Most Common Cause: Histoplasmosis
-also seen in: PTb, papillary CA, Sarcoidosis
4. Dittrich’s Plugs
-Yellowish or gray caseous bodies(pinhead to navy bean)
-composed of: cellular bodies, fatty acid crystals, fat
globules and bacteria.
-seen in: Bronchitis and Bronchiectasis
5. Foreight Bodies
-Food Particles and buttons
6. Parasites
-Ascaris, E. Granulosus, T. Canis, P. Westermani.
(MICROSCOPIC EXAMINATION)
-Unstained & stained smears
*Stained Smear Preparation:
-Air Dry, Flame, Stain
*STAIN*
a) Gram’s Stain- Commoly used.
b) Wirghts or Giemsa- WBC Differential.
c) Buffered Crystal Violet- Bronchial Epithelial Cell.
d) Ziehl Neelsen- Tuberculi Bacili.
e) Papanicolaou- Malignant Cell.
*Spuamous EC- Marker in the rejection of a specimen
for culture.
>10 SEC/lpf-reject the specimen
Alveolar Macrophage- Sputum is from lower RT
*CYTOLOGY STAINS*
 No Stain
-Blastomycosis
-Cryptococcosis
 Gram Stain
-Gram Positive Bacteria
-Candida
-Tubercolosis (weakly gram positive)
-Nocardia (wealky gram positive)
 Direct Fluorescent Antibody Staining
-Legionella
 Wrigth stain or Giemsa stain
-Intracellular organisms
(MICROSCOPIC STRUCTURES IN SPUTUM)
 Alveolar Macrophage- Specimen is from the
lower respiratory tract.
 Neutrophils- Pyogenic Infection
 Eosinophils- Bronchial Asthma
 Acellular blue bodies- (PAS+) - Obstructive lung
disease.
 Elastin Fiber- Curved refractile bodies w/ split
ends, necrotizing pneumonia.
(COMMON DISEASES ASSOCIATED IN SPUTUM
ANALYSIS)
1. Pulmonary Tuberculosis
-Mycobacterium Tuberculosis
-Mucopurulent
-Pulmonary Hemorrhage
-Presence of cheesy ma.
Types of specimen:
-Early morning
-Induced sputum
-Bronchial washings
-Transtracheal aspiration : lower lung field Tb
-Gastric aspiration
2. Myotic Disease - Fungal Infection
-First morning specimen:preferred
-Uses directmount w/ 10% NaOH
Stain: India Ink
-Cryptococcus Neoformans
-Histoplasma Capsulatum
-Coccicoides Immitis
-Apergillus famigatus
3. Bronchial Asthma
-Periodic, reversible constrictions of the bronchi.
-White mucoid sputum, no blood and pus
Common Findings:
1. Eosinophils
2. Charcot-Leyded Crystals- colorless,pointed
hexagons. Derived from disintegration of
eosinophils.
3. Broncial epithelial Cells
a) Creola bodies- bronchial epithelial
cells in large clusters, vacuolated
cytoplasm and ciliated borders.
4. Curschmann spirals -Wavy thread frequently
coiled into little balls.
a) Also seen in:
-Chronic Bronchitis
-Heavy cigarette smokers
4. Bronchiectasis
Irreversible widening of portions of the bronchi
-Mucopurulent
-Putrid; gray-green
-Ocassional blood streaks
-Microscopic exam: bronchial epithelial cells
-Dittrich plugs, fatty crystals, bacteria
5. Chronic Bronchitis
Inflammation of bronchioles as well as the bronchi
-Smokers cough: mildest form
-Macroscopically: tenacious white, mucoid
-Microscopically: histiocytes & monocytes
6. Lung Abscess
Large amount of bloody, creamy, foul smelling sputum
Presence of elastic fibers cellular debris and leukocytes.
7. Pneumonia
Inflammation of the lungs caused by bacteria, viruses or
chemical irritants.
-Grams stain: important examination gram+pneumonia
1. Streptococcus pneumonia- principal pathogen
-Ealy stage: scanty, transparent;occasional blood.
a)
Klebsiella
b)
Haemophilus
c)
Branhamella
d)
Enterobacteria
e)
Pseudomonas
f)
Escherichia Coli
8. Pneumoconiosis
Fibrosis of the lung secondary to inhalation of organic
and inorganic dust.
1. Anthracosis- Accumulation of carbon in the
lungs from inhaled smoke or coal dust.
a) Blacklung disease
b) Coal workers pneumoconiosis
c) Miners pneumoconiosis
2. Silicosis- Silica dust, elongated and fragmented
crystals under polarized light.
3. Anthracosilicosis- carbon and silica; angular
black granules.
4. Asbestosis- Dumbbell shaped.
5. Byssinosis- Cotton Dust, rectangular, prism
shaped crystals that shine brightly under polarized
light.
9. Pulmonary Embolism
Sudden blocking of an artery of the lung by an embolus.
Brighten red, very tenacious, mucoid.
10. Heart Disease
Congestive Hearth Failure (Hemosiderin- laden
macrophages)
-Frothy and rust colored.
-Presence of heart failure cells (round, colorless bodies
filled w/ yellow to brown hemosiderin pigment.
11. Pulmonary Alveolar Proteinosis
Alveoli become plugged with a prtein rich fluid
Many macrophages with periodic acid-schiff PAS(+)
materials.
12. Pneumocystis Jiroveci
Causes an interstitial pneumonia in the immunologically
impaired hosts.
13. Viral Infections
70-90% of all respiratory infections
Observe for presence of inclusions bodies
(BRONCHOALVEOLAR LAVAGE (BAL))
-Obtaining cellular and microbiological information
from the lower RT.
-Saline infused by a bronchoscope mixes with the
bronchial content and is aspirated for cellular exam and
culture.
BAL- important diagnostic test for Pneumocystis
Jiroveci(Carinii)