Mock analysis. Clinical sputum analysis. What is a general sputum analysis?

Sputum sputum [lat. = spit] - bronchial secretion, “spitted out” (coughed up) or obtained using suction devices in humans with respiratory tract pathology.

There can be no “normal” sputum!

Structure of sputum analysis

1. Amount (per day): small, moderate, large, very large.

colorless (vitreous)

yellow (yellowish)

yellow-green

red (pink, bloody)

"rusty" (brown)

"raspberry or currant jelly"

chocolate (brown)

white-gray

dirty gray

"creamy" (white)

no (odorless), or weak

unpleasant

fetid (putrid)

cadaverous (sickening)

specific

4. Consistency:

viscous, thick, liquid

5. Adhesiveness:

weak, moderate, strong

6. Foaminess:

no (does not foam), weak, high

7. Layering:

one-, two-, three-layer

8. Character (macrocomposition):

mucous, purulent, bloody, serous, mixed.

Microscopy

9. Epithelium:

flat – single, many;

cylindrical – single, many;

alveolar macrophages – few, many;

siderophages – presence;

dust cells – presence;

menophages – presence;

tumor (atypical) cells – presence.

10. Leukocytes:

neutrophils – few, moderate, many;

eosinophils – few, moderate, many;

lymphocytes – single, many;

basophils – presence;

monocytes – presence.

11. Red blood cells:

red blood cells – single, moderate, many.

12. Fibrous formations

Kurshman spirals – a little, a moderate amount, a lot;

elastic fibers (“regular”) – availability;

coral-shaped elastic fibers – presence;

calcified elastic fibers – presence;

fibrinous fibers (threads, fibrin bundles) – presence;

diphtheria films – presence;

necrotic pieces of lung – presence.

13. Crystals:

Charcot-Leyden – a little, a moderate amount, a lot;

cholesterol – presence;

fatty acids (Dietrich's plugs) – presence;

hematoidin – presence.

14. Foreign bodies – presence.

Bacterioscopy

15. BC (Koch bacilli) – detected, not detected.

16. Other bacteria – not detected, detected:

pneumococcus catarrhal (bacillus influenza)

Frenkel-Wekselbaum pneumococci (diplococci)

Friedlander's pneumobacillus

Pfeiffer bacilli

streptococci

Klebsiella

staphylococci

Pseudomonas aeruginosa

coli

Loeffler's bacilli.

17. Mushrooms:

candida, aspergillus, actinomycetes, cryptococci.

18. Protozoa:

Trichomonas.

19. Helminths:

roundworms, echinococcus.

Amount of sputum– volume of coughing:

scanty K.M. – individual spits 1-5 ml;

moderate – 50-100 ml/day;

large – 200-300 ml/day;

very large (abundant) > 300 ml/day.

Color– depends on the composition (structure, character) of M.:

Colorless – glassy, ​​mucous, transparent. The main cellular composition is lymphocytes, squamous epithelium;

Yellowish – mucopurulent. Eosinophils give yellow color to sputum;

Green – purulent. The green color of sputum is given by neutrophils, or more precisely, by the breakdown products of the iron porphyrin group of the enzyme verdoperoxidase of neutrophils;

Red – bloody. Fresh red blood cells give sputum its red color;

- “rusty” - for lobar pneumonia - the color is given by the breakdown product of hemoglobin - hematin;

White (“creamy”) – when there is a large amount of lymph in the sputum; white color of sputum in flour millers;

Coal dust, etc. gives black color to sputum.

When describing sputum of complex composition, it is customary to place the predominant substrate in last place: purulent-mucous, mucopurulent, mucopurulent-bloody, etc.

Smell. Freshly secreted sputum is usually odorless. Sputum acquires an unpleasant odor during prolonged standing, during putrefactive and purulent processes in the lungs (gangrene, abscess, bronchiectasis). Sputum has specific odors when taking alcohol, antibiotics (smell of mold), poisoning with acetic acid (violet smell), drugs: valerian, marshmallow, anise, Corvalol, camphor, etc.

Consistency of sputum– thickness, viscosity. The sputum can be viscous (a lot of mucus), thick (a lot of formed elements and epithelium), liquid (a lot of serum in the sputum).

Stickiness of sputum. The more fibrin in the sputum, the more sticky it is. Sticky sputum sticks to the glass slide and to the walls of the test tube (spittoon).

Foamy sputum. The more protein (whey) there is in the sputum, the more foamy it becomes. Foamy sputum creates great obstacles to ventilation of the lungs.

Layering of sputum. Mucous sputum is single-layer, with tissue breakdown (lung gangrene, bronchiectasis) the sputum is three-layered: the bottom layer is pus (detritus), the middle is the liquid part, the top is foam; two-layer sputum (the upper layer is serous fluid, the lower is pus) – with an abscess, lobar pneumonia.

Components (substrates) of sputum:

Mucus and sweaty plasma;

Blood cells, respiratory tract epithelium, detritus;

Bacteria and special inclusions.

Slime– a product of the mucous glands of the upper respiratory tract. Mucous sputum in acute bronchitis, resolution of an attack of bronchial asthma, acute respiratory diseases, inhalation of substances that irritate the respiratory tract.

Detritus[lat. detritis = beaten] – remains of destroyed cells and tissues.

Crystals Charcot-Leyden crystalles Charcot-Leydeni - colorless, shiny, diamond-shaped formations - a product of the breakdown of eosinophils - have diagnostic value for bronchial asthma, allergic processes in the respiratory tract.

Koch lenses (lentils) lenticulae Kochi - rice-shaped bodies of a greenish-yellowish color, consisting of detritus, tuberculosis bacilli and elastic fibers - a product of the collapse of the lungs (with cavernous pulmonary tuberculosis).

Dietrich's corks (particles) particulae Ditrixi - purulent plugs - lumps of whitish or yellowish-gray color, the size of a pinhead with a fetid odor; consist of detritus, bacteria, crystals of fatty acids, appear with bronchiectasis, lung gangrene.

Kurshman spirals spirae Kurchmanni - spirally crimped transparent, whitish fibers, in the middle of which a shiny central thread is usually visible; may be covered with Charcot-Leyden crystals and eosinophils - pathognomonic for bronchial asthma - mucous-protein casts of spasmed small bronchi.

Cholesterol crystals– are formed during the breakdown of fat-degenerated cells, retention of sputum in cavities (cavities) and are located against the background of detritus; found in tuberculosis, abscesses, echinococcosis, and lung cancer.

Epithelium is flat– desquamate of the mucous membranes of the oral cavity, nasopharynx, epiglottis, vocal cords. Its quantity is determined by the amount of saliva that gets into the sputum.

Columnar epithelium– desquamate of the mucous membranes of the trachea and bronchi. It is found in large quantities in sputum during an acute attack of bronchial asthma, acute bronchitis.

Alveolar epithelium(alveolar macrophages) - appear in sputum during pneumonia, silicosis. Macrophages containing hemosiderin appear during pulmonary infarction, hemoptysis, and in patients with left ventricular failure.

Microorganisms– are determined bacterioscopically only when they contain at least 10 6 microbial bodies in 1 ml of sputum.

Streptococci[Greek streptos curved, kokkos grain] – chains of spherical microbes; characteristic of sputum during suppuration in the lungs, less often for bronchitis, pneumonia; insensitive to aminoglycosides (only in combination with penicillin!).

Friedlander's diplobacillus(pneumococci) – causative agents of lobar pneumonia; resistant to aminoglycosides.

Mycobacterium Koch- causative agents of tuberculosis.

Staphylococcus[Greek staphyle cluster] – clusters of cocci; Staphylococcus aureus, the causative agent of purulent processes, is often detected in hospitals.

Haemophilus influenzae bacteria Haemophilus influenze - short sticks (lictor's baton!) - causes acute respiratory diseases. The influenza bacterium secretes chloramphenicol acetyltransferase and destroys chloramphenicol.

Pseudomonas aeruginosa Bacterium pyocyaneum seu Pseudomonas aeruginosa is the causative agent of green suppuration. The following have antipseudomonal activity: inhibitor-protected penicillins: amoxicillin/clavulanate, ampicillin/salbactam, ticarcillin/clavulanate, piperacillin/tazobactam; a combination of two penicillins (ampicillin + oxacillin). According to antipseudomonas activity, drugs can be arranged as follows (in ascending order): carbenicillin< тикарциллин = азлоциллин < пиперациллин. Но они разрушаются метицилиназой, поэтому комбинируются с аминогликозидами II-III поколений или ципрофлоксацином (но не в одном шприце!).

Microorganisms with eponymous names: Escherichia coli (Escherichia coli Bacterium coli), Klebsiella pneumoniae, Moraxella catarrhalis.

Staphylococci, Klebsiella, and Escherichia coli have beta-lactamase activity. They inactivate penicillin, ampicillin, and cephalosporins.

Third generation quinolines (“respiratory” difluoroquinolines) are effective against most microbes that cause damage to the respiratory tract: sparfloxacin, levofloxacin, as well as macrolides: azithromycin, etc. Second generation fluoroquinolines are ineffective against strepto-, pneumo-, enterococci, mycoplasmas, chlamydia , spirochetes, listeria and most anaerobes.

Sometimes they resort to assessing the pH of sputum. It fluctuates in a wide range - from 5.0 to 9.0. As a rule, the sputum reaction is slightly alkaline. This should be taken into account when choosing medications. Sputum becomes acidic either when it decomposes or when gastric contents are mixed with it.

Antitussives:

narcotic drugs of central action:

Codeine and drugs containing it: codeterpine, panadeine, perdolan; neocodion (codeine camphosulfonate + sulfoguaiacol + grindelia thick extract);

Biocalyptol, hexapneumin;

non-narcotic central action:

Glaucine, dimemorphan, oxeladine, pentoxyverine,

peripheral action:

Levodropronisin, prenoxydiazine (libexin)

Mucolytics, expectorants (expectorants):

Dornisa alpha – deoxyribonuclease I – mucolytic;

Acetylcysteine ​​is a mucolytic;

Ambroxol is a metabolite of bromhexine and is a mucolytic;

Bromhexine is a mucolytic;

Solvin expectorant (bromhexine + pseudoephedrine) – mucolytic;

Carbocisteine ​​is a mucolytic;

Mesna is a mucolytic;

Tonsilgon (marshmallow root + chamomile flowers + horsetail + walnut leaves + yarrow + oak bark + dandelion);

Pulmex (Peruvian balsam + camphor + eucalyptus and rosemary oils);

Collections (herbs) No. 1, 2, 4;

Ledum;

Licorice root extract;

Tussamag (liquid thyme extract);

Timi (a mixture of primrose root and Pimpinella aniseturn root extracts);

Sinupret (powder of gentiana root + tulip flowers + sorrel + verbena + elderberry flowers);

Mucaltin (marshmallow herb extract + sodium bicarbonate);

Bronchosan (bromhexine + menthol + oils of fennel, anise, oregano, peppermint, eucalyptus);

Bronchicum drops (tincture of thyme, quebracho, soapwort herbs); bronchicum elixir (tincture of grindelia herb, wildflower root, primrose root, quebracho bark, thyme);

Doctor MOM solution (eucalyptus oil + menthol + camphor + methyl salicylate);

Zedex (bromhexine + dextromethorphan + ammonium chloride + menthol);

Carmolis (menthol + thyme, anise, Chinese cinnamon, clove, lemon, angustifolia lavender, broadleaf lavender, citronella, sage, nutmeg oil);

Terpon (terpin + essential oils of Siberian pine, nyauli, eucalyptus);

Pectussin (menthol + eucalyptus oil (eucalyptol);

Pertussin (thyme, caraway extracts + potassium bromide);

Stoptussin (butamirate citrate + guaifenesin);

Trisolvin (ambroxol + guaifenesin + theophylline);

Altalex (a mixture of essential oils of lemon balm, peppermint, fennel, nutmeg, cloves, thyme, pine needles, anise, eucalyptus, sage, cinnamon and lavender);

Prothiazine expectorant (promethazine + guaifenesin + ipecac extract);

Mucodex (bromhexine + dextromethorphan + chlorphenamine).

Drugs that cause damage to the respiratory system:

1. Drugs, tranquilizers, sedatives, barbiturates, antihistamines - cause relaxation of the respiratory muscles with the development of pulmonary hypoventilation.

2. Diacarb, ethacrynic acid – cause disturbances in the water-electrolyte and acid-base state.

3. Respiratory analeptics – cause hyperventilation of the lungs and fatigue of the respiratory muscles.

4. Drugs (large group) that cause asthmatic syndrome (bronchospasm, bronchial obstruction with sputum), including due to allergic reactions:

Beta blockers, anticholinergics, sympatholytics;

Chymotrypsin;

Non-steroidal anti-inflammatory drugs;

Iodine, bromine, procainamide;

Antibiotics, sulfonamides.

It is dangerous to get mineral oils into the respiratory tract, which, unlike plant oils, do not clear the throat (suppress the cough reflex!), suppress the ciliary activity of the epithelium, are absorbed by macrophages and cause a chronic inflammatory process.

Morphine, nitrofurans, and aspirin may, although rarely, cause respiratory distress syndrome.

Cytostatics and glucocorticosteroids can aggravate or cause purulent processes in the lungs. Levomycetin has an immunosuppressive effect.

Allergic drug lesions of the bronchi are accompanied by sputum characteristic of bronchial asthma (eosinophils, Kurshman spirals, Charcot-Leyden crystals).

With drug-induced pneumonia (PAS, sulfonamides, antibiotics), streaks of blood and a large number of eosinophils appear in the sputum.

Drug-induced bronchial asthma often occurs in people working in the production of medicines and participating in their sales.

Read about what kind of research this is, who needs it, how it is conducted and how it is interpreted.

Types of sputum tests

Sputum is the secretion of glands located in the walls of the trachea and bronchi. Normally, there is little of it; it is excreted using the cilia of the ciliated epithelium unnoticed by humans and is swallowed. With pathological processes in the respiratory system, the amount of discharge increases, its properties change, it begins to separate when coughing or expectoration, mixing with secretions from the nasopharynx and saliva.

Depending on what a sputum test is needed for, a general practitioner or pulmonologist may prescribe different types.

• general (aka clinical) sputum analysis;
• bacteriological (“for microflora”, “for sowing”);
• on Mycobacterium tuberculosis;
• for malignant cells and other pathological inclusions.

General sputum analysis

This is an external assessment of the amount and nature of discharge followed by microscopic examination. What this analysis shows: with its help, the doctor determines the signs of inflammation in the lungs and bronchi and its severity.

Normally, there is no sputum or it is present in scant quantities, its nature is mucous. Microscopic examination shows no pathological inclusions; columnar epithelial cells and a small number of leukocytes are detected. All other inclusions in the sputum analysis, when deciphered, can be signs of disease.

For what diseases is a general sputum analysis performed?

• inflammatory processes (,);
• specific processes ( , );
• chronic respiratory diseases (,);
• , echinococcosis, actinomycosis, and some other conditions.

The study is not carried out at .

How to take a sputum test

A sputum test is taken after waking up. How to collect sputum so that its analysis is most informative:

A sputum test is taken after waking up

• sputum is collected in the morning after getting out of bed, before this you should not drink, eat, smoke, take medications, or brush your teeth;
• before collecting the discharge, the patient should rinse his mouth well, preferably with boiled water;
• you need to strive to ensure that nasal and pharyngeal mucus does not get into the material;
• after several successive deep breaths, expectorate the sputum and spit it out into a sterile jar, which is closed with a plastic lid or thick paper secured with an elastic band;
• the resulting material is quickly delivered to the laboratory.

Decoding the results

1. Normally, sputum is mucous. An admixture of pus occurs with the appropriate nature of the inflammatory process in chronic bronchitis, severe pneumonia, bronchiectasis, and lung tumors. Purulent discharge appears when a lung abscess has opened into the lumen of the bronchus, a suppurating echinococcal cyst, or an exacerbation of bronchiectasis.
2. Blood is recorded in case of bleeding caused by tuberculosis, disintegrating tumor, exacerbation of bronchiectasis, pulmonary infarction. occurs with syphilitic lesions, organ contusion, lobar pneumonia, silicosis, heart failure with left ventricular failure.
3. Normally, sputum is colorless or whitish in color. The greenish tint of the mucus indicates its purulent nature. If the sputum has a rusty appearance, this means that it contains decayed red blood cells, which are released in cases of lobar pneumonia, tuberculosis, pulmonary infarction, and also in severe heart failure.
4. A putrid odor is noted in the analysis of discharge from an abscess, bronchiectasis, gangrene, and disintegrating lung cancer.
5. If the sputum has an acidic environment (pH less than 7), this indicates too long a time has passed between the test and its study, when the mucus has time to decompose. A large amount of protein is characteristic of the tuberculosis process.
6. During microscopic analysis, the most important diagnostic value is the detection of:
   • “cells of heart defects” (macrophages that capture blood that sweats into the alveoli during pulmonary infarction and heart defects);
   • neutrophils (a sign of purulent sputum);
   • eosinophils (for bronchial asthma, pulmonary echinococcosis, tuberculosis, cancer, pulmonary infarction);
   • lymphocytes (for tuberculosis);
   • a large number of red blood cells is a sign of pulmonary hemorrhage.
7. Groups of atypical cells may be detected - this is a sign of a malignant tumor of the bronchi or lung tissue.
8. When lung tissue is destroyed, elastic fibers are found in the sputum (tuberculosis, abscess, lung cancer). It is characterized by the detection of Kurshman spirals (casts of small bronchi) and Charcot-Leyden crystals (clusters of eosinophils).

Bacteriological research can be carried out using different methods:

• express methods for identifying microorganisms;
• bacterioscopy (analysis of stained smears under a microscope);
• detection of Mycobacterium tuberculosis;
• culture on a nutrient medium to determine the sensitivity of pathogens to antibiotics.

These tests are performed for infectious diseases of the lungs: pneumonia, bronchitis, bronchiectasis, abscess and gangrene of the lung.

Bacteria in sputum

The most common pathogenic bacteria found in sputum are staphylococci, pneumococci, Klebsiella, and Haemophilus influenzae. So-called intermediate-level pathogens can also be detected - Moraxella, Enterobacteriaceae, and fungi of the genus Candida. They are often opportunistic flora and cause pneumonia or other inflammatory disease of the respiratory tract in people with weakened immune systems. Less common are mycoplasma, Pseudomonas aeruginosa, chlamydia, and legionella. Some of them cause so-called atypical pneumonia.

The number of bacteria in 1 ml of sputum is of clinical importance. It is believed to be 10 6 – 10 7 CFU/ml. CFU is a colony-forming unit, that is, a microorganism capable of reproduction.

If sputum is applied to a nutrient medium using a special technology, then after some time colonies of microorganisms present in the mucus will form on it. They are exposed to various antibacterial substances and it is determined under the influence of which antibiotics the isolated pathogens die. This is how sensitivity to antibiotics is determined. It is clear that such an analysis cannot be carried out quickly. A sputum sensitivity test is done over several days. Without waiting for the result, doctors begin treatment with broad-spectrum antibiotics; after receiving the analysis, therapy can be adjusted.

Sputum test for tuberculosis

To determine Mycobacterium tuberculosis, sputum is usually collected for three days in a row. It is called “analysis for BC” (Koch’s bacilli), “for AFB” (acid-fast mycobacteria). Determination of these pathogens is carried out either by microscopy of a stained smear, or by inoculation on nutrient media. The result in this case can be obtained only after 14–90 days, but it will be very informative. It will be possible not only to confirm bacterial excretion, but also to obtain data on the sensitivity of the pathogen to antibacterial agents.

An additional method for diagnosing tuberculosis is infection of laboratory animals with material obtained from sputum.

The detection of Mycobacterium tuberculosis in sputum indicates its “open” forms, in which the patient is infectious to others.

Sputum analysis for various diseases

Here is a table of sputum analysis for various diseases.

Disease	External signs			Microscopic signs
	Volume	Character	Pathological inclusions
Bronchitis acute	Scarce	Mucous or mucopurulent (white, yellow, yellow-green color)	No	Columnar epithelial cells, moderate number of leukocytes, with prolonged course macrophages are found
Chronic bronchitis, COPD	From scanty to abundant	Muco-purulent, muco-purulent-bloody (yellow, green shades, streaks of blood)	No	A large number of leukocytes, red blood cells, macrophages, a large number of microorganisms
Bronchiectasis	Abundant (when giving the morning portion)	Purulent-mucous, when settling it is divided into 3 layers	Dittrich's plugs (clusters of cells from dilated areas of the bronchi)	A large number of leukocytes and microorganisms. Crystals of fatty acids, hematoidin, cholesterol
Lobar pneumonia	First scanty, then abundant	First rusty, then mucopurulent with a yellow-green tint	Fibrin clots, altered red blood cells	Macrophages, erythrocytes, leukocytes, microorganisms (pneumococci), hematoidin crystals, hemosiderin grains
Bronchial asthma	Scarce	Mucous, light	Kurschmann spirals (convoluted casts of bronchi)	Columnar epithelium, Charcot-Leyden crystals, eosinophils
Lung abscess	After the abscess breaks into the bronchus, there is copious discharge	Purulent, green, foul-smelling	Areas of lung tissue	A large number of leukocytes, elastic fibers, various microbes, crystals of fatty acids, hematoidin, cholesterol
Tuberculosis	May be different	Mucopurulent, yellow, yellow-green, sometimes streaked with blood	In the cavernous form – “rice bodies” (Koch lenses)	Mycobacterium tuberculosis can be detected, elastic fibers and various crystals are also visible
Bronchial and lung cancer	May be different	Muco-bloody, may have a purulent component	When the tumor disintegrates - fragments of lung tissue	Atypical (malignant) cells

The video describes the laboratory diagnosis of tuberculosis:

[02-021 ] General sputum analysis

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Sputum is a pathological secretion discharged from the lungs and respiratory tract (trachea and bronchi). General sputum analysis is a laboratory test that allows you to evaluate the nature, general properties and microscopic features of sputum and gives an idea of ​​the pathological process in the respiratory organs.

Synonyms Russian

Clinical sputum analysis.

English synonyms

Sputum analysis.

Research method

Microscopy.

Units

Mg/dL (milligram per deciliter).

What biomaterial can be used for research?

How to properly prepare for research?

• It is recommended to drink a large amount of liquid (water) 8-12 hours before collecting sputum.

General information about the study

Sputum is a pathological secretion of the lungs and respiratory tract (bronchi, trachea, larynx), which is separated when coughing. Healthy people do not produce sputum. Normally, the glands of the large bronchi and trachea constantly produce a secretion in amounts of up to 100 ml/day, which is swallowed when secreted. Tracheobronchial secretion is a mucus that contains glycoproteins, immunoglobulins, bactericidal proteins, cellular elements (macrophages, lymphocytes, desquamated bronchial epithelial cells) and some other substances. This secretion has a bactericidal effect, promotes the removal of inhaled small particles and cleanses the bronchi. In diseases of the trachea, bronchi and lungs, the formation of mucus increases, which is expectorated in the form of sputum. Smokers without signs of respiratory diseases also produce copious amounts of sputum.

Clinical sputum analysis is a laboratory test that allows you to evaluate the nature, general properties and microscopic features of sputum. Based on this analysis, the inflammatory process in the respiratory organs is judged, and in some cases a diagnosis is made.

The composition of sputum is heterogeneous. It may contain mucus, pus, serous fluid, blood, fibrin, and the simultaneous presence of all these elements is not necessary. Pus forms accumulations that occur at the site of the inflammatory process. Inflammatory exudate is released in the form of serous fluid. Blood in the sputum appears when there are changes in the walls of the pulmonary capillaries or damage to blood vessels. The composition and associated properties of sputum depend on the nature of the pathological process in the respiratory organs.

Microscopic analysis makes it possible to examine the presence of various formed elements in sputum under multiple magnification. If microscopic examination does not reveal the presence of pathogenic microorganisms, this does not exclude the presence of infection. Therefore, if a bacterial infection is suspected, it is simultaneously recommended to perform a bacteriological examination of sputum to determine the sensitivity of pathogens to antibiotics.

The material for analysis is collected in a sterile disposable container. The patient must remember that the study requires sputum released during coughing, and not saliva and mucus from the nasopharynx. You need to collect sputum in the morning before meals, after thoroughly rinsing your mouth and throat, and brushing your teeth.

The results of the analysis should be assessed by a doctor in combination, taking into account the clinical picture of the disease, examination data and the results of other laboratory and instrumental research methods.

What is the research used for?

• To diagnose pathological processes in the lungs and respiratory tract;
• to assess the nature of the pathological process in the respiratory organs;
• for dynamic monitoring of the condition of the respiratory tract of patients with chronic respiratory diseases;
• to assess the effectiveness of the therapy.

When is the study scheduled?

• For diseases of the lungs and bronchi (bronchiectasis, fungal or helminthic invasion of the lungs, interstitial lung diseases);
• if you have a cough with sputum production;
• with a specified or unclear process in the chest according to auscultation or x-ray examination.

What do the results mean?

Reference values

Amount of sputum for various pathological processes it can range from several milliliters to two liters per day.

A small amount of sputum is released when:

• acute bronchitis,
• pneumonia,
• congestion in the lungs, at the beginning of an attack of bronchial asthma.

Large amounts of sputum may be produced when:

• pulmonary edema,
• suppurative processes in the lungs (with an abscess, bronchiectasis, gangrene of the lung, with a tuberculosis process accompanied by tissue decay).

By changing the amount of sputum, it is sometimes possible to assess the dynamics of the inflammatory process.

Sputum color

Most often the sputum is colorless.

A green tint may indicate the addition of purulent inflammation.

Various shades of red indicate an admixture of fresh blood, and rusty indicates signs of decay.

Bright yellow sputum is observed when a large number of eosinophils accumulate (for example, in bronchial asthma).

Blackish or grayish sputum contains coal dust and is observed in pneumoconiosis and in smokers.

Some drugs (for example, rifampicin) can also stain sputum.

Smell

Sputum is usually odorless.

A putrid odor is observed as a result of the addition of a putrefactive infection (for example, with an abscess, gangrene of the lung, with putrefactive bronchitis, bronchiectasis, lung cancer complicated by necrosis).

A peculiar “fruity” smell of sputum is characteristic of opened sputum.

Character of sputum

Mucous sputum is observed with catarrhal inflammation in the respiratory tract, for example, against the background of acute and chronic bronchitis, tracheitis.

Serous sputum is determined by pulmonary edema due to the release of plasma into the lumen of the alveoli.

Mucopurulent sputum is observed in bronchitis, pneumonia, bronchiectasis, and tuberculosis.

Purulent sputum is possible with purulent bronchitis, abscess, pulmonary actinomycosis, gangrene.

Bloody sputum is released during pulmonary infarction, neoplasms, lung injury, actinomycosis and other factors of bleeding in the respiratory organs.

Consistency sputum depends on the amount of mucus and formed elements and can be liquid, thick or viscous .

Flat epithelium in an amount of more than 25 cells indicates contamination of the material with saliva.

Columnar ciliated epithelial cells – cells of the mucous membrane of the larynx, trachea and bronchi; they are found in bronchitis, tracheitis, bronchial asthma, and malignant neoplasms.

Alveolar macrophages in increased quantities in sputum are detected during chronic processes and at the stage of resolution of acute processes in the bronchopulmonary system.

Leukocytes are detected in large quantities with severe inflammation, as part of mucopurulent and purulent sputum.

Eosinophils found in bronchial asthma, eosinophilic pneumonia, helminthic lesions of the lungs, and pulmonary infarction.

Red blood cells . Detection of single red blood cells in sputum has no diagnostic value. In the presence of fresh blood, unchanged red blood cells are detected in the sputum.

Cells with signs of atypia present in malignant neoplasms.

Elastic fibers appear during the breakdown of lung tissue, which is accompanied by the destruction of the epithelial layer and the release of elastic fibers; they are found in tuberculosis, abscess, echinococcosis, and tumors in the lungs.

Coral fibers detected in chronic diseases (for example, cavernous tuberculosis).

Calcified elastic fibers – elastic fibers impregnated with salts. Their detection in sputum is characteristic of tuberculosis.

Kurshman spirals are formed due to the spastic condition of the bronchi and the presence of mucus in them; characteristic of bronchial asthma, bronchitis, lung tumors.

Charcot crystals – Leiden - eosinophil breakdown products. Characteristic of bronchial asthma, eosinophilic infiltrates in the lungs, pulmonary fluke.

Mushroom mycelium appears with fungal infections of the bronchopulmonary system (for example, in the lungs).

Other flora . The detection of bacteria (cocci, bacilli), especially in large quantities, indicates the presence of a bacterial infection.



Literature

• Laboratory and instrumental studies in diagnostics: Handbook / Transl. from English V. Yu. Khalatova; under. ed. V. N. Titova. – M.: GEOTAR-MED, 2004. – P. 960 .
• Nazarenko G.I., Kishkun A. Clinical assessment of laboratory research results. – M.: Medicine, 2000. – P. 84-87.
• Roytberg G. E., Strutinsky A. V. Internal diseases. Respiratory system. M.: Binom, 2005. – P. 464.
• Kincaid-Smith P., Larkins R., Whelan G. Problems in clinical medicine. – Sydney: MacLennan and Petty, 1990, 105-108.

Microscopic examination of sputum includes the study of native (natural, unprocessed) and colored preparations. For the first, purulent, bloody, crumbly lumps are selected and transferred to a glass slide in such quantity that when covered with a cover glass, a thin translucent preparation is formed. At low microscope magnification can be detected Kurschmann spirals in the form of dense strands of mucus of various sizes. They consist of a central dense shiny convoluted axial thread and a spiral-shaped mantle enveloping it (Fig. 9), in which they are interspersed. Kurschmann spirals appear in bronchial sputum. At high magnification, in the native preparation (Fig. 11) one can detect leukocytes, alveolar macrophages, cells of cardiac defects, cylindrical and flat, malignant tumor cells, drusen of actinomycetes, fungi, Charcot-Leyden crystals, eosinophils. Leukocytes- gray granular round cells. A large number of leukocytes can be found during the inflammatory process in the respiratory organs. Red blood cells- small homogeneous yellowish discs that appear in sputum during stagnation in the pulmonary circulation, pulmonary infarction and tissue destruction. Alveolar macrophages- cells 2-3 times larger than leukocytes with abundant coarse granularity. By doing this, they cleanse the lungs of particles that enter them (dust, cell decay). By capturing red blood cells, alveolar macrophages turn into heart defect cells(Fig. 12 and 13) with yellow-brown hemosiderin grains, giving a reaction to Prussian blue. To do this, add 1-2 drops of a 5% solution of yellow blood salt and the same amount of a 2% solution to a lump of sputum on a glass slide, mix, and cover with a coverslip. After a few minutes, they are examined under a microscope. Hemosiderin grains turn blue.

Columnar epithelium the respiratory tract is recognized by the wedge-shaped or goblet-shaped cells, at the blunt end of which cilia are visible in fresh sputum; there is a lot of it in acute bronchitis and acute catarrh of the upper respiratory tract. Flat epithelium- large polygonal cells from the oral cavity have no diagnostic value. Malignant tumor cells- large, of various irregular shapes with large nuclei (recognizing them requires a lot of experience of the researcher). Elastic fibers- thin, crimped, double-circuit colorless fibers of equal thickness throughout, branching in two at the ends. They are often folded into ring-shaped bundles. Occurs during the breakdown of lung tissue. For more reliable detection, several milliliters of sputum are boiled with an equal amount of 10% caustic until the mucus dissolves. After cooling, the liquid is centrifuged by adding 3-5 drops of a 1% alcohol solution of eosin. The sediment is microscopically examined. The elastic fibers appear as described above, but are bright pink in color (Fig. 15). Drusen of actinomycetes for microscopy, crush in a drop of glycerin or alkali. The central part of the drusen consists of a plexus of thin mycelial filaments; it is surrounded by radiant flask-shaped formations (Fig. 14). When crushed drusen is stained with a Gram stain, the mycelium turns purple and the cones turn pink. Candida albicans fungus has the character of budding yeast cells or short branched mycelium with a small number of spores (Fig. 10). Charcot - Leiden crystals- colorless rhombic crystals of various sizes (Fig. 9), formed from the breakdown products of eosinophils, are found in sputum along with a large number of eosinophils in bronchial asthma, eosinophilic infiltrates and helminthic infestations of the lung. Eosinophils in the native preparation they differ from other leukocytes by their large shiny granularity, they are better distinguishable in a smear stained sequentially with a 1% eosin solution (2-3 min.) and a 0.2% solution of methylene blue (0.5 min.) or according to Romanovsky-Giemsa (Fig. 16). With the last staining, as well as with May-Grunwald staining, tumor cells are recognized (Fig. 21).

Rice. 9. Kurshman spiral (top) and Charcot-Leyden crystals in sputum (native preparation). Rice. 10. Candida albicans (in the center) - budding yeast-like cells and mycelium with spores in sputum (native preparation). Rice. 11. Sputum cells (native preparation): 1 - leukocytes; 2 - red blood cells; 3 - alveolar macrophages; 4 - columnar epithelial cells. Rice. 12. Cells of cardiac defects in sputum (reaction to Prussian blue). Rice. 13. Cells of cardiac defects in sputum (native preparation). Rice. 14. Drusen of actinomycetes in sputum (native preparation). Rice. 15. Elastic fibers in sputum (eosin staining). Rice. 16. Eosinophils in sputum (Romanovsky-Giemsa stain): 1 - eosinophils; 2 - neutrophils. Rice. 17. Pneumococci and in sputum (Gram stain). Rice. 18. Friedlander's diplobacillus in sputum (Gram stain). Rice. 19. Pfeiffer bacillus in sputum (muchsin staining). Rice. 20. Mycobacterium tuberculosis (Ziehl-Neelsen staining). Rice. 21. Conglomerate of cancer cells in sputum (May-Grunwald staining).

At low magnification, Kurshman spirals are found in the form of strands of mucus of various sizes, consisting of a central axial thread and a spiral-shaped mantle enveloping it (tsvetn. Fig. 9). The latter is often interspersed with leukocytes, columnar epithelial cells, and Charcot-Leyden crystals. When the microscrew is turned, the axial thread sometimes shines brightly, sometimes becomes dark, may be invisible, and often only it alone is visible. Kurshman spirals appear during bronchospasm, most often with bronchial asthma, less often with pneumonia and cancer.

At high magnification the following is found. Leukocytes are always present in sputum; there are many of them during inflammatory and suppurative processes; among them there are eosinophils (with bronchial asthma, asthmatic bronchitis, helminthic infestations of the lungs), characterized by large shiny granularity (color. Fig. 7). Single red blood cells can be present in any sputum; there can be many of them when lung tissue is destroyed, with pneumonia and blood stagnation in the pulmonary circulation. Squamous epithelium - large polygonal cells with a small nucleus that enter the sputum from the pharynx and oral cavity, have no diagnostic value. Columnar ciliated epithelium appears in sputum in significant quantities with lesions of the respiratory tract. Single cells can be in any sputum, they are elongated, one end is pointed, the other is blunt, bears cilia, found only in fresh sputum; in bronchial asthma, round groups of these cells are found, surrounded by mobile cilia, giving them a resemblance to ciliated ciliates.

Cytological examination. Native and colored preparations are studied. To examine cells, lumps of sputum are carefully stretched onto a glass slide using splinters. When searching for tumor cells, material is collected from the native specimen. The dried smear is fixed with methanol and stained with Romanovsky-Giemsa (or Papanicolaou). Cancer cells are characterized by a homogeneous, sometimes vacuolated cytoplasm from gray-blue to blue, a large loose, and often hyperchromic, purple nucleus with nucleoli. There may be 2-3 or more nuclei, sometimes they are irregular in shape; characterized by polymorphism of nuclei in one cell.

The most convincing are complexes of polymorphic cells of the described nature (tsvetn. fig. 13 and 14). Eosinophils are stained either according to Romanovsky - Giemsa, or sequentially with a 1% eosin solution (2 min.) and 0.2% methylene blue solution (0.5-1 min.).

Sputum production is observed only during pathological processes in the respiratory organs, so its appearance is an alarming sign. Laboratory examination of sputum will help determine the nature of the disease and its severity. How to correctly collect biological material for analysis and how are its results interpreted?

What is sputum

Sputum is a secretion secreted from the respiratory tract and lungs. The separated mucus is used for laboratory analysis, which allows us to identify pathological changes in the respiratory organs (bronchi, lungs and trachea). Analysis is used in pulmonology and is aimed at studying the composition (qualitative and quantitative), physical characteristics, cytological and bacteriological properties of sputum.

If the disease develops, the discharge contains a large number of pathogenic microorganisms, blood cells and other substances.

Carrying out a sputum test allows the doctor to obtain information about the patient’s health status and helps to make an accurate diagnosis by identifying the pathogen. The study is carried out to differentiate respiratory diseases, so that the pulmonologist can select the appropriate antibiotic and other effective treatment.

Indications for analysis

• a wet cough has been observed for a long time;
• there is a suspicion of the development of chronic (bronchial asthma) or acute (pneumonia or bronchitis) lung diseases;
• pulmonary tuberculosis or respiratory cancer, as well as helminthic infestation, are suspected.

In addition, sputum analysis is performed to evaluate the effectiveness of treatment of respiratory diseases.

Rules for sputum collection

To carry out the analysis, it is important to correctly collect sputum. This can be done in a medical facility or independently at home. In case of home collection, a sample of biological material must be delivered to the laboratory as quickly as possible, within a maximum of 1.5 hours. To collect sputum, use only a sterile container that is sealed tightly.

Before collecting the test, thoroughly brush your teeth and rinse your mouth. Cough and collect the sputum in a container, trying to avoid large amounts of saliva getting into the biological material.

Drinking plenty of fluids the day before, taking samples in the morning, and performing simple breathing exercises can improve sputum discharge.

If you have difficulty collecting material, inhale over steamy water to which table salt and baking soda have been added. The duration of the procedure is 5 minutes. This will facilitate the process of sputum removal, and you can easily collect material for analysis.

Norms and deviations

Sputum is assessed using several indicators at once, which make it possible to most accurately determine the severity of the disease and its causative agent. The presence of more than 25 epithelial cells in the sample indicates a high saliva content, which may distort the analysis result.

Amount of sputum

Normally, it is absent or its secretion is insignificant. A slight separation of sputum may indicate the development of pneumonia, acute bronchitis, or the formation of congestion in the lungs before bronchial asthma. A large amount of mucus is observed during pulmonary edema and suppurative processes occurring in them (abscess, gangrene or pulmonary tuberculosis).

Sputum color

As a rule, it is colorless, and a change in its shade indicates various pathologies:

• green indicates the occurrence of a purulent process;
• red is observed in the presence of fresh blood;
• rusty indicates traces of red blood cell breakdown;
• bright yellow color indicates a large number of eosinophils;
• gray or blackish is observed in smokers or in patients with pneumoconiosis.

Taking certain medications, such as Rifampicin, can also change the color of sputum.

Mucus smell

In most cases, it does not have a specific odor. The appearance of a putrid odor indicates purulent processes: abscess, gangrene and lung cancer with complications in the form of necrosis. A peculiar “fruit” aroma is observed when an echinococcal cyst is opened.

Character of sputum

Increased mucous indicates catarrhal inflammation in the upper respiratory tract, which is observed with tracheitis or bronchitis. Serous character occurs with pulmonary edema, and mucopurulent sputum is detected with gangrene and lung abscess, as well as with pneumonia. Bloody mucus indicates a lung infarction, the presence of tumors or injury.

Consistency of sputum

Depending on the amount of mucus and impurities, it can be thick, liquid or viscous.

Columnar ciliated epithelium

Detection of cylindrical ciliated epithelium in sputum indicates the development of bronchitis, malignant neoplasms or bronchial asthma. Eosinophils indicate these same diseases. A large number of leukocytes indicates the occurrence of an inflammatory process.