1

SPUTUM ANALYSIS.

It is a secretion that is produced in the lungs and the bronchi.

This mucus-like secretion may become infected, bloodstained, or contain abnormal cells that may lead to a diagnosis

Sputum Definition

2

Tracheobronchial secreations are an inconstant mixture of plasma, water, electrolytes and mucinAs these mixture pas through the lower and upper respiratory tract, they become contaminated with cellular exfoliations, nasal and salivary gland secretions and normal bacterial flora of the oral cavity

Sputum Definition

3

1. Drinking a lot of water and other fluids the night before the test may help to get the sample

2. To be asked to cough deeply and spit any sputum in a sterile cup

3. The sputum is then taken to the laboratory

4. There, it is placed in a special substance (medium) under conditions that allow the organisms to grow

Sputum Collection

4

Sputum Collection

5

Viscid & yellow

* a/c bronchitis * Bronchiectasis * Lung abscess

6

White & Mucoid

* c/c bronchitis * Bronchial Asthma * Pulmonary Tuberculosis

7

Rusty sputum

* Pneumococcal pneumonia

8

Cursch -man’s spirals Bronchial asthma Allergic bronchopulmonary aspergillosis

9

Watery & blood stained sputum

* Pulmonary edema

10

Blood in sputum [hemoptysis]

*TB, *Pneumonia, *Bronchiectasis, * Lung abscess, *Mitral Stenosis, *Bronchogenic carcinoma

11

Chocolate coloured sputum

* Amoebiasis

12

Foul smell

c/c suppuration

bronchiectasis lung abscess

13

MICROSCOPY

Wet preparations entamoeba, paragonimus

Wet staining wt methylene blue malignant cells

Gram’s staining bacterial pathogens

14

Ziehl – Neelsen Staining * Mycobacteria 50,000/ml- sputum positive

*at least 2 bacilli

*at least 100 fields

15

Papanicolaou stain

* cytological abnormalities * identify malignant cells * demonstrate bronchial casts

16

Neutrophils : pyogenic infection of respiratory tract

Eosinophil's : asthma and parasitic infections of lung.

Lymphocytes: early pulmonary tuberculosisRBCs: haemorrhage into the lungs.Heart failure cells: cvc of lungs pulmonary infarction and pulmonary haemorrhage

Anthracotic pigment laden cells: coal workers pneumoconiosis, smoky polluted areas. 17

Types of cells.

Sputum Analysis

18

This slide shows typical buccal squamous epithelial cells which are much larger than polymorph nuclear leukocytes (PMN) and take up most of the field in a high power view

This cell is covered with chains of Gram positive cocci typical of normal oral flora such as peptostreptococci. (oil immersion, 1000x)

1. Appearance• It may be described as liquid

(serous), mucous, purulent, bloody or combination of theses

2. Color• Its color is determined by the

material contained, and often color can indicate the pathological process

• Yellow color indicates pus and epithelial cells are present

19

Physical Properties of Sputum

Odor• Usually no odor is present in normal

and pathological sputum, but if bacterial decomposition has been taken place within the body or after expectoration, a variety of odor will be present

Physical Properties of Sputum

20

1. Cheesy Masses • These are fragments of necrotic

pulmonary tissue seen in such disease as pulmonary gangrene or tuberculosis

2. Bronchial Casts• These are branching tree like casts of

bronchi whose size varies with that of bronchi in which they are formed

• They are composed of fibrin and are white or gray color

21

Miscellaneous Findings in Sputum

3. Broncholiths (Lung Stones)• They are formed by calcification

of necrotic or infected tissues• Chronic tuberculosis is the most

common cause for their formation

Miscellaneous Findings in Sputum

22

4. Dietrich's Plugs• They are frequently observed

in putrid bronchitis and bronchiectasis

• They are composed of cellular debris, fatty acids, crystals, fat globules and bacteria

23

Miscellaneous Findings in Sputum,

Pneumonia, Cont’d

The alveoli filled with mucus such as submucosa widened by smooth muscle hypertrophy, edema, and inflammation (mainly eosinophils)

These are changes of bronchial asthma

The peripheral eosinophil count or the sputum eosinophils can be increased during an asthmatic attack.

24

Pneumonia

25

Pneumonia, Cont’d

26

Pneumonia symptoms vary depending upon the type of pneumonia. Symptoms may include:•Fever •Chest pain and/or muscle pain •Cough that may produce white, yellow, or green mucus (phlegm)

•Lack of energy

Symptoms of Pneumonia

27

Sputum Analysis: Pneumonia

28

Moraxella catarrhalis, a large number of Gram negative (red) cocci are seen and many appear to be attaching to or residing within the PMNs

Some physicians confuse these organisms with the Gram negative coccobacillary

Sputum Analysis: Pneumonia, Cont’d

29

Hemophilus influenzae pneumonia demonstrating the typical Gram negative coccobacillary forms

Because of the red background produced by the Gram stain method, these organisms can be difficult to see (oil immersion, 1000x)

Sputum Analysis: Pneumonia, Cont’d

30

Hemophilus influenzae pneumonia

Sputum Analysis: Pneumonia, Cont’d

31

Klebsiella pneumoniae pneumonia demonstrating Gram negative bacillary organisms. (oil immersion, 1000x)

Sputum Analysis: Pneumonia, Cont’d

32

Gram stain of the sputum from a patient with Staphylococcus aureus pneumonia demonstrating clusters of Gram positive cocci some of which are associated with the PMNs (oil immersion, 1000x)

Normal and Asthmatic Bronchiole

33

Analysis of Sputum: Asthma

34

Analysis of Sputum: Asthma,

35

Analysis of Sputum: Asthma,

36

37

AFB smear

AFB (shown in red) are tubercle bacilli

38

Aims of sputum microscopyAims of sputum microscopy

Diagnosis of patients with infectious tuberculosis Monitoring progress of patients on treatment

39

Advantages of sputum microscopyAdvantages of sputum microscopy

More reliable than x-ray for the diagnosis of infectious TB Simple to perform Easy to read Minimal infrastructure required Inexpensive Quick Only tool to monitor and declare patients as “cured’’

40

Diagnosis of pulmonary tuberculosisDiagnosis of pulmonary tuberculosis

Three specimens optimalThree specimens optimal

Spot specimen on first visit;sputum

container given to patient

Early morning collection next day

Spot specimen during second visit

41

42

Normal/negative for malignancy [6] Moderate number of alveolar macrophages, pigmented macrophages and neutrophils. Few ciliated columnar cells and mucous spirals.

Inflammatory lesions  Squamous metaplasia  Regular squamous

metaplasia. Squamous metaplasia with mild atypia. Squamous metaplasia with moderate atypia. Squamous metaplasia with marked atypia.

43

Positive for malignancy [5]Squamous cell carcinoma [Figure 3] Well-differentiated (keratinizing) squamous cell

carcinoma. Poorly differentiated squamous cell carcinoma.

Adenocarcinoma . Acinar adenocarcinoma. Bronchoalveolar carcinoma.

Large cell undifferentiated carcinoma. Small cell undifferentiated carcinoma.

44

45

46

Thank you.

Enjoy the subject and learn it.