Collection of sputum for bacteriological examination. Collection of sputum for research Bacteriological examination of sputum includes
Sputum (sputum) is a pathological secretion formed when the trachea, bronchial tree and lung tissue are damaged. Its release is observed not only in diseases of the respiratory system, but also of the cardiovascular system. General analysis of sputum includes macroscopic, chemical, microscopic and bacterioscopic determination of its properties.
Macroscopic examination
Quantity
In various pathological processes, the amount of sputum varies widely - from several spits to 1 liter or more per day. A small amount of sputum is released during acute bronchitis, pneumonia, sometimes with chronic bronchitis, congestion in the lungs, at the beginning of an attack of bronchial asthma. At the end of an attack of bronchial asthma, the amount of sputum produced increases. A large amount of sputum (sometimes up to 0.5 liters) can be released during pulmonary edema. A lot of sputum is released during suppurative processes in the lungs, provided that the cavity communicates with the bronchus (with an abscess, bronchiectasis, lung gangrene). During the tuberculous process in the lung, accompanied by tissue decay, especially in the presence of a cavity communicating with the bronchus, a lot of sputum can also be released.
An increase in the amount of sputum can be regarded as a sign of deterioration of the patient’s condition if it depends on an exacerbation, for example, a suppurative process; in other cases, when an increase in the amount of sputum is associated with improved drainage of the cavity, it is regarded as a positive symptom. A decrease in the amount of sputum may be a consequence of the subsidence of the inflammatory process or, in other cases, the result of impaired drainage of the purulent cavity, often accompanied by a deterioration in the patient’s condition.
Character
Mucous sputum is secreted in acute bronchitis, chronic bronchitis, bronchial asthma, pneumonia, bronchiectasis, and lung cancer. Mucopurulent sputum is released in case of chronic bronchitis, pneumonia, bronchiectasis, lung abscess, suppurating pulmonary echinococcus, pulmonary actinomycosis, and lung cancer accompanied by suppuration. Pure purulent sputum is found in cases of lung abscess, suppurating pulmonary echinococcus, rupture of pleural empyema into the bronchus, and bronchiectasis.
Bloody sputum, consisting of almost pure blood, is most often observed with pulmonary tuberculosis. The appearance of bloody sputum can occur with lung cancer, bronchiectasis, lung abscess, middle lobe syndrome, pulmonary infarction, lung injury, actinomycosis and syphilis. Hemoptysis and even blood mixed with sputum occur in 12-52% of pulmonary infarctions. The admixture of blood in sputum is determined in case of lung tumors, pulmonary infarction, lobar and focal pneumonia, pulmonary silicosis, congestion in the lungs, cardiac asthma and pulmonary edema. Serous sputum is released during pulmonary edema.
Color
Mucous and serous sputum is colorless or whitish. The addition of a purulent component to sputum gives it a greenish tint, which is characteristic of a lung abscess, lung gangrene, bronchiectasis, and actinomycosis of the lung.
Sputum is rusty or brown in color, indicating that it contains not fresh blood, but its breakdown products (hematin) and is found in lobar pneumonia, pulmonary tuberculosis with cheesy decay, stagnation of blood in the lungs, pulmonary edema, pulmonary anthrax, heart attack lung
Sputum released during various pathological processes in the lungs, combined with the presence of jaundice in patients, may have a dirty green or yellow-green color. Sputum in eosinophilic pneumonia sometimes has a canary-yellow color. Ocher-colored sputum is noted with pulmonary siderosis. Blackish or grayish sputum occurs when there is an admixture of coal dust. With pulmonary edema, serous sputum, often released in large quantities, is evenly colored in a faint pink color, which is due to the admixture of red blood cells. The appearance of such sputum is sometimes compared to liquid cranberry juice. Some medications may stain sputum. For example, the antibiotic rifampicin turns it red.
Smell
Sputum acquires a putrid (cadaverous) odor in cases of gangrene and lung abscess, bronchiectasis, putrefactive bronchitis, lung cancer complicated by necrosis.
Layering
When standing, purulent sputum is usually divided into 2 layers and usually occurs with lung abscess and bronchiectasis; putrefactive sputum is often divided into 3 layers (upper - foamy, middle - serous, lower - purulent), characteristic of gangrene of the lung.
Impurities
An admixture to the sputum of just eaten food is noted when the esophagus communicates with the trachea or bronchus, which can occur with esophageal cancer.
Fibrinous clots, consisting of mucus and fibrin, are found in fibrinous bronchitis, tuberculosis, and pneumonia.
Rice bodies (lentils) or Koch lenses consist of detritus, elastic fibers and MBT and are found in the sputum of tuberculosis.
Dietrich's plugs, consisting of decay products of bacteria and lung tissue, crystals of fatty acids, are found in putrefactive bronchitis and gangrene of the lung. In case of chronic tonsillitis, plugs may be released from the tonsils, reminiscent in appearance of Dietrich's plugs. Plugs from the tonsils can be released even in the absence of sputum.
Chemical research
Reaction
Freshly secreted sputum has an alkaline or neutral reaction. Decomposed sputum becomes acidic.
Protein
Determination of protein in sputum can be helpful in the differential diagnosis between chronic bronchitis and tuberculosis: with chronic bronchitis, traces of protein are detected in the sputum, while with pulmonary tuberculosis the protein content in the sputum is higher and can be determined quantitatively (up to 100-120 g /l).
Bile pigments
Bile pigments can be detected in sputum in diseases of the respiratory tract and lungs, combined with jaundice, during communication between the liver and lung (when a liver abscess ruptures into the lung). In addition to these conditions, bile pigments can be detected in pneumonia, which is associated with intrapulmonary breakdown of red blood cells and subsequent transformations of hemoglobin.
Microscopic examination
Epithelial cells
Squamous epithelial cells found in sputum have no diagnostic value. Columnar epithelial cells (both single and in the form of clusters) can be found in bronchial asthma, bronchitis, and bronchogenic lung cancer. At the same time, the appearance of columnar epithelial cells in sputum may also be due to an admixture of mucus from the nasopharynx.
Alveolar macrophages
Alveolar macrophages are reticuloendothelial cells. Macrophages containing phagocytosed particles in protoplasm (so-called dust cells) are found in the sputum of people who are in prolonged contact with dust. Macrophages containing hemosiderin (a breakdown product of hemoglobin) in their protoplasm are called “heart defect cells.” “Cells of heart defects” are found in sputum during pulmonary congestion, mitral stenosis, and pulmonary infarction.
Leukocytes
Leukocytes are found in small numbers in any sputum. A large number of neutrophils are observed in mucopurulent and especially purulent sputum. Sputum in bronchial asthma, eosinophilic pneumonia, helminthiasis of the lungs, pulmonary infarction, tuberculosis and lung cancer is rich in eosinophils. Lymphocytes are found in large numbers in whooping cough. An increase in the content of lymphocytes in sputum is possible with pulmonary tuberculosis.
Red blood cells
The detection of single red blood cells in sputum has no diagnostic value. The appearance of a large number of red blood cells in the sputum is observed in conditions accompanied by hemoptysis and pulmonary hemorrhage. In the presence of fresh blood in the sputum, unchanged red blood cells are determined, but if blood that has been retained in the respiratory tract for a long time leaves with the sputum, then leached red blood cells are detected.
Tumor cells
Tumor cells found in sputum in groups indicate the presence of a lung tumor. If only single cells suspicious for a tumor are detected, difficulties often arise in their assessment; in such cases, several repeated sputum examinations are done.
Elastic fibers
Elastic fibers appear as a result of the breakdown of lung tissue during tuberculosis, abscess, lung gangrene, and lung cancer. With gangrene of the lung, elastic fibers are not always detected, since under the influence of enzymes in the sputum, they can dissolve. Kurshman's spirals are special tubular bodies that are detected by microscopic examination and sometimes visible to the naked eye. Typically, Kurschmann spirals are determined for bronchial asthma, pulmonary tuberculosis and pneumonia. Charcot-Leiden crystals are found in sputum rich in eosinophils in bronchial asthma and eosinophilic pneumonia.
The opening of a petrified tuberculosis focus into the lumen of the bronchus may be accompanied by the simultaneous detection in the sputum of calcified elastic fibers, cholesterol crystals, MBT and amorphous lime (the so-called Ehrlich tetrad) - 100%.
Bacterioscopic examination
Sputum testing for Mycobacterium tuberculosis (MBT) is performed on a specially stained smear. It has been established that a routine study of a stained smear for MBT gives a positive result only if the MBT content is at least 50,000 in 1 ml of sputum. It is impossible to judge the severity of the process by the number of detected MBTs.
When bacterioscopy of sputum of patients with nonspecific lung diseases can be detected:
- for pneumonia - pneumococci, Frenkel diplococci, Friedlander bacteria, streptococci, staphylococci - 100%;
- with gangrene of the lung - a spindle-shaped rod in combination with Vincent's spirochete - 80%;
- yeast-like fungi, to determine the type of which a sputum culture is necessary - 70%;
- for actinomycosis - actinomycete drusen - 100%.
Norms
The volume of tracheobronchial secretion normally ranges from 10 to 100 ml/day. A healthy person usually swallows all this amount without noticing it. Normally, the number of leukocytes in sputum is small. Normally, examination of a stained smear for MBT gives a negative result.
Diseases for which a doctor may prescribe a general sputum test
Lung abscess
Bronchiectasis
With bronchiectasis, a large amount of sputum is produced. An increase in the amount of sputum is regarded as a sign of deterioration of the patient's condition. Sputum can be mucous, mucopurulent, purely purulent, and bloody. The presence of pus gives the sputum a greenish tint. The smell of sputum is putrid (cadaverous). When standing, purulent sputum usually separates into 2 layers.
Lung gangrene
With gangrene of the lung, a large amount of sputum is produced. An increase in the amount of sputum is regarded as a sign of deterioration of the patient's condition. The presence of pus gives the sputum a greenish tint. The smell of sputum is putrid (cadaverous). Putrefactive sputum is often divided into 3 layers (upper - foamy, middle - serous, lower - purulent). Dietrich's plugs, consisting of decay products of bacteria and lung tissue, and fatty acid crystals, may be found in sputum; elastic fibers resulting from the breakdown of lung tissue. With gangrene of the lung, elastic fibers are not always detected, since under the influence of enzymes in the sputum, they can dissolve. When bacterioscopy of sputum can be detected, a spindle-shaped rod in combination with Vincent's spirochete (80%).
Acute pleural empyema
When pleural empyema breaks through into the bronchus, the sputum is purely purulent.
Chronic lung abscess
With a lung abscess, a large amount of sputum is released. An increase in the amount of sputum is regarded as a sign of deterioration of the patient's condition. Sputum can be mucopurulent, purely purulent, and bloody. The smell of sputum is putrid (cadaverous). The presence of pus gives the sputum a greenish tint. When standing, purulent sputum usually separates into 2 layers. When a liver abscess ruptures into the lung, bile pigments may be detected in the sputum due to communication between the liver and lung. As a result of the breakdown of lung tissue during an abscess, elastic fibers appear in the sputum.
Lung cancer
With lung cancer, the sputum produced is mucous and bloody. Mucopurulent sputum is released in case of lung cancer, accompanied by suppuration. In case of lung cancer complicated by necrosis, the sputum acquires a putrid (cadaverous) odor. In bronchogenic lung cancer, columnar epithelial cells (both single and in the form of clusters) can be detected. In lung cancer, eosinophils, tumor cells, and elastic fibers can be found in the lung.
Esophageal cancer
When the esophagus communicates with the trachea or bronchus, which can occur with esophageal cancer, the sputum contains an admixture of food that has just been taken.
Bronchial asthma
At the beginning of an attack of bronchial asthma, a small amount of sputum is released; at the end of the attack, its amount increases. Sputum in bronchial asthma is mucous. Columnar epithelial cells (both single and in the form of clusters), eosinophils, Kurschmann spirals, and Charcot-Leyden crystals can be found in it.
Acute bronchitis
In acute bronchitis, a small amount of sputum is released. Sputum is mucous. Columnar epithelial cells (both single and in the form of clusters) can be found in it.
Chronic tonsillitis
In case of chronic tonsillitis, plugs may be released from the tonsils, reminiscent in appearance of Dietrich's plugs. Plugs from the tonsils can be released even in the absence of sputum.
Pulmonary tuberculosis (miliary)
Silicosis
With pulmonary silicosis, an admixture of blood is detected in the sputum.
Whooping cough
With whooping cough, lymphocytes are found in large numbers in the sputum.
Pulmonary tuberculosis (focal and infiltrative)
During a tuberculous process in the lung, accompanied by tissue disintegration, especially in the presence of a cavity communicating with the bronchus, a lot of sputum can be released. Bloody sputum, consisting of almost pure blood, is most often observed with pulmonary tuberculosis. In pulmonary tuberculosis with cheesy disintegration, the sputum is rusty or brown in color. Fibrinous clots consisting of mucus and fibrin may be detected in the sputum; rice-shaped bodies (lentils, Koch lenses); eosinophils; elastic fibers; Kurschmann spirals. An increase in the content of lymphocytes in sputum is possible with pulmonary tuberculosis. Determination of protein in sputum can be helpful in the differential diagnosis between chronic bronchitis and tuberculosis: with chronic bronchitis, traces of protein are detected in the sputum, while with pulmonary tuberculosis the protein content in the sputum is higher and can be determined quantitatively (up to 100-120 g /l).
Acute obstructive bronchitis
In acute bronchitis, the sputum is mucous. Columnar epithelial cells (both single and in the form of clusters) can be found in it.
Anthrax
With pulmonary anthrax, the sputum may be rusty or brown in color, indicating that it contains breakdown products (hematin) rather than fresh blood.
Pneumonia
Pneumonia produces a small amount of sputum. By nature it can be mucous, mucopurulent. The admixture of blood in the sputum is determined in lobar and focal pneumonia. Sputum is rusty or brown in color, indicating that it contains not fresh blood, but its breakdown products (hematin) and is found in lobar pneumonia. Sputum in eosinophilic pneumonia sometimes has a canary-yellow color. Fibrinous clots consisting of mucus and fibrin can be found in the sputum; bile pigments, which is associated with intrapulmonary breakdown of red blood cells and subsequent transformations of hemoglobin; eosinophils (with eosinophilic pneumonia); Kurschmann spirals; Charcot-Leiden crystals (for eosinophilic pneumonia); pneumococci, Frenkel diplococci, Friedlander bacteria, streptococci, staphylococci (100%).
Goodpasture's syndrome
There are a lot of fresh red blood cells, siderophages, and hemosiderin.
Algorithm for collecting sputum for bacteriological examination
Preparation for the procedure:
- Introduce yourself to the patient, explain the process and purpose of the procedure
2.. Collect sputum only when coughing, not expectorating.
- Personal hygiene must be observed before and after sputum collection
- Make sure that the patient brushes his teeth in the evening, and in the morning rinses his mouth and throat with boiled water immediately before collection. (If necessary, this procedure is monitored by junior medical staff)
- Treat hands hygienically and dry.
- Wear gloves and mask
Executing the procedure
- Open the lid of the jar
- Ask the patient to cough and collect sputum in a sterile jar in an amount of at least 5 ml. During the collection, the m/s hands the jar from behind the patient’s back.
- Close the lid
End of the procedure
- Remove the mask, gloves, place in a container for disinfection
- Treat hands hygienically and dry
- Make a referral
- Make an appropriate entry about the results of the implementation in the medical documentation
Arrange delivery of the analysis to the laboratory
Additional information about the features of the technique
Make sure that the sputum does not get on the edge of the jar and do not touch the inner surface of the lid and jar
Freshly isolated sputum is examined no later than 1-1.5 hours
Sputum is delivered to the bacteriological laboratory in a sealed container.
Patient informed consent form when performing the technique and additional information for the patient and his family members
- Upon admission to the hospital, the patient signs voluntary informed consent for medical intervention (based on Articles 32, 33 of the “Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens’ Health”, order No. 101 dated March 29, 2011);
- Treatment in a hospital can be carried out for the patient by court decision.
3. The patient must be informed about the upcoming study. Information about taking sputum for bacteriological examination, communicated to him by a medical professional, includes information about the purpose of this study. Written confirmation of the consent of the patient or his relatives to take sputum for bacteriological examination is not required, since this diagnostic method is not potentially dangerous to the life and health of the patient
Parameters for assessing and quality control of the method implementation
— Availability of a record of the results of the prescription in the medical documentation.
— Timely execution of the procedure (in accordance with the appointment time).
- No complications.
— There are no deviations from the execution algorithm
— Patient satisfaction with the quality of medical services provided
These are pathological secretions from the respiratory organs that are expelled when coughing. When conducting laboratory tests of sputum, it becomes possible to determine the nature of the pathological process in the respiratory system, and in some cases it becomes possible to determine its etiology. To do this, carry out the following steps:
- sputum is collected for the purpose of general clinical analysis;
- sputum is collected to detect tuberculosis in the respiratory organs;
- sputum is collected to identify atypical cells;
- sputum is collected to determine antibiotic sensitivity.
The pleura area of a healthy person contains a certain amount of fluid, which facilitates the sliding of the pleura during breathing and is very close in composition to lymph. In cases of impaired circulation of blood and lymph in the lung cavity, an increase in the volume of pleural fluid is possible. This can occur both during inflammatory changes in the pleura (exudate), and during processes that occur in the absence of inflammation. Primary clinical infection of the pleura can contribute to the manifestation of exudate, or it can accompany some general infections and in the case of certain diseases of the lungs and mediastinum, such as rheumatism, heart attack, tuberculosis and lung cancer, lymphogranulomatosis. Pleural fluid is examined for the following purposes: determining its nature; study of the cellular composition of the fluid, containing information about the properties of the pathological process, and in some cases (for tumors) and about the diagnosis; in case of infectious lesions, identification of the pathogen and determination of its sensitivity to antibiotics. Analysis of pleural fluid includes physical-chemical, microscopic, and in some cases microbiological and biological studies.
Sputum examination methods
To examine sputum in the respiratory organs, radiography, fluoroscopy, bronchography and tomography of the lungs are used.
Fluoroscopy is the most common research method that allows you to visually determine how the transparency of the lung tissue changes, detect places of compaction or cavities in its structure, determine the presence of air in the pleural cavity and other pathologies.
Radiography is carried out for the purpose of recording and documenting changes in the respiratory system detected during fluoroscopy, which appear on x-ray film. Pathological processes that occur in the lungs can lead to loss of airiness with subsequent compaction of lung tissue (pulmonary infarction, pneumonia, tuberculosis). In this case, healthy lung tissue on the negative film will be darker than the corresponding areas of the lungs. The lung cavity, which contains air, surrounded by an inflammatory ridge, will look like an oval dark spot in the pale shadow of the lung tissue. The fluid contained in the pleural plane transmits fewer x-rays compared to lung tissue and leaves a shadow on the negative x-ray film that has a darker shade compared to the shadow of lung tissue. X-rays make it possible to determine the amount of fluid in the pleural cavity and its nature. If there is inflammatory fluid or exudate in the pleural cavity, its level of contact with the lungs looks like an oblique line directed upward from the line of the middle clavicle. If there is an accumulation of non-inflammatory fluid or transudate in the pleural cavity, its level is located more horizontally.
Bronchography is performed to study the bronchi. After preliminary anesthesia of the respiratory tract has been carried out, a contrast agent is injected into the lumen of the bronchi, which blocks X-rays. After this, an x-ray of the lungs is performed in order to obtain a clear image of the bronchial tree on the x-ray. This method makes it possible to diagnose dilation of the bronchi, as well as their narrowing as a result of a tumor or a foreign body entering the lumen of the bronchi.
Lung tomography is a special type of radiography, which makes it possible to conduct a layer-by-layer X-ray examination of the lungs. It is carried out to determine the presence of tumors in the bronchi and lungs, cavities and cavities located in the lungs at different depths.
Collection of sputum for examination
It is best to collect sputum for examination in the morning, since it accumulates at night, and before eating. Preliminary brushing of teeth and rinsing the mouth with boiled water ensures the reliability of sputum analysis. All this makes it possible to significantly reduce the contamination of oral bacteria.
To collect sputum, use a special disposable sealed bottle made of material that is sufficiently shock-resistant and has a tight-fitting lid or cap that screws on tightly. It is necessary that the bottle has a capacity of 25-50 ml and a wide opening. This is required so that the patient can spit sputum into the bottle. To be able to assess the quality and quantity of the sample that was collected, the material from which the bottle is made must be completely transparent.
If the collected sputum needs to be transported to another institution, the bottles with the collected material should be stored in the refrigerator for no more than three days until it is sent. If storage is necessary for a longer period, preservation agents should be used. During transportation, sputum must be protected from exposure to wind and direct sunlight.
Examination of sputum for general analysis
Examination of sputum for general analysis usually begins with an examination of its appearance. In this case, some general rules are observed: transparent mucus means standard external sputum, the inflammatory process is characterized by the presence of cloudy sputum. Serous sputum is colorless and has a liquid consistency and the presence of foam. Its release occurs during pulmonary edema.
Putrid sputum is characterized by the presence of pus. Its color is green and yellow. Most often, putrefactive sputum is observed when a lung abscess breaks into the bronchus; in most cases it occurs in the form of a mixture of pus and mucus.
Green sputum is present in pathology associated with slowed outflow. This could be sinusitis, bronchiectasis, disorders after tuberculosis. If green sputum appears in teenage children, chronic bronchitis should not be assumed; ENT pathology can also be excluded.
An allergic reaction and eosinophilia are determined by the appearance of amber-orange sputum.
Pulmonary hemorrhages are characterized by the appearance of bloody or mixed sputum, in particular mucopurulent sputum with blood streaks. When blood is retained in the respiratory tract, hemoglobin is converted into hemosiderin, followed by the sputum acquiring a rusty hue. The presence of blood in sputum is an alarming factor that requires special examination.
Pearl-colored sputum is distinguished by rounded opalescent inclusions consisting of detritus and atypical cells. It is observed in squamous cell lung cancer.
Bacteriological examination of sputum
Conducting a bacteriological examination of sputum makes it possible to determine the presence of pathogens of pulmonary diseases. A purulent lump of sputum with blood is rubbed between two glasses. The hardened smears are subject to fire fixation, after which one of them is stained in accordance with the Gram staining method, and the other - with the Ziehl-Neelsen staining method. The first staining method allows you to detect gram-positive microbes, the second - tuberculosis bacteria. A piece of filter paper should be placed on the smear, the area equal to the smear itself, Ziel fuchsin should be poured onto it and heated over a low flame until vapor appears. After the paper is discarded, the smear should be dipped in a solution of sulfuric acid, a concentration of 5-10%, or a solution of hydrochloric acid, a concentration of 3% to decolorize it, after which it should be rinsed well with water. Then, for half a minute, you should finish painting with a solution of methylene blue, concentration 0.5%, after which it is washed with water again. Red mycobacteria are clearly displayed against the blue background of the preparation. In the event that Mycobacterium tuberculosis is not in the smear, the method of their accumulation - flotation - is used. 15-25 ml of sputum are placed in a quarter-liter container, a double volume of sodium hydroxide solution, 0.5% concentration, is added to it, after which the resulting mixture is shaken until the sputum is completely dissolved. 100 ml of distilled water with 2 ml of toluene is added, the mixture is shaken for fifteen minutes, after which it is topped up with water from the neck of the bottle and kept for two hours. A layer is formed on top, its consistency reminiscent of cream, it is sucked out using a pipette with a spray can and drops are applied to heated glass, each time on the previous dried drop. Then the drug is fixed and applied according to the Ziehl-Neelsen principle. If the result is negative, you should resort to bacteriological culture of sputum or inoculate it into the animal (biological research). In order to determine how sensitive the sputum flora is to antibiotics, they resort to culture.
Microscopic examination of sputum
Microscopic examination of sputum consists of studying colored and native (unprocessed, natural) preparations. For the latter, purulent, crumbly, bloody lumps are selected, they are placed on a glass slide in such a volume that when covered with a cover glass, a thin translucent preparation is formed. If the microscope magnification is low, Kirschmann spirals can be detected, which look like stretched mucus of varying thickness. They include a central axial line, which is enveloped by a spiral-shaped mantle interspersed with leukocytes. Such spirals appear in sputum during bronchospasm. Using high magnification, one can detect in the native preparation leukocytes, alveolar macrophages, erythrocytes, cellular formations characteristic of heart defects, flat and columnar epithelium, all kinds of fungi, cancer cells, eosinophils. Leukocytes are round granular cells. Red blood cells are yellowish homogeneous discs of small size, the appearance of which is characteristic of sputum during pneumonia, pulmonary infarction and destruction of lung tissue. Alveolar macrophages are cells three times larger than red blood cells with large, abundant granularity in the cytoplasm. The columnar epithelium of the respiratory tract is determined by the goblet or wedge-shaped cells. It appears in large quantities in respiratory catarrh and acute bronchitis. Squamous epithelium is a large cellular formation with many angles that has no diagnostic value and originates from the oral cavity. Cancer cells are identified by large nuclei, to recognize the nature of which requires significant experience of the researcher. These cells are large in size and have an irregular shape.
Macroscopic examination of sputum
When conducting a macroscopic examination of sputum, attention is paid to its quantity and character, smell, color, consistency, the presence of all kinds of inclusions and mucousness.
The composition of sputum determines its character.
Mucous sputum includes mucus, a product of the activity of the mucous glands of the respiratory system. Its release occurs during acute bronchitis, resolution of bronchial asthma attacks, and catarrh of the respiratory tract.
Mucopurulent sputum is a mixture of pus and mucus, with a predominance of mucus and the inclusion of pus in the form of small lumps and streaks. Its appearance occurs during purulent inflammation, bronchopneumonia, and acute bronchitis.
Purulent-mucous sputum consists of pus and mucus with a predominance of pus, while the mucus is presented in the form of strands. Its appearance is typical for chronic bronchitis, abscess pneumonia, and bronchiectasis.
Sputum is a viscous secretion of the mucous membrane of the respiratory tract. In a healthy body, its amount is minimal. During inflammatory processes, sputum production increases significantly.
This is a kind of protective mechanism that removes infectious pathogens and their waste products from the bronchi and lungs. Sputum examination allows us to determine the nature of inflammation of the respiratory system and conduct a differential diagnosis of diseases.
General characteristics of sputum analysis
The study of discharge obtained from the bronchi is carried out in several stages.
Clinical analysis
This is a visual examination of sputum. The laboratory technician describes the following characteristics:
- The total number - in the pathological process increases in proportion to the severity.
- Color.
- Smell.
- Presence of impurity. With the naked eye you can see streaks of blood and pus.
Using clinical analysis, it is quickly determined how serious the pathological process is developing in the respiratory tract.
Microscopic analysis
Detects various cells: red blood cells, eosinophils and other elements.
Bacteriological analysis
A special study that allows you to differentiate different types of infectious agents. It is prescribed for indirect signs of bacterial inflammation - the presence of pus upon visual examination, which is confirmed by a large number of leukocytes under microscopy.
Additionally, the sensitivity of microorganisms to antibiotics is determined, which greatly facilitates the treatment of the disease.
Indications
The list of diseases for which sputum examination can help in treating a patient is quite extensive. Let's list some of them:
- Acute inflammatory processes: bronchitis, pneumonia.
- Specific infections - whooping cough.
- Chronic diseases of an infectious nature: tuberculosis, lung abscess.
- Non-infectious processes: bronchiectasis, chronic bronchial obstruction, bronchial asthma, emphysema and others.
- Oncology.
In most cases, sputum analysis is prescribed as an additional research method to clarify the diagnosis. it is fundamental in diagnosis.
Material collection rules
Patients often have difficulty collecting sputum. To facilitate this process and ensure the reliability of the results, several rules should be followed:
- Sputum is always collected in the morning, since it accumulates in sufficient quantities at night.
- The minimum amount to be obtained is 1 ml. Ideally - 3 ml.
- Before collection, the patient sits in front of an open window.
- First, it is recommended to take two slow deep breaths with a slight breath hold.
- On the third inhalation, the patient stands up to maximize the expansion of the lungs and exhales sharply. If the diaphragm connects to the lungs as a result of these movements, it will provoke a cough impulse, and phlegm will come out. It is immediately spat out into the prepared container.
- Dishes for collecting material must be sterilized (usually by boiling, but there are also ready-made vessels).
- No saliva allowed. If there is not enough material, you can make several cough pushes. The lid of the container is opened only at the moment of spitting; the rest of the time it should be closed.
- The following methods stimulate sputum production: taking expectorants, irritating inhalations, drinking plenty of warm water, and physical exercise.
- If the patient is very weakened or sputum needs to be collected from a small child, you need to touch the root of the tongue with a sterile napkin, thereby causing a cough. In this case, part of the secretion from the bronchi gets onto the napkin. It is quickly transferred from a napkin to a glass slide and immediately sent to the laboratory.
To collect the material, choose a transparent container with a wide neck (for ease of spitting) and an airtight lid. The material should be delivered for examination no later than 2 hours.
Only then will the results not be distorted (extra microorganisms may have time to multiply in the sputum, and the result will become false positive). The collected material should only be stored in the refrigerator.
Interpretation of results
In a healthy person, bronchial secretions are swallowed, since their significance is insignificant. If the patient can spit out sputum, then its amount has increased. This indicates a disease of the respiratory system.
Let's look at what results a sputum test can show:
- A viral disease is a transparent, viscous secretion. This discharge is characteristic of an acute inflammatory process.
- An admixture of blood is the most dangerous symptom that characterizes a serious pathology: tuberculosis, cancer, systemic damage to connective tissue. Sometimes small streaks of blood occur with a very strong, dry cough (whooping cough, tracheitis with the flu).
- Allergic sputum has a viscous consistency and an amber tint.
- Purulent sputum usually characterizes a bacterial infection. The discharge is cloudy, yellow-green, sometimes whitish. This symptom occurs in many diseases - bronchitis, pneumonia, sinusitis, lung abscess and others.
- Serous sputum is characteristic of pulmonary edema. It contains an increased amount of liquid component.
- If leukocytes are found in the secretion in numbers exceeding 25 thousand in the field of view, this indicates inflammation, most often of a bacterial nature.
- Microscopic examination reveals a large number of eosinophils. Then they immediately assume a helminthic infestation, which also often causes a cough or an allergic reaction.
- Specific signs of bronchial asthma are Kurshman spirals and Charcot-Leiden crystals. The first are “casts” of small bronchi, consisting of viscous secretion. Crystals are formed from the secretion of eosinophils and are excreted in the sputum in the form of oblong pyramids.
- Elastic fibers. Their detection is always alarming, as it occurs when lung tissue is destroyed (tuberculosis, tumor, abscess pneumonia).
Table for interpretation of the results of microscopic examination of sputum
| Cells | Result |
| Flat - usually indicates improperly collected material when saliva gets into the sputum. The detection of columnar epithelium indicates bronchitis, bronchial asthma or lung cancer. | |
| Alveolar macrophages | The result of a long stay in a dusty room. Sometimes hemosiderin is detected along with them - a breakdown product of hemoglobin (this is a sign of mitral stenosis, pulmonary infarction, stagnation) |
| Leukocytes | If eosinophils predominate - bronchial asthma, pneumonia, tuberculosis If lymphocytes - tuberculosis, whooping cough |
| Red blood cells | A sign of a violation of the integrity of the lung tissue is destructive forms of tuberculosis. tumor |
| Tumor cells | Detection of atypical cells is significant only when there is a large accumulation of them. If single ones are present, the study is repeated. |
| Elastic fibers | Decay of lung tissue due to tuberculosis, tumor, abscess |
Features of sputum analysis for bronchitis
Bronchitis is a respiratory tract disease that usually complicates the course of a viral infection.
Inflammation of the bronchial mucosa is caused by bacteria, viruses or an allergic reaction. Treatment for bronchitis varies greatly depending on the cause, so sputum examination is important to make the correct diagnosis.
The results may be as follows:
- Viral bronchitis- mucous sputum, without impurities.
- Bacterial bronchitis, suspected pneumonia- the appearance of purulent impurities in the mucous discharge.
- Bronchiectasis, chronic bronchitis of staphylococcal nature- completely purulent discharge.
- Allergic bronchitis- a small amount of transparent secretion, in which a large number of eosinophils are detected upon microscopic examination.
When cloudy sputum settles, it usually separates into two layers, which indicates the purulent nature of the inflammation. If the liquid is stratified into three layers, this indicates the presence of a putrefactive process (a sign of incipient gangrene of the lung).
You should not independently draw conclusions about the presence of the disease only from the results of a sputum examination. It is better to entrust this to a doctor, who compares them with clinical manifestations and only after that makes a final diagnosis.
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Target:
Diagnostic.
Indications:
Diseases of the respiratory system and cardiovascular system.
Equipment:
Clean glass wide mouth clear glass jar, direction.
Sequence of actions:
1. Explain the collection rules and obtain consent.
2. In the morning, brush your teeth and rinse your mouth with boiled water.
3. Cough and collect 3-5 ml of sputum in a jar, close the lid.
4. Make a referral.
5. Deliver to the clinical laboratory within 2 hours.
Note:
To determine the daily amount, sputum is collected during the day in one large container and stored in a cool place.
The outside of the jar must not be contaminated.
Evaluated: consistency (viscous, gelatinous, glassy), color (transparent, purulent, gray, bloody), cellular composition (presence of leukocytes, erythrocytes, epithelium, additional inclusions.
Collection of sputum for bacteriological examination:
Target:
Identification of the causative agent of the disease and determination of its sensitivity to antibiotics.
Equipment:
Sterile test tube or jar with a lid (to be ordered from the laboratory), direction.
Sequence of actions:
1. Explain the purpose and essence of sputum collection, obtain consent.
2. In the morning on an empty stomach after toileting the oral cavity and before the appointment of a/b.
3. Bring the test tube or jar to your mouth, open it without touching the edges of the container with your hands and mouth, cough up the sputum and immediately close the lid, maintaining sterility.
4. Send the analysis to the laboratory within 2 hours in a container using special transport. Note: The sterility of the dishes is maintained for 3 days.
Sputum collection for MBT (Mycobacterium tuberculosis):
Target:
Diagnostic.
Procedure for collecting sputum:
1. Explain the essence and purpose of the appointment, obtain consent.
2. Make a referral.
3. In the morning on an empty stomach after toileting the oral cavity, after several deep breaths, cough up the sputum into a clean, dry jar (15-20 ml), close the lid. If there is little sputum, then it can be collected within 1-3 days, stored in a cool place.
4. Deliver the test to the clinical laboratory.
Note: If sputum culture is prescribed for VK, then the sputum is collected in a sterile container for 1 day, stored in a cool place, and delivered to the bacteriological laboratory.
Collection of sputum for atypical cells:
Target:
Diagnostic (diagnosis, exclusion of oncopathology).
Collection sequence:
1. Explain to the patient the rules for collecting sputum.
2. In the morning after using the oral cavity, collect sputum in a clean, dry jar.
3. Make a referral.
4. Deliver to the cytology laboratory immediately, because atypical cells are quickly destroyed.
Rules for using a pocket spittoon:
The spittoon is used by patients who produce sputum.
Prohibited:
Spit phlegm outdoors, indoors, into a scarf or towel;
Swallow sputum.
The spittoon is disinfected as it is filled, but at least once a day. If there is a large amount of sputum - after each use.
To disinfect sputum: pour 10% bleach in a ratio of 1:1 for 60 minutes or cover with dry bleach at the rate of 200 g/l of sputum for 60 minutes.
If VK is isolated or suspected- 10% bleach for 240 minutes or dry bleach for 240 minutes in the same ratios; 5% chloramine for 240 min.
After disinfection, the sputum is drained into the sewer, and the dishes in which the sputum was disinfected are washed in the usual way, followed by disinfection.
Disinfection of pocket spittoons: boiling in a 2% soda solution for 15 minutes or in 3% chloramine for 60 minutes.
