Sputum analysis. Decoding

Sputum (sputum) is a pathological secretion formed when the trachea is damaged, bronchial tree And lung tissue. Its release is observed not only in diseases of the respiratory system, but also of the cardiovascular system. General analysis sputum includes macroscopic, chemical, microscopic and bacterioscopic determination of its properties.

Macroscopic examination

Quantity

At different pathological processes the amount of sputum varies widely - from a few 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 l) 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). At tuberculosis process in the lung, accompanied by tissue disintegration, 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, for pneumonia, bronchiectasis, lung cancer. Mucopurulent sputum is released in case of chronic bronchitis, pneumonia, bronchiectasis, lung abscess, and festering echinococcus lung, actinomycosis of the lungs, with 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 rusty or Brown, indicates that it contains not fresh blood, but its breakdown products (hematin) and occurs when lobar pneumonia, with pulmonary tuberculosis with cheesy disintegration, blood stagnation in the lungs, pulmonary edema, with pulmonary form anthrax, pulmonary infarction.

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 may stain sputum medicinal substances. 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 fatty acids, 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 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 it can be quantified (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

Cells found in sputum squamous epithelium 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 congestion in the lungs, mitral stenosis, 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. If there is fresh blood in the sputum, unchanged red blood cells are determined, but if blood retained in the sputum is removed respiratory tract over a long period of time, leached red blood cells are detected.

Tumor cells

Tumor cells found in sputum in groups indicate the presence of lung tumors. 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 tetralogy) - 100%.

Bacterioscopic examination

Sputum testing for Mycobacterium tuberculosis (MBT) is performed on a specially stained smear. It has been established that a routine examination of a stained smear for MBT gives 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 that appear as a result of 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 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 carcinoma
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, and 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 determined in the sputum, while with pulmonary tuberculosis in the sputum the protein content 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.

…> Cholesterol and fatty acid crystals

3. Detritus

For bronchiectasis:

1. Dietrich's plugs

2. Crystals of cholesterol, fatty acids and hematoidin

3. Leukocytes

For pulmonary tuberculosis:

1. Ehrlich tetrad

2. Rice bodies

3. Elastic fibers

4. Various crystals

5. Mycobacterium tuberculosis (in a colored preparation)

Microscopic examination of sputum.

Microscopic examination of sputum is carried out in fresh unstained (native) and fixed stained preparations. When preparing preparations, careful selection of material is necessary. With a calcined and cooled spatula or a metal loop, all suspicious grains, blood streaks, lumps are selected from the sputum one by one and preparations are prepared from them, placing them on a glass slide.

Study of a native drug.

The drug is prepared using iron sticks with flattened ends.

Two native preparations are made on one slide, in each of them sputum is taken after viewing it alternately on a white and black background from three to four places (lumps, fibers, etc.). The selected sputum particles, without smearing, are covered with a cover glass and pressed down with a hand spatula. For research, the material must be taken in such a quantity that the preparation is not too thick, and so that when pressed onto the cover glass, the contents do not protrude beyond its edges. If this happens, then place a second one next to the first cover slip, moving the first one slightly to the side. The prepared preparation is examined under a microscope, first under low magnification (10 x 8), and then under high magnification (10 x 40).

Elements of sputum that are found in the native preparation can be divided into groups: cellular, fibrous, crystalline and combined formations.

Cellular elements.

1. Flat epithelium - this is the desquamated epithelium of the mucous membrane oral cavity, nasopharynx, epiglottis and vocal cords, having the appearance of flat thin cells with a small pyknotic vesicular nucleus and homogeneous cytoplasm. Single cells of squamous epithelium are always found in large numbers - with an admixture of saliva or inflammatory phenomena in the oral cavity. Has no diagnostic value.

2. Columnar epithelium - the epithelium of the mucous membrane of the larynx, trachea and bronchi has the appearance of elongated cells with a pointed and elongated lower end, in which an oval nucleus is located and a blunt upper end. The wider part of the cell faces the lumen of the bronchus and is equipped with cilia. Cells rejected from the mucous membrane sometimes change (deform) and acquire a pear-shaped or spindle-shaped shape, with one of the ends stretching into a long thread; cilia are rarely preserved. Columnar epithelium is found in sputum in the form of clusters in large quantities during an acute attack of bronchial asthma, acute bronchitis, acute catarrhal lesions of the respiratory tract, and malignant neoplasms.

3. Alveolar epithelium - round cells, 2-3 times larger in diameter than leukocytes, and externally similar to it (granular cytoplasm, rounded nucleus, centrally located nucleus).

4. Alveolar macrophages - cells of reticulohistiocytic origin, have an oval or oval round shape, size from 15 to 20-25 microns, usually one (sometimes more) eccentrically located nucleus, vacuolated cytoplasm containing various dark brown inclusions. They move freely and have the ability to phagocytose. Macrophages capture dust particles, leukocytes, and red blood cells. Occurs in various inflammatory processes in the bronchi and lung tissue (pneumonia, bronchitis, occupational lung diseases). For chronic inflammatory diseases fatty-degenerated macrophages (cells with fatty degeneration, lipophages). These are cells round shape, the cytoplasm of which is filled with fat droplets (granular balls). Fat may be colored with Sudan III in orange color. Clusters of such cells are found in malignant neoplasms, tuberculosis, and actinomycosis. With congestion in the lungs, circulatory disorders in the pulmonary circle, pulmonary infarction, hemorrhages, macrophages containing hemosiderin appear ( siderophages) in the form of golden-yellow inclusions in the cytoplasm (the old name is “cells of heart defects”). When destroyed in lung tissue, hemoglobin is converted into the tissue pigment hemosiderin, which is absorbed by alveolar macrophages. They are determined by a reaction to Prussian blue; macrophages are stained blue-green (blue).

5. Dust cells (coniophages) - these are cells with phagocytosed dust and coal particles that are often detected in people with occupational lung diseases (smokers, workers in the tobacco and flour milling industries).

6. Giant cells - oval or round with a diameter of up to 60 microns, containing from 5 to 15 nuclei, are very rare in pulmonary tuberculosis.

7. Tumor cells - usually large with one or more nuclei with a clear chromatin network or karyokinetic figures with vacuolated cytoplasm. They are found in sputum in the form of single cells or conglomerates (complexes). If such cells are detected, the drug and the rest of the sputum are subjected to a special, thorough cytological examination.

8. Leukocytes - round cells with a diameter of 10-12 to 15 microns with a poorly distinguishable nucleus, equally abundant granularity, grayish color. Found in almost every sputum; in the mucosa - single, and in the purulent (with lung abscess, tuberculosis, bronchiectasis) they completely cover the entire field of view

*Eosinophils - large leukocytes with a distinct and dark granularity that refracts light. Eosinophils appear in allergic conditions (bronchial asthma, eosinophilic bronchitis).

9. Red blood cells - round or slightly oval shape cells, yellowish in color (fresh) or colorless (changed and having lost pigment), with a diameter smaller than leukocytes, sometimes without granularity in the protoplasm, double-circuited (target cell), somewhat refracting light. Single red blood cells in sputum can be found in any sputum; found in large quantities in sputum stained with blood (pulmonary hemorrhage, pulmonary infarction, congestion in the lungs).

Fibrous formations.

1. Elastic fibers - have the appearance of twisted, shiny, thin threads that refract light, folded into bundles, sometimes repeating the structure of alveolar tissue. Elastic fibers indicate the breakdown of lung tissue and are found in tuberculosis, abscess, and lung tumors. Since the walls of the alveoli consist of single-layer alveolar epithelium, shrouded in thin layers connective tissue containing elastic fibers. The breakdown of lung tissue is accompanied by the destruction of the epithelial layer with the release of elastic fibers that are released with sputum.

2. Coral fibers - rough, branching formations with lumpy thickenings due to the deposition of fatty acids and soaps on the fibers. Are allocated when chronic diseases lungs, cavernous tuberculosis.

3. Calcified elastic fibers - rough, rod-shaped formations impregnated with layers of lime (calcium). They lose their elasticity and become brittle. They are excreted in sputum during the disintegration of a calcified area of the lung.

4. Fibrinous fibers - thin fibers in the form of a whitish structureless mass. They are found in fibrinous bronchitis, tuberculosis, actinomycosis, and lobar pneumonia.

5. Kurshman spirals - compacted spiral formations of mucus. Outdoor loose part called the mantle, the inner, tightly twisted part is the central axial thread. Occasionally, only thin central filaments without a mantle and spirally twisted fibers without a central filament are found separately. Spirals are formed when the bronchi are spastic and there is mucus in them. During a cough push, viscous mucus is thrown into the lumen of a larger bronchus, twisting into a spiral. Kurshman spirals are observed in pulmonary pathology accompanied by bronchospasm (bronchial asthma, asthmatic bronchitis, bronchial tumors).

Crystalline formations.

1. Charcot-Leyden crystals - found in sputum along with eosinophils and have the appearance of shiny, smooth, colorless rhombuses of varying sizes, sometimes with bluntly cut ends. The formation of Charcot-Leyden crystals is associated with the breakdown of eosinophils and is considered a product of protein crystallization. Often, freshly secreted sputum does not contain Charcot-Leyden crystals; they form in it in a sealed container after 24-48 hours. The presence of these crystals in sputum is characteristic of bronchial asthma, eosinophilic bronchitis, helminthic lesions of the lungs, less often with lobar pneumonia, various bronchitis.

2. Hematoidin crystals - have the shape of diamonds and needles (sometimes tufts and stars) of golden yellow color. These crystals are a product of the breakdown of hemoglobin and form in the depths of hematomas and extensive hemorrhages, in necrotic tissue.

3. Cholesterol crystals - colorless, quadrangular tablets with a broken step-like corner, formed during the breakdown of fat and fat-degenerated cells, retention of sputum in cavities (tuberculosis, neoplasms, abscess, etc.).

4. Fatty acid crystals - droplets of fat in the form of long thin needles are often contained in purulent sputum (Dietrich's plug), formed when sputum stagnates in cavities (abscess, bronchiectasis).

Combined and other formations in sputum.

1. Dietrich's plugs – yellowish-gray lumps with an unpleasant odor. They consist of detritus and bacteria. They are found when sputum stagnates in the cavities of tuberculosis, lung abscess, bronchiectasis.

2. Ehrlich tetrad -consists of four elements: calcified detritus, calcified elastic fibers, cholesterol crystals and mycobacterium tuberculosis. Appears during the disintegration of a calcified primary tuberculosis focus. The cause of this decay may be pneumonia or neoplasm.

3. Rice bodies - round, whitish dense formations containing accumulations of coral-shaped fibers, fatty breakdown products, soap, sometimes cholesterol crystals and a large number of mycobacterium tuberculosis. Occurs in tuberculosis.

4. Sufractant is a phospholipoprotein that prevents the alveoli from sticking together. Happens various shapes and matte gray values. When studying the surfactant, it is possible to determine the bacterial flora and the degree of activity of the inflammatory process.

6. Mushrooms – in case of fungal infections of the lungs, the causative agent of the disease can be identified in the sputum. Microscopically visible plexus of mycelium threads.

7. Bacteria – stained smears reveal a variety of microorganisms, which are always found in small quantities in the respiratory tract of a healthy body. Under unfavorable conditions, this flora, multiplying vigorously, becomes pathogenic and causes disease. Mycobacterium tuberculosis (tuberculosis), pneumococcus (lobar pneumonia and chronic bronchitis) are found. Streptococci and staphylococci are found in purulent sputum in lung abscesses, bronchitis and pneumonia.

Sputum in VARIOUS DISEASES

RESPIRATORY SYSTEM.

Acute bronchitis. At the beginning of the disease, a small amount of mucous, viscous sputum is released. As the disease progresses, the amount of sputum increases. It becomes mucopurulent. Microscopic examination reveals a significant amount of columnar epithelium, leukocytes, and erythrocytes.

Chronical bronchitis. Usually a lot of mucopurulent sputum is released, often streaked with blood. Microscopically, a large number of leukocytes, erythrocytes, and alveolar macrophages are detected. In fibrotic bronchitis, fibrous casts of bronchioles are found. Many different microorganisms.

Bronchial asthma. A scanty amount of mucous, viscous, glassy sputum is released. Macroscopically you can see the Kurshman spirals. Microscopy reveals the presence of eosinophils and columnar epithelium. There are Charcot-Leyden crystals.

Bronchiectasis. A lot of purulent sputum is released (up to 1 liter in the morning) of a greenish-grayish color. When standing, it is divided into three layers: mucous, serous and purulent. Dietrich's plugs are found in the pus. Microscopically, a large number of leukocytes, crystals of fatty acids, sometimes crystals of hematoidin and cholesterol, and a variety of microflora are detected.

Lobar pneumonia. At the beginning of the disease, a small amount of very viscous (sticky) rusty sputum is released. During the period of resolution of the disease, sputum is released abundantly, acquiring a mucopurulent character. Rusty sputum contains fibrin clots and altered blood, giving it a brownish tint. Microscopically, at the beginning of the disease, red blood cells, hemosiderin grains, hematoidin crystals, a small number of leukocytes, and many pneumococci are detected. At the end of the disease, the number of leukocytes increases, and erythrocytes decrease, there are many alveolar macrophages.

Lung abscess. At the moment the abscess breaks into the bronchus, a large amount of purulent, foul-smelling sputum (up to 600 ml) is released. when standing, liquid sputum becomes two-layered. Microscopically, many leukocytes, elastic fibers, fragments of lung tissue, crystals of fatty acids, hematoidin and cholesterol, and a variety of microflora are detected.

Pulmonary tuberculosis. The amount of sputum depends on the stage of the disease. If there are cavities in the lungs, it can be significant. The nature of the sputum is mucopurulent, often containing an admixture of blood. Macroscopically, rice-shaped bodies (Koch lenses), consisting of elements of the breakdown of lung tissue, can be detected in sputum. Under a microscope, elastic fibers, crystals of fatty acids, and hematoidin are found. With the disintegration of an old calcified tuberculosis focus, Ehrlich's tetralogy is detected. To diagnose a disease highest value has the presence of Mycobacterium tuberculosis in the sputum.

Lung cancer.The amount of sputum may vary. When the tumor decays - significant. Character - mucous-purulent-bloody. Upon inspection, scraps of tissue may be seen. Atypical cells and their complexes are detected microscopically.

Table No. 3. Sputum in VARIOUS PULMONARY PATHOLOGIES.

Nosological form	Amount of sputum	Character of sputum	Macroscopic study	Microscopic study
Acute bronchitis	Scanty, in the later stages - a large amount	Mucous, mucopurulent	______	Columnar epithelium, leukocytes - a moderate amount, with a prolonged course - macrophages.
Chronical bronchitis	Various	Continuation "

Curschmann's spirals (H. Curschmann, German physician) are whitish-transparent corkscrew-shaped tubular formations formed from mucin in the bronchioles. Strands of mucus consist of a central dense axial thread and a spiral-shaped mantle enveloping it, in which leukocytes (usually eosinophils) and Charcot-Leyden crystals are interspersed. Sputum analysis, in which Kurshman spirals are detected, is characteristic of bronchospasm (most often with bronchial asthma, less often with pneumonia and lung cancer).

Charcot-Leyden crystals

Charcot-Leyden crystals (J.M. Charcot, French neurologist; E.V. Leyden, German neurologist) look like smooth, colorless crystals in the shape of octahedrons. Charcot-Leyden crystals consist of a protein that releases eosinophils during the breakdown, so they are found in sputum containing many eosinophils (allergic processes, bronchial asthma).

Formed elements of blood

A small number of leukocytes can be found in any sputum; during inflammatory (and especially suppurative) processes, their number increases.

Neutrophils in sputum. The detection of more than 25 neutrophils in the field of view indicates an infection (pneumonia, bronchitis).

Eosinophils in sputum. Single eosinophils can be found in any sputum; in large quantities (up to 50-90% of all leukocytes) they are found in bronchial asthma, eosinophilic infiltrates, helminthic infestations of the lungs, etc.

Red blood cells in sputum. Red blood cells appear in sputum during the destruction of lung tissue, pneumonia, stagnation in the pulmonary circulation, pulmonary infarction, etc.

Epithelial cells

Flat epithelium enters the sputum from the oral cavity and has no diagnostic value. The presence of more than 25 squamous epithelial cells in the sputum indicates that the sputum sample is contaminated with oral secretions.

Columnar ciliated epithelium is present in small quantities in any sputum, and in large quantities in cases of damage to the respiratory tract (bronchitis, bronchial asthma).

Alveolar macrophages

Alveolar macrophages are localized mainly in the interalveolar septa. Therefore, analysis of sputum, where at least 1 macrophage is present, indicates that they are affected lower sections respiratory system.

Elastic fibers

Elastic fibers have the appearance of thin double-circuit fibers of equal thickness throughout, dichotomously branching. Elastic fibers originate from the pulmonary parenchyma. The detection of elastic fibers in sputum indicates destruction of the pulmonary parenchyma (tuberculosis, cancer, abscess). Sometimes their presence in sputum is used to confirm the diagnosis of abscess pneumonia.

Components of sputum. Analysis transcript

Kurshman spirals - Bronchospastic syndrome, the most likely diagnosis is asthma.

Charcot-Leyden crystals - Allergic processes, bronchial asthma.

Eosinophils, up to 50-90% of all leukocytes - Allergic processes, bronchial asthma, eosinophilic infiltrates, helminthic invasion of the lungs.

Neutrophils, more than 25 in the field of view - Infectious process. It is impossible to judge the localization of the inflammatory process.

Flat epithelium, more than 25 cells in the field of view - An admixture of discharge from the oral cavity.

Alveolar macrophages - The sputum sample comes from the lower respiratory tract.

Atypical cells

Sputum may contain malignant tumor cells, especially if the tumor grows endobrochially or disintegrates. Cells can only be identified as tumor cells if a complex of atypical polymorphic cells is found, especially if they are located together with elastic fibers.

Trophozoites of E.histolytica - pulmonary amoebiasis.

Larvae and adults of Ascaris lumbricoides - pneumonitis.

Cysts and larvae of E. granulosus - hydatid echinococcosis.

P. westermani eggs are paragonimiasis.

Larvae of Strongyloides stercoralis - strongyloidiasis.

N.americanus larvae - hookworm.

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Sputum analysis explanation

Sputum analysis decoding is a microscopic study of cells and their decoding. which allows you to set the activity of the process when chronic diseases bronchi and lungs, diagnose lung tumors. Deciphering sputum analysis allows you to identify various diseases.

Leukocytes in sputum

Lymphocytes

Eosinophils

Eosinophils make up up to 50-90% of all leukocytes, elevated eosinophils diagnose diseases:

allergic processes;
bronchial asthma;
eosinophilic infiltrates;
helminthic infestation of the lungs.

Neutrophils

If the number of neutrophies is more than 25 in the field of view, this indicates the presence of an infectious process in the body.

Flat epithelium

Flat epithelium, more than 25 cells in the field of view - an admixture of discharge from the oral cavity.

Elastic fibers

Elastic fibers - Destruction of lung tissue, abscess pneumonia.

Kurshman spirals

Kurshman spirals are used for diagnosing bronchospastic syndrome, diagnosing asthma.

Charcot-Leyden crystals

Charcot-Leyden crystals diagnose allergic processes, bronchial asthma.

Alveolar macrophages

Alveolar macrophages - The sputum sample comes from the lower respiratory tract.

Sputum is released when various diseases respiratory organs. Sputum analysis to collect it better in the morning, before this you need to rinse your mouth with a weak antiseptic solution, then boiled water.

During examination, the daily amount of sputum, the nature, color and smell of sputum, its consistency, as well as separation when standing in a glass container are noted.

Increased sputum production is observed with:

If an increase in the amount of sputum is associated with a suppurative process in the respiratory organs, this is a sign of a deterioration in the patient’s condition; if with improved drainage of the cavity, it is regarded as a positive symptom.

gangrene of the lung;
pulmonary tuberculosis, which is accompanied by tissue breakdown.

Reduced sputum production is observed with:

acute bronchitis;
pneumonia;
congestion in the lungs;
attack of bronchial asthma (at the beginning of the attack).

Greenish color of sputum is observed when:

lung abscess;
bronchiectasis;
sinusitis;
post-tuberculosis disorders.

Sputum mixed with blood is observed when:

Rusty color of sputum is observed when:

focal, lobar and influenza pneumonia;
pulmonary tuberculosis;
pulmonary edema;
congestion in the lungs.

Sometimes the color of sputum is affected by taking certain medicines. If you have an allergy, the sputum may be bright orange.

Yellow-green or dirty green color of sputum is observed with various lung pathologies in combination with jaundice.

Blackish or grayish color of sputum is observed in people who smoke (admixture of coal dust).

Putrid odor of sputum is observed when:

When an echinococcal cyst is opened, the sputum acquires a peculiar fruity smell.

bronchitis complicated by putrefactive infection;
bronchiectasis;
lung cancer complicated by necrosis.

The separation of purulent sputum into two layers is observed with a lung abscess.

The division of putrefactive sputum into three layers - foamy (upper), serous (middle) and purulent (lower) - is observed with gangrene of the lung.

As a rule, decomposed sputum acquires an acidic reaction.

The production of thick mucous sputum is observed when:

acute and chronic bronchitis;
asthmatic bronchitis;
tracheitis.

The release of mucopurulent sputum is observed when:

lung abscess;
gangrene of the lung;
purulent bronchitis;
staphylococcal pneumonia;
bronchopneumonia.

The release of purulent sputum is observed when:

bronchiectasis;
lung abscess;
staphylococcal pneumonia;
actinomycosis of the lungs;
gangrene of the lungs.

The production of serous and serous-purulent sputum is observed when:

Bloody sputum is produced when:

A large number of alveolar microphages in sputum are observed in chronic pathological processes in the bronchopulmonary system.

The presence of fatty macrophages (xanthoma cells) in sputum is observed when:

lung abscess;
actinomycosis of the lung;
pulmonary echinococcosis.

Columnar ciliated epithelial cells

The presence of columnar ciliated epithelial cells in sputum is observed when:

The presence of squamous epithelium in sputum is observed when saliva enters the sputum. This indicator has no diagnostic value.

A large number of eosinophils in sputum is observed when:

bronchial asthma;
damage to the lungs by worms;
pulmonary infarction;
eosinophilic pneumonia.

The presence of elastic fibers in sputum is observed when:

The presence of calcified elastic fibers in the sputum is observed in pulmonary tuberculosis.

The presence of coral fibers in sputum is observed in cavernous tuberculosis.

The presence of Kurshman spirals in sputum is observed when:

The presence of Charcot-Leyden crystals in the sputum - products of the breakdown of eosinophils - is observed when:

allergies;
bronchial asthma;
eosinophilic infiltrates in the lungs;
infection with pulmonary fluke.

The presence of cholesterol crystals in sputum is observed when:

lung abscess;
pulmonary echinococcosis;
neoplasms in the lungs.

The presence of hematodin crystals in sputum is observed when:

Bacteriological analysis of sputum

Bacteriological analysis of sputum is necessary to clarify the diagnosis of the choice of treatment method, to determine the sensitivity of microflora to various drugs, has great importance for the detection of Mycobacterium tuberculosis.

The appearance of a cough with sputum requires mandatory consultation with a doctor.

Sputum analysis

Microscopic examination of sputum reveals

Alveolar macrophages are cells of reticulohistiocytic origin. A large number of macrophages occurs when chronic processes and at the stage of resolution of acute processes in the bronchopulmonary system. Alveolar macrophages containing hemosiderin (“cells of heart defects”) are detected during pulmonary infarction, hemorrhage, and congestion in the pulmonary circulation. Macrophages with lipid droplets are a sign of an obstructive process in the bronchi and bronchioles.

Xanthomia cells (fat macrophages) are found in abscesses, actinomycosis, and pulmonary echinococcosis.

Cells of the cylindrical ciliated epithelium - cells of the mucous membrane of the larynx, trachea and bronchi; found in bronchitis, tracheitis, bronchial asthma, and malignant tumors of the lungs.

Flat epithelium is caused by an admixture of saliva and its detection has no diagnostic value.

Leukocytes are found in small numbers in every sputum. A large number of neutrophils are present in mucopurulent and purulent sputum. Sputum is rich in eosinophils in bronchial asthma, eosinophilic pneumonia, helminthic lesions of the lungs, and pulmonary infarction. Eosinophils can be found in sputum in tuberculosis and lung cancer. Lymphocytes are found in large numbers in whooping cough and less frequently in tuberculosis.

Red blood cells. The detection of single red blood cells in sputum has no diagnostic value. 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.

Malignant tumor cells are found in malignant neoplasms.

Fibers

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 released with sputum during tuberculosis, abscess, echinococcosis, and neoplasms in the lungs.

Coral fibers are released in chronic lung diseases, for example, cavernous tuberculosis.

Calcified elastic fibers are elastic fibers impregnated with calcium salts. Their presence in sputum is characteristic of the disintegration of tuberculosis petrification.

Spirals and crystals

Kurshman spirals are formed when the bronchi are spastic and there is mucus in them. During a cough push, viscous mucus is thrown into the lumen of a larger bronchus, twisting into a spiral. Kurshman spirals appear in cases of bronchial asthma, bronchitis, and lung tumors that compress the bronchi.

Charcot-Leyden crystals are breakdown products of eosinophils. Typically appear in sputum containing eosinophils; characteristic of bronchial asthma, allergic conditions, eosinophilic infiltrates in the lungs, pulmonary fluke.

Cholesterol crystals appear with an abscess, pulmonary echinococcosis, and tumors in the lungs.

Hematoidin crystals are characteristic of abscess and gangrene of the lung.

Actinomycete drusen are characteristic of pulmonary actinomycosis.

Echinococcus elements appear in pulmonary echinococcosis.

Dietrich's plugs are yellowish-gray lumps with an unpleasant odor. Consist of detritus, bacteria, fatty acids, fat droplets; characteristic of lung abscess and bronchiectasis.

Ehrlich's tetralogy consists of four elements: calcified detritus, calcified elastic fibers, cholesterol crystals and mycobacterium tuberculosis. Appears during the disintegration of a calcified primary tuberculosis focus.

Mycelium and budding fungal cells appear during fungal infections of the bronchopulmonary system.

Pneumocystis appear in Pneumocystis pneumonia.

Fungal spherules are detected in pulmonary coccidioidomycosis.

Ascaris larvae are detected in ascariasis.

Intestinal eel larvae are detected in strongyloidiasis.

Pulmonary fluke eggs are detected during paragonimiasis.

Elements found in sputum in bronchial asthma

Normally, elements of bronchial asthma are not detected in sputum.

With bronchial asthma there is a scanty amount of mucous, viscous sputum. Macroscopically you can see the Kurshman spirals. Microscopy is especially characterized by the presence of eosinophils, columnar epithelium, and Charcot-Leyden crystals.

Microscopic examination of sputum

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, Kurschmann spirals can be detected 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 leukocytes are interspersed. Kurschmann spirals appear in sputum during bronchospasm. At high magnification, in the native preparation (Fig. 11) one can detect leukocytes, erythrocytes, alveolar macrophages, cells of cardiac defects, cylindrical and flat epithelium, malignant tumor cells, drusen of actinomycetes, fungi, Charcot-Leyden crystals, eosinophils. Leukocytes are gray granular round cells. A large number of leukocytes can be found during the inflammatory process in the respiratory organs. Red blood cells are small homogeneous yellowish discs that appear in sputum during pneumonia, congestion in the pulmonary circulation, pulmonary infarction and tissue destruction. Alveolar macrophages are cells 2-3 times larger than leukocytes with abundant coarse granularity in the cytoplasm. By phagocytosis, they cleanse the lungs of particles that enter them (dust, cell decay). Capturing red blood cells, alveolar macrophages turn into cells of cardiac defects (Fig. 12 and 13) with yellow-brown hemosiderin grains that react 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 of hydrochloric acid 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.

The columnar epithelium of 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 are large and varied irregular shape with large nuclei (recognizing them requires very great experience researcher). Elastic fibers are 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 alkali until the mucus dissolves. After cooling, the liquid is centrifuged by adding 3-5 drops of 1% alcohol solution 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 are crushed 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. The fungus Candida albicans has the character of budding yeast cells or short branched mycelium with a small number of spores (Fig. 10). Charcot-Leiden crystals are colorless rhombic crystals of different sizes (Fig. 9), formed from the breakdown products of eosinophils, 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 differ from other leukocytes in their large shiny granularity; they are better distinguishable in a smear stained sequentially with a 1% eosin solution (2-3 min.) and 0.2% methylene blue solution (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 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 analysis.

Microscopic examination of sputum

Cellular elements of sputum

Crystals in sputum preparations

No contraindications or special equipment

Spontaneous sputum production

Possibility of multiple research

Presence of cells from all parts of the lung in the material

High efficiency in diagnosing tumors of central localization, with lung lesions of squamous cell and small cell cancer

Possibility of diagnosing tumors in the asymptomatic stage of the disease

Dependence of performance on the qualifications of the laboratory assistant

The preparation of the drug is very labor-intensive

Long-term study of the drug

Low effectiveness of studies in peripheral localization of pulmonary lesions

Low efficiency in diagnosing benign neoplasms

Lack of information on the location and extent of the lesion

The need to exclude tumor localization in a neighboring organ (oral cavity, pharynx, larynx, esophagus)

The daily amount of sputum depends on the disease

For acute bronchitis, bronchial asthma, initial stage of pneumonia, ml/day

For chronic bronchitis, adenomatosis, pulmonary tuberculosis ml/day

For bronchiectasis, actinomycosis, some helminthic infestations - up to 2 l/day

When opening a lung abscess - up to 4 l

Normally odorless

The sputum reaction is usually alkaline. It becomes acidic when sputum decomposes (prolonged standing) and from the admixture of gastric juice (which helps differentiate hemoptysis from hematemesis).

Mucous sputum is colorless and transparent, or has a whitish color.

Purulent and purulent-mucous sputum - gray, yellowish, greenish in color

Bloody sputum - the color of blood (with pulmonary hemorrhage)

Rusty color - typical for lobar pneumonia

Brownish color - typical for paragonimiasis

Brown color - typical for tuberculosis, gangrene, malignant neoplasms of the lung

Raspberry color - typical for malignant neoplasms

Dirty green or greenish yellow - with jaundice

Mucous sputum - sputum is colorless, viscous, with a small amount of cellular elements

Chronic inflammation of the upper respiratory tract

During an asthmatic attack

Infiltrative and focal tuberculosis (sometimes)

Nonspecific inflammatory processes of the lungs (scanty amount of mucous, with small grains, “tearing” sputum)

Diseases of the bronchi and lung parenchyma

Upper respiratory tract diseases

Lung cancer (with whitish-gray or bloody streaks)

Lung abscess (large amount of purulent greenish sputum with a putrid odor)

Opening of pleural empyema into the lumen of the bronchus (purely purulent)

Fibrous-cavernous form of tuberculosis

Sometimes the source of bleeding may be of non-pulmonary origin (rupture of an aortic aneurysm into the lumen of the bronchus or trachea, nosebleeds, gastric ulcer/round ulcer)

Pulmonary infarction in the stage of reverse development

Inflammation of the upper respiratory tract and nasopharynx

Severe inflammatory processes of the upper respiratory tract with congestion

Kurshman spirals in sputum can be represented by quite large (visible in a Petri dish during macroscopic examination) and small formations (when formed in small bronchioles).

Kurshman spirals are typical for diseases such as:

Inflammatory processes with spasm and obstruction of the bronchi

Dietrich's plugs are located in the lower purulent layer of three-layer sputum formed in cavities during lung abscess and bronchiectasis.

Leukocytes can be either well preserved or different stages degeneration

The more pus in the sputum, the more neutrophils. In nonspecific inflammatory processes, neutrophils in thick pus look like colorless, fine-grained, clearly contoured volumetric cells; in liquid serous sputum, neutrophils are large cells (2.5 times larger than red blood cells) with well-defined fragmented nuclei.

Preparations are stained with azure-eosin

Cytoplasmic granules with a large amount of alkaline protein and peroxides with bactericidal activity

Acid phosphatase, acrylic sulfatase, collagenase, elastase, glucuronidase, cathepsin myeloperoxidase and other enzymes with lytic activity are detected in eosinophil granules

Eosinophils have weak phagocytic activity and cause extracellular cytolysis, participating in prohelminthic immunity and allergic reactions

Exogenous allergic alveolitis

Lefler's eosinophilic pneumonia

Langerhans cell granulomatosis

Lung damage by protozoa

Malignant neoplasms of the lungs

The presence of tissue basophils in sputum and bronchopulmonary lavage may indicate exogenous allergic alveolitis

A large number of lymphocytes appear when the body’s immunological reactivity is activated.

Lymphocytes are found in large numbers in sputum when:

Exogenous allergic alveolitis

Single red blood cells can be found in any sputum.

Blood-stained sputum suggests:

Stagnation in the pulmonary circulation

Malignant neoplasms of the lungs

Cells of the cylindrical ciliated epithelium are found in sputum during the preparation of preparations from whitish strands and threads, films against a background of mucus, which represent areas of inflamed hypertrophied mucous membrane of the respiratory tract rejected during calcium shocks.

Coniophages phagocytose dust, soot, nicotine, and paint.

Inclusions in the form of yellowish-brown, brown, black and colored granules of various sizes, sometimes filling almost the entire cellular cytoplasm (black in miners, white in flour millers, etc.)

Lipophages are alveolar macrophages with fat droplets or xanthoma cells from foci of fatty degeneration of lung tissue.

Chronic inflammatory process in the lungs

Malignant neoplasms of the lungs

Stagnation in the pulmonary circulation

Idiopathic pulmonary hemosiderosis (“iron” lung, Selen-Gellerstedt syndrome)

Appear in sputum as a result of breakdown:

Malignant neoplasms of the lungs

Found in sputum with severe decomposition

Formed in the hearth chronic inflammation, cavernous tuberclesis

Found in sputum during the disintegration of the primary tuberculosis focus of Gon, with abscess and gangrene of the lung, malignant neoplasms of the lungs

Calcified elastic fibers

Charcot-Leiden crystals do not form immediately in sputum (they can form after hours from collecting sputum), they are characteristic of diseases such as:

Bronchial asthma (interictal period)

In sputum preparations, hematoidin crystals are located against the background of detritus, elastic fibers, malignant cells, in foci of necrosis of lung tissue or disintegration of hematomas.

They are formed when sputum stagnates in cavities, in foci of degeneration of lung tissue, with malignant neoplasms, and lung abscess.

A cytological examination of sputum in the cytoplasm of columnar epithelial cells or macrophages in vacuoles reveals small polymorphic dark cherry-colored inclusions. Empty vacuoles are detected in the cytoplasm of these cells.

With lobar pneumonia in the early stages of the disease, the sputum is viscous, very scanty, and rusty in color. Microscopy identifies red blood cells. macrophages with hemosiderin, leukocytes, small fibrin bundles and pneumococci. During the period of resolution of the inflammatory process, the sputum acquires a mucopurulent character without a rusty color. In the fulminant form of lobar pneumonia, the patient experiences hemoptysis.

In focal pneumonia, the sputum is mucopurulent.

With pneumonia, the causative agent of which is Friedlander's bacillus, the sputum is mucopurulent, sometimes mixed with blood. Inside the dense dark or light pink worm-like formations in colorless polysaccharide capsules, short, straight, thick rods with rounded and slightly thickened ends, located singly or in pairs, are visible.

Haemophilus influenzae is detected in sputum by staining with azure-eosin.

Sputum preparations reveal giant multinucleated columnar epithelial cells with fairly large nuclei of the same size and shape. There are many nuclei, they usually overlap each other, lie tightly, forming facets. This microscopic appearance may resemble malignant cells.

At low microscope magnification, Kurschmann spirals can be detected 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 leukocytes are interspersed. Kurschmann spirals appear in sputum during bronchospasm. At high magnification, in the native preparation (Fig. 11) one can detect leukocytes, erythrocytes, alveolar macrophages, cells of cardiac defects, cylindrical and flat epithelium, malignant tumor cells, drusen of actinomycetes, fungi, Charcot-Leyden crystals, eosinophils. Leukocytes are gray granular round cells. A large number of leukocytes can be found during the inflammatory process in the respiratory organs. Red blood cells are small homogeneous yellowish discs that appear in sputum during pneumonia, congestion in the pulmonary circulation, pulmonary infarction and tissue destruction. Alveolar macrophages are cells 2-3 times larger than leukocytes with abundant coarse granularity in the cytoplasm. By phagocytosis, they cleanse the lungs of particles that enter them (dust, cell decay). Capturing red blood cells, alveolar macrophages turn into cells of cardiac defects (Fig. 12 and 13) with yellow-brown hemosiderin grains that react 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 of hydrochloric acid 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.

The columnar epithelium of 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. The cells of malignant tumors are large, of various irregular shapes with large nuclei (recognizing them requires a lot of experience of the researcher). Elastic fibers are 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 alkali 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 are crushed 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. The fungus Candida albicans has the character of budding yeast cells or short branched mycelium with a small number of spores (Fig. 10). Charcot-Leiden crystals are colorless rhombic crystals of different sizes (Fig. 9), formed from the breakdown products of eosinophils, 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 differ from other leukocytes in their large shiny granularity; they are better distinguishable in a smear stained sequentially with a 1% eosin solution (2-3 min.) and 0.2% methylene blue solution (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).

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.

Sputum analysis explanation

Sputum analysis decoding is a microscopic study of cells and their decoding. which makes it possible to determine the activity of the process in chronic diseases of the bronchi and lungs and to diagnose lung tumors. Deciphering sputum analysis allows you to identify various diseases.

Leukocytes in sputum

Lymphocytes

Eosinophils

Eosinophils make up up to 50-90% of all leukocytes; elevated eosinophils diagnose diseases:

allergic processes;
bronchial asthma;
eosinophilic infiltrates;
helminthic infestation of the lungs.

Neutrophils

If the number of neutrophies is more than 25 in the field of view, this indicates the presence of an infectious process in the body.

Flat epithelium

Flat epithelium, more than 25 cells in the field of view - an admixture of discharge from the oral cavity.

Elastic fibers

Kurshman spirals

Kurshman spirals are used for diagnosing bronchospastic syndrome, diagnosing asthma.

Charcot-Leyden crystals

Charcot-Leyden crystals diagnose allergic processes, bronchial asthma.

Alveolar macrophages

Alveolar macrophages - The sputum sample comes from the lower respiratory tract.

Sputum is produced in a variety of respiratory diseases. It is better to collect sputum in the morning; before doing this, you need to rinse your mouth with a weak antiseptic solution, then with boiled water.

During examination, the daily amount of sputum, the nature, color and smell of sputum, its consistency, as well as separation when standing in a glass container are noted.

Increased sputum production is observed with:

gangrene of the lung;
pulmonary tuberculosis, which is accompanied by tissue breakdown.

Reduced sputum production is observed with:

acute bronchitis;
pneumonia;
congestion in the lungs;
attack of bronchial asthma (at the beginning of the attack).

Greenish color of sputum is observed when:

lung abscess;
bronchiectasis;
sinusitis;
post-tuberculosis disorders.

Sputum mixed with blood is observed when:

Rusty color of sputum is observed when:

focal, lobar and influenza pneumonia;
pulmonary tuberculosis;
pulmonary edema;
congestion in the lungs.

Sometimes the color of sputum is affected by taking certain medications. If you have an allergy, the sputum may be bright orange.

Yellow-green or dirty green color of sputum is observed with various lung pathologies in combination with jaundice.

Blackish or grayish color of sputum is observed in people who smoke (admixture of coal dust).

Putrid odor of sputum is observed when:

When an echinococcal cyst is opened, the sputum acquires a peculiar fruity smell.

bronchitis complicated by putrefactive infection;
bronchiectasis;
lung cancer complicated by necrosis.

The separation of purulent sputum into two layers is observed with a lung abscess.

The division of putrefactive sputum into three layers - foamy (upper), serous (middle) and purulent (lower) - is observed with gangrene of the lung.

As a rule, decomposed sputum acquires an acidic reaction.

The production of thick mucous sputum is observed when:

acute and chronic bronchitis;
asthmatic bronchitis;
tracheitis.

The release of mucopurulent sputum is observed when:

lung abscess;
gangrene of the lung;
purulent bronchitis;
staphylococcal pneumonia;
bronchopneumonia.

The release of purulent sputum is observed when:

bronchiectasis;
lung abscess;
staphylococcal pneumonia;
actinomycosis of the lungs;
gangrene of the lungs.

The production of serous and serous-purulent sputum is observed when:

Bloody sputum is produced when:

A large number of alveolar microphages in sputum are observed in chronic pathological processes in the bronchopulmonary system.

The presence of fatty macrophages (xanthoma cells) in sputum is observed when:

lung abscess;
actinomycosis of the lung;
pulmonary echinococcosis.

Columnar ciliated epithelial cells

The presence of columnar ciliated epithelial cells in sputum is observed when:

The presence of squamous epithelium in sputum is observed when saliva enters the sputum. This indicator has no diagnostic value.

A large number of eosinophils in sputum is observed when:

bronchial asthma;
damage to the lungs by worms;
pulmonary infarction;
eosinophilic pneumonia.

The presence of elastic fibers in sputum is observed when:

The presence of calcified elastic fibers in the sputum is observed in pulmonary tuberculosis.

The presence of coral fibers in sputum is observed in cavernous tuberculosis.

The presence of Kurshman spirals in sputum is observed when:

The presence of Charcot-Leyden crystals in the sputum - products of the breakdown of eosinophils - is observed when:

allergies;
bronchial asthma;
eosinophilic infiltrates in the lungs;
infection with pulmonary fluke.

The presence of cholesterol crystals in sputum is observed when:

lung abscess;
pulmonary echinococcosis;
neoplasms in the lungs.

The presence of hematodin crystals in sputum is observed when:

Bacteriological analysis of sputum

Bacteriological analysis of sputum is necessary to clarify the diagnosis of the choice of treatment method, to determine the sensitivity of microflora to various drugs, and is of great importance for identifying Mycobacterium tuberculosis.

The appearance of a cough with sputum requires mandatory consultation with a doctor.

Sputum analysis. Decoding

Sputum microscopy

Microscopic analysis of sputum is carried out in both native and stained preparations. The specimen is first viewed at low magnification for initial orientation and search for large elements (Curshman spirals), and then at high magnification for differentiation shaped elements.

Kurshman spirals

Charcot-Leyden crystals

Formed elements of blood

A small number of leukocytes can be found in any sputum; during inflammatory (and especially suppurative) processes, their number increases.

Neutrophils in sputum. The detection of more than 25 neutrophils in the field of view indicates an infection (pneumonia, bronchitis).

Red blood cells in sputum. Red blood cells appear in sputum during the destruction of lung tissue, pneumonia, stagnation in the pulmonary circulation, pulmonary infarction, etc.

Epithelial cells

Columnar ciliated epithelium is present in small quantities in any sputum, and in large quantities in cases of damage to the respiratory tract (bronchitis, bronchial asthma).

Alveolar macrophages

Alveolar macrophages are localized mainly in the interalveolar septa. Therefore, analysis of sputum, where at least 1 macrophage is present, indicates that the lower parts of the respiratory system are affected.

Elastic fibers

Components of sputum. Analysis transcript

Kurshman spirals - Bronchospastic syndrome, the most likely diagnosis is asthma.

Charcot-Leyden crystals - Allergic processes, bronchial asthma.

Eosinophils, up to 50-90% of all leukocytes - Allergic processes, bronchial asthma, eosinophilic infiltrates, helminthic invasion of the lungs.

Neutrophils, more than 25 in the field of view - Infectious process. It is impossible to judge the localization of the inflammatory process.

Flat epithelium, more than 25 cells in the field of view - An admixture of discharge from the oral cavity.

Alveolar macrophages - The sputum sample comes from the lower respiratory tract.

Elastic fibers - Destruction of lung tissue, abscess pneumonia.

Atypical cells

Trophozoites of E.histolytica - pulmonary amoebiasis.

Larvae and adults of Ascaris lumbricoides - pneumonitis.

Cysts and larvae of E. granulosus - hydatid echinococcosis.

P. westermani eggs are paragonimiasis.

Larvae of Strongyloides stercoralis - strongyloidiasis.

N.americanus larvae - hookworm.

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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.

red (pink, bloody)

"raspberry or currant jelly"

no (odorless), or weak

viscous, thick, liquid

weak, moderate, strong

no (does not foam), weak, high

one-, two-, three-layer

8. Character (macrocomposition):

mucous, purulent, bloody, serous, mixed.

flat – single, many;

cylindrical – single, many;

alveolar macrophages – few, many;

dust cells – presence;

tumor (atypical) cells – presence.

neutrophils – few, moderate, many;

eosinophils – few, moderate, many;

lymphocytes – single, many;

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.

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

fatty acids (Dietrich's plugs) – presence;

14. Foreign bodies – presence.

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

16. Other bacteria – not detected, detected:

pneumococcus catarrhal (bacillus influenza)

Frenkel-Wekselbaum pneumococci (diplococci)

candida, aspergillus, actinomycetes, cryptococci.

Amount of sputum– volume of coughing:

scant K.M. – individual spits 1-5 ml;

moderate – ml/day;

large – ml/day;

very large (abundant) > 300 ml/day.

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

Colorless – glassy, mucous, transparent. Basic cellular composition– lymphocytes, squamous epithelium;

Yellowish – mucopurulent. Yellow Eosinophils impart sputum;

Green – purulent. Green color sputum is imparted 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 sputum in flour millers;

Coal dust, etc. gives black color to sputum.

When describing sputum 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. Unpleasant smell sputum acquires 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 ( upper layer– serous fluid, lower pus) – with 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; often detected in hospitals Staphylococcus aureus– causative agent of purulent processes.

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. He hesitates 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.

narcotic drugs of central action:

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

non-narcotic central action:

Glaucine, dimemorphan, oxeladine, pentoxyverine,

Levodropronisin, prenoxydiazine (libexin)

Mucolytics, expectorants (expectorants):

Dornisa alpha – deoxyribonuclease I – mucolytic;

Ambroxol is a metabolite of bromhexine and is a mucolytic;

Solvin expectorant (bromhexine + pseudoephedrine) – 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;

Licorice root extract;

Tussamag ( liquid extract thyme);

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, 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;

Non-steroidal anti-inflammatory drugs;

Iodine, bromine, procainamide;

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 medicinal lesions 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.

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General sputum analysis

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.

What is this analysis used for?

For diagnosis and assessment of the pathological process in the lungs and respiratory tract.

For respiratory diseases, which are accompanied by cough and sputum production.

Clinical sputum analysis.

Mg/dL (milligram per deciliter).

What biomaterial can be used for research?

How to properly prepare for research?

General information about the study

Sputum is a pathological secretion of the lungs and respiratory tract (bronchi, trachea, larynx), which is separated when coughing. U healthy people No sputum is produced. Normal glands large bronchi and the trachea constantly form a secretion in amounts of up to 100 ml/day, which is swallowed when excreted. Tracheobronchial secretion is a mucus containing 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 is formed by accumulations of leukocytes that arise 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 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 (bronchitis, pneumonia, bronchial asthma, chronic obstructive pulmonary disease, tuberculosis, bronchiectasis, neoplasms of the respiratory system, fungal or helminthic infestation lungs, interstitial diseases lungs);
if you have a cough with sputum production;
with a clarified or unclear process in chest according to auscultation or x-ray examination.

The amount of sputum in various pathological processes 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.

A large amount 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.

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 traces of the breakdown of red blood cells.

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 may also stain sputum. medicines(eg rifampicin).

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 an opened echinococcal cyst.

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.

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

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

Cells of cylindrical ciliated epithelium - cells of the mucous membrane of the larynx, trachea and bronchi; they are found in bronchitis, tracheitis, bronchial asthma, and malignant neoplasms.

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

Leukocytes are detected in large numbers with severe inflammation, in the composition of mucopurulent and purulent sputum.

Eosinophils are 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 are 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 are detected in chronic diseases (for example, cavernous tuberculosis).

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

Kurshman spirals are formed when the bronchi are spastic and there is mucus in them; characteristic of bronchial asthma, bronchitis, lung tumors.

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

Fungal mycelium appears during fungal infections bronchopulmonary system(for example, with pulmonary aspergillosis).

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

What can influence the result?

The analysis results will be unreliable if:

improper collection of material (for example, collecting saliva rather than sputum);
penetration of foreign substances and biomaterials into the material.

Taking antibacterial, antifungal or anthelmintic drugs that affect the causative agents of the infectious process in the lungs changes the nature of sputum.

If sputum is difficult to separate, expectorants may be prescribed before taking the test, copious amounts of warm drink, inhalation with saline solution.
Sputum collection is carried out in the morning, before meals. The analysis of sputum will be more reliable if, before collecting the material, you brush your teeth and rinse your mouth with boiled water, which will reduce the number of bacteria in the oral cavity.
The interpretation of the analysis results should be carried out by the attending physician, taking into account clinical data and other laboratory and instrumental examinations.

Who orders the study?

The native preparation is prepared from selected elements of sputum. Using dissecting needles, place a lump of sputum in the middle of the slide and cover it with a coverslip. With the clean end of a dissecting needle, lightly press on the cover glass, making the preparation flatter and translucent. At the same time, make sure that the sputum does not extend beyond the edges of the cover glass. At least 4 native preparations are prepared from different areas of sputum.

They microscopy first under low magnification - survey microscopy, and then under high magnification.

The elements of sputum that are found in the native preparation can be divided into 3 main groups: cellular, fibrous and crystalline formations.

Cellular elements

Squamous epithelium is desquamated epithelium of the mucous membrane of the oral cavity, nasopharynx, epiglottis and vocal cords, having the appearance of thin cells with a small pictonic vesicular nucleus and homogeneous cytoplasm.
Single cells of squamous epithelium are always found in large numbers - with an admixture of saliva or inflammatory phenomena in the oral cavity.

Columnar epithelium is the epithelium of the mucous membrane of the bronchi and trachea. It has the appearance of elongated cells, one end of which, facing the lumen of the bronchus, is expanded, the other is pointed and narrowed, containing an oval nucleus. The cells are equipped with a crown of cilia (cilia are usually visible only in very fresh sputum). The cylindrical epithelium sometimes changes and acquires a spindle-shaped shape, with one of the ends stretching into a long thread. It is found in large quantities during an acute attack of bronchial asthma, acute bronchitis, and acute catarrhal lesions of the upper respiratory tract.

Macrophages are cells of bone marrow origin, oval or round in shape, size from 15 to 20-25 microns, usually 1 (sometimes more) eccentrically located nucleus, vacuolated cytoplasm containing various dark brown inclusions.
Occurs in various inflammatory processes in the bronchi and lung tissue (pneumonia, bronchitis). Macrophages with symptoms of fatty degeneration - lipophages (“fat balls”), stained orange by Sudan 3, are found in lung cancer, tuberculosis, echinococosis, actinomycosis. Macrophages containing hemosiderin, siderophages (old name “heart defect cells”), have golden-yellow inclusions in the cytoplasm. They are reliably determined by the reaction to Prussian blue.

Definition of siderophages. A piece of sputum is placed on a glass slide, 1-2 drops of a 2-5% solution of hydrochloric acid and 1-2 drops of a 5% solution of yellow blood salt (potassium iron-synoxide) are added. Hemosiderin, lying intracellularly, is colored blue and blue-green.

Siderophages are found in the sputum of patients with congestion in the pulmonary circulation, pulmonary infarction, Goodpasture syndrome, and idiopathic pulmonary hemosiderosis.

Dust macrophages (coniophages) are recognized by the content of particles of coal or dust of other origin in the cytoplasm.
These cells are located in the form of strands and accumulations in the mucous part of the sputum. Their detection is important in the diagnosis of pneumoconiosis and dust bronchitis.

Tumor cells are most often presented in the form of squamous cell (with or without keratinization) glandular cancer or adenocarcinoma. Difficulties often arise in distinguishing tumor cells from metaplastic squamous or columnar epithelial cells. Tumor cells are characterized by polymorphism (can be gigantic in size), enlargement and hyperchromia of the nucleus with nucleoli and mitoses, basophilia of the cytoplasm, and the ability to phagocytosis. In this case, only the detection of conglomerates, complexes of tumor cells located on a fibrous base is reliable. Suspicions of tumor cells when studying the native drug are confirmed by a thorough cytological examination of stained preparations. In this case, the study of bronchial washings and pleural exudate is more informative.

Leukocytes are round cells with a diameter of 10-12 to 15 microns with a poorly distinguishable nucleus and uniform, abundant granularity. They are found in almost every type of sputum: in mucous - single, and in purulent they completely cover the entire field of view (sometimes eosinophils can be distinguished among leukocytes - large leukocytes with a distinct and dark granularity).

Red blood cells are round or slightly oval-shaped cells, yellowish in color (fresh) or colorless (changed and lost pigment), with a diameter smaller than leukocytes, never have granularity in the protoplasm, double-circuited (target cell), somewhat refracting light. Single red blood cells can be found in any sputum; found in large quantities in blood-stained sputum ( pulmonary hemorrhage, pulmonary infarction, congestion in the lungs, etc.).

Fibrous formations

Elastic fibers have the appearance of crimped, shiny, thin threads that refract light, collected in bundles, sometimes repeating the structure of alveolar tissue. As a rule, these fibers are located against a background of leukocytes and detritus. They indicate the breakdown of lung tissue and are found in tuberculosis, abscess, and lung tumors. Sometimes, in these diseases, coral fibers are found in the sputum - rough, branching formations with lumpy thickenings due to the deposition of fatty acids and soaps on the fibers, as well as calcified elastic fibers - rough, rod-shaped formations impregnated with layers of lime.

To detect elastic fibers, add 2-3 volumes of a 10% caustic alkali solution to sputum and boil until dissolved (elastic fibers do not dissolve). After cooling, add 5-7 drops of a 1% alcohol solution of eosin to the liquid and centrifuge. The sediment is examined under a microscope. When locating fibers, you need to be careful not to confuse them with elastic fibers from food.

Diagnostic significance can be assigned only to those fibers that occur in groups (bundles) and exhibit an alveolar location.

Elastic fibers are found in sputum at a late stage of the destructive process and only if the cavity is drained by the bronchus.

Fibrinous fibers are thin fibers that noticeably lighten in the preparation when a 30% solution of acetic acid is added, and dissolve when chloroform is added. Occurs in fibrinous bronchitis, tuberculosis, actinomycosis, and lobar pneumonia.

Kurshman's spirals are compacted, twisted mucus formations. The outer loose part is called the mantle, the inner, tightly twisted part is called the central axial thread. Occasionally, only thin central filaments without a mantle and spirally twisted fibers without a central filament are found separately. Kurshman spirals are viewed under low magnification microscope. When examined under high magnification, leukocytes and Charcot-Leyden crystals can be seen along the periphery of the spirals. Kurshman spirals are observed in pulmonary pathology accompanied by bronchospasm (bronchial asthma, asthmatic bronchitis, bronchial tumors).

Crystal formations

Charcot-Leyden crystals are found in sputum along with eosinophils and have the appearance of shiny, smooth, colorless rhombuses of varying sizes, sometimes with blunt ends. The formation of Charcot-Leyden crystals is associated with the breakdown of eosinophils; they are considered a product of protein crystallization. Often, freshly secreted sputum does not contain Charcot-Leyden crystals; they form in it in a sealed container after 24-28 hours. The presence of these crystals in sputum in bronchial asthma is characteristic not even at the height of the attack, but in the interictal period. In addition, they occur with helminthic lesions of the lungs, less often with lobar pneumonia and various bronchitis.

Hemotaidin crystals are shaped like diamonds and needles (sometimes tufts and stars) and are golden yellow in color. These crystals are a product of the breakdown of hemoglobin and form in the depths of hematomas and extensive hemorrhages, in necrotic tissue. In the preparations, hematoidin crystals are located against the background of detritus and elastic fibers. They should be distinguished from hemosiderin grains - golden-yellow inclusions in the cytoplasm of macrophages that give a positive reaction to Prussian blue.

Cholesterol crystals are colorless, quadrangular in shape with a broken step-like corner; are formed during the breakdown of fat-degenerated cells, retention of sputum in the cavities and are located against the background of detritus (tuberculosis, neoplasms, echinococcosis, abscess, etc.).

Crystals of fatty acids in the form of long thin needles and droplets of fat are often contained in purulent sputum (Dietrich's plug); are formed when sputum stagnates in cavities (abscess, bronchiectasis).

Sputum analysis. Decoding

Macroscopic examination

Quantity

Character

Color

Smell

Layering

Impurities

Chemical research

Reaction

Protein

Bile pigments

Microscopic examination

Epithelial cells

Alveolar macrophages

Leukocytes

Red blood cells

Tumor cells

Elastic fibers

Bacterioscopic examination

Norms

Diseases for which a doctor may prescribe a general sputum test

Lung abscess

Bronchiectasis

Lung gangrene

Acute pleural empyema

Chronic lung abscess

Lung cancer

Esophageal carcinoma

Bronchial asthma

Acute bronchitis

Chronic tonsillitis

Pulmonary tuberculosis (miliary)

Silicosis

Whooping cough

Pulmonary tuberculosis (focal and infiltrative)

Acute obstructive bronchitis

anthrax

Pneumonia

Goodpasture's syndrome

Microscopic examination of sputum.

Charcot-Leyden crystals

Formed elements of blood

Epithelial cells

Alveolar macrophages

Elastic fibers

Components of sputum. Analysis transcript

Atypical cells

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Sputum analysis explanation

Leukocytes in sputum

Lymphocytes

Eosinophils

Neutrophils

Flat epithelium

Elastic fibers

Kurshman spirals

Charcot-Leyden crystals

Alveolar macrophages

Bacteriological analysis of sputum

Sputum analysis

Fibers

Spirals and crystals

Elements found in sputum in bronchial asthma

Microscopic examination of sputum

Sputum analysis.

Sputum analysis explanation

Leukocytes in sputum

Lymphocytes

Eosinophils

Neutrophils

Flat epithelium

Elastic fibers

Kurshman spirals

Charcot-Leyden crystals

Alveolar macrophages