Sputum analysis. Decryption

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

Macroscopic examination

Quantity

With various pathological processes, the amount of sputum varies widely - from a few spittles to 1 liter or more per day. A small amount of sputum is separated in acute bronchitis, pneumonia, sometimes in chronic bronchitis, congestion in the lungs, at the beginning of an attack of bronchial asthma. At the end of an asthma attack, the amount of sputum secreted increases. A large amount of sputum (sometimes up to 0.5 liters) can be released with pulmonary edema. A lot of sputum is secreted during suppurative processes in the lungs, provided that the cavity communicates with the bronchus (with an abscess, bronchiectasis, lung gangrene). With a tuberculous process in the lung, accompanied by tissue breakdown, 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 a deterioration in 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 an improvement in the drainage of the cavity, it is regarded as a positive symptom. A decrease in the amount of sputum may be the result of a subsidence of the inflammatory process or, in other cases, the result of a violation of the drainage of the purulent cavity, often accompanied by a deterioration in the patient's condition.

Character

Mucous sputum is secreted in acute bronchitis, chronic bronchitis, bronchial asthma, pneumonia, bronchiectasis, lung cancer. Mucopurulent sputum is secreted in chronic bronchitis, pneumonia, bronchiectasis, lung abscess, festering lung echinococcus, lung actinomycosis, lung cancer, accompanied by suppuration. Purely purulent sputum is found in lung abscess, festering echinococcus of the lung, breakthrough of pleural empyema in the bronchus, bronchiectasis.

Bloody sputum, consisting almost of pure blood, is most often observed in pulmonary tuberculosis. The appearance of bloody sputum can be with lung cancer, bronchiectasis, lung abscess, middle lobe syndrome, pulmonary infarction, lung injury, actinomycosis and syphilis. Hemoptysis and even the admixture of blood to sputum occur in 12-52% of pulmonary infarctions. The admixture of blood in the sputum is determined with lung tumors, with pulmonary infarction, with lobar and focal pneumonia, silicosis of the lungs, with congestion in the lungs, cardiac asthma and pulmonary edema. Serous sputum is released with 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 typical for lung abscess, lung gangrene, bronchiectasis, lung actinomycosis.

Sputum is rusty or brown in color, indicates the content of not fresh blood in it, but its decay products (hematin) and occurs with lobar pneumonia, with pulmonary tuberculosis with cheesy decay, blood stasis in the lungs, pulmonary edema, with pulmonary anthrax, heart attack lung.

Dirty green or yellow-green color may have sputum that is separated during various pathological processes in the lungs, combined with the presence of jaundice in patients. Yellow-canary color is sometimes sputum with eosinophilic pneumonia. Ocher-colored sputum is noted with siderosis of the lung. Blackish or grayish sputum occurs with the admixture of coal dust. With pulmonary edema, serous sputum, which is often released in large quantities, is evenly colored in a slightly 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 drugs may stain sputum. For example, the antibiotic rifampicin stains it red.

Smell

Sputum acquires a putrid (cadaverous) smell with gangrene and lung abscess, bronchiectasis, putrefactive bronchitis, lung cancer, complicated by necrosis.

Layering

Purulent sputum on standing is usually divided into 2 layers and is usually associated with lung abscess and bronchiectasis; putrid sputum is often divided into 3 layers (upper - foamy, middle - serous, lower - purulent), characteristic of lung gangrene.

impurities

An admixture to the sputum of just taken food is noted when the esophagus communicates with the trachea or bronchus, which can occur with esophageal cancer.

Fibrinous convolutions, 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 sputum in tuberculosis.

Dietrich plugs, consisting of decay products of bacteria and lung tissue, fatty acid crystals, are found in putrefactive bronchitis and gangrene of the lung. In chronic tonsillitis, corks can be released from the tonsils, resembling Dietrich's corks in appearance. Plugs from the tonsils can also stand out in the absence of sputum.

Chemical research

Reaction

Freshly isolated sputum has an alkaline or neutral reaction. Decomposed sputum becomes acidic.

Protein

Determination of protein in sputum can be helpful in the differential diagnosis between chronic bronchitis and tuberculosis: in chronic bronchitis, traces of protein are determined in sputum, while in pulmonary tuberculosis, the protein content in sputum is higher, and it can be quantified (up to 100-120 g /l).

bile pigments

Bile pigments can be found in sputum in diseases of the respiratory tract and lungs, combined with jaundice, when communicating between the liver and the lung (when a liver abscess ruptures into the lung). In addition to these conditions, bile pigments can be found in pneumonia, which is associated with intrapulmonary breakdown of erythrocytes and subsequent transformations of hemoglobin.

microscopic examination

epithelial cells

Squamous epithelial cells found in sputum have no diagnostic value. Cells of the cylindrical epithelium (both single and in the form of clusters) can be found in bronchial asthma, bronchitis, bronchogenic lung cancer. At the same time, the appearance of cylindrical epithelial cells in sputum may also be due to the admixture of mucus from the nasopharynx.

Alveolar macrophages

Alveolar macrophages are reticuloendothelial cells. Macrophages containing phagocytosed particles in protoplasm (the so-called dust cells) are found in the sputum of people who have been in prolonged contact with dust. Macrophages containing hemosiderin (a breakdown product of hemoglobin) in their protoplasm are called "cells of heart defects." "Cells of heart defects" are found in sputum with congestion in the lungs, mitral stenosis, pulmonary infarction.

Leukocytes

Leukocytes are found in small numbers in any sputum. A large number of neutrophils is observed in mucopurulent and especially in purulent sputum. Sputum is rich in eosinophils in bronchial asthma, eosinophilic pneumonia, helminthiases of the lungs, lung infarction, tuberculosis and lung cancer. 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

Detection of single erythrocytes in sputum has no diagnostic value. The appearance of a large number of red blood cells in the sputum is noted in conditions accompanied by hemoptysis and pulmonary hemorrhage. In the presence of fresh blood in the sputum, unchanged erythrocytes are determined, but if blood remains in the respiratory tract for a long time with sputum, then leached erythrocytes are detected.

tumor cells

Tumor cells found in sputum in the form of groups indicate the presence of a lung tumor. If only single cells suspicious of a tumor are found, it is often difficult to evaluate them; in such cases, several repeated sputum studies are performed.

Elastic fibers

Elastic fibers appear as a result of the breakdown of lung tissue in tuberculosis, abscess, lung gangrene, and lung cancer. With gangrene of the lung, elastic fibers are not always detected, since they can dissolve under the action of enzymes in the sputum. Kurshman spirals are special tubular bodies that are found under microscopic examination, and sometimes visible to the naked eye. Usually Kurschmann spirals are determined in bronchial asthma, pulmonary tuberculosis and pneumonia. Charcot-Leiden crystals are found in sputum rich in eosinophils in bronchial asthma, eosinophilic pneumonia.

The opening of a petrified tuberculous focus in the lumen of the bronchus may be accompanied by the simultaneous detection in the sputum of calcified elastic fibers, crystals of cholesterol, MBT and amorphous lime (the so-called Ehrlich's tetrad) - 100%.

Bacterioscopic examination

Sputum examination for Mycobacterium tuberculosis (MBT) is performed in a specially stained smear. It has been established that a routine study of a stained smear for MBT gives a positive result only if the MBT content is at least 50,000 in 1 ml of sputum. By the number of MBT detected, it is impossible to judge the severity of the process.

When bacterioscopy of sputum of patients with nonspecific lung diseases can be detected:

with pneumonia - pneumococci, Frenkel diplococci, Friedlander bacteria, streptococci, staphylococci - 100%;
with gangrene of the lung - spindle-shaped stick in combination with Vincent's spirochete - 80%;
yeast-like fungi, to determine the type of which requires sputum culture - 70%;
with 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, a study of a stained smear for MBT gives a negative result.

Diseases for which the 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 a deterioration in the patient's condition. Sputum can be mucous, mucopurulent, purely purulent, 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.
Gangrene of the lung
With gangrene of the lung, a large amount of sputum is secreted. An increase in the amount of sputum is regarded as a sign of a deterioration in the patient's condition. The presence of pus gives the sputum a greenish tint. The smell of sputum is putrid (cadaverous). Putrid sputum is often divided into 3 layers (upper - foamy, middle - serous, lower - purulent). Dietrich's plugs can be found in sputum, consisting of decay products of bacteria and lung tissue, fatty acid crystals; elastic fibers resulting from the breakdown of lung tissue. With gangrene of the lung, elastic fibers are not always detected, since they can dissolve under the action of enzymes in the sputum. When bacterioscopy of sputum can be detected spindle-shaped rod in combination with Vincent's spirochete (80%).
Acute pleural empyema
With a breakthrough of pleural empyema in the bronchus, the sputum is purely purulent.
Chronic lung abscess
With a lung abscess, a large amount of sputum is secreted. An increase in the amount of sputum is regarded as a sign of a deterioration in the patient's condition. Sputum can be mucopurulent, purely purulent, 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 due to communication between the liver and lung, bile pigments may be found in the sputum. As a result of the collapse of the lung tissue during an abscess, elastic fibers appear in the sputum.
Lung cancer
In lung cancer, the sputum produced is mucous, bloody. Mucopurulent sputum is secreted in lung cancer, accompanied by suppuration. With lung cancer, complicated by necrosis, sputum acquires a putrid (cadaverous) smell. In bronchogenic lung cancer, cells of the cylindrical epithelium can be detected (both single and in the form of clusters). In lung cancer, eosinophils, tumor cells, and elastic fibers can be found in the mouth.
Esophageal carcinoma
When the esophagus communicates with the trachea or bronchus, which can occur with cancer of the esophagus, an admixture of just taken food is noted in the sputum.
Bronchial asthma
At the beginning of an asthma attack, a small amount of sputum is separated, at the end of an attack, its amount increases. Sputum in bronchial asthma is mucous. Cells of a cylindrical epithelium (both single and in the form of clusters), eosinophils, Kurschmann's spirals, Charcot-Leiden crystals can be found in it.
Acute bronchitis
In acute bronchitis, a small amount of sputum is separated. Sputum is mucous. It can be found cells of the cylindrical epithelium (both single and in the form of clusters).
Chronic tonsillitis
In chronic tonsillitis, corks can be released from the tonsils, resembling Dietrich's corks in appearance. Plugs from the tonsils can also stand out in the absence of sputum.
Pulmonary tuberculosis (miliary)
Silicosis
With silicosis of the lungs, an admixture of blood is determined in the sputum.
Whooping cough
With whooping cough, lymphocytes are found in large numbers in the sputum.
Pulmonary tuberculosis (focal and infiltrative)
With a tuberculous process in the lung, accompanied by tissue breakdown, especially in the presence of a cavity communicating with the bronchus, a lot of sputum can be secreted. Bloody sputum, consisting almost of pure blood, is most often observed in pulmonary tuberculosis. In pulmonary tuberculosis with cheesy decay, sputum is rusty or brown in color. Fibrinous convolutions consisting of mucus and fibrin can be found in sputum; rice 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: in chronic bronchitis, traces of protein are determined in sputum, while in pulmonary tuberculosis, the protein content in sputum is higher, and it can be quantified (up to 100-120 g /l).
Acute obstructive bronchitis
In acute bronchitis, sputum is mucous. It can be found cells of the cylindrical epithelium (both single and in the form of clusters).
anthrax
With the pulmonary form of anthrax, sputum may be rusty or brown, indicating that it does not contain fresh blood, but its decay products (hematin).
Pneumonia
With pneumonia, a small amount of sputum is separated. By nature, it can be mucous, mucopurulent. The admixture of blood in the sputum is determined in lobar and focal pneumonia. The sputum is rusty or brown in color, indicates the content of not fresh blood in it, but its decay products (hematin) and occurs with croupous pneumonia. Yellow-canary color is sometimes sputum with eosinophilic pneumonia. Fibrinous convolutions consisting of mucus and fibrin can be detected in sputum; bile pigments, which is associated with intrapulmonary breakdown of erythrocytes 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 many fresh erythrocytes, siderophages, hemosiderin.

…> Cholesterol and fatty acid crystals

3. Detritus

For bronchiectasis:

1. Dietrich corks

2. Crystals of cholesterol, fatty acids and hematoidin

3. Leukocytes

For pulmonary tuberculosis:

1. Ehrlich's tetrad

2. Rice bodies

3. Elastic fibers

4. Various crystals

5. Mycobacterium tuberculosis (in stained 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 the material is necessary. With a calcined and cooled spatula or a metal loop, all suspicious grains, blood streaks, lumps are selected in turn from sputum and preparations are made from them by placing them on a glass slide.

Study of the native drug.

The drug is prepared using iron sticks with flattened ends.

Two native preparations are made on one slide, sputum is taken into each of them 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 coverslip and pressed down with a hand spatula. For research, the material must be taken in such an amount that the preparation is not too thick, and that when pressed on the coverslip, the contents do not protrude beyond its edges. If this happens, then a second cover slip is placed next to the first cover slip, moving the first one a little to the side. The prepared preparation is examined under a microscope, first at low magnification (10 x 8), and then at high magnification (10 x 40).

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

Cellular elements.

1. squamous epithelium - This is a desquamated epithelium of the mucous membrane of the oral cavity, nasopharynx, epiglottis and vocal cords, which looks like flat thin cells with a small pycnotic vesicular nucleus and homogeneous cytoplasm. Single cells of squamous epithelium are always found, in large numbers - with an admixture of saliva or inflammation in the oral cavity. Has no diagnostic value.

2. Cylindrical 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 the oval nucleus is located and a blunt upper end. The wider part of the cell faces the lumen of the bronchus and is provided with cilia. Cells rejected from the mucous membrane sometimes change (deform), acquire a pear-shaped or spindle-shaped shape, while one of the ends is pulled into a long thread, cilia are rarely preserved. Cylindrical 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 outwardly similar to it (granular cytoplasm, rounded nucleus, centrally located nucleus).

4. Alveolar macrophages - cells of reticulohistiocytic origin, have an oval or 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 phagocytosis. Macrophages capture dust particles, leukocytes, erythrocytes. They are found in various inflammatory processes in the bronchi and lung tissue (pneumonia, bronchitis, occupational lung diseases). In chronic inflammatory diseases, fat-transformed macrophages (cells with fatty degeneration, lipophages). These are round-shaped cells, the cytoplasm of which is filled with drops of fat (granular balls). Fat can be stained with sudan III in orange color. Accumulations of such cells are found in malignant neoplasms, tuberculosis, actinomycosis. With congestion in the lungs, circulatory disorders in the pulmonary circulation, 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"). Destroying in the lung tissue, hemoglobin is converted into the tissue pigment hemosiderin, which is absorbed by alveolar macrophages. They are determined by the reaction to Prussian blue, macrophages are stained in blue-green (light blue) color.

5. Dust cells (coniophages) - these are cells with phagocytized dust particles, coal are often detected in people with occupational lung diseases (smokers, workers in the tobacco, flour-grinding industry).

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 karyokinesis figures with vacuolated cytoplasm. They are found in sputum in the form of single cells or conglomerates (complexes). If such cells are found, the preparation 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, the same abundant granularity, grayish in color. Found in almost every sputum; in the mucosa - single, and in the purulent (with lung abscess, tuberculosis, bronchiectasis) completely cover the entire field of view

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

9. Erythrocytes - round or slightly oval-shaped cells, yellowish (fresh) or colorless (altered and lost pigment), smaller than leukocytes in diameter, sometimes do not have granularity in protoplasm, double-circuit (target cell), somewhat refracting light. Single red blood cells in sputum can occur in any sputum; found in large quantities in blood-stained sputum (pulmonary hemorrhage, pulmonary infarction, congestion in the lungs).

fibrous formations.

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

2. Coral fibers - rough, branching formations with tuberous thickenings due to the deposition of fatty acids and soaps on the fibers. They are isolated in chronic lung diseases, cavernous tuberculosis.

3. Calcified elastic fibers - rough, soaked with layers of lime (calcium) rod-shaped formations. They lose their elasticity and become brittle. Excreted with sputum during the decay of the calcified area of the lung.

4. fibrinous fibers - thin fibers in the form of a whitish structureless mass. Meet with fibrinous bronchitis, tuberculosis, actinomycosis, lobar pneumonia.

5. Kurshman spirals - compacted spiral formations of mucus. 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 filaments without a central filament are found separately. Spirals are formed in the spastic condition of the bronchi and the presence of mucus in them. During a cough shock, viscous mucus is ejected into the lumen of a larger bronchus, twisting in a spiral. Curshman spirals are observed in pulmonary pathology accompanied by bronchospasm (bronchial asthma, asthmatic bronchitis, bronchial tumors).

crystalline formations.

1. Charcot Leiden Crystals - occur in sputum along with eosinophils and look like shiny, smooth, colorless rhombuses of various sizes, sometimes with bluntly cut ends. The formation of Charcot-Leiden crystals is associated with the breakdown of eosinophils, they are considered a product of protein crystallization. Often, fresh sputum does not contain Charcot-Leiden crystals; they form in it in a sealed container after 24-48 hours. The presence of these crystals in sputum is characteristic in bronchial asthma, eosinophilic bronchitis, helminthic lesions of the lungs, less often in croupous pneumonia, and various bronchitis.

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

3. Cholesterol crystals - colorless, quadrangular-shaped plates with a broken off step-like angle, are formed during the breakdown of fat and fat-regenerated cells, sputum retention in cavities (tuberculosis, neoplasms, abscess, etc.).

4. fatty acid crystals - in the form of long thin needles, droplets of fat are often found in purulent sputum (Dietrich's plug), formed during stagnation of sputum in cavities (abscess, bronchiectasis).

Combined and other formations in sputum.

1. Dietrich corks - lumps of yellowish-gray color, having an unpleasant odor. They consist of detritus, bacteria. They are found during stagnation of sputum in cavities with tuberculosis, lung abscess, bronchiectasis.

2. Ehrlich's tetrad - consists of four elements: calcified detritus, calcified elastic fibers, cholesterol crystals and Mycobacterium tuberculosis. Appears at disintegration of the calcified primary tuberculosis focus. The reason for this decay may be pneumonia, neoplasm.

3. Rice bodies - rounded, whitish dense formations containing accumulations of coral-like fibers, fatty decomposition products, soap, sometimes cholesterol crystals and a large number of mycobacteria of tuberculosis. Found in tuberculosis.

4. Supractant is a phospholipoprotein that prevents the alveoli from sticking together. It comes in various shapes and sizes in a matte gray color. When examining the surfactant, it is possible to determine the bacterial flora, the degree of activity of the inflammatory process.

6. Mushrooms - with fungal lesions of the lungs in sputum, the causative agent of the disease can be identified. Microscopically visible plexus filaments of mycelium.

7. bacteria - in stained smears, various microorganisms are found, which in a small amount are always found in the respiratory tract of a healthy body. Under unfavorable conditions, this flora, intensively multiplying, becomes pathogenic and causes disease. There are mycobacteria of tuberculosis (tuberculosis), pneumococci (croupous pneumonia and chronic bronchitis). Streptococci and staphylococci are found in purulent sputum in lung abscess, bronchitis and pneumonia.

SPUMUM IN VARIOUS DISEASES

RESPIRATORY SYSTEM.

Acute bronchitis. At the beginning of the disease, a small amount of mucous, viscous sputum is secreted. In the further course of the disease, the amount of sputum increases. It becomes mucopurulent. Microscopic examination reveals a significant amount of cylindrical epithelium, leukocytes, erythrocytes.

Chronical bronchitis. Usually a lot of mucopurulent sputum is secreted, often with streaks of blood. Microscopically, a large number of leukocytes, erythrocytes, alveolar macrophages are found. With fibrous bronchitis, fibrous casts of bronchioles are found. Many different microorganisms.

Bronchial asthma. A meager amount of mucous, viscous, vitreous sputum is allocated. Macroscopically, one can see Kurshman's spirals. Microscopically, the presence of eosinophils and columnar epithelium is especially characteristic. There are Charcot-Leiden crystals.

bronchiectasis. There is a lot of purulent sputum (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 plugs are found in the pus. Microscopically, a large number of leukocytes, crystals of fatty acids, sometimes crystals of hematoidin and cholesterol, and a diverse microflora are found.

Croupous pneumonia. At the beginning of the disease, a small amount of very viscous (sticky) rusty sputum is separated. During the period of resolution of the disease, sputum is secreted 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, erythrocytes, hemosiderin grains, hematoidin crystals, a small number of leukocytes, and many pneumococci are found. At the end of the disease, the number of leukocytes increases, and the number of erythrocytes decreases, there are many alveolar macrophages.

Lung abscess. At the time of the breakthrough of the abscess, a large amount of purulent, fetid sputum (up to 600 ml) is released into the bronchus. when standing, liquid sputum becomes two-layered. Microscopically, a lot of leukocytes, elastic fibers, scraps of lung tissue, crystals of fatty acids, hematoidin and cholesterol, various microflora are found.

Pulmonary tuberculosis. The amount of sputum depends on the stage of the disease. In the presence of cavities in the lungs, it can be significant. The nature of sputum is mucopurulent, often it contains an admixture of blood. Macroscopically, sputum can detect rice-shaped bodies (Koch's lenses), consisting of elements of the decay of lung tissue. Under the microscope, elastic fibers, crystals of fatty acids, hematoidin are found. With the collapse of the old calcified tuberculosis focus, Ehrlich's tetrad is found. For the diagnosis of the disease, the presence of Mycobacterium tuberculosis in the sputum is of the greatest importance.

Lung cancer.The amount of sputum may vary. With the collapse of the tumor - significant. Character - mucopurulent-bloody. On examination, fragments of fabric may be seen. Microscopically detected atypical cells and their complexes.

Table number 3. Sputum AT VARIOUS PULMONARY PATHOLOGIES.

Nosological form	The amount of sputum	The nature of sputum	macroscopic study	microscopic study
Acute bronchitis	Scanty, in the later stages - a large number	Mucous, mucopurulent	______	Cylindrical epithelium, leukocytes - a moderate amount, with a protracted course - macrophages.
Chronical bronchitis	Miscellaneous	Continuation "

Kurshman's spirals (H.Curschmann, a German physician) are whitish-transparent, corkscrew-shaped, convoluted tubular formations formed from mucin in the bronchioles. Mucus strands consist of a central dense axial thread and a mantle that spirally envelops it, into which leukocytes (usually eosinophils) and Charcot-Leiden crystals are interspersed. Sputum analysis, in which Kurshman's spirals were found, is characteristic of bronchospasm (most often with bronchial asthma, less often with pneumonia and lung cancer).

Charcot Leiden Crystals

Charcot-Leyden crystals (J.M.Charcot, French neuropathologist; E.V.Leyden, German neuropathologist) look like smooth colorless crystals in the form of octahedrons. Charcot-Leiden 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, with 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 numbers (up to 50-90% of all leukocytes) they are found in bronchial asthma, eosinophilic infiltrates, helminthic invasions of the lungs, etc.

Erythrocytes in sputum. Erythrocytes appear in sputum when lung tissue is destroyed, pneumonia, stagnation in the pulmonary circulation, pulmonary infarction, etc.

epithelial cells

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

Cylindrical ciliated epithelium is present in a small amount in any sputum, in large quantities - with damage to the respiratory tract (bronchitis, bronchial asthma).

Alveolar macrophages

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

Elastic fibers

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

Sputum components. Deciphering the analysis

Kurshman's spirals - Bronchospasm syndrome, the most likely diagnosis is asthma.

Charcot-Leiden 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.

Squamous 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

The sputum may contain malignant tumor cells, especially if the tumor grows endobrochially or disintegrates. It is possible to define cells as tumor cells only if a complex of atypical polymorphic cells is found, especially if they are located together with elastic fibers.

Trophozoites 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.

Add a comment Cancel reply

Honey holidays

new entries

©. "Smolensk medical portal". At a reprint of materials the reference to the site is required.

Sputum analysis transcript

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

Leukocytes in sputum

Lymphocytes

Eosinophils

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

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

Neutrophils

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

squamous epithelium

Squamous 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's spirals are diagnosed - bronchospastic syndrome, asthma diagnostics.

Charcot Leiden Crystals

Charcot-Leiden crystals are diagnosed - allergic processes, bronchial asthma.

Alveolar macrophages

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

Sputum is secreted in various diseases of the respiratory system. Sputum analysis is better to collect it in the morning, before that you need to rinse your mouth with a weak antiseptic solution, then with boiled water.

On examination, the daily amount of sputum is noted, the nature, color and smell of sputum, its consistency, as well as stratification when standing in a glass dish.

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 an improvement in the drainage of the cavity, then 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;
an attack of bronchial asthma (at the beginning of an attack).

Greenish sputum is observed when:

lung abscess;
bronchiectasis;
sinusitis;
posttuberculous disorders.

Separation of sputum with an admixture of blood is observed when:

The rusty color of sputum is observed when:

focal, croupous and influenzal pneumonia;
pulmonary tuberculosis;
pulmonary edema;
congestion in the lungs.

Sometimes the color of sputum is affected by certain medications. With allergies, sputum may be bright orange in color.

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

Blackish or grayish sputum is observed in smokers (an admixture of coal dust).

A putrid smell of sputum is observed when:

When opening an echinococcal cyst, sputum acquires a peculiar fruity smell.

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

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.

Isolation of thick mucous sputum is observed when:

acute and chronic bronchitis;
asthmatic bronchitis;
tracheitis.

Isolation of mucopurulent sputum is observed when:

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

Isolation of purulent sputum is observed when:

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

Isolation of serous and serous-purulent sputum is observed when:

Isolation of bloody sputum is observed when:

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

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

lung abscess;
actinomycosis of the lung;
echinococcosis of the lung.

Columnar ciliated epithelium cells

The presence in the sputum of cells of a cylindrical ciliated epithelium is observed with:

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

A large number of eosinophils in sputum is observed with:

bronchial asthma;
damage to the lungs with worms;
lung 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-like fibers in sputum is observed in cavernous tuberculosis.

The presence of Kurshman spirals in sputum is observed when:

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

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

The presence of cholesterol crystals in the sputum is observed when:

lung abscess;
echinococcosis of the lung;
neoplasms in the lungs.

The presence of hematodin crystals in the 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 the microflora to various drugs, and is of great importance for the detection of Mycobacterium tuberculosis.

The appearance of a cough with sputum requires a mandatory visit to the doctor.

Sputum analysis

Microscopic examination of sputum reveals

Alveolar macrophages are cells of reticulohistiocytic origin. A large number of macrophages occurs in 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 in pulmonary infarction, hemorrhage, stagnation in the pulmonary circulation. Macrophages with lipid drops are a sign of an obstructive process in the bronchi and bronchioles.

Xanthomia cells (fatty macrophages) are found in abscess, actinomycosis, echinococcosis of the lungs.

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

The squamous epithelium is due to the 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, pulmonary infarction. Eosinophils can be found in sputum from tuberculosis and lung cancer. Lymphocytes are found in large numbers in whooping cough and less often in tuberculosis.

Erythrocytes. Detection of single erythrocytes in sputum has no diagnostic value. In the presence of fresh blood in the sputum, unchanged erythrocytes are determined, but if blood remains in the respiratory tract for a long time with sputum, then leached erythrocytes are detected.

Cells of malignant tumors are found in malignant neoplasms.

fibers

Elastic fibers appear during the disintegration of lung tissue, which is accompanied by the destruction of the epithelial layer and the release of elastic fibers excreted with sputum in tuberculosis, abscess, echinococcosis, neoplasms in the lungs.

Coral fibers are secreted in chronic lung diseases, such as cavernous tuberculosis.

Calcified elastic fibers - elastic fibers impregnated with calcium salts. Their presence in sputum is characteristic of the breakdown of tuberculous petrificate.

Spirals and crystals

Kurshman's spirals are formed in the spastic condition of the bronchi and the presence of mucus in them. During a cough shock, viscous mucus is ejected into the lumen of a larger bronchus, twisting in a spiral. Kurshman's spirals appear in bronchial asthma, bronchitis, lung tumors that compress the bronchi.

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

Cholesterol crystals appear with abscess, echinococcosis of the lung, neoplasms in the lungs.

Hematoidin crystals are characteristic of lung abscess and gangrene.

Actinomycete drusen are characteristic of lung actinomycosis.

Elements of echinococcus appear with echinococcosis of the lungs.

Dietrich's corks are lumps of a yellowish-gray color that have an unpleasant odor. Consist of detritus, bacteria, fatty acids, fat droplets; characteristic of lung abscess and bronchiectasis.

Ehrlich's tetrad consists of four elements: calcified detritus, calcified elastic fibers, cholesterol crystals, and Mycobacterium tuberculosis. Appears at disintegration of the calcified primary tuberculosis center.

Mycelium and budding fungal cells appear with fungal lesions of the broncho-pulmonary system.

Pneumocysts appear with pneumocystis pneumonia.

Fungal spherules are detected in coccidioidomycosis of the lungs.

Ascaris larvae are detected with ascariasis.

Intestinal acne larvae are detected with strongyloidiasis.

Pulmonary fluke eggs are found in paragonimiasis.

Elements found in sputum in bronchial asthma

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

In bronchial asthma, a scanty amount of mucous, viscous sputum. Macroscopically, one can see Kurshman's spirals. Microscopically, the presence of eosinophils, cylindrical epithelium, and Charcot-Leiden crystals are especially characteristic.

Microscopic examination of sputum

Microscopic examination of sputum includes the study of native (natural, untreated) and stained preparations. For the first, purulent, bloody, crumbly lumps are selected, they are transferred to a glass slide in such an amount that, when covered with a cover glass, a thin translucent preparation is formed. At a low magnification of the microscope, Kurschmann's spirals can be detected in the form of dense strands of mucus of various sizes. They consist of a central dense, shiny, twisted axial filament and a mantle that spirally envelops it (Fig. 9), into which leukocytes are interspersed. Kurschmann's spirals appear in sputum with bronchospasm. At high magnification in the native preparation (Fig. 11), one can detect leukocytes, erythrocytes, alveolar macrophages, heart defects cells, cylindrical and squamous 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 in the inflammatory process in the respiratory system. Erythrocytes are small homogeneous yellowish discs that appear in sputum with pneumonia, congestion in the pulmonary circulation, pulmonary infarction and tissue destruction. Alveolar macrophages - cells 2-3 times larger than leukocytes with abundant coarse granularity in the cytoplasm. By phagocytosis, they cleanse the lungs of particles (dust, cell decay) that enter them. Capturing erythrocytes, alveolar macrophages turn into cells of heart defects (Fig. 12 and 13) with yellow-brown grains of hemosiderin, giving a reaction to Prussian blue. To do this, 1-2 drops of a 5% solution of yellow blood salt and the same amount of 2% hydrochloric acid solution are added to a lump of sputum on a glass slide, mixed, covered with a cover slip. Microscopic examination after a few minutes. Hemosiderin granules turn blue.

The cylindrical 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. Squamous epithelium - large polygonal cells from the oral cavity, have no diagnostic value. Cells of malignant tumors are large, of various irregular shapes with large nuclei (to recognize them, a very large experience of the researcher is required). Elastic fibers are thin, twisted, two-circuit colorless fibers of the same thickness throughout, branching in two at the ends. They often fold into annular bundles. Occurs when lung tissue breaks down. For their 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 to it. The sediment is microscopically examined. The elastic fibers look as described above, but are bright pink in color (Fig. 15). Druses of actinomycetes for microscopy are crushed in a drop of glycerol or alkali. The central part of the drusen consists of a plexus of thin filaments of mycelium, it is surrounded by radiantly located flask-shaped formations (Fig. 14). When staining a crushed drusen according to Gram, the mycelium is stained purple, the cones are pink. The fungus Candida albicans has the character of budding yeast cells or a short branched mycelium with a small number of spores (Fig. 10). Charcot-Leiden crystals - colorless rhombic crystals of various sizes (Fig. 9), formed from the decay products of eosinophils, are found in sputum along with a large number of eosinophils in bronchial asthma, eosinophilic infiltrates and helminthic invasions of the lung. Eosinophils in the native preparation differ from other leukocytes in large shiny granularity, they are better distinguishable in a smear stained sequentially with 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 stain, as well as with May-Grunwald stain, tumor cells are recognized (Fig. 21).

Rice. 9. Curshman spiral (top) and Charcot-Leiden crystals in sputum (native preparation). Rice. 10. Candida albicans (center) - budding yeast-like cells and mycelium with spores in sputum (native preparation). Rice. 11. Sputum cells (native preparation): 1 - leukocytes; 2 - erythrocytes; 3 - alveolar macrophages; 4 - cells of cylindrical epithelium. Rice. 12. Cells of heart defects in sputum (reaction to Prussian blue). Rice. 13. Cells of heart defects in sputum (native drug). Rice. 14. Druse of actinomycetes in sputum (native preparation). Rice. 15. Elastic fibers in sputum (eosin stain). Rice. 16. Eosinophils in sputum (Romanovsky-Giemsa stain): 1 - eosinophils; 2 - neutrophils. Rice. 17. Pneumococci and in sputum (Gram stain). Rice. 18. Friedlander's diplobacilli in sputum (Gram stain). Rice. 19. Pfeiffer stick in sputum (magenta stain). Rice. 20. Mycobacterium tuberculosis (Ziehl-Nelsen stain). Rice. 21. Conglomerate of cancer cells in sputum (May-Grunwald stain).

At low magnification, Kurshman's spirals are found in the form of strands of mucus of various sizes, consisting of a central axial thread and a mantle spirally enveloping it (tsvetn. Fig. 9). The latter is often interspersed with leukocytes, cylindrical epithelial cells, Charcot-Leiden crystals. When turning the microscrew, the axial thread either shines brightly, or becomes dark, may be invisible, and often only one is visible. Kurshman's spirals appear with bronchospasm, most often with bronchial asthma, less often with pneumonia, cancer.

At high magnification, the following is found. Leukocytes are always present in sputum, there are many of them in inflammatory and suppurative processes; among them there are eosinophils (with bronchial asthma, asthmatic bronchitis, helminthic invasions of the lungs), characterized by large shiny granularity (tsvetn. Fig. 7). Erythrocytes can be single in any sputum, there can be a lot of them with the destruction of lung tissue, with pneumonia and blood stasis in the pulmonary circulation. The epithelium is squamous - large polygonal cells with a small nucleus that enter the sputum from the pharynx and oral cavity have no diagnostic value. Cylindrical 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, carries cilia found only in fresh sputum; in bronchial asthma, rounded groups of these cells are found, surrounded by mobile cilia, giving them a resemblance to ciliated ciliates.

Cytological study. Study of native and stained preparations. To study the cells, sputum lumps are carefully stretched on a glass slide with the help of splinters. When searching for tumor cells, the material is taken in a native preparation. The dried smear is fixed with methanol and stained according to Romanovsky - Giemsa (or Papanicolaou). Cancer cells are characterized by a homogeneous, sometimes vacuolated, gray-blue to blue cytoplasm, a large loose, and often hyperchromic, purple nucleus with nucleoli. There can be 2-3 or more nuclei, sometimes they are irregular in shape; polymorphism of nuclei in one cell is characteristic.

The complexes of polymorphic cells of the described nature are the most convincing (tsvetn. fig. 13 and 14). Eosinophils are stained either according to Romanovsky - Giemsa, or sequentially with 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 and special equipment

Spontaneous sputum production

Possibility of multiple studies

The presence in the material of cells from all parts of the lung

High performance in the diagnosis of tumors of central localization, with lung lesions with squamous and small cell cancer

The possibility of diagnosing tumors in the asymptomatic stage of the disease

The dependence of performance on the qualifications of the laboratory assistant

High labor intensity of preparation

Long term drug study

Low effectiveness of research in peripheral localization of pulmonary lesions

Low efficiency in the diagnosis of benign neoplasms

Lack of information on the location and extent of the lesion

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

The daily amount of sputum depends on the disease

In acute bronchitis, bronchial asthma, the initial stage of pneumonia/day

In chronic bronchitis, adenomatosis, pulmonary tuberculosis ml/day

With bronchiectasis, actinomycosis, some helminthic invasions - up to 2 l / day

At the opening of a lung abscess - up to 4 l

Normally odorless

The reaction of sputum, as a rule, has an alkaline character. It becomes acidic when sputum decomposes (prolonged standing) and from the admixture of gastric juice (which helps to differentiate hemoptysis from bloody vomiting).

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

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

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

Rusty color - typical of croupous 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 asthma attack

Infiltrative and focal tuberculosis (sometimes)

Nonspecific inflammatory processes of the lungs (a scanty amount of mucous, with small grains, "torn" sputum)

Diseases of the bronchi and lung parenchyma

Diseases of the upper respiratory tract

Lung cancer (with whitish gray or bloody streaks)

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

Opening of the empyema of the pleura in the lumen of the bronchus (purely purulent)

Fibrous-cavernous form of tuberculosis

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

Lung infarction in the stage of reverse development

Inflammation of the upper respiratory tract and nasopharynx

Severe inflammation of the upper respiratory tract with congestion

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

Kurshman's spirals are characteristic of diseases such as:

Inflammatory processes with spasm and obstruction of the bronchi

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

Leukocytes can be both well-preserved and at different stages of 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 erythrocytes) with well-defined fragmented nuclei.

Slides are stained with azure-eosin.

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

In the granules of eosinophils, acid phosphatase, acryl sulfatase, collagenase, elastase, glucuronidase, cathepsin myeloperoxidase, and other enzymes with lytic activity are determined.

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

Damage to the lungs 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 appears when the immunological reactivity of the body is activated.

Lymphocytes are found in large numbers in sputum when:

Exogenous allergic alveolitis

Single erythrocytes can be found in any sputum.

With sputum stained with blood, it can be assumed:

Stagnation in the pulmonary circulation

Malignant neoplasms of the lungs

Cells of the cylindrical ciliated epithelium are found in sputum when preparing preparations from whitish strands and filaments, films against the background of mucus, which are areas of inflamed hypertrophied respiratory mucosa rejected during fecal shocks.

Coniophages phagocytize dust, soot, nicotine, 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 millers, etc.)

Lipophages - alveolar macrophages with drops of fat or xanthoma cells from foci of fatty degeneration of the lung tissue.

Chronic inflammatory process in the lungs

Malignant neoplasms of the lungs

Stagnation in the pulmonary circulation

Idiopathic hemosiderosis of the lungs ("iron" lung, Selenium-Gellerstedt syndrome)

Appear in sputum as a result of decay:

Malignant neoplasms of the lungs

Found in sputum with pronounced decay

Formed in the focus of chronic inflammation, cavern with cavernous tuberculosis

They are found in sputum during the decay of the primary tuberculous focus of Gon, with abscess and gangrene of the lung, malignant neoplasms of the lungs

Calcified elastic fibers

Charcot-Leyden crystals do not form immediately in sputum (they may form hours after sputum collection), 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 lung tissue necrosis or hematoma collapse.

Formed during stagnation of sputum in the cavities, in the foci of degeneration of the lung tissue, with malignant neoplasms, lung abscess.

Cytological examination of sputum in the cytoplasm of cells of cylindrical epithelium or macrophages in vacuoles reveals small polymorphic inclusions of a dark cherry color. The cytoplasm of these cells contains empty vacuoles.

With croupous pneumonia in the early stage of the disease, sputum is viscous, very scanty, rusty in color. Microscopy reveals erythrocytes. macrophages with hemosiderin, leukocytes, small fibrin bundles and pneumococci. During the period of resolution of the inflammatory process, sputum acquires a mucopurulent character without a rusty color. With a lightning-fast form of croupous pneumonia, the patient develops hemoptysis.

With focal pneumonia, the nature of sputum is mucopurulent.

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

Haemophilus influenzae is determined in sputum when stained with azure-eosin.

In sputum preparations, giant multinucleated cells of cylindrical epithelium with fairly large nuclei of the same size and shape are found. There are many nuclei, they usually overlap each other, lie tightly, forming facets. Such a microscopic picture may resemble malignant cells.

At a low magnification of the microscope, Kurschmann's spirals can be detected in the form of dense strands of mucus of various sizes. They consist of a central dense, shiny, twisted axial filament and a mantle that spirally envelops it (Fig. 9), into which leukocytes are interspersed. Kurschmann's spirals appear in sputum with bronchospasm. At high magnification in the native preparation (Fig. 11), one can detect leukocytes, erythrocytes, alveolar macrophages, heart defects cells, cylindrical and squamous 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 in the inflammatory process in the respiratory system. Erythrocytes are small homogeneous yellowish discs that appear in sputum with pneumonia, congestion in the pulmonary circulation, pulmonary infarction and tissue destruction. Alveolar macrophages - cells 2-3 times larger than leukocytes with abundant coarse granularity in the cytoplasm. By phagocytosis, they cleanse the lungs of particles (dust, cell decay) that enter them. Capturing erythrocytes, alveolar macrophages turn into cells of heart defects (Fig. 12 and 13) with yellow-brown grains of hemosiderin, giving a reaction to Prussian blue. To do this, 1-2 drops of a 5% solution of yellow blood salt and the same amount of 2% hydrochloric acid solution are added to a lump of sputum on a glass slide, mixed, covered with a cover slip. Microscopic examination after a few minutes. Hemosiderin granules turn blue.

Sputum analysis transcript

Leukocytes in sputum

Lymphocytes

Eosinophils

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

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

Neutrophils

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

squamous epithelium

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

Elastic fibers

Kurshman spirals

Kurshman's spirals are diagnosed - bronchospastic syndrome, asthma diagnostics.

Charcot Leiden Crystals

Charcot-Leiden crystals are diagnosed - allergic processes, bronchial asthma.

Alveolar macrophages

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

On examination, the daily amount of sputum is noted, the nature, color and smell of sputum, its consistency, as well as stratification when standing in a glass dish.

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;
an attack of bronchial asthma (at the beginning of an attack).

Greenish sputum is observed when:

lung abscess;
bronchiectasis;
sinusitis;
posttuberculous disorders.

Separation of sputum with an admixture of blood is observed when:

The rusty color of sputum is observed when:

focal, croupous and influenzal pneumonia;
pulmonary tuberculosis;
pulmonary edema;
congestion in the lungs.

Sometimes the color of sputum is affected by certain medications. With allergies, sputum may be bright orange in color.

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

Blackish or grayish sputum is observed in smokers (an admixture of coal dust).

A putrid smell of sputum is observed when:

When opening an echinococcal cyst, sputum acquires a peculiar fruity smell.

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

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.

Isolation of thick mucous sputum is observed when:

acute and chronic bronchitis;
asthmatic bronchitis;
tracheitis.

Isolation of mucopurulent sputum is observed when:

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

Isolation of purulent sputum is observed when:

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

Isolation of serous and serous-purulent sputum is observed when:

Isolation of bloody sputum is observed when:

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

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

lung abscess;
actinomycosis of the lung;
echinococcosis of the lung.

Columnar ciliated epithelium cells

The presence in the sputum of cells of a cylindrical ciliated epithelium is observed with:

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

A large number of eosinophils in sputum is observed with:

bronchial asthma;
damage to the lungs with worms;
lung 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-like fibers in sputum is observed in cavernous tuberculosis.

The presence of Kurshman spirals in sputum is observed when:

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

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

The presence of cholesterol crystals in the sputum is observed when:

lung abscess;
echinococcosis of the lung;
neoplasms in the lungs.

The presence of hematodin crystals in the sputum is observed when:

Bacteriological analysis of sputum

The appearance of a cough with sputum requires a mandatory visit to the doctor.

Sputum analysis. Decryption

Sputum microscopy

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

Kurshman spirals

Charcot Leiden Crystals

Formed elements of blood

A small number of leukocytes can be found in any sputum, with 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).

Erythrocytes in sputum. Erythrocytes appear in sputum when lung tissue is destroyed, pneumonia, stagnation in the pulmonary circulation, pulmonary infarction, etc.

epithelial cells

Cylindrical ciliated epithelium is present in a small amount in any sputum, in large quantities - with damage to the respiratory tract (bronchitis, bronchial asthma).

Alveolar macrophages

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

Elastic fibers

Sputum components. Deciphering the analysis

Kurshman's spirals - Bronchospasm syndrome, the most likely diagnosis is asthma.

Charcot-Leiden 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.

Squamous 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 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.

Add a comment Cancel reply

Honey holidays

new entries

©. "Smolensk medical portal". At a reprint of materials the reference to the site is required.

Sputum analysis

Phlegm sputum [lat. = spit] - bronchial secret, "spitting out" (expelled) or obtained with the help of suction devices in humans with pathology of the respiratory tract.

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"

none (odorless), or weak

viscous, thick, liquid

weak, moderate, strong

no (does not foam), weak, high

one-, two-, three-layer

8. Character (macro composition):

mucous, purulent, bloody, serous, mixed.

flat - single, many;

cylindrical - single, many;

alveolar macrophages - few, many;

dust cells - presence;

tumor (atypical) cells - presence.

neutrophils - a little, a moderate amount, a lot;

eosinophils - a little, a moderate amount, a lot;

lymphocytes - single, many;

erythrocytes - single, moderate, many.

12. Fibrous formations

Kurshman's spirals - a little, a moderate amount, a lot;

elastic fibers ("normal") - presence;

elastic coral-like fibers - presence;

calcified elastic fibers - presence;

fibrinous fibers (threads, fibrin bundles) - presence;

diphtheria films - presence;

necrotic pieces of the lung - presence.

Charcot Leiden - a little, a moderate amount, a lot;

fatty acids (Dietrich's plugs) - presence;

14. Foreign bodies - presence.

15. BC (Koch's bacilli) - detected, not detected.

16. Other bacteria - not found, found:

catarrhal pneumococci (influenza bacilli)

pneumococci (diplococci) Frenkel-Vekselbaum

candida, aspergillus, actinomycetes, cryptococci.

The amount of sputum- volume of expectoration:

meager K.M. - individual spitting 1-5 ml;

moderate - ml / day;

large - ml / day;

very large (copious)> 300 ml / day.

Color- depends on the composition (structure, nature) of M.:

Colorless - vitreous, mucous, transparent. The main cellular composition is lymphocytes, squamous epithelium;

Yellowish - mucopurulent. Eosinophils give yellow color to sputum;

Green - purulent. The green color of sputum is given by neutrophils, or rather, the breakdown products of the iron porphyrin group of the neutrophil verdoperoxidase enzyme;

Red is bloody. The red color of sputum is given by fresh red blood cells;

- "rusty" - with croupous pneumonia - the color gives the breakdown product of hemoglobin - hematin;

White ("creamy") - in the presence of a large amount of lymph in the sputum; white color of sputum in millers;

The black color of sputum is given by coal dust, etc.

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

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

Sputum consistency- density, viscosity. Sputum can be viscous (a lot of mucus), thick (a lot of shaped elements and epithelium), liquid (a lot of serum in the sputum).

Stickiness of sputum. The more fibrin in the sputum, the greater its stickiness. Sticky sputum sticks to the glass slide, to the walls of the test tube (spittoon).

Foamy sputum. The more protein (serum) in the sputum, the more it foams. Foamy sputum creates great obstacles to ventilation of the lungs.

Layering of sputum. Mucous sputum is single-layer, with tissue breakdown (lung gangrene, bronchiectasis) sputum is three-layer: the lower layer is pus (detritus), the middle layer is the liquid part, the upper one is foam; two-layer sputum (upper layer - serous fluid, lower pus) - with an abscess, croupous 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] - the remains of destroyed cells, tissues.

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

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

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

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

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

squamous epithelium- desquamation of the mucous membranes of the oral cavity, nasopharynx, epiglottis, vocal cords. Its quantity is determined by the amount of saliva that has entered the sputum.

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

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

Microorganisms- bacterioscopically determined only when their content is not less than 10 6 microbial bodies in 1 ml of sputum.

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

Diplobacillus Friedlander(pneumococci) - causative agents of croupous pneumonia; resistant to aminoglycosides.

Mycobacterium Koch tuberculosis pathogens.

Staphylococci[gr. staphyle bunch] - bunches of cocci; in hospitals, Staphylococcus aureus is often detected - the causative agent of purulent processes.

Hemophilus bacteria Haemophilus influenze - short sticks (lictor rod!) - cause acute respiratory diseases. The influenza stick releases levomycetin-acetyltransferase and destroys chloramphenicol.

Pseudomonas aeruginosa Bacterium pyocyaneum seu Pseudomonas aeruginosa is the causative agent of green suppuration. Antipseudomonal activity is possessed by: inhibitor-protected penicillins: amoxicillin / clavulanate, ampicillin / salbactam, ticarcillin / clavulanate, piperacillin / tazobactam; a combination of two penicillins (ampicillin + oxacillin). By antipseudomonal 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 (E. coli Bacterium coli), Klebsiella pneumoniae, Moraxella catarrhalis.

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

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

Sometimes resort to the assessment of sputum pH. It fluctuates in a wide range - from 5.0 to 9.0. As a rule, the reaction of sputum is slightly alkaline. This should be taken into account when choosing medicines. Sour sputum becomes either decomposed or mixed with gastric contents.

narcotic central action:

Codeine and drugs containing it: codterpine, panadeine, perdolan; neocodione (codeine camphosulfonate + sulfogvaiacol + grindelia thick extract);

non-narcotic central action:

Glaucine, dimemorphan, oxeladin, pentoxyverine,

Levodropronisin, prenoxydiazine (libexin)

Mucolytics, expectorants (expectorants):

Dornise alfa - deoxyribonuclease I - mucolytic;

Ambroxol - a metabolite of bromhexine - 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);

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

Licorice root extract;

Tussamag (thyme liquid extract);

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

Sinupret (Gentian root powder + Reflower flowers + Sorrel + Verbena + Elder flowers);

Mukaltin (marshmallow herb extract + sodium bicarbonate);

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

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

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

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

Carmolis (menthol + oil of thyme, anise, Chinese cinnamon, clove, lemon, narrow-leaved lavender, broad-leaved lavender, citronella, sage, nutmeg oil);

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

Pectussin (menthol + eucalyptus oil (eucalyptol);

Pertussin (extracts of thyme, cumin + 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);

Mukodex (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 hypoventilation of the lungs.

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, novocainamide;

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

Morphine, nitrofurans, aspirin can, although rarely, cause respiratory distress syndrome.

Cytostatics, glucocorticosteroids can exacerbate purulent processes in the lungs, or cause them. Levomycetin has an immunosuppressive effect.

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

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

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

To continue downloading, you need to collect the image:

General sputum analysis

Sputum is a pathological secret discharged from the lungs and respiratory tract (trachea and bronchi). A general sputum analysis is a laboratory study 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 the diagnosis and evaluation of the pathological process in the lungs and respiratory tract.

With diseases of the respiratory system, which are accompanied by cough and sputum production.

Clinical analysis of sputum.

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 secret of the lungs and respiratory tract (bronchi, trachea, larynx), which is separated during coughing. Healthy people do not produce mucus. Normally, the glands of the large bronchi and trachea constantly form a secret in an amount of up to 100 ml / day, which is swallowed during excretion. The tracheobronchial secret is a mucus, which includes glycoproteins, immunoglobulins, bactericidal proteins, cellular elements (macrophages, lymphocytes, desquamated bronchial epithelial cells) and some other substances. This secret has a bactericidal effect, helps to eliminate inhaled small particles and cleanse 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 sputum.

Clinical analysis of sputum is a laboratory study 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.

Sputum composition 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 occur at the site of the inflammatory process. Inflammatory exudate is released in the form of serous fluid. Blood in the sputum appears with 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 system.

Microscopic analysis makes it possible, under multiple magnification, to consider the presence of various formed elements in sputum. If microscopic examination did not reveal the presence of pathogenic microorganisms, this does not exclude the presence of an 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 needs sputum secreted during coughing, and not saliva and mucus from the nasopharynx. Sputum should be collected in the morning before meals, after thoroughly rinsing the mouth and throat, brushing your teeth.

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

What is research used for?

For the diagnosis of the pathological process in the lungs and respiratory tract;
to assess the nature of the pathological process in the respiratory organs;
for dynamic monitoring of the state of the respiratory tract of patients with chronic respiratory diseases;
to evaluate the effectiveness of the therapy.

When is the study scheduled?

In diseases of the lungs and bronchi (bronchitis, pneumonia, bronchial asthma, chronic obstructive pulmonary disease, tuberculosis, bronchiectasis, neoplasms of the respiratory organs, fungal or helminthic invasion of the lungs, interstitial lung diseases);
in the presence of cough with sputum;
with a refined or unclear process in the chest according to auscultation or X-ray examination.

The amount of sputum in various pathological processes can range from a few milliliters to two liters per day.

A small amount of sputum is separated when ...

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

A large amount of sputum can be produced when ...

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

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

Most of the time, 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 - traces of decay of red blood cells.

Bright yellow sputum is observed with the accumulation of a large number of eosinophils (for example, with bronchial asthma).

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

Some drugs (eg, rifampicin) can also stain sputum.

The sputum is usually odorless.

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

A peculiar "fruity" smell of sputum is characteristic of an echinococcal cyst that has opened.

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 with pulmonary edema due to the release of plasma into the lumen of the alveoli.

Mucopurulent sputum is observed with bronchitis, pneumonia, bronchiectasis, tuberculosis.

Purulent sputum is possible with purulent bronchitis, abscess, actinomycosis of the lungs, gangrene.

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

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

A squamous epithelium with more than 25 cells indicates contamination of the material with saliva.

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

Alveolar macrophages in increased amounts in sputum are detected in chronic processes and at the stage of resolving acute processes in the bronchopulmonary system.

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

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

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

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, neoplasms in the lungs.

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

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

Kurshman's spirals are formed in the spastic state of the bronchi and the presence of mucus in them; characteristic of bronchial asthma, bronchitis, lung tumors.

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

Mycelium of fungi appears with fungal lesions of the bronchopulmonary system (for example, with aspergillosis of the lungs).

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

What can influence the result?

The results of the analysis will be unreliable if:

incorrect collection of material (for example, collection of saliva, not sputum);
ingress of foreign substances and biomaterials into the material.

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

With difficult to separate sputum, expectorant drugs, plenty of warm drink, inhalation with saline can be prescribed before the test.
Sputum collection is carried out in the morning, before meals. Sputum analysis will be more reliable if you brush your teeth and rinse your mouth with boiled water before collecting the material, which will reduce the number of bacteria in the oral cavity.
The interpretation of the results of the analysis 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 drug is prepared from selected elements of sputum. Dissecting needles place a lump of sputum in the middle of a glass slide and cover with a coverslip. With the clean end of the dissecting needle, lightly press on the coverslip, making the preparation flatter, translucent. At the same time, make sure that sputum does not go beyond the edges of the coverslip. Prepare at least 4 native preparations from different areas of sputum.

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

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

Cellular elements

Squamous epithelium is a desquamated epithelium of the mucous membrane of the oral cavity, nasopharynx, epiglottis and vocal cords, which looks like 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 inflammation in the oral cavity.

Cylindrical epithelium - 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, contains an oval nucleus. The cells are provided with a corolla of cilia (usually cilia are only visible in very fresh sputum). The cylindrical epithelium sometimes changes, acquires a spindle shape, while one of the ends is extended into a long thread. It occurs in large quantities in an acute attack of bronchial asthma, acute bronchitis, acute catarrhal lesions of the upper respiratory tract.

Macrophages - cells of bone marrow origin, have an oval or round shape, size from 15 to 20-25 microns, usually 1 (sometimes more) eccentrically located nucleus, vacuolated cytoplasm containing various dark brown inclusions.
They are found 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 (the old name is “cells of heart defects”), have golden yellow inclusions in the cytoplasm. With reliability they are 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 (ferrous-cyanogen potassium) are added. Hemosiderin lying intracellularly stains blue and blue-green.

Siderophages are found in sputum in patients with congestion in the pulmonary circulation, with pulmonary infarction, Goodpasture's syndrome, 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 clusters in the mucous part of the sputum. Their detection is important in the diagnosis of pneumoconiosis and dust bronchitis.

Tumor cells are more often presented in the form of squamous cells (with or without keratinization) glandular cancer or adenocarcinoma. Often there are difficulties in distinguishing between tumor cells and metaplastic cells of squamous or columnar epithelium. Tumor cells are characterized by polymorphism (they can be gigantic), enlargement and hyperchromia of the nucleus with nucleoli and mitoses, basophilia of the cytoplasm, and the ability to phagocytosis. At the same time, only the detection of conglomerates, complexes of tumor cells located on a fibrous basis is reliable. Suspicions of tumor cells in the study of the native preparation are confirmed by a thorough cytological examination of stained preparations. At the same time, the study of bronchial washings and pleural exudate is more informative.

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

Erythrocytes - round or slightly oval-shaped cells, yellowish (fresh) or colorless (altered and lost pigment) with a diameter less than leukocytes, never have granularity in the protoplasm, double-circuit (target cell), somewhat refracting light. Single erythrocytes can be found in any sputum; in large quantities are found in sputum stained with blood (pulmonary bleeding, pulmonary infarction, congestion in the lungs, etc.).

fibrous formations

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

To detect elastic fibers, 2-3 volumes of a 10% solution of caustic alkali are added to sputum and boiled until dissolved (elastic fibers do not dissolve). After cooling, 5-7 drops of 1% alcohol solution of eosin are added to the liquid and centrifuged. The sediment is examined under a microscope. When finding fibers, care must be taken not to confuse them with elastic fibers from food.

It is possible to attach diagnostic significance only to those fibers that occur in groups (bundles) and show an alveolar arrangement.

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, which noticeably lighten in the preparation when a 30% solution of acetic acid is added, and dissolve when chloroform is added. Meet with fibrinous bronchitis, tuberculosis, actinomycosis, lobar pneumonia.

Kurshman's spirals are compacted, twisted into a spiral formations of mucus. 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 filaments without a central filament are found separately. Curshman spirals are viewed under a low magnification microscope. When examined under high magnification, leukocytes, Charcot-Leiden crystals can be seen along the periphery of the spirals. Kurshman's spirals are observed in pulmonary pathology accompanied by bronchospasm (bronchial asthma, asthmatic bronchitis, bronchial tumors).

crystalline formations

Charcot-Leyden crystals are found in sputum along with eosinophils and look like shiny, smooth, colorless diamonds of various sizes, sometimes with blunt ends. The formation of Charcot-Leiden crystals is associated with the breakdown of eosinophils, they are considered a product of protein crystallization. Often, freshly excreted sputum does not contain Charcot-Leiden 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 are found in helminthic lesions of the lungs, less often in lobar pneumonia, various bronchitis.

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

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

Fatty acid crystals in the form of long thin needles and droplets of fat are often found in purulent sputum (Dietrich's plug); are formed during stagnation of sputum in the cavities (abscess, bronchiectasis).

Sputum analysis. Decryption

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 the doctor may prescribe a general sputum test

lung abscess

Bronchiectasis

Gangrene of the lung

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 Leiden Crystals

Formed elements of blood

epithelial cells

Alveolar macrophages

Elastic fibers

Sputum components. Deciphering the analysis

atypical cells

Read also:

Add a comment Cancel reply

Post navigation

Honey holidays

new entries

Sputum analysis transcript

Leukocytes in sputum

Lymphocytes

Eosinophils

Neutrophils

squamous epithelium

Elastic fibers

Kurshman spirals

Charcot Leiden 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 transcript

Leukocytes in sputum

Lymphocytes

Eosinophils

Neutrophils

squamous epithelium

Elastic fibers

Kurshman spirals

Charcot Leiden Crystals

Alveolar macrophages