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1
SPUTUM ANALYSIS.
It is a secretion that is produced in the lungs and the bronchi.
This mucus-like secretion may become infected, bloodstained, or contain abnormal cells that may lead to a diagnosis
Sputum Definition
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Tracheobronchial secreations are an inconstant mixture of plasma, water, electrolytes and mucinAs these mixture pas through the lower and upper respiratory tract, they become contaminated with cellular exfoliations, nasal and salivary gland secretions and normal bacterial flora of the oral cavity
Sputum Definition
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1. Drinking a lot of water and other fluids the night before the test may help to get the sample
2. To be asked to cough deeply and spit any sputum in a sterile cup
3. The sputum is then taken to the laboratory
4. There, it is placed in a special substance (medium) under conditions that allow the organisms to grow
Sputum Collection
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Sputum Collection
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Viscid & yellow
* a/c bronchitis * Bronchiectasis * Lung abscess
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White & Mucoid
* c/c bronchitis * Bronchial Asthma * Pulmonary Tuberculosis
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Rusty sputum
* Pneumococcal pneumonia
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Cursch -man’s spirals Bronchial asthma Allergic bronchopulmonary aspergillosis
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Watery & blood stained sputum
* Pulmonary edema
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Blood in sputum [hemoptysis]
*TB, *Pneumonia, *Bronchiectasis, * Lung abscess, *Mitral Stenosis, *Bronchogenic carcinoma
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Chocolate coloured sputum
* Amoebiasis
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Foul smell
c/c suppuration
bronchiectasis lung abscess
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MICROSCOPY
Wet preparations entamoeba, paragonimus
Wet staining wt methylene blue malignant cells
Gram’s staining bacterial pathogens
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Ziehl – Neelsen Staining * Mycobacteria 50,000/ml- sputum positive
*at least 2 bacilli
*at least 100 fields
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Papanicolaou stain
* cytological abnormalities * identify malignant cells * demonstrate bronchial casts
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Neutrophils : pyogenic infection of respiratory tract
Eosinophil's : asthma and parasitic infections of lung.
Lymphocytes: early pulmonary tuberculosisRBCs: haemorrhage into the lungs.Heart failure cells: cvc of lungs pulmonary infarction and pulmonary haemorrhage
Anthracotic pigment laden cells: coal workers pneumoconiosis, smoky polluted areas. 17
Types of cells.
Sputum Analysis
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This slide shows typical buccal squamous epithelial cells which are much larger than polymorph nuclear leukocytes (PMN) and take up most of the field in a high power view
This cell is covered with chains of Gram positive cocci typical of normal oral flora such as peptostreptococci. (oil immersion, 1000x)
1. Appearance• It may be described as liquid
(serous), mucous, purulent, bloody or combination of theses
2. Color• Its color is determined by the
material contained, and often color can indicate the pathological process
• Yellow color indicates pus and epithelial cells are present
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Physical Properties of Sputum
Odor• Usually no odor is present in normal
and pathological sputum, but if bacterial decomposition has been taken place within the body or after expectoration, a variety of odor will be present
Physical Properties of Sputum
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1. Cheesy Masses • These are fragments of necrotic
pulmonary tissue seen in such disease as pulmonary gangrene or tuberculosis
2. Bronchial Casts• These are branching tree like casts of
bronchi whose size varies with that of bronchi in which they are formed
• They are composed of fibrin and are white or gray color
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Miscellaneous Findings in Sputum
3. Broncholiths (Lung Stones)• They are formed by calcification
of necrotic or infected tissues• Chronic tuberculosis is the most
common cause for their formation
Miscellaneous Findings in Sputum
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4. Dietrich's Plugs• They are frequently observed
in putrid bronchitis and bronchiectasis
• They are composed of cellular debris, fatty acids, crystals, fat globules and bacteria
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Miscellaneous Findings in Sputum,
Pneumonia, Cont’d
The alveoli filled with mucus such as submucosa widened by smooth muscle hypertrophy, edema, and inflammation (mainly eosinophils)
These are changes of bronchial asthma
The peripheral eosinophil count or the sputum eosinophils can be increased during an asthmatic attack.
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Pneumonia
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Pneumonia, Cont’d
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Pneumonia symptoms vary depending upon the type of pneumonia. Symptoms may include:•Fever •Chest pain and/or muscle pain •Cough that may produce white, yellow, or green mucus (phlegm)
•Lack of energy
Symptoms of Pneumonia
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Sputum Analysis: Pneumonia
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Moraxella catarrhalis, a large number of Gram negative (red) cocci are seen and many appear to be attaching to or residing within the PMNs
Some physicians confuse these organisms with the Gram negative coccobacillary
Sputum Analysis: Pneumonia, Cont’d
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Hemophilus influenzae pneumonia demonstrating the typical Gram negative coccobacillary forms
Because of the red background produced by the Gram stain method, these organisms can be difficult to see (oil immersion, 1000x)
Sputum Analysis: Pneumonia, Cont’d
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Hemophilus influenzae pneumonia
Sputum Analysis: Pneumonia, Cont’d
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Klebsiella pneumoniae pneumonia demonstrating Gram negative bacillary organisms. (oil immersion, 1000x)
Sputum Analysis: Pneumonia, Cont’d
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Gram stain of the sputum from a patient with Staphylococcus aureus pneumonia demonstrating clusters of Gram positive cocci some of which are associated with the PMNs (oil immersion, 1000x)
Normal and Asthmatic Bronchiole
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Analysis of Sputum: Asthma
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Analysis of Sputum: Asthma,
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Analysis of Sputum: Asthma,
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AFB smear
AFB (shown in red) are tubercle bacilli
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Aims of sputum microscopyAims of sputum microscopy
Diagnosis of patients with infectious tuberculosis Monitoring progress of patients on treatment
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Advantages of sputum microscopyAdvantages of sputum microscopy
More reliable than x-ray for the diagnosis of infectious TB Simple to perform Easy to read Minimal infrastructure required Inexpensive Quick Only tool to monitor and declare patients as “cured’’
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Diagnosis of pulmonary tuberculosisDiagnosis of pulmonary tuberculosis
Three specimens optimalThree specimens optimal
Spot specimen on first visit;sputum
container given to patient
Early morning collection next day
Spot specimen during second visit
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Normal/negative for malignancy [6] Moderate number of alveolar macrophages, pigmented macrophages and neutrophils. Few ciliated columnar cells and mucous spirals.
Inflammatory lesions Squamous metaplasia Regular squamous
metaplasia. Squamous metaplasia with mild atypia. Squamous metaplasia with moderate atypia. Squamous metaplasia with marked atypia.
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Positive for malignancy [5]Squamous cell carcinoma [Figure 3] Well-differentiated (keratinizing) squamous cell
carcinoma. Poorly differentiated squamous cell carcinoma.
Adenocarcinoma . Acinar adenocarcinoma. Bronchoalveolar carcinoma.
Large cell undifferentiated carcinoma. Small cell undifferentiated carcinoma.
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Thank you.
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