Sputum analysis.final 1.

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  • 2. Sputum Definition 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 2
  • 3. Sputum Definition Tracheobronchial secreations are an inconstant mixture of plasma, water, electrolytes and mucin As 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 3
  • 4. Sputum Collection 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 4
  • 5. Sputum Collection 5
  • 6. *Viscid & yellow * a/c bronchitis * Bronchiectasis * Lung abscess 6
  • 7. *White & Mucoid * c/c bronchitis * Bronchial Asthma * Pulmonary Tuberculosis 7
  • 8. *Rusty sputum * Pneumococcal pneumonia 8
  • 9. *Cursch -man’s spirals Bronchial asthma Allergic bronchopulmonary aspergillosis 9
  • 10. *Watery & blood stained sputum * Pulmonary edema 10
  • 11. * Blood in sputum [hemoptysis] *TB, *Pneumonia, *Bronchiectasis, * Lung abscess, *Mitral Stenosis, *Bronchogenic carcinoma 11
  • 12. *Chocolate coloured sputum * Amoebiasis 12
  • 13. Foul smell *c/c suppuration bronchiectasis lung abscess 13
  • 14. MICROSCOPY *Wet preparations entamoeba, paragonimus *Wet staining wt methylene blue malignant cells *Gram’s staining bacterial pathogens 14
  • 15. * Ziehl – Neelsen Staining * Mycobacteria  50,000/ml- sputum positive *at least 2 bacilli *at least 100 fields 15
  • 16. *Papanicolaou stain * cytological abnormalities * identify malignant cells * demonstrate bronchial casts 16
  • 17. Types of cells. * Neutrophils : pyogenic infection of respiratory tract * Eosinophil's : asthma and parasitic infections of lung. * Lymphocytes: early pulmonary tuberculosis * RBCs: haemorrhage into the lungs. * Heart failure cells: cvc of lungs pulmonary infarction and pulmonary haemorrhage * Anthracotic pigment laden cells: coal workers pneumoconiosis, smoky17 polluted areas.
  • 18. Sputum Analysis 18 * This slide shows typical buccal squamous epithelial cells which are much larger than polymorph nuclear leukocytes (PMN) and take up most of the field in a high power view * This cell is covered with chains of Gram positive cocci typical of normal oral flora such as peptostreptococci. (oil immersion, 1000x)
  • 19. Physical Properties of Sputum 1. Appearance • It may be described as liquid (serous), mucous, purulent, bloody or combination of theses 2. Color • Its color is determined by the material contained, and often color can indicate the pathological process • Yellow color indicates pus and epithelial cells are present 19
  • 20. 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 20
  • 21. Miscellaneous Findings in Sputum 1. Cheesy Masses • These are fragments of necrotic pulmonary tissue seen in such disease as pulmonary gangrene or tuberculosis 2. Bronchial Casts • These are branching tree like casts of bronchi whose size varies with that of bronchi in which they are formed • They are composed of fibrin and are white or gray color 21
  • 22. 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 22
  • 23. Miscellaneous Findings in Sputum, 4. Dietrich's Plugs • They are frequently observed in putrid bronchitis and bronchiectasis • They are composed of cellular debris, fatty acids, crystals, fat globules and bacteria 23
  • 24. Pneumonia, Cont’d * The alveoli filled with mucus such as submucosa widened by smooth muscle hypertrophy, edema, and inflammation (mainly eosinophils) * These are changes of bronchial asthma * The peripheral eosinophil count or the sputum eosinophils can be increased during an asthmatic attack. 24
  • 25. Pneumonia 25
  • 26. Pneumonia, Cont’d 26
  • 27. Symptoms of Pneumonia *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 27
  • 28. Sputum Analysis: Pneumonia 28 * Moraxella catarrhalis, a large number of Gram negative (red) cocci are seen and many appear to be attaching to or residing within the PMNs * Some physicians confuse these organisms with the Gram negative coccobacillary
  • 29. Sputum Analysis: Pneumonia, Cont’d 29 * Hemophilus influenzae pneumonia demonstrating the typical Gram negative coccobacillary forms * Because of the red background produced by the Gram stain method, these organisms can be difficult to see (oil immersion, 1000x)
  • 30. Sputum Analysis: Pneumonia, Cont’d 30 * Hemophilus influenzae pneumonia
  • 31. Sputum Analysis: Pneumonia, Cont’d 31 * Klebsiella pneumoniae pneumonia demonstrating Gram negative bacillary organisms. (oil immersion, 1000x)
  • 32. Sputum Analysis: Pneumonia, Cont’d 32 * Gram stain of the sputum from a patient with Staphylococcus aureus pneumonia demonstrating clusters of Gram positive cocci some of which are associated with the PMNs (oil immersion, 1000x)
  • 33. Normal and Asthmatic Bronchiole 33
  • 34. Analysis of Sputum: Asthma 34
  • 35. Analysis of Sputum: Asthma, 35
  • 36. Analysis of Sputum: Asthma, 36
  • 37. AFB smear AFB (shown in red) are tubercle bacilli 37
  • 38. AAiimmss ooff ssppuuttuumm mmiiccrroossccooppyy  Diagnosis of patients with infectious tuberculosis  Monitoring progress of patients on 38 treatment
  • 39. Advantages ooff ssppuuttuumm mmiiccrroossccooppyy  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’’ 39
  • 40. DDiiaaggnnoossiiss ooff ppuullmmoonnaarryy ttuubbeerrccuulloossiiss TThhrreeee ssppeecciimmeennss ooppttiimmaall Spot specimen on first visit;sputum container given to patient Early morning collection next day Spot specimen during second visit 40
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  • 43. * Normal/negative for malignancy [6] Moderate number of alveolar macrophages, pigmented macrophages and neutrophils. Few ciliated columnar cells and mucous spirals. * Inflammatory lesions * Squamous metaplasia Regular squamous metaplasia. * Squamous metaplasia with mild atypia. * Squamous metaplasia with moderate atypia. * Squamous metaplasia with marked atypia. 43
  • 44. * Positive for malignancy [5]Squamous cell carcinoma [Figure 3] * Well-differentiated (keratinizing) squamous cell carcinoma. * Poorly differentiated squamous cell carcinoma. * Adenocarcinoma . * Acinar adenocarcinoma. * Bronchoalveolar carcinoma. * Large cell undifferentiated carcinoma. * Small cell undifferentiated carcinoma. 44
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  • 47. Thank you. Enjoy the subject and learn it.