SPUTUM

Presented By

Narmeen Arshad

What is Sputum ?

• Sputum is mucus that is coughed up from the lower airways.

• (Phlegm, mucus)

Sputum definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms

Types Of Sputum

• Bloody• Rusty colored• Purulent • Foamy white • Frothy pink

Sputum Color is the Key to Treating Acute COPD Exacerbations

Sample Collection

Diagnosis of disease using Sputum

• Smear ----Gram Stain----Microscopy• Culture -----Microscopy• Others (PCR, etc.)

Smear Test Requirements

Selection of Sample

The specimen that is uniformly green and purulent presents no problem. Any portion of it will provide useful information.

These are specimens that consists mainly of saliva with a small amount of material that may be sputum. The flecks should be selected.

Specimens may be heavily stained with blood. Select the portion of the sample that is mucoid and blood stained.

When only a few blood stained flecks are present, these are the portions to select.

Avoid any part of the specimen that is watery, as this is probably saliva.

Collection of SampleUse a sterile cotton swab to extract the specimen from the container.

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Microscopy

Possible Infections

• Bacterial(pneumonia, whooping cough, Legionnaire's disease, an atypical pneumonia, parrot fever, TB, otitis media, bronchitis, sinusitis, laryngitis )

• Fungal (Aspergillosis, Blastomycosis, Coccidioidomycosis, Cryptococcus, Histoplasmosis )

• Viral (In combination with certain bacteria)

Possible Bacterial Pathogens

• Streptococcus pneumoniae• Staphylococci• Hemophilus influenzae• Members of the family Enterobacteriaceae• Some pseudomonads• Moraxella catarrhalis • Mycobacterium tuberculosis

Mucus

Streptococcus pneumoniae

• cause of bacterial pneumonia• organisms are arranged in pairs

and are lancet shaped• surrounded by a large capsule• organisms are reported as Gram

positive cocci in pairs.

Staphylococcus aureus

• They are usually round or slightly oval cocci which occur singly in small clusters.

• Report these organisms as Gram positive cocci in pairs and clusters.

Haemophilus influenzae

• The presence of many very tiny pleomorphic Gram negative rods is strongly suggestive of Hemophilus influenzae.

• They should be reported as small, pleomorphic Gram negative rods.

Enterobacteriaceae

• These organisms are gram negative rods

• They are usually fat rods, larger than Hemophilus sp.

Pseudomonas sp.

• Pseudomonads are usually long slender Gram negative rods.

• Like Enterobacteriaceae, their morphology is not sufficiently typical to be able to characterize them on a Gram smear.

• Gram-negative, aerobic, oxidase-positive diplococcus

Moraxella catarrhalis • Gram Negative, Rod shaped• Diplococcus

Mycobacterium Tuberclosis

•M. tuberculosis is characterized by granulomas containing Langhans giant cells, which have a "horseshoe" pattern of nuclei. •Organisms are identified by their red color on acid-fast staining.

Yeast • Yeasts and pseudohyphal elements are

frequently seen. • Small numbers.• Increased numbers are often seen in

patients who are immuno-logically compromised and in those who have been extensively treated with antibiotics.

• These patients often have oral candidiasis.• Yeasts are much larger than bacteria.

Notice the size difference between the yeast and the gram negative rods.

Viral Infection

• Viruses are a common cause of pneumonia. For a viral culture, sputum is mixed with commercially-prepared animal cells in a test tube. Characteristic changes to the cells caused by the growing virus help identify the virus. The time to complete a viral culture varies with the type of virus. It may take from several days to several weeks.

Media Culture used for sputum

• Mac Conkey Agar• Chocolate Agar• Blood Agar

Clinical Correlation

• Moraxella catarrhalis - : otitis media,

bronchitis, sinusitis, laryngitis.

Streptococcus pneumoniae- • acute sinusitis, otitis media, conjunctivitis, meningitis,

bacteremia, sepsis, osteomyelitis, septic arthritis, endocarditis, peritonitis,pericarditis, cellulitis, and brain abscess.

Mycobacterium tuberculosis

• (Mycobacterium africanum,Mycobacterium bovis (Dassie's bacillus), Mycobacterium caprae, Mycobacterium microti, Mycobacterium mungi, Mycobacterium orygis and Mycobacterium pinnipedii) – TB

Haemophilus influenzae -

• (oppurtunistic pathogen) bacteremia, pneumonia, epiglottitis and acute bacterial meningitis, cellulitis, osteomyelitis, and infectious arthritis.

Fungal Diseases

• Aspergillosis, Blastomycosis, Coccidioidomycosis, Cryptococcus, Histoplasmosis

Treatment

• Antibiotics (cefotaxime , ceftriaxone ampicillin , sulbactam, cephalosporins , rifampicin, izoniacid,etc.)

• Vaccines (BCG, Hib conjugate vaccine , etc. )

Mucus

• "Mucus is incredibly important for our bodies, It is the oil in the engine. Without mucus, the engine seizes."

Explains Michael M. Johns, III, MD, director of the Emory Voice Center and assistant professor of otolaryngology -- head and neck surgery at Emory University.

References• Sputum definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms• Clinical Microbiology procedures handbook, American Society for Microbiology 2nd Ed. 2007 update• Richard F.LeBlond. Diagnostics_expectoration. US: McGraw-Hill Companies, Inc. ISBN 0-07-140923-8.• Richard F.LeBlond. Diagnostics_expectoration. US: McGraw-Hill Companies, Inc. ISBN 0-07-140923-8.• Sputum Color is the Key to Treating Acute COPD Exacerbations• Mawas F, Ho MM, Corbel MJ (January 2009). "Current progress with Moraxella catarrhalis

antigens as vaccine candidates". Expert Rev Vaccines 8 (1): 77–90. doi:10.1586/14760584.8.1.77.PMID 19093775.

• Yu S, Gu XX (June 2007). "Biological and Immunological Characteristics of Lipooligosaccharide-Based Conjugate Vaccines for Serotype C Moraxella catarrhalis". Infect. Immun. 75 (6): 2974–80.doi:10.1128/IAI.01915-06. PMC 1932890. PMID 17371852

• Winstanley, T.G. and R.C. Spencer. “Moraxea catarrkar: antibiotic susceptibility with special reference to trimethoprim.” Journal of Antimicrobial Chemotherapy 18, no. 3 (1986): 425-426.

• Helminen, Merja E., Isobel Maciver, Jo L. Latimer, Julia Klesney-Tait, Leslie D. Cope, Maria Paris, George H. McCracken, Jr., and Eric J. Hansen. “A Large, Antigenically Conserved Protein on the Surface of Moraxella catarrhalis Is a Target for Protective Antibodies.” The Journal of Infectious Diseases 170, no. 4 (1994): 867-872.

• h Melendez, Philipp R. and Royce H. Johnson. “Bacteremia and Septic Arthritis Caused by Moraxella catarrhalis.” Reviews of Infectious Diseases 13, no. 3 (1991): 428-429.

• Maciver, Isobel, Manaswat Unhanand, George H. McCracken Jr., and Eric J. Hansen. “Effect of Immunization on Pulmonary Clearance of Moraxella Catarrhalis in an Animal Model.” The Journal of Infectious Diseases 168, no. 2 (1993): 469-472.

• Kuhnert P; Christensen H (editors). (2008).Pasteurellaceae: Biology, Genomics and Molecular Aspects. Caister Academic Press. ISBN 978-1-904455-34-9.

• Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 396–401. ISBN 0-8385-8529-9.• Slack, MP; et al. (1998). "Enhanced surveillance of invasive Haemophilus influenzae disease in England, 1990 to 1996:

impact of conjugate vaccines.". Pediatr Infect Dis J. 17 (9 suppl): S204–7. PMID 9781764.• Behrman, Richard E.; Robert M Kliegman and Hal B. Jenson (2004). Nelson Tratado de Pediatría. Elsevier. p. 904. ISBN

84-8174-747-5. Retrieved 2009-09-11.• Puri J, Talwar V, Juneja M, Agarwal KN, Gupta HC (1999). "Prevalence of antimicrobial resistance among respiratory isolates

of Haemophilus influenzae". Indian Pediatr 36 (10): 1029–32. PMID 10745313.• Levine OS, Schuchat A, Schwartz B, Wenger JD, Elliott J; Centers for Disease Control (1997).

"Generic protocol for population-based surveillance of Haemophilus influenzae type B". World Health Organization. WHO/VRD/GEN/95.05.

• John TJ, Cherian T, Steinhoff MC, Simoes EA, John M (1991). "Etiology of acute respiratory infections in children in tropical southern India". Rev Infect Dis 13: Suppl 6:S463–9.PMID 1862277.

• Kennedy WA, Chang SJ, Purdy K, LE T, Kilgore PE, Kim JS et al. (2007). "Incidence of bacterial meningitis in Asia using enhanced CSF testing: polymerase chain reaction, latex agglutination and culture". Epidemiol Infect 135 (7): 1217–26. doi:10.1017/S0950268806007734.PMC 2870670. PMID 17274856.

• Pericone, Christopher D., Overweg, Karin, Hermans, Peter W. M., Weiser, Jeffrey N. (2000). "Inhibitory and Bactericidal Effects of Hydrogen Peroxide Production by Streptococcus pneumoniae on Other Inhabitants of the Upper Respiratory Tract". Infect Immun 68 (7): 3990–3997.doi:10.1128/IAI.68.7.3990-3997.2000. PMC 101678.PMID 10858213.

• Lysenko E, Ratner A, Nelson A, Weiser J (2005). "The role of innate immune responses in the outcome of interspecies competition for colonization of mucosal surfaces". PLoS Pathog 1 (1): e1. doi:10.1371/journal.ppat.0010001.PMC 1238736. PMID 16201010.

• Chang CM, Lauderdale TL, Lee HC, et al. (August 2010)."Colonisation of fluoroquinolone-resistant Haemophilus influenzae among nursing home residents in southern Taiwan". J. Hosp. Infect. 75 (4): 304–8.doi:10.1016/j.jhin.2009.12.020. PMID 20356651.