Meaning of Different Types of Sputum

Clear sputum (colorless) that is slightly sticky and a bit viscous (thicker than water) is

accepted as normal sputum. It is produced and secreted in moderate amounts to moisten

the respiratory tract and trap dust and microorganisms (mucus) and lubricate the mouth and

aid with chewing, swallowing and digestion (saliva). While any expectorated sputum is

considered to be abnormal,  small amounts of sputum can be coughed up or spat out with

effort even in the absence of any respiratory pathology.

However, in certain conditions, particularly related to irritation of the respiratory tract, the

amount of sputum may become excessive. In these pathological cases, the color, texture

and even odor of the sputum may change. These variations may give an indication of the

possible cause.

Serous

Normal, clear sputum is a serous discharge.

Large amounts of clear, frothy or pink sputum that is of a similar consistency as normal

sputum may be a sign of pulmonary edema, which is an accumulation of fluid in the lungs.

If it extremely profuse and lasting for weeks or months, then it may be due to lung cancer.

Frothy sputum is caused by surfactant in the lung alveoli which reduces the surface tension

of the sputum. It indicates that the sputum had contact with the lung alveoli or originated

from this site.

Mucopurulent

Mucoid, mucopurulent or purulent sputum is thicker and often more sticky than normal

sputum. This is partly due to the greater mucus production coupled with pus in the purulent

types.

Apart from the consistency, the color of purulent sputum may vary from white or gray to

yellow, green, rust-colored or brown. It may also have a pink tinge (blood streaked) which

may be due to a small quantity of blood.

Mucoid sputum is a sign of non-infectious airway disease like chronic bronchitis (COPD) and

asthma or may occur in the early stages of infection. Mucopurulent sputum is an indication

of infection of the respiratory tract, particularly of the bronchi or lungs – acute bronchitis and

pneumonia.

Blood-Stained

Sputum may be blood stained where the normal sticky or mucopurulent thick consistency

becomes thinner due to the presence of varying amounts of blood. In severe cases involving

the coughing up of large amounts of blood (hemoptysis), the consistency of the sputum may

be the same viscosity as blood and little or no sputum may be visible. Blood stained sputum

may be due to tuberculosis, bronchiectasis, pulmonary embolism or lung cancer.

Green Mucus, Phlegm Sputum – Meaning and CausesWritten by Dr. Chris   

The color of mucus may vary although it usually clear in color. Its if often mixed with saliva

when passed out through the mouth (spitting or coughing).

Clear, thin and watery mucus (serous) or clear to white, thick mucus (mucoid) is often

accepted as the normal color and may be seen in the early stages of an infection or other

inflammatory conditions. Pink to red or rust colored mucus is a sign of blood within the

mucus and is usually associated with a severe infection or inflammatory response.

Why is mucus green?

Green mucus is a result of dead neutrophils, a type of white blood cell active in infectious

and inflammatory responses, within the sputum. When neutrophils die and burst (lysis), it

releases a green pigment known as verdoperoxidase. This is an enzyme responsible for

the perioxidase activity of pus.

Initially, in the acute stage of an infection or inflammation, the presence of live neutrophils

causes the mucus to be yellow in color. Another type of white blood cell known as an

eosinophil, which is often seen in allergy-related conditions like asthma, also causes mucus

to be yellow in color. As the infection or inflammation becomes longer lasting (sub-acute or

chronic), the lysis of neutrophils results in green mucus.

There is a common misconception that yellow to green mucus is associated specifically with

bacterial infections. Neutrophil activity is seen in the presence of any invading pathogen,

whether it is bacteria, viruses or fungi. Prolonged inflammatory responses, even if not due to

infectious causes, will also result in green mucus.

Causes of Green Mucus

Mucus is often secreted in excess in certain conditions, especially in respiratory tract

infections. It may originate from from the nose of mouth (catarrh) or from lower down the

respiratory tract (sputum, phlegm). Rarely, it may emanate from the upper esophagus.

Colds

Flu (infleunza)

Hay fever

Sinusitis

Acute bronchitis

COPD , particularly in chronic bronchitis

Bronchiectasis

Pneumonia

Lung abscess

Cystic fibrosis

Pneumonia Cough, Sputum and Other Signs and SymptomsWritten by Dr. Chris   

The typical symptom associated with infectious pneumonia, similar to other lower

respiratory tract infections like bronchitis, is a productive and persistent cough. It is

usually described as a deep cough that is nagging with sputum being expectorated into the

throat or mouth.

However, in the early stages, a pneumonia cough may not present in this manner. Initially it

is dry and non-productive with pain in the center of the chest. This is similar to the cough

in tracheitis.

Coughing up blood or bloody sputum becomes evident as the condition progresses although

this may not be present in every case of pneumonia. Typically the cough lasts for less than 3

weeks (acute) although a chronic dry cough associated with lung inflammation (evident on

x-ray) is seen in interstitial pneumonia.

The color and nature of expectorated mucus may provide some indication of the type of

infection :

Yellow mucus is seen in the early stages of a productive penumonia cough

Green mucus is seen in more chronic infectious pneumonia

Rusty red-colored mucus is seen in pneumococcal pneumonia (Streptococcus

pneumoniae)

Deeper red-colored mucus may be seen in Klebsiella pneumoniae infection

Bad tasting and foul smelling mucus is seen in infectious pneumonia caused by

anaerobic bacteria like S.pneumoniae, S.aureus and K.pneumoniae

Signs and Symptoms of Pneumonia

Apart from the cough mentioned above, the other symptoms of pneumonia may vary greatly

depending on the cause and type of pneumonia.

Chest paino Centrally located early in the disease and progresses to the affected side,

although the unaffected side may experience some discomfort as well.o May be associated with pleuritis that is often associated with lung diseases

like pneumonia.o Pain pronounced on coughing or breathing in deeply. Refer to lung chest

pain for other causes of chest pain associated with respiratory diseases.o Pain may be referred to shoulder or upper abdomen.

o Upper abdominal tenderness may be a sign of lower lobe pneumonia.

Shortness of breath (dyspnea)o Difficulty breathing (‘not getting enough air’) is reported in most cases to

varying degrees.o In milder cases, shortness of breath may only be reported after activity, which

is uncharacteristic for the patient’s usual exercise tolerance.o Rapid, shallow breathing may be present in severe cases (ARDS = acute

respiratory distress syndrome) and may be accompanied by pallor

(infrequent) or cyanosis (very rare).

Abnormal breathing soundso Bronchial breathing, whispering pectoriloquy and crackles my be present in

pneumonia.

The other signs and and symptoms of pneumonia are non-specific and may be seen in many

infectious diseases, particularly respiratory tract infections.

Fever and chills

Sweating

Fatigue

Nausea and/or vomiting

Loss of appetite

Headache

Diarrhea (sometimes)

Coughing Up Excessive Phlegm (Mucus, Sputum) from the ThroatWritten by Jan Modric   

What Is Phlegm?

Phlegm (pronounced flem; from Greek phlegma = inflammation) is an informal name

for mucuscoughed up from the throat. In this article, a term phlegm will be used only for

mucus produced in the mucous layer of bronchi and windpipe (trachea). Medical term

for phlegm is expectorated matter or sputum.

Phlegm appears as thick, jelly-like fluid of various colors and consistency, depending on the

cause.

Phlegm is composed mainly from water and glycoproteins secreted by mucous glands.

Colors of Phlegm

Clear phlegm means there is no pus or blood in it. Yellow or green (not translucent)

phlegm is mucus mixed with pus. Rusty or brown phlegm may be due to smoking, air

pollution, blood or infection. Blood in phlegm may appear as read streaks. Pink phlegm

may be from asthma. Frothyphlegm originates from the lungs. Read more about phlegm

colors.

Symptoms Caused by Phlegm

Phlegm may irritate the lower airways and trigger cough. Cough and constant movements

of tinny hairy-like projections (cilia) in the lining of the lower airways push phlegm into the

throat, from where it can be coughed up or swallowed. Swallowed mucus is degraded by

bowel bacteria that produce gas, what may result in abdominal bloating.

Acute Diseases with Phlegm

Phlegm may be produced in the following acute diseases:

Chest cold (acute bronchitis) - an infection of the windpipe (trachea) or airways

that lead to the lungs (bronchi). It is often preceded by a common cold. Itchy

throat, coughing up clear phlegm and moderate chest pain during

coughing are main symptoms, which usually resolve within two weeks. There is

usually no or only moderate fever.

Influenza (flu) , including swine flu, can present with clear phlegm, high fever,

runny nose, sore throat, headache and muscular pains.

Bacterial pneumonia, coughing up yellow or green frothy phlegm, high

fever and rapid breathing are main symptoms. In viral pneumonia, dry cough is

characteristic, though.

Chronic Diseases with Phlegm

Coughing up phlegm may be a long lasting problem:

In chronic bronchitis, mostly caused by smoking or air pollution, coughing up

thick phlegm is the main symptom. In severe bronchitis, phlegm may obstruct the

bronchi, resulting in lack of oxygen in the blood (hypoxemia), reflected in bluish lips

and skin around the mouth(cyanosis).

In tuberculosis, yellow or green phlegm, often with blood, may be coughed up.

Low grade fever, coughing, low appetite and generally feeling ill are main symptoms

that usually lastsover 3 weeks.

In asthma, an allergic inflammation of the bronchi, a small amount of clear or pink

phlegm may be produced and coughed up along with difficult breathing.

Certain types of lung cancer produce mucus. Chest pain, coughing up blood or

yellow phlegm, low appetite and losing weight are main but late symptoms.

Phlegm in Small Children

Acute viral infections, like chest cold or influenza are main causes of coughing up

phlegm in small children.

A baby with cystic fibrosis, a rare genetic disease, can cough up thick yellow or

green phlegm, and have blocked nose, diarrhea, and respiratory infections shortly

after birth and later in life. 

Does Drinking Milk Cause Phlegm?

Drinking milk does not cause phlegm, but it may make it thick and thus hard to expel.

Other Causes of Mucus in the Throat

Mucus produced in the nose or peri-nasal sinuses and dripped down the throat is informally

calledpost nasal drip or, medically, catarrh.

Bacterial infection of tonsils or epiglottis (membrane that covers the voice box during

swallowing) usually causes high fever, strong pain in the throat, enlarged lymph nodes in

the neck and white-yellow pus that covers tonsils and the throat walls.

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Sputum or Phlegm Bacteria Culture Lab TestWritten by Dr. Chris   

What is a sputum culture?

The material which is coughed up from the lungs and then spat out or expectorated is called

sputum or sometimes referred to as phlegm. A sputum culture is done to identify the

microorganism causing lower respiratory tract infections such as pneumonia and

tuberculosis. A fever with a chronic cough , along with blood or pus-like material in the

sputum, is usually an indication for undertaking a sputum culture.

Collection of Sputum Specimen

The sputum should be collected in a sterile container, preferably early in the morning before

eating or drinking anything. The mouth should be rinsed with water to rinse out bacteria

from the mouth and dilute the saliva which may contaminate the specimen. With a forceful

cough, the sputum should be spat out into the sterile container immediately, avoiding

prolonged collection in the mouth cavity. Three consecutive samples may have to be

collected if testing for tuberculosis.

A special stain called the acid-fast stain may be done in the laboratory to identify the

tuberculous bacilli. Different types of microorganisms may be identified using gram stain. A

fungal culture may be done if a fungal infection is suspected and a viral culture is done to

detect viral infection such as pneumonia. Due to the prevalence of bacterial respiratory tract

infections, most sputum samples are first tested for bacteria.

Sputum Culture Report

Bacterial Culture

The initial report indicating the presence of any bacteria may be available on the same day.

The final report will take one to three days and this will include identification of the specific

type and quantity of bacteria as well as the antibiotics most effective against it. Culture for

tuberculosis may take two to four weeks.

Fungal Culture

Reports may take several weeks.

Viral Culture

It may take several days to several weeks to get the report depending on the type of virus

present.

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To enlarge an image, please click on the small pictures shown below. See links posted above to other pages of the CMPT Photo Album. The colour of some of the photographs has been altered to either best show the bacteria and/or cells. SeeGram protocol

G101 Sputum smear for gram stain: 4+ (>25/lpf)neutrophils, no epithelial cells seen, 3+ (11-50/oif) gram negative diplococci/cocci, moderate mucus. Suitable to culture. Companion culture yielded Moraxella

catarrhalis

G012 Sputum smear: > 25 epithelial cells per low power field [lpf, x10]), few  Unsuitable for culturing.Low power view.

G043 Sputum smear for Gram stain: 4+ (> 25/low power field) neutrophils, 4+ (> 50/ oil immersion field) gram-negative bacilli/coccobacilli, 2+ (2-10/oif) gram-positive cocci Interpretation: Suitable to culture.Companion culture yielded Haemophilus parainfluenzae. 

G92 Sputum smear: Greater than 25 epithelial cells/lpf suggesting oral contamination Interpretation: unsuitable for cultureLow power view.G021 Sputum smear: suitable to culture, > 25 neutrophils, < 10 epithelial cells/lpf; 4+ gram-positive bacilli, 2+ gram-positive cocci/oifCompanion culture (Corynebacterium pseudodiphtheriticum)

G91 Sputum smear: Greater than 25 epithelial cells/lpf suggesting oral contamination Interpretation: unsuitable for culture

(Oil immersion view shown. Interpret number of epithelial cells on low power. Confirm cellular and bacterial morphology on oil immersion.)

G24 Sputum smear: suitable to culture, > 25 neutrophils, 10-15 epithelial cells/lpf; 4+ gram-negative coccobacilli, 1+ gram-positive cocci, plus mixed normal resp. flora/oif Also readM052-4 Aug 

Companion culture yielded Acinetobacter baumannii, a gram-negative coccobacillary rod, frequently arranged in pairs.G061 Sputum smear: 3+ neutrophils, 2+ yeast cells, 3+ gram-negative diplococci – Suitable for culturing. Click to enlarge image. No companion culture. Lymphoma patient. Yeast cells = Cryptococcus neoformans; gram-negative diplococci=Moraxella catarrhalisG23 Sputum smear: suitable to culture, > 25 neutrophils, 10-15 epithelial cells/lpf; 4+ gram-positive bacilli, 2+ gram-positive cocci in pairs/oifCompanion culture positive for Streptococcus pneumoniaeand Corynebacterium pseudodiphtheriticum.

G063 Sputum smear for Gram staining: 4+ (> 25/lpf, > 10/oif) neutrophils, 1+ (1-4/lpf, [<1/oif]) epithelial cells, 4+ gram-positive cocci (suggestive of S. pneumoniae), 2+ gram-negative diplococci/cocci Interpretation: suitable to culture

Please click image to enlarge.The companion sample for culture, M063-3,contained Streptococcus pneumoniae andMoraxella catarrhalis.

G044  Endotracheal aspirate smear for Gram stain: no neutrophils, rare epithelial cells, 4+ (> 50/ oil immersion field) gram-negative bacilli) The companion sampleM044-2 yieldedSerratia NOTE: In the presence of a burn injury this patient would be considered as

immunosuppressed, and as such the absence of neutrophils does not necessarily represent absence of infection. This sample could either reflect colonization, or infection. G044 was the companion sample to M044-2, which yielded 4+ Serratia marcescens.

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