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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/09/29 20:21:44」(JST)
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| Abnormal sputum |
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Cocci-shaped Enterococcus sp. bacteria taken from a pneumonia patient.
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| Classification and external resources |
| Specialty |
Pulmonology |
| ICD-10 |
R09.3 |
| ICD-9-CM |
786.4 |
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[edit on Wikidata]
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Sputum ['spju.təm] is mucus and is the name used for the coughed-up material (phlegm) from the lower airways (trachea and bronchi). This process is known as sputilization. [1] In medicine, sputum samples are usually used for naked eye exam, microbiological investigations of respiratory infections and cytological investigations of respiratory systems. It is critical that the patient not give a specimen that includes any mucoid material from the interior of the nose. Naked eye exam of sputum can be done at home by a patient in order to note the various colors (see below). Any hint of yellow color suggests an airway infection (but does not indicate between the types of organisms causing it). Such color hints are best detected when the sputum is viewed on a very white background such as white paper, a white pot, or a white sink surface. The more intense the yellow color, the more likely it is a bacterial infection (bronchitis, bronchopneumonia, or pneumonia).
The best sputum samples contain very little saliva,[2] as saliva contaminates the sample with oral bacteria. This is especially true for samples for lab testing in cytology or microbiology. Specimen adequacy is assessed by the laboratory technologists by examining a Gram stain or cytology stain of the sputum. More than 25 squamous epithelial cells at low power magnification exam with the microscope strongly suggests salivary contamination.[citation needed]
When a sputum specimen is plated out in microbiology, it is best to get the portion of the sample that most looks like yellow pus onto the swab. If there is any blood in the sputum, this should also be on the swab.[citation needed] Microbiological sputum samples are used to look for infections...just to name several...by Moraxella catarrhalis, Mycobacterium tuberculosis, Streptococcus pneumoniae, and Haemophilus influenzae. Other pathogens can also be found.
Purulent sputum[3] contains pus, composed of white blood cells, cellular debris, dead tissue, serous fluid, and viscous liquid (mucus). Purulent sputum is typically yellow or green. It is seen in cases of bronchiectasis, lung abscess, an advanced stage of bronchitis, or acute upper respiratory tract infection (common cold, laryngitis).
Sputum can be (when examined by the naked eye):
- Bloody[4] (hemoptysis)
- Blood-streaked sputum – inflammation of throat (larynx and/or trachea) or bronchi; lung cancer; other bleeding erosions, ulcers, or tumors of the lower airway.
- Pink sputum – sputum evenly mixed with blood from alveoli and/or small peripheral bronchi.
- Massive blood – cavitary tuberculosis or tumor such as lung cancer of lung, or lung abscess; bronchiectasis; lung infarction; pulmonary embolism.
- Green or greenish colored - indicative of longstanding respiratory infection (green from degenerative changes in cell debris) as in pneumonia, ruptured lung abscess, chronic infectious bronchitis, and infected bronchiectasis or cystic fibrosis.
- Rust colored – usually caused by pneumococcal bacteria (in pneumonia), pulmonary embolism, lung cancer or pulmonary tuberculosis.
- Brownish – chronic bronchitis (greenish/yellowish/brown); chronic pneumonia (whitish-brown); tuberculosis; lung cancer.
- Yellow, yellowish purulent – containing pus. The sputum color of patients with acute cough and no underlying chronic lung disease does not imply therapeutic consequences such as prescription of antibiotics.[5] The color can provide hints as to effective treatment in chronic bronchitis patients:[6]
- A yellow-greenish (mucopurulent) color suggests that treatment with antibiotics can reduce symptoms. Green color is caused by degenerating neutrophil Myeloperoxidase.
- Whitish gray sputum color against a white color background (such as a white sink surface) tends to indicate either a specimen from someone who is dehydrated, and/or from an older person, and/or a specimen with a mixed, modest number of eosinophils and maybe some acute inflammatory neutrophil cells (this last choice tends to suggest a chronic allergic bronchitis).
- A white, milky, or opaque (mucoid) appearance means that antibiotics are less likely to be effective in treatment because the likelihood is greater of a viral infection or allergy (even asthma...thick sputum) than of antibiotic-responsive micro-organisms.
- Foamy white – may come from earlier-phase pulmonary edema.
- Frothy pink – may indicate more severe pulmonary edema.
- Clear – pulmonary embolism (clear to frothy); COPD chronic obstructive pulmonary disease (clear to gray); viral respiratory infection (clear to whitish & sometimes a hint of yellow); asthma (thick and white to yellowish).
See also
- Sputilization - the process of producing sputum: Word origin - group 5
- Phlegm – the mucus produced by the respiratory system that is called sputum after it is expelled by coughing it up
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 colour for diagnosis of a bacterial infection in patients with acute cough
- ^ Sputum Color is the Key to Treating Acute COPD Exacerbations
External links
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Symptoms and signs relating to the respiratory system (R04–R07, 786)
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Medical examination and history taking
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| Auscultation |
- Stethoscope
- Respiratory sounds
- Stridor
- Wheeze
- Crackles
- Rhonchi
- Hamman's sign
- Pleural friction rub
- Fremitus
- Bronchophony
- Elicited findings
- Percussion
- Pectoriloquy
- Whispered pectoriloquy
- Egophony
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| Breathing |
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Rate
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- Apnea
- Dyspnea
- Hyperventilation
- Hypoventilation
- Hyperpnea
- Tachypnea
- Hypopnea
- Bradypnea
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Pattern
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- Agonal respiration
- Biot's respiration
- Cheyne–Stokes respiration
- Kussmaul breathing
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Other
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- Respiratory distress
- Respiratory arrest
- Orthopnea/Platypnea
- Trepopnea
- Aerophagia
- Asphyxia
- Breath holding
- Mouth breathing
- Snoring
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| Other |
- Chest pain in children
- Chest pain
- Precordial catch syndrome
- Pleurisy
- Clubbing
- Schamroth's window test
- Hippocratic fingers
- Cyanosis
- Cough
- Sputum
- Hemoptysis
- Epistaxis
- Silhouette sign
- Post-nasal drip
- Hiccup
- COPD
- asthma
- Curschmann's spirals
- Charcot–Leyden crystals
- chronic bronchitis
- sarcoidosis
- pulmonary embolism
- Hampton hump
- Westermark sign
- pulmonary edema
- Hamman's sign
- Golden S sign
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UpToDate Contents
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English Journal
- Time to detection in liquid culture of sputum in pulmonary MDR-TB does not predict culture conversion for early discharge.
- Rieu R1, Chang C1, Collin SM2, Fazekas J1, Dassanaike S1, Abbara A1, Davidson RN1.
- The Journal of antimicrobial chemotherapy.J Antimicrob Chemother.2016 Mar;71(3):803-6. doi: 10.1093/jac/dkv407. Epub 2015 Dec 11.
- OBJECTIVES: UK guidelines advise that patients with pulmonary MDR-TB are isolated in hospital until the results of sputum cultures are negative (culture conversion), typically after 42 days of incubation with no growth. MDR-TB patients may be isolated ≥42 days longer than is necessary for public s
- PMID 26661394
- Highly active antiretroviral therapy reduces pulmonary IL-8 in HIV-positive women smokers.
- Taylor GH1, Williams AA2, Garzino-Demo A3.
- Pathogens and disease.Pathog Dis.2016 Mar;74(2). pii: ftv115. doi: 10.1093/femspd/ftv115. Epub 2015 Dec 9.
- Increased levels of the proinflammatory cytokine IL-8 are detected in the sputum of patients with chronic obstructive pulmonary disease (COPD) and during the pathological pulmonary manifestations of HIV infection : To explore a potential interrelationship between smoking, highly active antiretrovira
- PMID 26656889
Japanese Journal
- 患者喀痰および環境から分離したMycobacterium avium complexの抗結核薬感受性
- 感染症学雑誌 = The journal of the Japanese Association for Infectious Diseases 91(2), 137-144, 2017-03
- NAID 40021169914
Related Links
- Based on the broadly reviewed results of Guardian's product prototype for sputum analysis, using Signature Mapping[TM] capabilities for the automated detection and quantification of Tuberculosis, Guardian has expanded its ...
- Typically, the first step in the routine analysis of a sputum sample is a Gram stain to identify the general type of bacteria that may be present. ...
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