WordNet

expectorated matter; saliva mixed with discharges from the respiratory passages; in ancient and medieval physiology it was believed to cause sluggishness (同)sputum

PrepTutorEJDIC

つば,たん
痰(たん) / 冷淡,冷静;鈍感,無気力;粘液質

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/08 07:25:24」(JST)

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Sputum ['spju.təm] is mucus that is coughed up from the lower airways. This process is known as sputilization. ^[1] In medicine, sputum samples are usually used for microbiological investigations of respiratory infections and cytological investigations of respiratory systems.

The best sputum samples contain very little saliva,^[2] as saliva contaminates the sample with oral bacteria. This event is assessed by the clinical microbiologist by examining a Gram stain of the sputum. More than 25 squamous epithelial cells at low enlargement indicates salivary contamination.^{[citation needed]}

When a sputum specimen is plated out, it is best to get the portion of the sample that most looks like 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 usually used to look for infections 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:

Bloody^[4] (hemoptysis)
1. Blood-streaked sputum – inflammation of throat, bronchi; lung cancer;
2. Pink sputum – sputum evenly mixed with blood, from alveoli, small bronchi;
3. Massive blood – cavitary tuberculosis of lung, lung abscess, bronchiectasis, infarction, embolism.
Rust colored – usually caused by pneumococcal bacteria (in pneumonia)
Purulent – containing pus. The sputum colour of patients with acute cough and no underlying chronic lung disease does not imply therapeutic consequences such as prescription of antibiotics.^[5] The colour can provide hints as to effective treatment in chronic bronchitis patients:^[6]
1. A yellow-greenish (mucopurulent) color suggests that treatment with antibiotics can reduce symptoms. Green color is caused by Neutrophil Myeloperoxidase.
2. A white, milky, or opaque (mucoid) appearance often means that antibiotics will be ineffective in treating symptoms. This information may correlate with the presence of bacterial or viral infections, but current research does not support that generalization.
Foamy white – may come from obstruction or even edema.
Frothy pink – pulmonary edema.

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

UpToDate Contents

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1. 細菌性肺炎の評価のための喀痰培養 sputum cultures for the evaluation of bacterial pneumonia
2. 成人における亜急性および慢性咳嗽の評価 evaluation of subacute and chronic cough in adults
3. 慢性閉塞性肺疾患（COPD）治療における粘膜作用剤の役割 role of mucoactive agents in the treatment of copd
4. 成人における市中肺炎に対する診断的アプローチ diagnostic approach to community acquired pneumonia in adults
5. Anesthesia for patients with chronic obstructive pulmonary disease

English Journal

Aggravation of airway inflammation and hyper-responsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma.

Wang W1, Xian M1, Xie Y1, Zheng J1, Li J1,2.
Allergy.Allergy.2016 Mar;71(3):378-86. doi: 10.1111/all.12808. Epub 2015 Dec 29.
BACKGROUND: House dust mites are the most prevalent allergen causing sensitizations in patients with rhinitis and asthma in China. We aimed to investigate the changes in both upper and lower airway inflammation and responsiveness following Dermatophagoides pteronyssinus (Der-p) nasal provocation tes
PMID 26595454

Survey of Clinical Laboratory Practices for 2015 Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea.

Lee MK1, Kim S2, Kim MN3, Kweon OJ1, Lim YK1, Ki CS4, Kim JS5, Seong MW6, Sung H4, Yong D2, Lee H7, Choi JR2, Kim JH8; MERS-CoV Laboratory Response Task Force of The Korean Society for Laboratory Medicine.
Annals of laboratory medicine.Ann Lab Med.2016 Mar;36(2):154-61. doi: 10.3343/alm.2016.36.2.154.
BACKGROUND: It is crucial to understand the current status of clinical laboratory practices for the largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infections in the Republic of Korea to be well prepared for future emerging infectious diseases.METHODS: We conducted a surv
PMID 26709263

Quality of life changes over time in patients with chronic obstructive pulmonary disease.

Jones GL1.
Current opinion in pulmonary medicine.Curr Opin Pulm Med.2016 Mar;22(2):125-9. doi: 10.1097/MCP.0000000000000242.
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is often considered to be a disease in which an inevitable decline in lung function results in increasing dyspnea and deteriorating quality of life. This review summarizes recent data that calls this classic paradigm into question. Stud
PMID 26814143

Japanese Journal

Association of Eosinophilic Inflammation with FKBP51 Expression in Sputum Cells in Asthma.

Tajiri Tomoko,Matsumoto Hisako,Niimi Akio,Ito Isao,Oguma Tsuyoshi,Nakaji Hitoshi,Inoue Hideki,Iwata Toshiyuki,Nagasaki Tadao,Kanemitsu Yoshihiro,Petrova Guergana,Mishima Michiaki
PloS one 8(6), 2013-06-06
… [Objective]: To evaluate the relationship between eosinophilic inflammation and FKBP51 expression in sputum cells in asthma. … [Methods]: The FKBP51 mRNA levels in sputum cells from steroid-naı¨ve patients with asthma (n = 31) and stable asthmatic patients on inhaled corticosteroid (ICS) (n = 28) were cross-sectionally examined using real-time PCR. …
NAID 120005296109

血痰を契機に発見された成人における気管支内腔毛細血管腫の1例

齋藤弘明,足立雄太,山下高明,若井陽子,齊藤和人,小貫琢哉,稲垣雅春,篠原陽子
気管支学 : 日本気管支研究会雑誌 35(2), 179-183, 2013-03-25
背景.気管支内腔毛細血管腫は小児に比べて,成人において稀である.今回我々は,成人における気管支内腔毛細血管腫の1例を経験したので報告する.症例. 61歳男性.血痰を主訴に受診.胸部X線写真で特記すべきものはなかったが,気管支内視鏡検査で左主気管支に発赤した表面平滑な隆起性病変を認めた.病変は生検後内視鏡所見で認めず,病理所見より毛細血管腫と診断した. 2カ月後に再発したため, Nd-YAGレーザー …
NAID 110009597491

気管支食道瘻に対して食道バイパス術を行った肺扁平上皮癌の1例

内堀健,須原宏造,千葉佐保子,土屋公威,藤江俊秀,玉岡明洋,坂下博之,稲瀬直彦
気管支学 : 日本気管支研究会雑誌 35(2), 150-155, 2013-03-25
背景.肺癌での気管・気管支食道瘻の発生頻度は非常に稀とされている.治療としては食道ステント・気管ステントを選択されることが多いが,明確な治療指針は示されていない.症例. 62歳女性.湿性咳嗽を主訴に近医を受診.胸部CTにて肺癌を疑われ,精査により肺扁平上皮癌と診断された.腫瘍による気道の高度狭窄のため閉塞性肺炎の合併を認め,抗菌薬併用のもと放射線化学療法を開始した.治療開始5週で腫瘍の著明な縮小を …
NAID 110009597486

Related Pictures

★リンクテーブル★

リンク元	「肺膿瘍」「phlegm」「痰」
拡張検索	「sputum cytology」

「肺膿瘍」

Abnormal sputum
	Cocci-shaped Enterococcus sp. bacteria taken from a pneumonia patient.
Classification and external resources
Specialty	Pulmonology
ICD-10	R09.3
ICD-9-CM	786.4

　　[★]

英: lung abscess, pulmonary abscess

概念

肺化膿症の一つで、広義の肺炎である。　→　肺化膿症と同義に使われている印象がある。
肺実質の壊死を来たし、膿瘍・空洞を形成する。
ニボー像が特徴的

病原体

嫌気性菌が最多。
黄色ブドウ球菌、クレブシエラ、大腸菌、緑膿菌も原因となる。

治療

薬物療法：病原体が特定されれば感受性のある抗菌薬を、不明であれば広域スペクトルの抗菌薬を用いる(セフェム系抗菌薬、クリンダマイシン、カルバペネム系抗菌薬)
外科療法：難治例に対して空洞切開術、肺葉切除

USMLE

Q book p.289 8
A patient develops an acute febrile illness with shivers, nonproductive cough, and pleuritic chest pain. Five days later, he presents to the emergency department after abruptly having "cough up" nearly a cup of blood-stained sputum.