Investigation

Seminar
Sputum ExamiNAtion
By
Dr.Ajay Chavan

04/12/09 1
Objective
 Production of Sputum .
 Collection of sample.

04/12/09
 Examination –

Ø Macroscopic .
Ø Microscopic .
 Conclusion .


2
PRODUCTION OF SPUTUM
 Sputum is produced by a spontaneous
deep cough bringing up material from

04/12/09
small airways and alveoli.
 Sputum is basically a product of secretions
of mucous glands & goblet cells in the
bronchial wall. It's the cellular material
from the respiratory tree.
 95% water,5%solids 3
COLLECTION OF SPECIMEN
1.Before collecting or expectorating sputum
the mouth should be prerinsed and this

04/12/09
removes contaminants from oral cavity.
2.For best results early morning freshly
expectorated sputum specimen should
be collected in dry sterile bottle.
 A cough plate is held before the
child’s mouth & the child’s
4
urged to cough.

 CONT ….
 Cough swab method gives the most
representative, non contaminated

04/12/09
sputum sample. Child’s mouth is held
open by using tongue depressor.
Material expelled from Trachea is
deposited on the swab, which can then
plated on the appropriate culture
media.
 In pts who are uncooperative or cannot 5

produce adequate sputum, induction

 04/12/09
6

 DIFFERENT SPUTUM CONTAINERS

 04/12/09
SPUTUM IN THE CONTAINER 7
EXAMINATION
 Specimen should be collected in a sterile,
disposable , impermeable container.

04/12/09
 Transfer specimen in sterile petridish placed
against dark background.
 Wooden applicator sticks can be used to
spread it thinly & can be seen by naked
eye or by using lens.
8
 CONT ….
A.MACROSCOPIC OR BEDSIGHT

04/12/09


B. MICROSCOPIC OR IN LABORATERY


9
MACROSCOPIC
 VOLUME-
A 24 hr volume of sputum is measured in

04/12/09


pt with chronic bronchitis, lung abscess or

bronchial asthma. A rising volume indicates
worsening & decreasing volume indicates
improvement.



10
 CONT ….
 COLOUR-

ØWatery or Frothy = pulmonary oedema

ØGreen= Early stage of T.B.

04/12/09
ØYellow= Brochiectasis
ØBlood in sputum= T.B., Ca of lung
ØPink= lung oedema
ØWhite= mucoid
ØBlack= excess ‘C’in respiratory track
ØRusty= lobar pneumonia (Streptococcal) 11

Ø
 CONT….
 ODOUR-

04/12/09
ØNormal sputum is odorless
ØSuppurative smell= pulmonary
disorders
ØFecal odour= liver abscess
ØIntolerable smell= gangrene of lungs
12
 CONT ….
 VISOSITY-
Ø Mucoid sputum has high viscosity

04/12/09
Ø Purulent sputum has low viscosity
Ø Mucopurulent has intermediate viscosity

13
 CONT ….
 APPEARANCE-

04/12/09
ØSerous frothy= bronchioalvolar CA
ØNummular sputum= pulmonary TB
ØThick viscid sputum= asthma
ØThin watery sputum= pulmonary
oedema
14
MICROSCOPIC
 After macroscopic examination
transfer material to a clear slides.

04/12/09
 Smears made on clear slides should be
air dried, fixed over flame and
stained.
 Then examine under the microscope.

15
 04/12/09
16
 SPUTUM SLIDE
 CONT ….
 Diff stains used:-

ØGram’s stain/ Ziehl-Neelsen stain = for

04/12/09
AFB
ØWright’s stain= for blood cells
ØBuffered crystal violet= for epithelial
cells
ØPap’s stain= cytology of sputum 17

ØUsual peripheral smear stain= for

 Gram’s Stain

Smear the sputum
Stained by

Gentian violet stain 

04/12/09
Keep for 3 min.

Bacteria get violet colour
Pour

Gram’s Iodine
For 1 min.

Wash with Alcohol

Wash with water and dry

Mount under oil immersion
18
04/12/09
19
 Zie hl Nie lse n's 
Stain
Smear the sputum
Fixed by Heating

Pour carbol fuchin and heat it from below
Keep for 5 min.

04/12/09
Wash with water

Decolorize with 20%H2SO4
Wash with

Loffler's methyene blue for 1 min.
Wash &dry

Mount under oil immersion

20
SPUTUM CULTURE
 Each specimen received for culture
should be plated on agar.

04/12/09
 Diff agars:-

ØBlood agar
ØChocolate agar
ØMacConkey’s agar
ØThioglycollate broth
o 21
04/12/09
22
Classical References
 Pitavarna ,Kaphasthibana – Pittaj Kasa.
 (Ch.chi. 18\14)

04/12/09
 Madhur Snigdha Ghana – Kaphaj Kasa.
 (Ch.Chi. 18\17)
 Pita Shava Sashonita – Kshataja Kasa.
 (Ch.Chi 18\19)

23
 CONT ….
 Duraghanda Harita – Kshayaja Kasa
 Rakta Puyamapi (Ch.Chi. 18\25)

04/12/09
 Shonita Drashana (Raktasthibana) –
Rajayakshama.
 (Ma.Ni.Rajayakshama \
2,6,7)
 Shonita Shleshamana Chardi – Ekadasha
rupa of
Rajayakshama.
 (Ch.Chi.8\43) 24
Conclusion
 Sputum sample are easily obtained is the
advantage.

04/12/09
 Sputum have cellular contain which
represented the entire Respiratory tract.

25
REFERENCES
 Chamberlain’s symptoms & signs in clinical
medicine

04/12/09
 Medical laboratory technology-Dr. Sood

 Index of differential diagnosis

 Harrison’s Internal Medicine

 Text book of pathology- Harsha Mohan

 Hutchison’s

 Charka Sahita Chikastastana

 Madava Nidana

 www.Scribed.com

 26


 04/12/09
Thank
You
27