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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 Causes


Written 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.

y y y y y y y y y y

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 Symptoms


Written 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 : y y y y y 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. y Chest pain o 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. In milder cases, shortness of breath may only be reported after activity, which is uncharacteristic for the patients usual exercise tolerance. 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 sounds o 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. y y y y y y y Fever and chills Sweating Fatigue Nausea and/or vomiting Loss of appetite Headache Diarrhea (sometimes)

Coughing Up Excessive Phlegm (Mucus, Sputum) from the Throat


Written 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: y 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 y 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: y 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.

y y

Phlegm in Small Children


y y 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 Test


Written 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+ (1150/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) gramnegative 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 culture Low power view.G021 Sputum smear: suitable to culture, > 25 neutrophils, < 10 epithelial cells/lpf; 4+ gram-positive bacilli, 2+ gram-positive cocci/oif Companion 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, 1015 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 gramnegative 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 catarrhalis G23 Sputum smear: suitable to culture, > 25 neutrophils, 10-15 epithelial cells/lpf; 4+ gram-positive bacilli, 2+ gram-positive cocci in pairs/oif Companion 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 sampleM0442 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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