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Examination of Sputum
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Examination of Sputum
Dayyal Dg.
B.Sc., CLT
(C.E.O. and Founder of BioScience Pakistan)
normal saline in order to reduce the amount 1. Direct test: This involves detection
of contaminating normal bacterial flora in of M. tuberculosis or its components
the inoculum. Blood agar plate and 2. Indirect test: This consists of
chocolate agar (heated blood agar) are detection of cellular or humoral
inoculated with the washed sputum. The immune response to tuberculosis
chocolate agar plate is incubated in an infection.
atmosphere of extra carbon dioxide (CO2)
and blood agar plate is incubated Direct tests for the detection of tuberculosis
aerobically. After the incubation for 18 on sputum sample are as follows:
hours, inoculated agar plates are examined
for growth; if growth is not sufficient, 1. Examination of sputum smear
incubation for further 24 hours is indicated. – Ziehl-Neelsen technique
Antibiotics sensitivity test is carried out only – Fluorescence microscopy
if the amount of bacterial growth is 2. Molecular Method
significant. 3. Culture on standard media
4. Commercial automated culture
EXAMINATION OF system
CYTOLOGICAL
EXAMINATION OF
Figure 989.5 BACTEC™ 460TB system
SPUTUM
EXAMINATION OF Cytological examination of sputum is
normally carried out for the diagnosis of
SPUTUM FOR bronchogenic carcinoma. Occasionally, it
ORGANISMS OTHER may also be useful in the identification of
fungi, protozoa, asbestos bodies and viral
THAN TUBERCLE inclusions (like those of cytomegalovirus
BACILLI and Herpes simplex virus).
Further interpretations given below are For cytological examination, early morning
demonstrated when infection by following sputum sample is preferred. For the
organisms is suspected: diagnosis of lung cancer, it is suggested to
collect sputum sample daily for first five
successive days. This method will increase The average sensitivity is about 65% in
the chances of detection of malignant cells sputum examination for detection of
(see Figure 989.7). malignant cells. Sensitivity increases as per
following conditions:
REFERENCES
Figure 989.7 Sputum examination showing malignant cells of
squamous type 1. Thunissen FBJM. Sputum examination
for early detection of lung cancer. J Clin
Sputum sample may be either spontaneously Path 2003;56:805-10.
produced or artificially induced. If the 2. Watterson SA, Drobniewski FA.
patient is not able to expectorate the sputum Modern laboratory diagnosis of
spontaneously, inhaling aerosol of 15% mycobacterial infections. J Clin Path
2000;53:727-32.
sodium chloride (NaCl) and 20% propylene
3. Soini H, Musser JM. Molecular
glycol (C3H8O2) for 20 minutes can induce diagnosis of mycobacteria. Clin Chem
expectoration. This normally results in the 2001;47:809-14.
induction of sufficient sputum sample. 4. Indian Council of Medical Research.
What is new in the diagnosis of
The sputum sample should be sent to the tuberculosis? Part I: Techniques for
laboratory just after the collection without diagnosis of tuberculosis. ICMR
the addition of any fixative. If the sample is Bulletin 2002;32;No 8
to be transported to a remote laboratory,
prefixation of sputum with Saccomano’s
fixative is recommended. This involves
collection of sputum in a mixture of 2%
carbowax and 50% ethyl alcohol.