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.
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.
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
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
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)
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.
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.
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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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