Sputum examination for pneumonia

Causes and treatment of sputum in case of pneumonia

Sputum for pneumonia, bronchitis and bronchial asthma, its analysis allows you to identify the cause of the disease, its nature, stage, so that treatment in the future was correct and effective. The tactics of treatment through this microbiological study are more effective, in contrast to the empirical method of treatment, is directed at a particular patient, becomes less expensive and of high quality.

Why does cough often go away with phlegm

Coughing is a reflex that works at the time of sputum excretion, other foreign particles from the patient's breathing pathways.The appearance of cough is promoted by a variety of diseases, so before treatment it is important to determine the cause of its occurrence, the nature, the color of sputum.Sputum is a secret between the trachea and the lungs.

With pneumonia, the discharge is pathological in nature, the serous purulent fluid begins to form from the nose, sometimes with impurities of blood. Mucus is secreted by the respiratory tract, and this is normal when the air that is moved, sometimes infected and enriched with microbes, gets into the body, meets a barrier, a flap in its path. The mucus contains immune cells, which immediately come into contact with them when they collide with microbes.

Coughing is not a separate disease, it is rather a reaction to the disease, a symptom, as a result of contractions of the muscles of the respiratory tract and irritation of their receptors. The respiratory system is designed so that the cleansing from the mucus is carried out by cilia, located inside the bronchi. Cilia move and clean bronchi.

In a healthy person, mucus is produced up to 100 ml per day. If the respiratory organs have undergone pathology, the produced mucus sharply increases in volume up to 1500 ml per day, can be of different color and composition.

What does sputum color mean?

With pneumonia, the discharge is pathological in nature, the serous purulent fluid begins to form from the nose, sometimes with impurities of blood. Mucus is secreted by the respiratory tract, and this is normal when the air that is moved, sometimes infected and enriched with microbes, gets into the body, meets a barrier, a flap in its path. The mucus contains immune cells, which immediately come into contact with them when they collide with microbes.

Coughing is not a separate disease, it is rather a reaction to the disease, a symptom, as a result of contractions of the muscles of the respiratory tract and irritation of their receptors. The respiratory system is designed so that the cleansing from the mucus is carried out by cilia, located inside the bronchi. Cilia move and clean bronchi.

In a healthy person, mucus is produced up to 100 ml per day. If the respiratory organs have undergone pathology, the produced mucus sharply increases in volume up to 1500 ml per day, can be of different color and composition.

How is cough with sputum treated?

Before treating a cough, you need to establish the cause of its occurrence, pay attention to the type of cough, dry or with the separation of sputum. Pneumonia is not treated at home. Sputum is taken for analysis for laboratory research, determining the clinic of the disease, as well as taking into account individual characteristics patient for the subsequent appointment of a medical course, prevention of side effects from the wrong drug treatment.

With a wet cough and sputum, the patient is recommended bed rest, plenty of drink, phytopreparations. Destinations include antibiotics; bronchodilator, enveloping, expectorant drugs; drugs designed to reduce mucosal irritation.

Useful inhalation with the use of chloride, sodium benzoate, ammonium chloride, plant extracts. It is important to moisten the mucous membrane, dilute sputum, strengthen its passage, relax the smooth muscles of the bronchi. In addition, the above drugs are considered excellent anesthetics and analgesics for throat swelling, difficulty in swallowing caused by persistent cough.

Steam inhalations are shown, but children under 1 year of age are not recommended for use, with the existing CNS lesions it is impossible to take thermopsis, ipecacuan: they lead to vomiting. In infants, vomiting when coughing can lead to aspiration, asphyxia.

Pneumonia is treated medically, prescribed medications consist of:

1. Expectorants that facilitate fast and easy separation of sputum, reduce its viscosity.
2. Mucoregulating drugs: acetylcysteine, bromhexine, carbocysteine, ambroxol, which restore the viscosity of mucus, will contribute to its rapid elimination. You can not take carbocysteine, bromgexidine, acetylcysteine ​​with exacerbation of bronchial asthma: this leads to spasms of the bronchi, which is very dangerous for the general condition of a person.
3. Mucolytic agents that promote the stabilization of secretions from the bronchi, improve mucus clearance. Mucolytics are similar to ATSTS, are prescribed for pathological processes occurring in the trachea, lungs or bronchi of the patient, as well as children from 1 to 3 years.
4. Antihistamines, if the cause of the cough was allergies. Loratadine, fexofenadine will quickly eliminate unpleasant symptoms, sputum will depart faster. Reflex agents for cough with sputum are thermopsis, marshmallow, licorice, essential oils, which, falling in the stomach, act irritatingly on it, and the mucous and salivary glands begin to work faster and more actively.

Cough without phlegm

Pneumonia, as a rule, proceeds with an increase in temperature, because the disease is infectious, caused by the ingestion and development of microbes into the bronchi and mucous membranes.

If there is a cough and there is no temperature, then you can suspect:

• venereal disease;
• heart failure;
• an allergic reaction to an object;
• respiratory disease;
• exposure to mucous toxins from outside.

Often, especially in the mornings, a cough can be provoked by ticks that attacked the feather pillows. Coughing is inevitable when smoking. If you cough without a temperature, you need to increase fluid intake, sputum will become less viscous, it will be faster to get out of the airways. Reception of antibiotics should not be independent and spontaneous, nevertheless about their reception it is better to consult with a doctor, many of them have contraindications, have a harmful effect on other, healthy organs.

What to do if a cough with phlegm does not go away

If all the above-described methods of treatment did not succeed, the cough does not stop, the unpleasant, fetid, incomprehensible color of sputum leaves, then a number of additional examinations should be performed. The doctor can appoint:

• Mantoux test (in young children);
• bakposev on the study of sputum flora;
• analyzes for the presence of chlamydia, mycoplasma;
• X-ray for examination of the patient's chest.

Postural drainage or special exercises will release respiratory organs from sputum, clear of accumulated mucus.

The patient needs to lie on his back, without a pillow, turn slowly around his axis by 45 degrees, breathe with full chest. Repeat the procedure 6-8 times. Mucus is activated, rises to the larynx, and it will remain spit.

Get on your knees, bend the trunk back and forth, and so 6-8 times.

Lie on your side closer to the edge of the bed, hanging up to the maximum forward of the upper body. Make 4-6 slopes. The procedure should be repeated 5-6 times a day.

Diagnosis of pneumonia is not difficult. Listening and X-rays will show her presence or absence. It is much more difficult to establish a pathogen of pneumonia.

If pneumonia is not particularly brutal and proceeds without complications, then recovery is possible in 3-4 weeks.

With such a pneumonia, you can be treated at home, following the recommendations of a doctor. But no self-medication, treatment should take place only under the supervision of a doctor. Be healthy!

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Microscopic analysis of sputum

Microscopic examination of native and fixed stained sputum preparations allows for a detailed study of its cellular composition, and to a certain extent reflecting the nature of the pathological process in the lungs and bronchi, its activity, to reveal various fibrous and crystalline formations, also having an important diagnostic value, and, finally, tentatively assess the state of the microbial flora of the respiratory tract (bacterioscopy).

At a microscopy use native and painted preparations of a sputum. To study the microbial flora (bacterioscopy), sputum smears are usually stained by Romanovsky-Giemsa, according to Gram, and for the detection of Mycobacterium tuberculosis, but Cilu-Nielsen.

Cellular elements and elastic fibers

Of the cellular elements that can be detected in the sputum of patients with pneumonia, epithelial cells, alveolar macrophages, leukocytes and erythrocytes are of diagnostic importance.

Epithelial cells. Flat epithelium from the oral cavity, nasopharynx, vocal folds and epiglottis has no diagnostic value, although the detection of a large number of cells flat epithelium, as a rule, indicates a low quality of sputum specimen delivered to the laboratory and containing a significant admixture of saliva.

In patients with pneumonia, sputum is considered suitable for investigation if, with a microscopy with a small increase, the number of epithelial cells does not exceed 10 in the field of vision. A larger number of epithelial cells indicates an unacceptable predominance of oropharyngeal contents in the biological sample.

Alveolar macrophages, which in a small amount can also be found in any sputum, are large cells reticulohistiocytic origin with an eccentrically located large nucleus and abundant inclusions in the cytoplasm. These inclusions can consist of macrophage-absorbed tiny dust particles (dust cells), leukocytes, and the like. Number of alveolar macrophages is increased in inflammatory processes in the pulmonary parenchyma and the airways, including pneumonia.

Cells of cylindrical ciliated epithelium lining the mucous membrane of the larynx, trachea and bronchi. They look like elongated cells, widened at one end, where the nucleus and cilia are located. Cells of cylindrical ciliated epithelium are found in any sputum, however their increase indicates about damage to bronchial mucosa and trachea (acute and chronic bronchitis, bronchiectasis, tracheitis, laryngitis).

Leukocytes in small amounts (2-5 in the field of vision) are found in any sputum. When inflammation of the lung tissue or bronchial mucosa and trachea, especially when suppuration (gangrene, lung abscess, bronchiectasis), their number is significantly increased.

When staining sputum preparations according to Romanovsky-Giemsa, it is possible to differentiate individual leukocytes, which sometimes has an important diagnostic value. Thus, with pronounced inflammation of the lung tissue or bronchial mucosa increases as the total number of neutrophilic leukocytes, and the number of their degenerative forms with fragmentation of nuclei and destruction of the cytoplasm.

An increase in the number of degenerative forms of leukocytes is the most important sign of the activity of the inflammatory process and the more severe course of the disease.

Erythrocytes. Single erythrocytes can be detected practically and any sputum. A significant increase is observed when vascular permeability is impaired in patients with pneumonia, with destruction of lung or bronchial tissue, stagnation in a small circle of blood circulation, a lung infarction, etc. In a large number of red blood cells in sputum are found during hemoptysis of any genesis.

Elastic fibers. One more element of sputum plastic fibers that appear in sputum when destruction of lung tissue (lung abscess, tuberculosis, disintegrating lung cancer, etc.) should also be mentioned. Elastic fibers are presented in sputum in the form of thin two-contour, crimped filaments with dichotomous division at the ends. The appearance of elastic fibers in sputum in patients with severe pneumonia indicates the occurrence of one of the complications of the disease - abscessing of lung tissue. In some cases, in the formation of lung abscess, elastic fibers in sputum can be detected even slightly earlier than the corresponding radiographic changes.

Often, with croupous pneumonia, tuberculosis, actinomycosis, fibrinous bronchitis in sputum preparations, thin fibrin fibers can be detected.

Signs of an active inflammatory process in the lungs are:

1. the nature of sputum (mucopurulent or purulent);
2. an increase in the number of neutrophils in sputum, including their degenerative forms;
3. an increase in the number of alveolar macrophages (from single clusters of several cells in the field of view and more);

The appearance in the sputum of elastic fibers indicates the destruction of lung tissue and the formation of lung abscess.

The final conclusions about the presence and degree of activity of inflammation and destruction of lung tissue are formed only when they are compared with the clinical picture of the disease and the results of other laboratory and instrumental methods of investigation.

Microbial flora

Microscopy of sputum smears, stained by Gram, and study of microbial flora (bacterioscopy) in some patients pneumonia allows tentatively to establish the most likely causative agent of pulmonary infection. This simple method of express diagnostics of the pathogen is not accurate enough and should be used only in combination with other (microbiological, immunological) methods of sputum examination. Immersion microscopy of stained smears is sometimes very useful for emergency selection and administration of adequate antibiotic therapy. However, one should keep in mind the possibility of contamination of the bronchial contents of the microflora of the upper respiratory tract and oral cavity, especially when sputum collection is incorrect.

Therefore, sputum is considered suitable for further investigation (bacterioscopy and microbiological examination) only if it meets the following conditions:

• Gram staining in sputum reveals a large number of neutrophils (more than 25 in the field of view with a small magnification of the microscope);
• The number of epithelial cells, more characteristic of the contents of the oropharynx, does not exceed 10;
• in the preparation there is a predominance of microorganisms of the same morphological type.

When painting on Gram in a smear of sputum, it is sometimes possible to identify well enough gram-positive pneumococci, streptococci, staphylococci and a group of gram-negative bacteria - klebsiella, Pfeiffer's stick, E. coli, etc. In this case, Gram-positive bacteria acquire a blue color, and Gram-negative bacteria - red.

Bacterial pathogens of pneumonia

Gram-positive	Gram-negative
Pneumococcus Streptococcus pneumoniae. Streptococcus Streptococcus pyogenes, Streptococcus viridans. Staphylococci: Staphylococcus aureus, Staphylococcus haemolyticus.	Klebsiella pneumoniae Hemophilus influenzae (Pfeiffer) Haemophilius influenzae Pseudomonas aeruginosa Legionnella (Legionella Pneumophilia) E. coli (Escherichia coli)

Preliminary sputum smear is the simplest way to verify the causative agent of pneumonia and has definite implications for the selection of optimal antibiotic therapy. For example, when detected in smears stained Gramm, loud-positive diplococci (pneumococci) or staphylococcus instead of broad-spectrum antibiotics that increase risk of selection and spreading of antibiotic-resistant microorganisms, it is possible to prescribe targeted therapy active against pneumococci or staphylococci. In other cases, the detection of the predominant Gram-negative flora in smears may indicate that the causative agent of pneumonia is Gram-negative enterobacteria (klebsiella, E. coli, etc.), which requires the appointment of appropriate targeted therapy.

True, an approximate conclusion about the likely causative agent of pulmonary infection with microscopy can only be done based on a significant increase in bacteria in sputum, in a concentration of 106- 107 m.k / ml and more (LL Vishnyakova). Low concentrations of microorganisms (<103 m.ks / ml) are characteristic for the accompanying microflora. If the concentration of microbial bodies varies from 104 to 106 m.ks / ml, this does not exclude the etiological role of this microorganism in the onset of pulmonary infection, but it does not prove it.

It should also be remembered that "atypical" intracellular pathogens (mycoplasma, legionella, chlamydia, rickettsia) do not stain Gramm. In these cases, suspicion of having an "atypical" infection can occur if smears are found in smears dissociation between a large number of neutrophils and an extremely small number of microbial cells.

Unfortunately, the method of bacterioscopy is generally quite low in sensitivity and specificity. Not predictive value, even for well-visualized pneumococci, barely reaches 50%. This means that in half the cases the method gives false positive results. This is due to several reasons, one of which is that about 1/3 of the patients before the hospitalization have already received antibiotics, which significantly reduces the effectiveness of sputum smear-microscopy. In addition, even in the case of positive results of the study, indicating a sufficiently high concentration in the smear of "typical" bacterial pathogens (for example, pneumococci), the presence of co-infection by "atypical" intracellular pathogens (mycoplasma, chlamydia, legionella) can not be completely ruled out.

The method of bacterioscopy of sputum smears, stained by Gram, in some cases helps to verify the causative agent of pneumonia, although it generally has very low predictive value. Atypical intracellular pathogens (mycoplasma, legionella, chlamydia, rickettsia) are not verified at all by the method of bacterioscopy, since they do not stain Gramm.

It should be mentioned the possibility of microscopic diagnosis in patients with pneumonia of fungal lung infection. The most relevant for patients receiving long-term treatment with broad-spectrum antibiotics is the detection of microscopy of native or stained sputum preparations of Candida albicans in the form of yeast-like cells and branched mycelium. They indicate a change in the microflora of the tracheobronchial contents, which occurs under the influence of antibiotic treatment, which requires a substantial correction of therapy.

In some cases in patients with pneumonia, there is a need to differentiate the existing lung disease with tuberculosis. For this purpose, the color of the sputum smear is used according to Tsiol-Nielsen, which in some cases makes it possible to identify mycobacteria tuberculosis, although the negative result of such a study does not mean that the patient does not have tuberculosis. When staining sputum according to Tsiol-Nielsen, mycobacterium tuberculosis is colored red, and all other sputum elements are blue. Tuberculous mycobacteria have the appearance of feces, straight or slightly curved sticks of different lengths with separate thickenings. They are located in the preparation in groups or singly. Diagnostic value is the detection in the preparation of even single mycobacteria tuberculosis.

To increase the effectiveness of microscopic detection of mycobacteria tuberculosis use a number of additional methods. The most common of these is the so-called flotation method, in which homogenized sputum shaken with toluene, xylene or gasoline, the drops of which, popping up, capture mycobacteria. After settling the sputum, the top layer is pipetted onto a piece of glass. Then the drug is fixed and stained by Tsilyu-Nielsen. There are other methods of accumulation (electrophoresis) and microscopy of tuberculosis bacteria (luminescence microscopy).

Microscopic examination (analysis) of mucus allows to detect mucus, cellular elements, fibrous and crystalline formations, fungi, bacteria and parasites.

Cells

• Alveolar macrophages are cells of reticulogistocyte origin. A large number of macrophages in sputum is detected in chronic processes and at the stage of resolving acute processes in the bronchopulmonary system. Alveolar macrophages containing hemosiderin ("cells of cardiac defects") are detected with a mild infarct, hemorrhage, stagnation in a small circle of circulation. Macrophages with lipid droplets are a sign of obstructive process in the bronchi and bronchioles.
• Xantom cells (fatty macrophages) are found in abscess, actinomycosis, echinococcosis of the lungs.
• Cells of the cylindrical ciliated epithelium are cells of the mucous membrane of the larynx, trachea and bronchi; their are found in bronchitis, tracheitis, bronchial asthma, malignant neoplasms of the lungs.
• The flat epithelium is detected when spittle enters the sputum, it has no diagnostic significance.
• Leukocytes in one or another quantity are present in any sputum. A large number of neutrophils are detected in mucopurulent and purulent sputum. Eosinophils are rich in sputum in bronchial asthma, eosinophilic pneumonia, glottis lung lesions, and lung infarction. Eosinophils may appear in sputum for tuberculosis and lung cancer. Lymphocytes in large numbers are found in whooping cough and, more rarely, with tuberculosis.
• Erythrocytes. Detection of single red blood cells in sputum is not of diagnostic significance. If there is fresh blood in the sputum, unchanged erythrocytes are determined, if blood spills with phlegm, which was in the airways for a long time, reveal leached red blood cells.
• Cells of malignant tumors are found in malignant neoplasms.

Fibers

• Elastic fibers appear in the decay of lung tissue, which is accompanied by the destruction of the epithelial layer and liberation elastic fibers; they are found in tuberculosis, abscess, echinococcosis, neoplasms in the lungs.
• Coronal fibers are detected in chronic lung diseases, such as cavernous tuberculosis.
• Calcined elastic fibers are elastic fibers impregnated with calcium salts. Detection of them in sputum is characteristic for the breakdown of tubercular petrichitis.

Spirals,crystals

• Kurshman spirals are formed in the spastic state of the bronchi and the presence of mucus in them. During a cough thrust, viscous mucus is released into the lumen of a larger bronchus, twisting in a spiral. Kurshman spirals appear with bronchial asthma, bronchitis, lung tumors, compressing bronchi.
• The Charcot-Leiden crystals are the products of the decay of eosinophils. Usually appear in a sputum containing eosinophils; are characteristic for bronchial asthma, allergic conditions, eosinophilic infiltrates in the lungs, pulmonary flukes.
• Cholesterol crystals appear with abscess, lung echinococcosis, neoplasms in the lungs.
• Crystals of hematoidin are characteristic for abscess and gangrene of the lung.
• Druses of actinomycete are detected in the actinomycosis of the lungs.
• Elements of echinococcus appear with echinococcosis of the lungs.
• Corks Dietrich - lumps of a yellowish-gray color, having an unpleasant smell. They consist of detritus, bacteria, fatty acids, droplets of fat. They are typical for an abscess of lung and bronchiectasis.
• Ehrlich's tetrad consists of four elements: calcified detritus, calcified elastic fibers, cholesterol crystals and mycobacterium tuberculosis. Appears in the decay of the calcified primary tubercular focus.

Mycelium and budding fungal cells appear in fungal lesions of the bronchopulmonary system.

Pneumocystis occurs with pneumocystis pneumonia.

Spherules of fungi are detected in coccidioidomycosis of the lungs.

The ascarid larvae are detected with ascariasis.

Larvae of the intestinal ugristic are identified with strongyloidiasis.

Eggs of the pulmonary fluke are identified with paragonimosis.

Elements found in sputum in bronchial asthma. When bronchial asthma is usually separated by a small amount of mucous, viscous sputum. Macroscopically you can see the Kurshman spiral. When microscopic research is characteristic of the presence of eosinophils, cylindrical epithelium, there are crystals of Charcot-Leiden.

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Blood test for pneumonia

Pneumonia, or pneumonia, is an infectious disease that is characterized by the defeat of various parts of the lungs.The blood test for pneumonia should be taken immediately after the discovery of this disease.

Clinically, this disease can be divided into:

• focal - pneumonia affecting certain parts of the lungs (alveoli and bronchi);
• croupous - in which a whole lobe of the lung is involved in the pathological process.

Inflammation of the lungs is one of the most common diseases of the respiratory system.

Studies show that of the 10, 00 population it is sick about 400 people.

Careful diagnosis is needed to diagnose and prescribe the right treatment. One of the most indicative stages of diagnosis of this disease are general, clinical methods of examination. These include the examination and preparation of an anamnesis of the patient. In addition to a general objective examination, the diagnosis will require laboratory research data. Analyzes for this disease should necessarily include general and biochemical blood tests, urine and sputum analysis. The most important and obligatory laboratory test is a general blood test. Sometimes in the inflammatory process, blood tests are normal. The lack of a blood reaction in this disease suggests that the immune system is weakened, which can not adequately respond to inflammation.

Test results

Consider the results of a blood test for pneumonia. In norm of leukocytes in men and women should be 4-9 × 10 9. Leukocytosis, that is, an increase in the number of leukocytes, is characteristic of most patients and is considered one of the first indicators of the presence of inflammation in the lungs. An exception is pneumonia, caused by chlamydia and mycoplasma.

In the analysis of blood at an acute focal stage, moderate neutrophilic leukocytosis is observed, and in acute lobar pneumonia severe leukocytosis is seen. The leukocyte formula is the percentage of different types of leukocytes.

1. Myelocytes.
2. Metamyelocytes.
3. Stab neutrophils: 1-5%
4. Neutrophils segmented: 40-70%.
5. Lymphocytes: 20-45%.
6. Monocytes: 3-8%.
7. Eosinophils: 1-5%.
8. Basophils: 0-1%.
9. Plasmocytes.

Types of leukocyte formula

With various diseases in the human body, there are 3 main types of changes in the leukocyte formula:

1. Shift of the leukocyte formula to the left (there are myelocytes and metamyelocytes).
2. Shift of the leukocyte formula to the left with rejuvenation (there are myelocytes, metamyelocytes, promyelocytes, myeloblasts and erythroblasts).
3. Shift of the leukocyte formula to the right (the number of stab neutrophils decreases in combination with the presence of hypersegmented neutrophil nuclei).

In acute focal pneumonia, moderate neutrophilic leukocytosis is observed, shifting the leukocyte formula to the left. At an acute lobar form a shift of the leukocyte formula to the left before myelocytes and metamyelocytes is observed, the toxic granularity of neutrophils.

Another important indicator of inflammation is ESR (erythrocyte sedimentation rate). Normally, the erythrocyte sedimentation rate in men is 1-10 mm for one hour, for women - 2-15 mm for one hour. In acute focal pneumonia, ESR increases moderately, but with a fractional disease, a sharp increase in ESR can occur up to 50-60 mm in one hour.

A biochemical blood test is also used to diagnose the disease. In this case, attention is drawn to the presence of fibrinogen and C-reactive protein. The norm of fibrinogen in the body in an adult is kept within the limits of 2 to 4 g per liter, and the norm of the C-reactive protein is 5 mg / l. Increasing the amount of fibrinogen and C-reactive protein is an indicator of inflammation in the body. Thus, in acute pneumonia, there is an increase in the level of fibrinogen and C-reactive protein, as well as sialic acids.

With chronic pneumonia laboratory indicators may vary. In the phase of remission, that is, during the period of the weakening of the disease, the patient's state of health is satisfactory, therefore laboratory indicators may not appear, since there is no inflammatory process. If laboratory indicators are manifested, they are characterized by a slight increase in ESR, as well as moderate leukocytosis with a shift of the formula to the left. There is also an increase in fibrinogen and alpha-2 and gamma globulins.

One of the no less important studies is the study of the gas composition of arterial blood. In severe illness, due to a respiratory disorder, respiratory failure develops, so when examining a gas the composition observed hypoxemia (decrease in oxygen in the blood) and hypercapnia (increase in carbon dioxide content). In this study, the question of the appointment of oxygen therapy to eliminate oxygen deficiency is being solved.

respiratoria.ru

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