Sputum expectorated

Long-term inhalation of ipratropium decreases the frequency of cough, severity of cough, and the volume of expectorated sputum. 

Particularly problematic are expectorated sputum specimens that must be evaluated carefully by determination of the presence of squamous epithelial cells and leukocytes. A predominance of epithelial cells in sputum specimens reduces the likelihood that recovered bacteria are pathogenic, especially when multiple types of organisms are seen on Gram stain. In contrast, the discovery of leukocytes in large numbers with one predominant type of organism is a more reliable indicator of a valid collection. In general, however, sputum evaluation has poor sensitivity and specificity as a diagnostic test. ... 

For patients unable to expectorate, sputum induction with aerosolized hypertonic saline may produce a diagnostic sample. Bronchoscopy, or aspiration of gastric fluid via a nasogastric tube, may be attempted in selected patients. For patients with suspected extrapul-monary TB, samples of draining fluid, biopsies of the infected site, or both may be attempted. Blood cultures are positive occasionally, especially in AIDS patients. ... 

In addition to the general symptoms described, the patient with cardiogenic edema also may become extremely anxious, perspire heavily, and expectorate sputum that is frothy and blood tinged. The skin is usually observed to be cold, ashen, and cyanotic as a result of a low cardiac output and increased sympathetic drive (Ingram and Braunwald, 1980). 

Expectorated sputum and tracheal aspirate specimens obtained by direct suctioning through the endotracheal tube in mechanically ventilated patients are easily obtained but notoriously nonspecific in the diagnosis of nosocomial pneumonia. Bartlett et al. prospectively evaluated cultures of expectorated sputum in 67 patients with nosocomial pneumonia whose final diagnosis was based on bacterial studies from uncontamined specimens (blood, transtracheal... 

Bartlett JG, Finegold SM. Bacteriology of expectorated sputum with quantitative culture and wash technique compared to transtracheal aspirates. Am Rev Respir Dis 1978 117 1019-1027. 

Expectorated sputum cultures are not useful in the diagnosis of pneumonia but may help identify the etiological agent and provide useful antimicrobial suscepUbdity data. 

Aderaye, G. Woldeamanuel, Y. Asrat, D. Lebbad, M. Beser, J. Worku, A. Fernandez, V. Lindquist, L. Evaluation of Toluidine Blue O staining for the diagnosis of Pneumocystis jiroveci in expectorated sputum sample and bronchoalveolar lavage from HIV-infected patients in a tertiary care referral center in Ethiopia. Infection 2008, 36, 237-243. 

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