Sputum Information and Courses from MediaLab, Inc.

These are the MediaLab courses that cover Sputum and links to relevant pages within the course.

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CLIA Microbiology / Serology Review
Recovered from a sputum sample, this suspicious form measures 112 micro meters by 55 micro meters.	View Page
Which of the following specimens is the most sensitive for detecting active CMV infection:	View Page

Current Topics in Clinical Microbiology
Acute Onset Pneumonia A 70-year-old transient with productive cough, pleuritic chest pain radiating to the mid back, fever, and chills was seen in the emergency room. Expectorated sputum was sent to the laboratory for gram stain and culture. (Continue on next page)	View Page
The patient was admitted to the hospital. The sputum specimen was inoculated to sheep blood agar. Based on the colony morphology seen in the accompanying photograph, the most likely identification is:	View Page

Mycology: Hyaline and Dematiaceous Fungi
Based on the structures observed in this photomicrograph, the most probable species of the fungus recovered from an induced sputum specimen is:	View Page
The fungus illustrated in this photomicrograph was recovered from an induced sputum specimen from a 74 year old man with chronic obstructive pulmonary disease. This isolate is most likely:	View Page
An Aspergillus species was recovered from a sputum specimen of a patient with X-ray evidence of fungal pneumonia. Microscopic examination did not permit a species identification. A small amount of vegetative mycelium was removed and a direct mount prepared. The features indicated by the red arrows in this image are associated with which Aspergillus species?	View Page

Mycology: Yeasts and Dimorphic Pathogens
The colonies shown in the upper image were obtained on blood agar from a sputum specimen after 10 days incubation at 30°C. The lower image is a photomicrograph of a lactophenol blue mount made from a portion of the colony. The diagnosis is:	View Page
The growth of the colonies shown in the upper image was obtained on blood agar from a sputum specimen after 8 days of incubation at 30°C. The lower image is a photomicrograph of a lactophenol blue mount made from a portion of the colony. The diagnosis is:	View Page

Reading Gram Stained Direct Smears
Cellular elements The gram stain reaction and appearance can be used to identify most cellular material seen in a direct smear. Identification of cellular elements present in a direct clinical smear is important because most of these elements play an important role in the disease process. For example, the quality of a sputum sample can be assessed by determining the relative numbers of squamous epithelial cells and polymorphonuclear leukocytes (segmented neutrophils) present.	View Page
Significance of Specific Findings: Epithelial cells in large numbers within sputum smears means that the specimen is predominantly oral saliva, rather than true sputum from the lung. Epithelial cells in urine smears indicate that the sample has been contaminated by organisms found on the vulva or distal urethra. Bacteria found near or on epithelial cells are usually normal contaminating bacterial flora.White blood cells indicate inflammation and possible infection. The direct smear examination should focus within and around these cells.Red blood cells in a direct smear are not usually significant.Yeast may be present as normal flora in upper respiratory tract or genital tract. They may be significant if they predominate, or if budding yeast forms are seen.Hyphae are more likely to indicate the presence of fungal infection, but this determination requires correlation with clinical findings.Bacteria found in spinal fluid, blood, tissue and specimens from other sterile sites are always significant.Body fluids which are normally sterile must be examined carefully. If only one organism per oil immersion field is identified, then there are about 105 organisms per mL present in the sample! Bacteria observed in specimens from the throat, genital tract and other areas containing normal flora suggest infection only if their composition and type varies significantly from the norm.	View Page

Tuberculosis Awareness for Healthcare Workers
Symptoms Symptoms of active TB include:coughing for more than 3 weeks,loss of appetite,unexplained weight loss,night sweats,bloody sputum,hoarseness,fever,fatigue,and chest pain.	View Page
Procedures with Increased TB Risk Some procedures increase the potential for TB risk because they create aerosols. They include: Sputum induction and aerosol treatments Bronchoscopy Endotracheal intubation and suctioning Autopsy Microbiology processing TB specimens Surgical drainage of TB abscesses	View Page

White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions

Case History 2

An 80 year old man was seen in the emergency room with sudden onset of right sided chest pain accentuated on inspiration. His cough was productive of yellow sputum, and he was short of breath.His temperature was 101.2F. A chest X-ray revealed right middle lobe pneumonia. His hemoglobin was 15.2 gm/dl, HCT 44%, and RBC 4.5 m/ml. The white blood count was 35,000/cuml, with 45% neutrophils, 20% bands, 5% lymphocytes, 3% eosinophils, 2% basophils, and 25% atypical monocytes as noted in the photograph.The atypical monocytes had abundant blue-grey cytoplasm with a few scattered vacuoles, which, in company with toxic neutrophils appeared to be a response to infection.The patient had a past history of tuberculosis which may account for the monocytosis.

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