[Sputum viscosity and sputum viscosimetry. Sputum viscosimetry with bronchosecretolytics].
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Three sputum-digesting agents, N-acetyl-l-cytseine, dithiothreitol, and pancreatin-trypsin, were shown to be equally effective in allowing for the isolation of Cryptococcus neoformans from sputum samples in quantitative comparisons. By quantitative plating on bird-seed medium it was also shown the centrifugation after digestion concentrated C. neoformans into a platable sediment and, further, that the organisms, when present in concentrations as low as 10 yeasts per ml. of sputum, could be isolated with much higher frequencies than when no digestion-centrifugation procedure was used.
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Growing evidence suggests that eosinophils play an important role as proinflammatory cells in asthma, possibly by releasing toxic cationic proteins. In this study concentrations of serum and sputum eosinophil cationic protein (ECP) from 134 patients with productive cough and a history suggestive of airflow obstruction were measured by radioimmunoassay. Small sputum volumes were suspended in saline, vortexed, and centrifuged and ECP measured in the supernatant. Serum ECP levels ranged from 0.002 to 0.095 mg/L (0.016 +/- 0.0014), whereas sputum ECP concentrations were between 0.024 and 5.66 mg/L ECP per g sputum (0.878 +/- 0.092). Only 17 of the 134 patients (14 asthma, one cystic fibrosis, one bronchiectasis, and one bronchitis) had not been pretreated with corticosteroids. Sputum but not serum ECP levels of the 14 patients with asthma were inversely correlated with impairment of FEV1 (r = -0.73). Airway resistance (Raw) (r = 0.71) as well as the change in FEV1 (r = 0.79) and Raw (r = 0.84) after inhalation of 0.2 mg albuterol were positively correlated. This relationship was not observed in the remaining 117 patients on topical and/or systemic corticosteroids, suggesting that corticosteroid treatment influences sputum ECP levels. Also, sputum ECP levels and the degree of sputum eosinophilia were not correlated in any of the patient groups. Neither did serum ECP levels predict sputum ECP concentrations. We conclude that sputum ECP concentrations serve as a marker of eosinophil degranulation in the sputum, and this marker correlates with airflow obstruction. Sputum ECP levels are more closely related to lung function parameters than serum ECP concentrations and/or microscopic sputum analysis.
Immunoglobulin levels and precipitating antibody against a range of microbial antigens were measured in simultaneously collected serum and sputum samples from patients with chronic bronchitis (11), cystic fibrosis (9), bronchiectasis (9), and asthma (4). Sputum was prepared by dialysis and high-speed centrifugation methods. Results showed that it was possible to detect precipitating antibody in the sputum, and the rate was increased when both methods were used. A discrepancy was noted between the detection rate in the sputum and serum. This, combined with the lack of correlation between sputum and serum immunoglobulins, lack of relationship between bronchial inflammation and sputum immunoglobulins, and the lack of IgM in the sputum suggested that the antibody and immunoglobulin were locally produced. Sputum IgA (7S) in patients with chronic bronchitis was significantly lower (P less than 0-05) than that found in patients with cystic fibrosis and bronchiectasis. Significant differences (P less than 0-05) were also noted in serum IgG levels between patients with chronic bronchitis, bronchiectasis, and cystic fibrosis while serum IgM levels in patients with chronic bronchitis were significantly lower (P less than 0-05) when compared to serum levels in patients with cystic fibrosis. The presence of precipitating antibody in the sputum raises the possibility that type III reactions may be important in the pathogenesis of these conditions.
Mucus and serum are always present in sputum. The concentrations of their markers were measured in mucoid and purulent sputum from patients with chronic bronchitis, asthma, cystic fibrosis, or bronchiectasis. Differences in the concentrations of both mucous and serum glycoproteins were greater among different macroscopic types of sputum than among diseases for the same macroscopic type. Comparison between diseases showed that sputum from patients with asthma had the widest variation in concentrations of markers of mucous glycoprotein and dry macromolecular weight. When the asthma group was further analyzed, it became apparent that patients with extrinsic asthma without chronic bronchitis represented a homogeneous group, whereas those with intrinsic asthma, with or without chronic bronchitis, were responsible for the wide variation. The concentrations of markers of mucous and serum glycoproteins in a sputum sample were correlated with the apparent viscosity of the sputum to establish the relative contribution of the glycoproteins to the viscosity of sputum. In mucoid sputum, the mucous glycoprotein was most important in determining the viscosity, whereas when in infected sputum, both mucous and serum components contributed to the viscosity.
Among a total of 114 cases of resected lung adenocarcinoma that were examined by sputum cytologic study before bronchoscopy, 17 were sputum cytology-positive, but had no abnormal bronchoscopic findings. In most of these cases, the reason for detection was sputum and bloody sputum (58.8 percent). Pathologically, many cases were classified as stage III A or more (82.4 percent) due to mediastinal lymph node metastases. More than 70 percent of the cases showed vascular invasion. The proportion of well-differentiated cases was also high (52.9 percent). The prognosis of these cases was worse than sputum cytology-negative adenocarcinoma without abnormal bronchoscopic findings and better than sputum cytology-positive adenocarcinoma with abnormal bronchoscopic findings. There was no significant difference between these cases and sputum cytology-negative adenocarcinoma with abnormal bronchoscopic findings. Combined with the bronchoscopic findings, sputum cytologic study is useful for preoperative evaluation of lymph node metastasis and prognosis. This combined approach can provide information necessary to perform sufficient dissection of mediastinal lymph nodes and proper adjuvant therapy in sputum cytology-positive adenocarcinoma cases, even though there are no abnormal bronchoscopic findings.
Serum and sputum sol phase from 23 patients with cystic fibrosis (CF) were examined for occurrence and titres of precipitins against Haemophilus influenzae and Staphylococcus aureus by means of crossed immunoelectrophoresis with intermediate gel. The patients had from four to nine H. influenzae precipitins in serum and in most cases fewer precipitins in sputum, but, on an average, there was no difference between the titres of the antibodies in serum and sputum. Most of the antibodies were cross-reactive with other species, notably those of the Haemophilus genus. S. aureus precipitins were generally found in higher numbers in serum than in sputum, but, on an average, the titre of the precipitins in sputum was higher than in serum. Three of the precipitins were detectable only in sputum and not in serum, and one of these is a S. aureus-specific precipitin. Most of the antibodies were cross-reactive with other species, and these antibodies were often present in sputum in much higher titres than in the corresponding sera. Antibodies against teichoic acid of the S. aureus cell wall could not be demonstrated in sputum, while they were present in 22 sera. The possible role of the local pulmonary humoral immune response in protective immunity and in the pathology of the lung disease in CF is discussed.
Although the Gram stain and culture of expectorated sputum are considered standard methods for the diagnosis of presumptive pneumococcal pneumonia, these methods remain relatively insensitive and nonspecific. We developed an enzyme immunoassay (EIA) for the quantitation of pneumococcal C polysaccharide (PnC) in the sputum of patients with presumptive pneumococcal pneumonia. Of 34 patient sputum samples collected within 24 h of the first radiographic report of pneumonia, 12 grew Streptococcus pneumoniae on culture. By using a cutoff point of 0.5 micrograms of PnC per ml of sputum, all 12 specimens were positive (sensitivity, 100%) by EIA. PnC levels ranged from 1.43 to 57.53 micrograms/ml. Blood samples from 18 of the 34 patients were cultured. S. pneumoniae grew in the culture of a blood sample from one patient, whose sputum also had the highest PnC level. Of 22 sputum samples from patients with pneumonia that did not grow S. pneumonia, two were positive by EIA (specificity, 90.1%). Sputa from both patients had low levels of PnC (2.7 and 4.5 micrograms/ml), and both patients had received antibiotics before sputum collection. The positive predictive value of the quantitative EIA was 85.7%. Quantitation of PnC has the potential for improving the accuracy of sputum examination for S. pneumoniae, monitoring disease severity and the effectiveness of antibiotic therapy, and differentiating between those patients with invasive pneumococcal disease and those who are carriers of S. pneumoniae.
BACKGROUND: Inflammatory and proteolytic activity occurs in sputum from patients with stable purulent bronchiectasis and has been proposed as the main pathogenetic mechanism of the disease. This study was designed to define further the role of inflammation and proteolysis in bronchiectasis. METHODS: Neutrophil elastase activity, sputum concentrations of the serum derived inhibitors alpha 1 antiproteinase and alpha 2 macroglobulin, and the sputum to serum ratios of albumin and C reactive protein concentration were measured in 26 patients with bronchiectasis. RESULTS: Free elastase activity was found in 15 sputum samples. A trend to higher proteolytic and inflammatory activity was found between mucoid and purulent sputum samples, suggesting that inflammatory and proteolytic activities are related to the macroscopic degree of purulence. Purulent sputum had a high sputum to serum ratio of C reactive protein, suggesting local production or active transport of this protein into bronchial secretions. C reactive protein was more sensitive than albumin in detecting a higher degree of inflammation in elastase positive samples. CONCLUSION: The finding of greater concentrations of alpha 2 macroglobulin in purulent and elastase positive samples than in mucopurulent, mucoid and elastase negative sputum samples suggests that this inhibitor may have a role in the proteolysis-antiproteolysis balance in bronchial secretions.