A sputum sample from a patient with suspected Streptococcus pneumoniae shows WBCs >25 per LPF, epithelial cells 10-25 per LPF, and mucus. How should you proceed?

Prepare for the CAMLPR Specimen Collection Competency Test. Practice with diverse question sets including multiple-choice and flashcards. Each question includes hints and explanations to help you become proficient before the exam.

Assess specimen quality by looking at squamous epithelial cells and white blood cells. A good sputum sample from the lower respiratory tract should have few epithelial cells and many neutrophils. Many epithelial cells mean contamination with oral/mucosal secretions, which can mask or distort culture and smear results for a lower airway infection. Here, epithelial cells are present (10–25 per LPF) alongside many WBCs and mucus, which raises concern for salivary contamination. Because the specimen may not reflect the true lower airway flora, the best next step is to reject it and obtain a repeat sputum sample collected properly (for example, early morning deep-cough sputum after mouth rinsing). Once a higher-quality specimen is obtained, proceed with culture and Gram stain to identify Streptococcus pneumoniae. Cytology isn’t helpful for this bacterial diagnosis, so sending for cytology isn’t indicated.