Leukocytes

Question

Hello,
my daughter, 11-years-old, suffers from CF and has for a few months much more mucus. The last three sputum samples were free of germs. However, our doctor asks all the time, if it had been a real good sputum. I always pay attention to the fact, that there is really mucus in it and not only saliva. Every time there is a yellowish plug in it. Also if she spits it out, it is yellow. He says that he asks this because there are no leukoytes in it. Could you tell me what this means if there are no leukocytes in the sputum?
I thank you very much in advance,
J.C.

Answer

Dear Mrs C.,

increased mucus in case of CF does always mean: increased bronchial reaction. That could sometimes be due to a bacterial infection. Then the mucus is more or less colored. If it is brownish, we have always to think about an interaction with mould fungi.

If now the mucus is light and rather clear, it could also be an allergic reaction, e.g. a pollen allery. Also in case of CF an allergy can be underlying. If the sputum is free of germs, this can mean, that indeed there is no bacterial infection, probably because the antibiotic therapy is effective. Theoretically and practically germs can induce reactions in the deeper parts of the lung. Then one would have to do e.g. a bronchoscopy or organize an induced sputum. This has to be discussed with the CF center.
A yellowish plug can in case of good clinical condition also be only muzine as mucus, that is released increasingly in case of CF.
Leukocytes in the sputum mean an increased responsiveness against an inflammation. The leukocytes are the health police. In case of CF, generally many leukocytes are present in the bronchial system. That is also the indication for rh-DNAse, that should resolve the viscous bronchial mucus that is composed of degradation products of the leukocytes.
Best regards,
Dr. H.-E. Heuer

28.07.2014