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Layman looking for advice

JEDilworth bactitech at nospamhortonsbay.com
Wed Jul 17 10:03:14 EST 2002


Here are some comments on your posting. Please realize I am NOT a
physician. I have performed mycobacterial cultures in the past, and
currently set them up but have not worked on them over 10 years. Here
are some web sites from Google (there are many others - I just searched
under Mycobacterium chelonei):

http://www.cdc.gov/mmwr/preview/mmwrhtml/00000175.htm

http://www.kfshrc.edu.sa/annals/173/96-242.html

http://path.upmc.edu/cases/case80/dx.html

http://www.postgradmed.com/issues/1997/04_97/cunha_1.htm

http://www.tdh.state.tx.us/ideas/factsht/mycobac.htm


> > Specimen/Site: Sputum Lab No:
> > Details: Collect date: 21/02/2000
> > Authorised by:XXXXXX 23/02/2000 Received: 21/02/2000
> 
> Appearance Mucoid Specimen
> Culture 1. 3+ Normal upper respiratory tract flora
> 
> > Specimen/Site: Sputum for TB Examination Lab No:
> > Details: Collect date: 21/02/2000
> > Authorised by:XXXXXX 12/ 04 /2000 Received: 21/02/2000
> Acid Fast Acid fast bacilli NOT seen
> Culture 1 Microbacterium species
> 2 Culture sent for reference

It should be spelled Mycobacterium species. Obviously this laboratory
does not do its own ID's on mycobacteria. Many don't, as it is a long
process and pretty specialized. Many smaller labs send the isolate to a
reference laboratory, so there's nothing wrong with that.
 
> >
> > Specimen/Site: AFB ID ( MYCOBACTERIA ) Lab No:
> > Details: Collect date: 21/02/2000
> > Authorised by:XXXXXX 15/05/2000 Received :12/04/2000
> Refered to Mycobacterium ref Lab
> Culture 1 Mycobacteriam Chelonei
> 2 This organism is a common enviromental saprophyte

There are many species of mycobacteria. M. chelonei is just that, an
environmental saprophyate. The BIG one you want to worry about, and that
can be classified as MDR or multidrug resistant, is M. tuberculosis
(TB). Have you EVER had a specimen positive for this organism? Other
acid fast organisms can also be implicated in infection. No offense but
are you HIV positive? Other organisms can be important if your immune
status is reduced. It also depends on your chest xray results.
> >
> > Dated 15/05/2000 End of Report
> >
> Note how many weeks this took to become positive.

Acid fast ID sometimes takes weeks. Some of the tests have to be
incubated 10 days or more. Then, if results don't work out, other tests
have to be added, etc. No tech will put their initials on a report
without all their ducks in a row. If there are problems with
identification, sometimes the lab directors must review things. These
take time. Some organisms don't even show up for 4 or 5 weeks, so
obviously subcultures take time also. Don't you mean 2001? Otherwise
you're going backwards in time here.
> 
> From the information given by these three microbiology reports of the same
> sputum :
> 
> Question 1. From the results of this one sputum would you instigate a full
> anti Tuberculosis treatment regime?

That's up to your physician. I'm not a physician, nor do I know anything
else about you.
> 
> Question 2. Could it be inferred that this was a multi drug resistant strain
> of microbacteria chelonei resistant to front line TB medication?

Depends if they did a sensitivity. Depends on a lot of things.
> 
> Question 3.  In context to the above sputum what does "Normal upper
> respiratory tract flora" mean?

If a routine bacterial culture was performed on the same specimen, it
means that nothing other than normal flora grew on the regular bacterial
specimen. Acid fast (mycobacterial) cultures are done separately by a
different methodology.
> 
> Question 4.  In context to the above sputum what does "Common enviromental
> saprophyte" mean?

It means that, in normal context, this organism occurs in the
environment and doesn't necessarily cause disease. However, from the
above URL's, it's becoming known that this organism can cause infections
in certain cases.
> 
> I gave three sputums dated 17th, 18th, 19th April all of which were negative
> and yet by June I was told I was to have my lung removed. I stopped the
> medication in August which consisted of usual front line TB drugs plus
> ciprofloxacin 1000mg + clarithromycin 1000mg totalling 18 tabs per day. The
> doctor however still insists I have chelonei and it is a matter of time
> before I appear at hospital with symptons. This was over two years ago. Can
> this be so? ANY help or advice would be helpful. I need to know asap. Please
> answer my via my email if possible.

Can you get a second opinion - preferably from an infectious disease
doc?

Judy Dilworth, M.T. (ASCP)
Microbiology



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