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Layman looking for advice

webeyes sr at kaysi.freeserve.co.uk
Wed Jul 17 10:09:59 EST 2002


thankyou very much for your prompt reply.  I will check out those sites
"JEDilworth" <bactitech at nospamhortonsbay.com> wrote in message
news:3D358740.D44D3FE2 at nospamhortonsbay.com...
> 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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