Help understanding culture results

Thanks for taking the time for such a thoughtful response. My symptoms haven't really changed much -- my fatigue is less, I can still walk our mile and half each evening, but shortness of breath continues as does the colored sputum.

As a happenstance, my sister-in-law was visiting last week. She's an OBY_GYN, and although it's surely not her area she read through it all and helped me reframe the questions. I did send them to my Pulmonary doc who gave me a one line reply saying my questions required an appointment. So, I'm waiting for my April 8th appointment. Hoping she'll take the time to help me understand. My first appointment she was double booked and was leaving the country the next day so time was limited. The waiting isn't a big deal to her, but patience isn't my strongest suit. This condition really requires a team approach with support folks like patient educators and respiratory therapists and such that can answer our day to day questions when we really only see the doctor every few months. Thank goodness for this patient driven support group.

I was heartened to see the latest Bronchiectasisand NTM newsletter announcing the development of specialized care centers across the country over the next 3 years. Maybe the increasing prevalence of this condition has finally caught the eye of the drug companies who are funding it.

@jml6812 You're right, these results, your history and your symptoms do raise a lot of questions.

Let's try to address a few of them:
The mucus - those yellow/tan globs COULD be the artifacts left behind by the earlier Pseudomonas infection, which airway clearance is finally removing from deep in your lungs.

The M. Abscessus - a single finding of a "few colonies" does not necessarily mean an active infection - this could have been an incidental finding and the bug failed to "take up residence" due to your airway clearance and/or other antibiotics.

The Pseudomonas - Yes, the newer lab tests (PCR type) show positive or negative for pseudo in a matter of hours, compared to the 3-5 days required by older culture methods.

The AFB/gram stain positive findings vs the negative culture -
AFB stains are used for detecting all forms of acid-fast bacilli, mainly mycobacteria and nocardia. That slide only indicates the presence of any acid-fast bacilli, but does not differentiate among them. Further testing is required to determine which is present.
Not all strains of Mycobacteria (well over 100) are considered pathogenic to humans, and I am not sure how various labs handle reporting them.

I'm not sure whether your doctor will order another sputum culture, but according to my ID doc, the "gold standard" is three sputum samples taken on 3 consecutive mornings and stored in the refrigerator, then brought to the lab. This rules out the potential for accidental contamination of a single sample by atmosphere or touch. Processing 3 samples in the lab also reduces risk of in-lab contamination.

In the mean time, are your symptoms improving?
Sue

Where is this Bronchiectasis and NTM newsletter from? I'd like to see this also. Glad to see you are with this support group. Good solid common sense info here.

Thank you for your post; you sound like you know your microbiology. Two of my most recent cultures yielded nothing of consequence and none of the Pseudomonas avium that showed up two years ago. In the third, a mystery microbe has been growing. Slowly. For more than two months, And there still is not enough of a colony to test. One of my daughters, who worked at Scripps Research Foundation's immunology laboratory, said this is common, but it was a surprise to me. I'm assuming Aspergillus and other rapid-growth critters are now out of the running. My question: Have you heard of any slow growers associated with bronchiecstasis?

@jml6812 You're right, these results, your history and your symptoms do raise a lot of questions.

Let's try to address a few of them:
The mucus - those yellow/tan globs COULD be the artifacts left behind by the earlier Pseudomonas infection, which airway clearance is finally removing from deep in your lungs.

The M. Abscessus - a single finding of a "few colonies" does not necessarily mean an active infection - this could have been an incidental finding and the bug failed to "take up residence" due to your airway clearance and/or other antibiotics.

The Pseudomonas - Yes, the newer lab tests (PCR type) show positive or negative for pseudo in a matter of hours, compared to the 3-5 days required by older culture methods.

The AFB/gram stain positive findings vs the negative culture -
AFB stains are used for detecting all forms of acid-fast bacilli, mainly mycobacteria and nocardia. That slide only indicates the presence of any acid-fast bacilli, but does not differentiate among them. Further testing is required to determine which is present.
Not all strains of Mycobacteria (well over 100) are considered pathogenic to humans, and I am not sure how various labs handle reporting them.

I'm not sure whether your doctor will order another sputum culture, but according to my ID doc, the "gold standard" is three sputum samples taken on 3 consecutive mornings and stored in the refrigerator, then brought to the lab. This rules out the potential for accidental contamination of a single sample by atmosphere or touch. Processing 3 samples in the lab also reduces risk of in-lab contamination.

In the mean time, are your symptoms improving?
Sue

Hello Sue-
I like the idea of sending in three sputum cultures "three sputum samples taken on 3 consecutive mornings and stored in the refrigerator, then brought to the lab".
Questions: How does insurance and or medicare handle this type of submission?
Do you know what lab your sputum cultures go to?
Have an enjoyable weekend.
Barbara

Hi Barbara, It is my understanding that due to the chance it is an "infectious disease" (TB) our clinic send AFB Positive tests to our State Department of Health lab. If mycobacteria are identified there, they were sent to NJH. With recent changes, I think I heard they are sent to a different lab for sensitivity culture. Since this is the best practice protocol, there has been no issue with payment by Medicare and my BCBS supplement.
Have you had issues with payment for cultures?

Sue- Interesting procedure with the chance it is an "infectious disease."
No I haven't had an issue with test submissions, so far.
I am waiting to see if Medicare approves the vest. I am doing it twice a day on a level comfortable for me.
My first sputum tests were done at NJH in October 2023 and it was the three separate days of submission. With my decision to go to Tyler rather than back to NJH, (due to distance/travel) the next sputum test done for submission was not until February 2024. I am waiting for results and hoping for the best.
In giving it thought after your post(s) I wonder(ed) if NJH was an exception with having Medicare approve and pay for more than one submission, being the facility that it is.
I was told I had a small amount of Mycobacterium avium-intracellulare (MAI) in three out of four specimens given at NJH. Dr. L, at NJH, felt it wasn't necessary to start the anti-biotic at that time. I was also to start the 7% saline solution and vest when I arrived home after the NJH visit in October, which I have done. So that also probably came into play with not starting the anti-biotic. I realize why their philosphy is somewhat a wait and see due to the anti-biotic resistance possibility down the line. Hope not starting the anti-biotic that was the right call for me. I haven't had an exacertation...no chills, fever, dark sputum etc. etc.
I will inquire with Tyler about three days of consecutive sputum samples and the procedure you outlined so I can fully understand how they handle it or will handle it.
Again, I like the idea of three consective days of preparting sputum culture samples. I feel, and I may be wrong, this would allow for a better chance of getting a good culture sample for testing.
P.S. At this juncture I am not doing much in the landscape other than 'directing' . I am lucky to have found someone who will help me with it. However, it is so difficult emotionally not doing some of it myself. Maybe once I get a better feel for everything I am learning, and as well, my trying to figure out the best ways to handle my daily tasks and routines to do things, I will allow myself to do more in the flower beds. Routines, such as you have mentioned, remembering to leave the shoes on the rug at the patio door when I come in. 😁 I am also trying to teach myself to accept things he does that might be exactly like I want or expected. 🤔
All thoughts or suggestions you have given are most welcomed and appreciated.
I am so glad you had/took the time to respond.
So for now, hello daffodils and Spring!
Thanks Sue.