1. < MAC & Bronchiectasis

Help understanding culture results

Posted by jml6812 @jml6812, Mar 8 3:07pm

I'm afraid that this is going to be long, but since I'm a newbie with understanding bronchiectasis & infections, I'd appreciate the thoughts of you veterans of the fight.

My first bronchoscopy (Oct 23) took samples from 4 different spots on my lungs with cultures. Two of the four cultures showed Pseudomonas (I think in the second week of culturing) and one showed few colonies of Abscessus (I think in 3rd week). I was treated for the Pseudomonas with Levoquin.

I changed pulmonologists to the University of FL Shands and we basically started over with a bronchoscopy in January 24. They went into one area of my lung where they saw the most activity. They did a culture at the UF lab and determined negative after 47 hours. I'm assuming that was looking for Pseudomonas. The Acid Fast Gram Stain was positive 3+ for gram positive cocci in pairs and chains (also done at the UF lab. The culture for that was sent to ARUP reference lab and after 8 weeks my results say Negative for Acid Fast Bacteria.

During these weeks of waiting I've been diligent on my airway clearance and have been coughing up some yellow/tan globs along with clear sputum. It sure looks to me like some kind of infections, but what do I know?

I'm pretty confused and trying to figure out the questions I should ask my doctor. At the moment I'm wondering the following:

1. Can the Gram stain be positive and the culture be negative for AFB? Did my Abscessus go away?

2. If only spot was cultured could other spots in my lung have different results?

3. Is a 2 day culture enough to show Pseudomonas? If the culture is negative -- then what's going on with the colored sputum I'm producing now?

4. Should I ask for a sputum culture now?

I am not scheduled to see her till April 8th and will be dealing with her via the portal messaging, so I really want to ask questions that are relevant. I'd appreciate your feedback before I start with her.

Thanks!

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

blm1007blm1007 | @blm1007blm1007 | Mar 23 6:53am

Thank you for reading my post and responding.
I gave thought to that being one possibility of how it might be presented, submitted, and then payment made.
Have a good weekend Harry.
Barbara

REPLY
cesaly1 | @cesaly1 | Mar 23 12:10pm
In reply to @sueinmn "To be honest, I never took a microbiology course in my life - it is all..." + (show)
@sueinmn

To be honest, I never took a microbiology course in my life - it is all experiential - and I do a bit of research from time to time.

There are some exceedingly slow-growing mycobacteria, but as far as I know, none is a threat to our lungs. (Over 100 types have been isolated, but there is little research on many of them.) There are also some slow-growing nocardia and rhodococcus, but these are mainly threats in immunocompromised people. I'm not sure how long they take to grow.

Like your daughter explained, almost every culture yields surprises. Most are not known to be a problem in humans, and are often omitted in the pathology results we see om My Chart.

What does your doc have to say about the "mystery bug"? Curious (aka nosy" minds would like to know.
Sue

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Sue, I just found out the critter is Mycoplasma fortuitum, not that different from M. avium.
So far, my immune system is containing it, so I don't have to think about antibiotic treatment. The simple breathing/huffing cycle twice a day has it under control, works better than 0.3% saline nebulizing. Long term, NMN is doing a good job repairing my DNA and maintaining energy levels. I am 85, and luckier than most.

REPLY
becleartoday | @becleartoday | Mar 24 9:57am

Sue’s detailed explanations are incredibly helpful and thought-provoking!!

I brought in 3 samples when I was initially diagnosed with bronchiectasis to determine whether I had any culturable bugs. Now, quarterly, I try to bring in a sample because sometimes we can have something going on and might not have any symptoms. Another scenario is that not all lung bacteria are culturable. For example, the mouth has over 700 bacteria and many of these commensals end up in the lungs. They are identified through high-level genetic testing like the research done in Dr. Leo Segal’s lab at NYU Langone.


Two years ago, I was producing a bit more sputum on a regular basis. I was patting myself on the back for doing excellent airway clearance. This went on for a while and I submitted a couple of samples over time and nothing grew. BUT, about 8 months into this period, I went for my routine pulmonary appointment and I cultured haemophilus. My doctor and I discussed it and I asked to submit a sample again before taking antibiotics. It grew again and I took antibiotics. By the third day of taking the medication, practically all mucus disappeared and unless I have a cold that is now my norm (yes, I continue with daily airway clearance:)).

So, why all this detail? Because it is possible that the antibiotic killed another bug or bugs that were causing the mucus and were unidentified through culture. I don’t think it was the haemophilus because right along I was not growing it.

I discussed this theory with Dr Segal at the World Bronchiectasis Conference and he said it was plausible. Jokingly, I offered him a sputum sample and he said that he would have needed samples over a longer period of time to know what was truly going on. This is where lung health is headed. Knowing an individual’s microbiomes - skin, mouth, lungs and gut - and when for that person there is dysbiosis (the type and quantity of bugs are off) and fixing it! Precision medicine at its best.

Happy Sunday,
Linda Esposito

REPLY
3 replies
gbooth54 | @gbooth54 | Mar 24 10:32am
In reply to @blm1007blm1007 "Sue- Interesting procedure with the chance it is an "infectious disease." No I haven't had an..." + (show)
@blm1007blm1007

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.

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Is it your understanding gardening is the usual source for MAI?

REPLY
blm1007blm1007 | @blm1007blm1007 | Mar 24 11:34am

As you noticed the Dr. L at NJH indicated I had a small amount of Mycobacterium avium-intracellulare (MAI) and that it was such a small amount he didn't want to start me on anti-biotics. He did not say it is related to soil, he didn' explain to be a soil related infection.
I am not the one to say yes or no to your question for many reasons and one being I am new to the diagonosis of BE and learnings one needs to understand.. My understanding, and I may be incorrect, it is more than likely contracted related to soil. Hopefully someone on this site might have a better answer and a 'yes' or ''no' to my belief and your question. Wish I knew for sure...but...what I do know is I have BE and a slight MAI infection. What I don't know is if I start an anti-biotic will it help with the MAI and will it stop this CONSTANT bringing up of a foamy, white. bubbly substance that does feel like mucus but even with that I don't truly know. It is so confusing, the substance I am bringing up. I was glad to see Linda Espositios post above.

REPLY
blm1007blm1007 | @blm1007blm1007 | Mar 24 11:58am
In reply to @becleartoday "Sue’s detailed explanations are incredibly helpful and thought-provoking!! I brought in 3 samples when I was..." + (show)
@becleartoday

Sue’s detailed explanations are incredibly helpful and thought-provoking!!

I brought in 3 samples when I was initially diagnosed with bronchiectasis to determine whether I had any culturable bugs. Now, quarterly, I try to bring in a sample because sometimes we can have something going on and might not have any symptoms. Another scenario is that not all lung bacteria are culturable. For example, the mouth has over 700 bacteria and many of these commensals end up in the lungs. They are identified through high-level genetic testing like the research done in Dr. Leo Segal’s lab at NYU Langone.


Two years ago, I was producing a bit more sputum on a regular basis. I was patting myself on the back for doing excellent airway clearance. This went on for a while and I submitted a couple of samples over time and nothing grew. BUT, about 8 months into this period, I went for my routine pulmonary appointment and I cultured haemophilus. My doctor and I discussed it and I asked to submit a sample again before taking antibiotics. It grew again and I took antibiotics. By the third day of taking the medication, practically all mucus disappeared and unless I have a cold that is now my norm (yes, I continue with daily airway clearance:)).

So, why all this detail? Because it is possible that the antibiotic killed another bug or bugs that were causing the mucus and were unidentified through culture. I don’t think it was the haemophilus because right along I was not growing it.

I discussed this theory with Dr Segal at the World Bronchiectasis Conference and he said it was plausible. Jokingly, I offered him a sputum sample and he said that he would have needed samples over a longer period of time to know what was truly going on. This is where lung health is headed. Knowing an individual’s microbiomes - skin, mouth, lungs and gut - and when for that person there is dysbiosis (the type and quantity of bugs are off) and fixing it! Precision medicine at its best.

Happy Sunday,
Linda Esposito

Jump to this post

Thank you for your post. More good information from you....THANKS.
It relates to many of my thoughts about what is or is not possibly going on with me and my present condition, the BE and the constant sputum I am constantly bringing up. I nearly fill an entire solo cup of this foamy, white, bubbly sputum, mucus by the end of the day. Surprisingly I have been able to sleep most nights but do have to clear my throat when I wake up in the middle of night to visit the bathroom. The clearing of my "throat" and sputum can take a while to do before I can fall back to sleep. My two things I know will make everything worse.....not enough sleep and inability to eat...and as well building back the BMIndex. I am hoping the liquid guaifenesin I have begun taking will help with this problem of the thick sputum, 'mucus' in my throat. Waiting on a one sputum vile result sent in, in February to Tyler. My answer below should have gone directly to gbooth54 to answer her question to me, I errored. 😁

REPLY
lolaf | @lolaf | Mar 27 5:58pm
In reply to @becleartoday "Sue’s detailed explanations are incredibly helpful and thought-provoking!! I brought in 3 samples when I was..." + (show)
@becleartoday

Sue’s detailed explanations are incredibly helpful and thought-provoking!!

I brought in 3 samples when I was initially diagnosed with bronchiectasis to determine whether I had any culturable bugs. Now, quarterly, I try to bring in a sample because sometimes we can have something going on and might not have any symptoms. Another scenario is that not all lung bacteria are culturable. For example, the mouth has over 700 bacteria and many of these commensals end up in the lungs. They are identified through high-level genetic testing like the research done in Dr. Leo Segal’s lab at NYU Langone.


Two years ago, I was producing a bit more sputum on a regular basis. I was patting myself on the back for doing excellent airway clearance. This went on for a while and I submitted a couple of samples over time and nothing grew. BUT, about 8 months into this period, I went for my routine pulmonary appointment and I cultured haemophilus. My doctor and I discussed it and I asked to submit a sample again before taking antibiotics. It grew again and I took antibiotics. By the third day of taking the medication, practically all mucus disappeared and unless I have a cold that is now my norm (yes, I continue with daily airway clearance:)).

So, why all this detail? Because it is possible that the antibiotic killed another bug or bugs that were causing the mucus and were unidentified through culture. I don’t think it was the haemophilus because right along I was not growing it.

I discussed this theory with Dr Segal at the World Bronchiectasis Conference and he said it was plausible. Jokingly, I offered him a sputum sample and he said that he would have needed samples over a longer period of time to know what was truly going on. This is where lung health is headed. Knowing an individual’s microbiomes - skin, mouth, lungs and gut - and when for that person there is dysbiosis (the type and quantity of bugs are off) and fixing it! Precision medicine at its best.

Happy Sunday,
Linda Esposito

Jump to this post

Thanks for sharing Linda, this is an incredibly interesting presentation. I’ve also learned that we can assist our natural microbiomes by reducing refined sugar intake since the bad bugs (& cancer) love it so much. Also, adding pre & probiotics may help limit or curtail exacerbations. Happy Spring!

REPLY
blm1007blm1007 | @blm1007blm1007 | May 1 2:35pm
In reply to @becleartoday "Sue’s detailed explanations are incredibly helpful and thought-provoking!! I brought in 3 samples when I was..." + (show)
@becleartoday

Sue’s detailed explanations are incredibly helpful and thought-provoking!!

I brought in 3 samples when I was initially diagnosed with bronchiectasis to determine whether I had any culturable bugs. Now, quarterly, I try to bring in a sample because sometimes we can have something going on and might not have any symptoms. Another scenario is that not all lung bacteria are culturable. For example, the mouth has over 700 bacteria and many of these commensals end up in the lungs. They are identified through high-level genetic testing like the research done in Dr. Leo Segal’s lab at NYU Langone.


Two years ago, I was producing a bit more sputum on a regular basis. I was patting myself on the back for doing excellent airway clearance. This went on for a while and I submitted a couple of samples over time and nothing grew. BUT, about 8 months into this period, I went for my routine pulmonary appointment and I cultured haemophilus. My doctor and I discussed it and I asked to submit a sample again before taking antibiotics. It grew again and I took antibiotics. By the third day of taking the medication, practically all mucus disappeared and unless I have a cold that is now my norm (yes, I continue with daily airway clearance:)).

So, why all this detail? Because it is possible that the antibiotic killed another bug or bugs that were causing the mucus and were unidentified through culture. I don’t think it was the haemophilus because right along I was not growing it.

I discussed this theory with Dr Segal at the World Bronchiectasis Conference and he said it was plausible. Jokingly, I offered him a sputum sample and he said that he would have needed samples over a longer period of time to know what was truly going on. This is where lung health is headed. Knowing an individual’s microbiomes - skin, mouth, lungs and gut - and when for that person there is dysbiosis (the type and quantity of bugs are off) and fixing it! Precision medicine at its best.

Happy Sunday,
Linda Esposito

Jump to this post

Linda,
I put this to the wrong person this past month in another area so reposting here where I found you. In your post elsewhere you mentioned stress, I agree, need to reduce stress to keep the immune system healthy and up.
STRESS: As we all know, in certain circumstances, reducing that stress for many is nearly, sometimes, impossible.... but it must be reduced. How women with children, especially young children and other family members that require their care and attention..... let alone their own, I believe causes much stress if they are not able to find ways or help themselves reduce it. (P.S. Bronchiectasis affects more women from what I have read, if that is correct?)
MY STORY: My belief is that stress, unrelenting stress for a good period of time, (which can and does lower ones immune system) greatly contributes to developing an infection with or without Bronchiectasis and was one of the main causes for my full blown Bronchictasis as well as a change in how and what I was eating during that period of stress, poor diet during an extremely stressful period, and then the straw that broke the camels back.....blowing dry leaves and soil away from the house foundation and not knowing to wear a mask.
QUESTIONS: If you have time to reply. Thanks
Are you a trainer of some sorts? Like weight/strength trainer etc.?
Was there a specific type of diet you followed, follow?
Have you had a MAC/MAI flare-up and have taken medications for MAC/MAI?
Have you been told you have Acid Reflux?
I ask due to how well it appears you have managed your health (BE etc.) to be able to travel as you have done?
Thank you for all your informative posts.
Barbara

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