Bronchiectasis and lung infection

Posted by magwil01 @magwil01, Aug 12 6:31pm

I have Bronchiectasis, never been told I have MAC or NMT , I am on 3 inhalents by nebulizer and do ACT and have cystic fibrosis vest daily.
Now I have lung infection that started a week ago. Diagnosed by the pulmo just by listening to my chest. Said I don't need sputum test or blood tests. Gave doxycycline for a week. I am very suspeptible to any infections as I lack IGA and IGM. I received infusions every 7 days. I would like a sputum test. Last sputum test was 6 years ago which showed gram positive cocci, gram negative rods, cocci in pairs +4, gram negative coccobacilli. no fungus. Should I not get a sputum test to see why I got infection? Doctor on vacation for 2 weeks with no backup as he is changing affiliations. Where can I get tested without a prescription? Quest and labcorp don't offer this.

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@magwil01

So if I ask another doctor to do a sputum test, I don't have to tell him what to look for? I don't have to know all the possible things a sputum should test for? I just say "sputum" and that test will look for everything I need including MAC, NTM, pseudo, rsv, bacteria, hib?

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Actually, there are 2 tests that need to be ordered, the sputum test and the followup culture. The first can be performed in most labs, but the second is performed in labs specially set up to incubate the culture in specific medium for 4 - 8 weeks, then to take the next step and see which antibiotics the mycobacteria is susceptible to.
Some PCP's may be familiar with this, especially those who have a wide-ranging practice - such as in rural areas where they see "everyone for everything". But, professionals who see a limited class of patients, and refer complex cases to specialists, may not be as familiar.

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@liz440

I would just add that the pseudomonas/susceptibility test comes back very quickly - like less than a week as I remember.

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Same here. My pseudo tests also come back quickly including susceptibility.

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@jnmy

As @sueinmn writes: “ A sputum culture means they do 2 specific tests on your sputum in your usual lab - to check for the presence of mycobacteria. My lab also tests for staph and strep at the same time. If either NTM or Pseudo is found, the specimen is sent to a specialty lab to be grown in an incubator for up to 8 weeks. This will show exactly what "bug" it is, and then they test to see which antibiotics have an effect on it. “

It really illustrates how the standard of care for patients with Bronchiectasis varies so widely. It is still considered a rare disease though one of the top lung diseases and becoming more prevalent worldwide.

Maybe a memo should go out to pulmonologists who refuse sputum tests. I thought only people like my own doctor who knew nothing of the chronic condition took those decisions.

It is such a relatively easy test for many to achieve and so critical to proper diagnosis for antibiotics, at a time when we really want to target antibiotic use.

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My pulmonologist is the opposite, she asks for sputum cultures regularly

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@pacathy

My pulmonologist has me keep a sputum container on hand in case I get sick and I send it for culture.

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You can also buy them online to have them on hand. I got mine on Amazon.

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@joeawesom

You can also buy them online to have them on hand. I got mine on Amazon.

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Who needs to buy them? Our lab hands me as many as I ask for. They are the same sealed, sterile containers used for other specimens.

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@sueinmn

Who needs to buy them? Our lab hands me as many as I ask for. They are the same sealed, sterile containers used for other specimens.

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Who needs to buy what? The sputum cups? The question was how to purchase the sputum tests not cups. The doctor won't order so the question was, where to get a lab that will do it at patients cost. 🙂

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@magwil01

Who needs to buy what? The sputum cups? The question was how to purchase the sputum tests not cups. The doctor won't order so the question was, where to get a lab that will do it at patients cost. 🙂

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@magwil01 Where are you located, in the US or elsewhere?

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@sueinmn

Actually, there are 2 tests that need to be ordered, the sputum test and the followup culture. The first can be performed in most labs, but the second is performed in labs specially set up to incubate the culture in specific medium for 4 - 8 weeks, then to take the next step and see which antibiotics the mycobacteria is susceptible to.
Some PCP's may be familiar with this, especially those who have a wide-ranging practice - such as in rural areas where they see "everyone for everything". But, professionals who see a limited class of patients, and refer complex cases to specialists, may not be as familiar.

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I have noted this for my doctor in case he ever lets me take it. Thanks for your knowledge.

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@scoop

Sputum cultures test for what you list except RSV which is a virus. The lab knows what to do. Any bacteria detected grows pretty quickly 2-3 days with NTM/MAC taking 8 weeks.

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I wonder if the protocol about what the specific lab will check for varies depending on state and/ or lab? Perhaps you could check with your new pulmonologist or lab. Just a thought. Take care.

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