Tuesday, April 7, 2009

Wet Mounts

The analysis of a blood wet mount has become part of the routine evaluation of patients presenting with an evaluation for TBD. Positive results are seen in 70 to 80% of patients. So far we do not know what the organisms are. Many patients have large numbers of small motile bacteria which stain gram negative. Other distinct and separate morphologies are also frequently seen. Some of these organisms are tear drop and crescent shaped and resemble Toxoplasmosis. Others appear as rods. It is important that researches be found who will take these anomalies seriously and help solve these mysteries. According to conventional medical knowledge,It is not normal for us to have bacteria and parasites freely swimming in our blood. Transient bacteremia occurs when we brush our teeth, but the normal immune system quickly eliminates the organisms. The blood should appear as a sterile fluid under normal circumstances. Well known blood borne pathogens such as HIV and Hepatitis C are viruses and cannot be seen with the light microscope.

Perhaps some of these organisms are normal residents of the human body. It is unknown. Perhaps these microbes appear in the blood in large numbers when immune suppression is present as may occur with Lyme disease.

It is not scientific- but my clinical experience indicates that the sickest TBD patients usually have the highest loads of these organisms- AND they usually have mixed morphologies, some resembling bacteria and other resembling parasites. Patients with the protozoa type morphologies are usually the sickest.

Ultimately the identity of these organisms will be disclosed. It is yet to be known how these results will play into the management of patients with tick borne illness- or other illness for that matter. Do these organisms represent a new set of previously unknown tick borne co-infections? Will it be shown that they are normal human flora? Will they be used as a marker of disease activity or will they require specific, targeted therapies? For now I can only offers clinical impressions which may or may not have validity as the science is unraveled.

The amazing thing about this part of the puzzle is that these findings are as clear as the tip of your nose. You don't need sophisticated Western Blot or PCR technology.
There can be no debate whether an adequate course of a particular antibiotic has eradicated a particular blood wet mount organism. These organisms appear right under your eyes.

All you need is a drop of blood and a standard light microscope set at 1000 power.

There are many patients will a complex multi-system disorder associated with Lyme disease and other tick borne infections. Many, if not most of these patients have blood organisms which remain unidentified. These patients as a whole respond to antimicrobial therapy of various sorts. As clinicians we do our best, but we need help.

We need scientists: parasitologists, microbiologists, molecular biologists, experts in DNA sequencing at high powered universities and research centers who have the expertise to solve the riddle. What are these mystery bugs and what role do they play in the course of human disease?

21 comments:

gale said...

Couldnt agree more about our need to have resourceful research institutions work on these organisms.
Unfortunately there is also a need for mpore practioners that are willing to approach these organisations.

Have you any experience regarding treatment of unidentified bacteria in the MBLs?
Gale

Aaron said...

Is it possible that the parasites that show up on these wet mounts are actually T. Cruzi? T. Cruzi is a vector borne infection common in South and Central America and has been found in N. America as well. I don't think it was on the radar of the CDC until recently. The red cross just started screening blood for it in 2006/7.

lyme4achange said...

Question...

What has the lab, ILADS, or yourself personally done in order to see that this is being studied?

Right now it is conjecture because, frankly, we don't know what it is and I'm not sure it is appropriate to speculate or not. As a doctor, patients are going to respect your speculations, and might not understand that they shouldn't just run with this as a source of their misery. We don't know if this is simply contamination of the specimine, and we cannot know that 100% because it is not being researched and no one is trying to replicate the findings independantly.

One of the problems we have, and you have commented on this yourself, is a wide array of "discreditation" of many of our doctors. Many of these views are not accepted by the mainstream, and the goal here is recognition.

Therefore, what are allopathic ILADS professionals and TBI friendly labs doing to get this reseached?

Thanks.

Lyme report: Montgomery County, MD said...

There are individuals, including Clongen, actively involved in some of the research- which Dr. K funds with his own money. He is able to look only at the bacterial component, not the protozoa component. Sequencing the genome of blood protozoa is very difficult. It is possible that experts in parasitology at research institutes might have a pretty good idea of what we are looking at if the organisms can be isolated and viewed through powerful microscopes such as an electron microscopes. High powered research institutes also have the advanced technology needed to isolate and sequence the organisms. Hopefully, some patients and/or readers may have academic connections and help to enlist researchers in these endeavors.

Currently mainstream medicine does not take TBD seriously and there is limited funding available to researchers.

I have a lot of confidence in Clongen labs and Dr. K. I am only reporting what has been described in my patients. Clongen and other small labs are not capable of performing they type of research that is required.

I am not making specific recommendations based on these observations. That would be irresponsible. I am only reporting what is being seen. I do believe it is real. Limited controls have been done at Clongen, but they are by no means scientific.

This is a BLOG. It is a collage of clinical case reports and laboratory findings and opinions.

It is easy to be IDSA. They all follow the same thinking and procedures.

ILADS types, for the most part, all do things a bit differently.
There are no firm guidelines. The ILADS guidelines are written in general terms, appropriately avoiding specificity given the state of the science.

When I do conjecture about various ideas I point that out. At times I engage in a "thinking out loud" conversation with my readers. Such things are food for thought and nothing more. They should not be interpreted in any other way.

I think it is important, no critical, for writers on the topic of TBD to differentiate between fact and theory.

Rami said...

So, a question and please excuse my lack of knowledge in technical terms. I am a lymie, and upon my first trip to the ER, they did a spinal tap. 2 days later, my culture grew which they then admitted me to regrow another culture. The second one did not grow. They determined that the first culture grew because of oral flora, though they didn't know how it happened and because I had no teeth problems, they thought someone coughed on my sample. Seemed odd to me. (mind you, they never diagnosed me with lyme, though I had/have all the classic signs)
I just read your post and again, I am just a lyme patient with no medical background, what do you think is the possiblity that this culture could have been what you are talking about? And because of the lack of research was simply brushed off as contaimination?
I know you wouldn't know without being there yourself, but just wondering your thoughts.

PatJ. said...

Recognition from whom, Montgomery Doctor?
We the patients adore him because he helps us, that's the only recognition he is looking for and he deserves, the rest are speculations and ideas trying to find a better way to treat his patients - does that makes you jealous?
If these researches and ideas make other Doctors look bad, well, sorry "lyme4achange", you must do better!
There's this Doctor who treats the patient and cares for his recovery and well being and tries to find answers to what is going on; and there are these other Doctors who just care for receiving the money from the appointment and don't do much for the well being of the patient... so, who do you think we, the patients prefer?
If you -other Doctors- are starting to look bad because of your incredible negligence, well, it is time to make a change and consider thinking and acting differently; or you think it is fair to have a person suffering and you just saying it is a "post-Lyme" and there's nothing else to do? or when you find a patient multi-symptomatic and you just give him a "Lorazepam" to calm him down? What are you other Doctors doing to find a solution or a cure against this so painful unbearable multy-systemic illness called LYME?
Yes Montgomery Doctor, your blog has gained or recognition - the "patients recognition" - because it is obvious that ILADS and IDSA and the other Doctors are never going to give you such recognition due to it will mean they ignored your - our - call and needs!
Hope labs and other scientists hear and respond to your call and help the humanity from a painful incurable pandemia.
GRACIAS MONTGOMERY DOCTOR, you are our hero!

Momcat1011 said...

The lack of care really boils down to moolah. If the standard of care is 3 weeks doxy and doctors follow this simple rule, then the risk of liability is low for physicians. If the standard of care requires the application of thought then the risk of liability is higher. It seems to me that a political solution is needed to fix this mess (health care)-- maybe the government should offer buy-out packages to doctors who are too risk adverse to think.

Blackbird said...

There is a need for a v simple and relatively inexpensive research project:

It requires two groups of people, age/gender matched. One group being ill with suspected TBD and the other considering themselves to be well.

Wet mount slides carried out from both - and assessed under microscope by someone who does not know which patient gave that blood sample. There would need to be a standardised method of assessment.

If there is a marked difference then the groups wouldn't need to even be that big to show a statistically significant result.

For an extra level of evidence, it would be possible to use gradations of how unwell the TBD group are to compare with numbers of "unidentified blood features" (UBF) found.

Also could track response to treatment in a more formalised way, and explore any correlation there.

The simplest level of research wouldn't prove cause and effect but might give evidence of a correlation.

Cause and effect might be that the UBF are causing the illness, or that the illness is permitting the UBF to be present, or that something else is causing both the illness and the co-incidental UBF, or a mixture of all these.

I am not aware that this sort of research has been carried out, and without it, it is hard to know what significance to give to the UBF.

I am not sure that borrelia spirochaetes are visible with a standard light miscroscope - I think, but don't know, that it needs darkfield for them to be visualised.

Pseudonymity said...

Aaron, I am no microbiologist, but Trypanosoma are quite large, unlikely to be confused with bacteria and have a characteristic appearance with some staining techniques. Chances of this being T. cruzi seems really low.

LymeMD, are you seeing positive clinical responses in patients with positive Clongen results to Bactrim and Mepron/Malarone/Artemisinin combinations? If not, will you or have you tried more potent DHFR inhibitors like pyrimethamine/sulfadoxine?

lymie said...

The question in my mind is whether any bacteria/parasites should be in the blood of a healthy person. I would have thought the answer to this would be no.

Blackbird said...

The following letter from the UK BMJ, (from 1942!), has an interesting comment, in the context of features found in blood that is considered sterile.

"With suitable technique, such as the use of dark-ground
illumination under a high-power objective, it is also possible
to demonstrate that there are other highly motile bodies in
disintegrating " sterile blood."

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2164520

More questions!

Blackbird said...

There was a reply, in BMJ, to the "sterile blood?" comment. See:

http://ukpmc.ac.uk/articlerender.cgi?artid=1172111

Again, it generates more questions!

If they were routinely seeing those phenomenon, are they universal effects of blood breakdown over time? Are they universal infections, some of which may emerge from blood cells as they breakdown?

Lyme report: Montgomery County, MD said...

some patients have negative wet mounts.

A result came back today.
Patient on 3 IV antibiotics has large numbers of 3 different morphologies in blood. Her drugs were first prescribed by 2 other high profile LLMDS. This cocktail has kept her neuro-Lyme in check for many months. I have to wonder if the presence of such organisms may be an indicator of her need for continued antibiotic therapy.

The blood is fresh, not disintegrating.

I am not going to use more toxic anti-parasite drugs unless we had an ID.

I am still of the mind that these co-infections, if that is what they are, are perhaps opportunistic and are easier to treat when Lyme is aggressively pursued first. This is just based on clinical practice. Of course every patient responds differently.

It is mystery waiting to be solved.

For now we are working with same familiar baskets of drugs.

gale said...

Aaron
I have some very interesting info for you if interested regarding T.Cruzi.
You can mail me at galehane@gmail.com

Blackbird said...

Seems from following article that waiting one hour from cleaning teeth to sample taking would cover clearance of most culturable oral bacteria in blood.

http://jcm.asm.org/cgi/reprint/46/6/2129

(I presume it would vary with spleen function and other elements of immune response).

In this research, there was some presence of oral-type bacteria in the blood prior to teeth cleaning in a v small minority of cases.

lymie said...

One would suppose that we have learned more about what should and should not be in human blood since the 1940s, and that microscopy has improved too. However, there is very little microscopy in clinical practice these days; it is all high volume automated lab testing, which is going to miss what it is not looking for. Is that true for research labs in universities too–no one is actually looking at blood very much?

And why are these billions of dollars being spent on biolabs around the country to work on biowarfare issues when there are already people with unidentified critters in their blood? Why are they not working on things we already have rather than those that have not yet struck? Leaving out anthrax, which came out of one of those supposedly secure govt labs!

Nematodes are found in ticks. Might any of these things that are being found be nematodes? Have heard of tickborne disease patients in other countries taking the drugs ivermectin and mebendazole. But without a positive ID, this might be premature to prescribe.

A number of us have traveled in foreign parts and possibly picked up germs along the way that were being held down by the immune system when well. But after lyme disease was contracted, maybe the immune system was no longer able to cope with them? Could chronic diseases, beyond AIDS, affect the immune system ability to handle other germs, latent or contracted later? And how many of these prior exposures would still be retained?

Wondering if details of patient treatments should be in a public blog, read by unfriendly eyes at times?

Juell said...

MY BLOG RESPONSE:
LYME MD!
You are the FIRST medical entity to corroborate MY findings!! I would like to offer an opinion about the inter-species nature of this germ based on my own experience and research. With a background in biochemistry and armed with a 1000x microscope, I, too, saw the motile germs (and a spirochete or two) as well as toxo-like crescent shaped “cells” all over my own specimens. I also found them in specimens from my VERY sick cat who had bitten me the summer before causing a horrible infection that required a course of doxy (14 days.) I remained sick the whole summer…and recovered slightly through the cold months. By the next summer I was very weakened with lethargy, brain-fog, swollen organs, low lymphocytes, and a systemic fungal infection. I couldn’t fathom how I could be sick with so many ailments and so many organisms! Despite my health, I worked feverishly around the clock with my microscope and internet research to identify the organism I believed my cat and I both had. Sadly, I couldn't put the pieces together fast enough to save her. She died a few weeks after I had finally concluded that she had a type of “toxoplasmosis”, confirmed by a positive blood test through the veterinarian. However, I was not able to convince the medical doctors or the vet that our illnesses were running a parallel course, with both of us simultaneously exhibiting neurological bouts of near-hysteria, countered with debilitating lethargy, indicating a organism with life-cycle phases. I was given the horrible “diagnosis” of psychosomatic DOP (delusions of parasitosis) and asked to take IBS medications to relieve some of my symptoms. NOT A SINGLE VET OR DOCTOR would look at my slides, marked with coordinates of the important artifacts Even when I took high resolution photos of what I found (to expedite communication) as well as medical literature/images of similar bacteria or parasites to assist in the identification process, I was completely dismissed for my eagerness to find a diagnosis and cure! In my sickest weeks I was nearly comatose with lethargy and cognitive confusion and was taken to the University Hospital ER where I tried to give the doctor important information before I “slipped away” mentally. He said to me “ you know too much for your own good” a phase that still rings in my ears! At a later appointment when an infectious disease doctor looked at one of my photos which was obviously a nematode (with distinct organs and eggs visible) but dismissed it as an epithelial cell, I knew I was witnessing a bizarre cover-up of the medical ignorance surrounding this illness(es)! I learned that few doctors have ANY recognition of the morphology of the germs for which they treat. The actual opportunity to see living proof of an organism on my slides and in my pictures apparently scared them.

Another year later, my blood tests from Igenex were highly positive for Bb even by CDC standards. Upon the advice of a LLMD, I had a co-infection panel of bloodwork done, which revealed a high titer of Rocky Mountain Spotted Fever. When I look back at the “malpractice” I received, I wonder how 6 doctors all overlooked the importance of the (RMSF) body rash I sustained for over a year. When I asked the ID doc what I could take for the terrible itching, she shrugged and said to ask the pharmacist for an anti-itching cream.

Why is it that I have to drive 6 hours to see a Lyme Literate MD in the USA when Germany has whole hospitals dedicated to curing Lyme Disease patients???

Thank you, Bethesda Lyme MD, for reassuring us with your literature and dedication! You say you take new patients. How does one go about making an appointment? ( I have a brother in D.C. who I could stay with.)

Lyme report: Montgomery County, MD said...

Toxo is seen as an opportunist. It is well known to be a problem with HIV. I read that 80% of Europe is seropositive for Toxo. The debate about chronic Toxo is about as crazed as the debate about chronic Lyme. I am of the mind set that Bb may be the major gateway infection which lowers immunity enough to allow Toxo to become an active problem. The drugs recommended for chronic Toxo overlap with drugs LLMDs use for and supposed Babesiosis. Now novel Rickettsia species have been found in Ixodes ticks. Yes, we are dealing with a complex polymicrobial disorder. We do not know what many of the bugs are or what the optimal therapies are. I think you are right about the cat issue. Apparently normal cat blood looks like Lyme patient blood, whereas normal dog blood shows no blood borne organisms.
Knowing all of this doesn't necessarily make me better at treating the illness than others. Perhaps I have a greater awareness of some of the unsolved mysteries.

gale said...

Question....

I believe that "lyme4achange" put a very legitimate question in the beginning of the thread.
That is :what are the labs- practitioners that find these things in the blood of their patients doing in order to have this researched by resouceful labs?To me it seems obvious that it should be reportd to the authorities?

PatJ. said...

I believe in opening doors trying!
So, YES, yes!!! "It is possible that experts in parasitology at research institutes might have a pretty good idea of what we are looking at if the organisms can be isolated and viewed through powerful microscopes such as an electron microscopes".

My beloved husband had an
incredible idea! Send letters to the experts!!! So, we are Colombians, very proud fans of Manuel Elkin Patarroyo, "a Colombian pathologist who developed the world's first synthetic vaccine for malaria"; and, why not give it a try, we just wrote a letter to his institute located in Bogota, Colombia and mentioned the "Wet mounts" to see if we can catch their interest and help!!!
I hope I have your permission, so I gave them the link of this blog;
and if God permits, it might be possible for good things to come!

I can help translating from English to Spanish and vice-versa if needed!!!

May God help us!
M.J.

PatJ. said...

"Found" a lab in CENTRAL FLORIDA that performs:
"Lyme Antigen Test by Flow Cytometry *
The Central Florida Research laboratory is located in Lake Alfred, Florida. Central Florida Research, Inc. is a state licensed CLIA approved laboratory and is dedicated to the research of Lyme disease and other (CSID) Chronic, Systemic, Infectious Diseases.
Antigen tests detect the organism itself and, unlike antibody tests, antigen tests aren't dependent upon a ‘sick’ immune system to produce antibodies. The Central Florida Research laboratory in Lake Alfred, Florida is doing antigen testing. CFR's antigen test is a one of a kind. It is a direct fluorescent antibody test using a special kind of technique called Flow Cytometry. This Flow Cytometer is a specific instrument designed to identify bacteria 50,000 events are counted in one minute and the number of bacteria reacting with the Borrelia burgdorferi fluorescent antibody are enumerated in a diluted blood specimen and reported as a percent.
The Flow Cytometer enumerates fluorescing events. The results are expressed as ≤0.02% negative, 0.03% borderline positive , ≥0.04 positive. The Borrelia burgdorferi Direct Fluorescent Antibody by Flow Cytometer test is the most definitive test of its kind available today. Since Borrelia burgdorferi is a spirochete, an antigen test is more accurate in detecting its presence in the blood than a test detecting antibodies.. The Flow Cytometry test from Central Florida Research is most beneficial in detecting Borrelia burgdorferi the causative agent for Lyme disease..." more info here: http://centralfloridaresearch.com/lab2/index.php?option=com_content&view=article&id=50&Itemid=58

WHAT DO YOU ALL THINK AH?
Hope it is for good!
M>J