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What do you think these are, in my blood?

About microscopic forms of life, including Bacteria, Archea, protozoans, algae and fungi. Topics relating to viruses, viroids and prions also belong here.

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Re:

Postby biohazard » Thu Dec 12, 2013 4:49 pm

snowathlete wrote:He thinks these are a micrococci - perhaps Staphylococcus.


Actually, Staphylococci are not the same as Micrococci. Some species of Staphylococcus are important human pathogens, whereas Micrococci are opportunistic pathogens at best (or worst?) and normally cause disease only in immunologically compromised persons. If you had Staphylococci (or similar-looking Streptococci) in your blood, I think you would almost certainly be hospitalized by now as those cases can be life-threatening. The symptoms include high fever and pains, petechiae, feeling unwell in general, shock, loss of consciousness and so forth.

One other possibility occured to me, though: how was the blood sample taken? If it was a venous blood sample taken into an evacuated tube then this is far-fetched, but if the sample was taken by skin-prick or similar method, could it be so that the blue dots we see are contaminating bacteria from the skin of the puncture site and thus unrelated to your being ill? Have these dots been seen multiple times in different samples, or just this one time? If latter, contamination is always a possibility. The skin if literally full of all kinds of cocci and other bacteria.
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Re: Re:

Postby snowathlete » Thu Dec 12, 2013 6:57 pm

biohazard wrote:Actually, Staphylococci are not the same as Micrococci. Some species of Staphylococcus are important human pathogens, whereas Micrococci are opportunistic pathogens at best (or worst?) and normally cause disease only in immunologically compromised persons. If you had Staphylococci (or similar-looking Streptococci) in your blood, I think you would almost certainly be hospitalized by now as those cases can be life-threatening. The symptoms include high fever and pains, petechiae, feeling unwell in general, shock, loss of consciousness and so forth.


I read that some cases can be asymptomatic, but perhaps something in between is unlikely?
Interestingly, and as an aside, I do have petechiae and they started as I got ill about 5 years ago. I am sure they are linked to my illness.

biohazard wrote:One other possibility occured to me, though: how was the blood sample taken? If it was a venous blood sample taken into an evacuated tube then this is far-fetched, but if the sample was taken by skin-prick or similar method, could it be so that the blue dots we see are contaminating bacteria from the skin of the puncture site and thus unrelated to your being ill? Have these dots been seen multiple times in different samples, or just this one time? If latter, contamination is always a possibility. The skin if literally full of all kinds of cocci and other bacteria.


Yes you raise a very real posibility. I made these smears myself at home and although I took what precautions I could, I cannot discount the possibility of contamination. Thing is, how can I be sure either way?
I am considering asking my GP to order a blood culture to see if anything turns up, but I doubt my GP will be willing.
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Re: Re:

Postby biohazard » Fri Dec 13, 2013 8:13 am

snowathlete wrote:I read that some cases can be asymptomatic, but perhaps something in between is unlikely?


Transient bacteremia is possible in rare cases, such as sometimes with severe tooth infections that 'seep' bacteria into the blood stream. But I guess in these cases their numbers would be so few that they do not show up on the blood film. And in any case, bacteremia rarely is a stable condition: you either get better (as I believe is normally the case with bartonellosis) or your status quickly worsens and requires medical intervention. However, I have read that bartonellosis can sometimes become chronic, but I do not know if it can last for 5 years, which apparently is the time you have been ill.

snowathlete wrote:Interestingly, and as an aside, I do have petechiae and they started as I got ill about 5 years ago. I am sure they are linked to my illness.


If you have been ill that long, I think the petechiae can equally well be related to something else than bacterial infection. After all, petechiae are not a specific symptom and various conditions can cause them. One of the more common ones in thrombocytopenia or lack of some clotting factors, which may slow down blood coagulation times and thus result in minor bleeding beneath the skin that causes the petechiae.

I do not know where you are based in, but in most countries you can privately order a set of basic blood tests (blood cell counts, standard blood chemistry etc.), which already gives a whole lot of information about your health -- although you may require some help from a medical professional with interpreting them -- for a cost of twenty to thirty bucks or euros or quid or [insert the equivalent in your currency here]. Unfortunately those tests do not normally measure other clotting factors than thrombocytes. One useful test could also be antibodies against Bartonella if such a test is available at your location.

snowathlete wrote: Yes you raise a very real posibility. I made these smears myself at home and although I took what precautions I could, I cannot discount the possibility of contamination. Thing is, how can I be sure either way?
I am considering asking my GP to order a blood culture to see if anything turns up, but I doubt my GP will be willing.


I do not think there is a way to be 100% sure about that. Venous blood samples usually have no problems, since the amount of blood cells in the sample (billions of them) totally overwhelms the few bacteria that may end up in the sample from the skin, and because the needle is very sharp. For blood culture purposes the skin is also carefully disinfected, but even that does not remove the bacteria from the deep layers of the skin. However, the skin bacteria are normally not very well adapted to growing in blood and thus any pathogens in the blood tend to stand up in the tests.

With the skin-prick method I'd say applying 70% ethanol carefully around the puncture site may help, but more important is to puncture the skin a neatly as possible (no scratching), let a drop or two of blood to flow from the puncture site before taking your specimen and finally, taking several sample specimens so that even if one is contaminated, you still have a chance to get one or two good ones.

All this being said, I would still stress that the 'dots' in your blood samples do not quite look like typical bacterial finding and that if you have been ill for a long time, blood-borne bacterial infection sounds unlikely. Blood is normally sterile and if bacteria manage to persist there, the condition often escalates rapidly. But since bartonellosis can in some rare cases cause chronic infections and possibly petechiae, perhaps a course of suitable antibiotics might be in order.

So in a nutshell: I cannot rule out the presence of bacteria for certain, but the findings in your blood film can also be staining artifacts or (bacterial) contamination. This is important to note, since especially some species of Bartonella can indeed cause persistent bacteremia. Furthermore, the petechiae are normally more likely to be related to other blood clotting issues than chronic bacterial infection, because the majority of infections that include bacteremia and cause petechiae are acute and very dangerous systemic infections (called sepsis) and require hospitalization within hours after detected. And do not forget the dangers of Internet diagnosis -- it is always possible that I simply got this wrong because, after all, all I have is a couple of blood film images (albeit technically quite good ones) that are not enough to make a conclusive diagnosis and therefore you must consider this as an educated guess.
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Re: Re:

Postby snowathlete » Fri Dec 13, 2013 2:08 pm

biohazard wrote:However, I have read that bartonellosis can sometimes become chronic, but I do not know if it can last for 5 years, which apparently is the time you have been ill.

I do not know where you are based in, but in most countries you can privately order a set of basic blood tests (blood cell counts, standard blood chemistry etc.), which already gives a whole lot of information about your health -- although you may require some help from a medical professional with interpreting them -- for a cost of twenty to thirty bucks or euros or quid or [insert the equivalent in your currency here]. Unfortunately those tests do not normally measure other clotting factors than thrombocytes. One useful test could also be antibodies against Bartonella if such a test is available at your location.


I'm in the UK. I've researched Bartonella quite a bit. I had serology and PCR tests on it. Serology was negative, but PCR was positive, but wasn't able to identify the species. There are lots of species (more found each year) and the test I had looked for a common shared seqence. So I know that I have Bartonella, or something genetically close to it. But perhaps my doctor is therefore assuming that what I showed him in the smears was Bartonella when it could actually be something else. I didn't mention that I had Bartonella in my original post as I didn't want to bias anybody's opinion on what they were seeing in the smears I posted.

It's not very widely known about but chronic Bartonella is more common than people realize. People tend to think of cat scratch disease when they hear of Bartonella, which is usually self limiting - or Carrion's disease which you get in Peru which is often fatal without rapid treatment. The reality though is that there are dozens of species in between these two extremes, many are newly discovered and not a lot is known about them. There are lots of people suffering from Bartonella who don't get much help and hang around on one or two sites on the net to get information and identify the handful of doctors who treat it. Some have got better with long-term abx. I am 6 months into abx treatment myself, but not feeling any better. I'm told this is normal as Bartonella is hard to get from within the erythrocytes they hang out in. I hope they are right about that. I've had symptoms of Bartonella - it turns out - since I was 14 (I'm now 32) but my doc says I've had it since an infant. Either way, it's not uncommon to have it decades undiagnosed and for health to slowly decline over that time.

I've had a lot of blood tests and have clear signs of infection (happy to list some if interested), but I've only had basic tests relating to blood clotting.

biohazard wrote:I do not think there is a way to be 100% sure about that. Venous blood samples usually have no problems, since the amount of blood cells in the sample (billions of them) totally overwhelms the few bacteria that may end up in the sample from the skin, and because the needle is very sharp. For blood culture purposes the skin is also carefully disinfected, but even that does not remove the bacteria from the deep layers of the skin. However, the skin bacteria are normally not very well adapted to growing in blood and thus any pathogens in the blood tend to stand up in the tests.

With the skin-prick method I'd say applying 70% ethanol carefully around the puncture site may help, but more important is to puncture the skin a neatly as possible (no scratching), let a drop or two of blood to flow from the puncture site before taking your specimen and finally, taking several sample specimens so that even if one is contaminated, you still have a chance to get one or two good ones.


I did it with a new needle prick pen that my dad gave me (he uses them for his diabetes). I wiped the skin with a 70% alcohol wipe first and I uses 3 different locations (but I don't know which photos are from which slides - they could all be from a single slide for all i know, though I'd have thought my vet friend would have mentioned if that were the case).

biohazard wrote:All this being said, I would still stress that the 'dots' in your blood samples do not quite look like typical bacterial finding and that if you have been ill for a long time, blood-borne bacterial infection sounds unlikely. Blood is normally sterile and if bacteria manage to persist there, the condition often escalates rapidly. But since bartonellosis can in some rare cases cause chronic infections and possibly petechiae, perhaps a course of suitable antibiotics might be in order.

So in a nutshell: I cannot rule out the presence of bacteria for certain, but the findings in your blood film can also be staining artifacts or (bacterial) contamination. This is important to note, since especially some species of Bartonella can indeed cause persistent bacteremia. Furthermore, the petechiae are normally more likely to be related to other blood clotting issues than chronic bacterial infection, because the majority of infections that include bacteremia and cause petechiae are acute and very dangerous systemic infections (called sepsis) and require hospitalization within hours after detected. And do not forget the dangers of Internet diagnosis -- it is always possible that I simply got this wrong because, after all, all I have is a couple of blood film images (albeit technically quite good ones) that are not enough to make a conclusive diagnosis and therefore you must consider this as an educated guess.


Thanks. I appreciate the input and accept you are basing your thoughts on very limited information. I think there is enough doubt that I have to exlore the posibility that it is not Bartonella and try and identify what may be in my blood. Ordering tests, even privately, In the UK, usually requires a doctor to order it. The NHS have very strict guidlines to what they investigate and treat and Bartonella isn't on it, neither are any other unexplained chronic conditions. They just give you a wastepaper diagnosis (ME/CFS) having ruled out the basics and send you home. I'm not prepared to give up so easily on my life though.
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Re: Re:

Postby biohazard » Mon Dec 16, 2013 8:27 am

snowathlete wrote:...


A neat move, not to disclose all the information you've got right away in order to obtain unbiased opinions from others. However, as it turns out, it seems you may know more about Bartonella than I do and thus I am not sure if there is much I can add that would be helpful to you.

If you still have questions that you think I can help with (I have professional experience in clinical microbiology and haematology among some other medical/biological stuff), or if you want to discuss some other aspects of your case, just shoot.

In any case, I hope that you get the answers you're looking for -- if not from here then somewhere -- and manage to overcome the whatever that lives in your blood or causes the illness.
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