Author: Alan R. Cantwell, Jr (---.vnnyca.adelphia.net)
Date: 07-10-03 09:14
Cell Wall Deficient Bacteria in the Blood of Sarcoidosis Patients
Author: Alan R Cantwell Jr., MD
Author's email: alanrcan@aol.com
Article Type: Review
Comment Upon: Brown ST, Brett I, Almenoff PL, Lesser M, Terrin M, Teirstein AS: Recovery of Cell Wall-Deficient Organisms From Blood Does Not Distinguish Between Patients With Sarcoidosis and Control Subjects. Chest 2003; 123: 413-417 [PubMed Abstract]
Publication Date: 16 Feb 2003
Abstract
In order to evaluate the contention that sarcoid bacteria can also be found in other diseases, it would be advantageous to search for CWD bacteria in other neoplastic and inflammatory diseases as well, and to compare any findings with a similar study of normal and disease-free tissue. Although the Brown paper might seem to discourage the earch for a bacterial agent in sarcoid blood, it seems to me it is a call to further re-examine sarcoid tissue and to search diligently for CWD acid-fast bacteria, and using te highest magnification possible (oil-immersion lens, magnification x 1000) in order to demonstrate them more successfully.
Discussion
The study by Brown et al. concludes that cell wall deficient forms (CWDF) of mycobacteria can be cultured with the same frequency from the blood of sarcoid patients as from the blood of normal control subjects. This study seemingly negates the significance of previous investigators who identified acid-fast organisms and mycobacteria-like microbes from the blood of sarcoid patients.
In 1981-1982, I reported in three separate publications the identification of pleomorphic CWD variably acid-fast bacteria, primarily in the coccoid form, in the histopathologic tissue specimens from sarcoidosis of the skin, lymph nodes, and lungs (1-3). Larger forms of the microbe were also observed in vivo and were morphologically similar to "large body" and "giant L-forms" previously described in vitro as valid CWD forms (4). The microbes I observed in vivo in sarcoid were similar to bacteria associated with certain forms of cancer and certain immunologic diseases of unknown etiology (5). This research has been reviewed in my book, The Cancer Microbe (Aries Rising Press, Los Angeles, CA, 1990).
The possible role of CWD bacteria in sarcoidosis and other diseases has been viewed with widespread skepticism, and even disdain. Nevertheless, for the past three decades there have been increasing reports that pleomorphic, occasionally acid-fast bacteria, are a constituent of all human blood. This, of course, goes against the almost universal belief that normal, healthy blood is sterile.
In 1978, G Tedeschi et al. detected pleomorphic bacteria as intracytoplasmic parasites in clinically healthy human subjects (6). A variety of microbes, such as micrococci,
staphylococci, and corynebacteria-like bacteria were cultured. A very recent study in the Journal of Clinical Microbiology confirms the presence of a wide diversity of microorganisms within the blood of healthy people (7). One intensively studied microbe was identified as Pseudomonas maltophilia (later called Xanthomonas maltophilia); another as Stenotrophomonas maltophilia.
It is apparent that the study of CWD bacteria in the blood is still in its infancy and that the possible role of these bacteria in human disease (and in health) needs further investigation.
The ubiquitous presence of CWD acid-fast bacteria in human blood makes the proof of an etiologic bacterial agent in sarcoid blood more difficult, if not impossible. One wonders if the culture for bacteria in sarcoid tissue might be also rendered moot in view of the fact that tissue contains blood.
It is my contention that the possible role of variably acid-fast bacteria as etiologic agents in sarcoid can be further strenghtened by an intensive search for CWD bacteria in vivo in sarcoid tissue sections. Such an evaluation must be made with a full understanding of the microscopic appearance (as well as the differential staining properties) of CWD "coccoid" bacteria and an awareness of larger forms consistent with "large bodies".
In order to evaluate the contention that sarcoid bacteria can also be found in other diseases, it would be advantageous to search for CWD bacteria in other neoplastic and inflammatory diseases as well, and to compare any findings with a similar study of normal and disease-free tissue.
Although the Brown paper might seem to discourage the search for a bacterial agent in sarcoid blood, it seems to me it is a call to further re-examine sarcoid tissue and to search diligently for CWD acid-fast bacteria, and using the highest magnification possible (oil-immersion lens, magnification x 1000) in order to demonstrate them more
successfully.
It is also useful to remember that pathologists and other researchers were remiss for months in failing to identify the bacteria that cause Legionnaire's disease, and to remember that bacteria in the form of Helicobacter pyloris were not identified in gastric ulcers for over a century.
References:
1. Cantwell AR Jr: Variably acid-fast bacteria in a rare case of coexistent malignant lymphoma and cutaneous sarcoid-like granulomas. Int J Dermatol. 1982 Mar;21(2):99-106 [PubMed Abstract]
2. Cantwell AR Jr: Histologic observations of variably acid-fast pleomorphic bacteria in systemic sarcoidosis: a report of 3 cases. Growth 1982 Summer;46(2):113-25 [PubMed Abstract]
3. Cantwell AR J:. Variably acid-fast bacteria in a case of systemic sarcoidosis and hypodermitis sclerodermiformis. Dermatologica 1981;163(3):239-48 [PubMed Abstract]
4. Cantwell AR Jr: Histologic forms resembling "large bodies" in scleroderma and "pseudoscleroderma". Am J Dermatopathol. 1980 Fall;2(3):273-6 [PubMed Abstract]
5. Livingston VW, Alexander-Jackson E: A specific type of organism cultivated from malignancy: bacteriology and proposed classification. Ann N Y Acad Sci. 1970 Oct 30;174(2):636-54 [PubMed Abstract]
6. Tedeschi GG, Bondi A, Paparelli M, Sprovieri G: Electron microscopical evidence of the evolution of corynebacteria-like microorganisms within human erythrocytes. Experientia 1978 Apr 15;34(4):458-60 [PubMed Abstract]
7. McLaughlin RW, Vali H, Lau PC, Palfree RG, De Ciccio A, Sirois M, Ahmad D, Villemur R, Desrosiers M, Chan E: Are there naturally occurring pleomorphic bacteria in the blood of healthy humans? J Clin Microbiol. 2002 Dec;40(12):4771-5 [PubMed Abstract]
FOOTNOTES
No agency funded this research
Competing Interests: None Declared
KEYWORDS
acid-fast bacteria
cell-wall-deficient bacteria
large bodies
scleroderma, linear
lupus erythematosus, cutaneous
leukemia, chronic myelogenous
mycosis fungoides (T cell lymphoma of the skin)
MeSH CLASSIFICATIONS
Sweat Glands
Atypical Bacterial Forms
Transformation, Bacterial
Scleroderma, Circumscribed
Lupus Erythematosus, Cutaneous
Leukemia, Myeloid, Chronic-phase
Mycosis Fungoides
Lymphoma, T-Cell
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