I just spent a fascinating afternoon with Dr Alan Cantwell, one of the first to report that a special type of bacteria had been found in the tissue of sarcoidosis patients. His first paper reporting these special pleomorphic bacteria was published in 1981, and a second paper in 1982. His discovery was ignored by Pulmonologists, although a number of other physicians have continued this work, with a detailed study of 20 patients and 20 controls in 1996, which clearly implicated bacteria as a likely cause of sarcoidosis. It was a bacteria similar to Mycobacterium Tuberculosis, but with an evolutionary adaptation that allows it to live without having a cell wall.

These special bugs are called "Cell Wall Deficient Bacteria" (CWD), and they have been found not only in Sarcoidosis, but also a number of other diseases, including Crohn's disease. There is a well written description of these bacteria at 'The Lyme Alliance'.

<--- A clump of tiny, round, 'coccoid forms', resembling minute granules, is at the far left of this image of a sweat gland from the skin of a lung sarc patient. Here are the 'rod' bacteria more commonly seen by a pathologist --->

Dr Cantwell came under intense criticism when he reported that he could also find these bacteria in cancer patients, and from that time onwards he was ostracized by many in the medical profession. Dr Lida Mattman has managed to plot a course through the medical politics, and she is still working and researching today. Dr Phyllis E Pease has also continued to publish. Dr EA Moscovic has also published about CWD in Sarcoidois.

These CWD bacteria grow very slowly. Sometimes it can take months to culture them in a lab. That is one of the reasons that the labs don't find them during their standard tests for fungi and bacteria. These CWD have also been referred to as mycoplasma, L-forms, mollicutes,and nanobacteria. Milton Wainright referred to them as 'pleomorphic' in his recent article.

Alan gave us the benefit of his decades of research on cell wall deficient bacteria, explaining how any pathologist could see them under a microscope, and which stains should be used to make the bacteria show up amongst the tissue. If you look at the two images above, on the left you have a microscope photo, at 1000 times magnification, of the tissue surrounding the sweat gland from the skin of a lung sarcoidosis patient. The orifice for the sweat gland is the large open space at the lower right, the clump of tiny bacteria (called a coccoid form) is at the middle left. Click the image for an enlarged view. It is not easy to see these bacteria, but a good pathologist should be capable of doing it.

Normally the stain would show up the bacteria as red, (like the 'bacterial rods' on the right from the University of Wisconsin). But they show up as light pink, or, as in this slide, a purplish violet (a mixture of pink and blue).

Your pathologist might even be able to find these bacteria in old biopsy slides (some hospitals keep these for years). Here is some info that will help him find these tiny bugs (include this with Doc's pathology request)

The stains that are most useful to view the bacteria are:
1. Intensified Kinyoun
2. Giemsa
3. Fite-Faraco (often used with Leprosy biopsies)

They must be viewed under oil using an "oil immersion lens" at a magnification of 1000.

There are several books that will help a pathologist recognise the cell wall deficient bacteria:
1. Mattman LH: Cell Wall Deficient Forms. ISBN 0-8493-4405-0 (info from B&N.com)
2. Domingue G: Cell Wall Deficient Bacteria. (info from Amazon)
3. Xalabarder C: Publicaciones del Instituto Antituberculoso Francisco Moragas, Caja de Pensiones Para La Vejezy de Ahorros, Paseo de San Juan, 20, Barcelona-10: "L-Forms of Mycobacteria and Chronic Nephritis". 1970

Dr Alan Cantwell's book is interesting reading, and extremely provocative. It has photographs of the sarcoidosis microbes in it.

Now of course this topic is a little more complex than I have made it sound. The University of Wisconsin has an excellent description of the importance of the cell wall to a microbe, and why certain antibiotics, such as the penicillins, attack the microbe's cell wall. Microbes that have evolved to live without a wall are immune to attack by the penicillins (but apparently not immune to Minocycline). In fact the existence of your CWD mutations may be due to the use of the Penicillins on microbes for which the Tetracyclines should have been chosen in the first place.

Additionally, species of the E-coli Bacterium, as well as the Strep bacterium, have been found in a cell-wall deficient form, not just the Mycobacteria.

Hopefully this tutorial will give you and your pathologist the information needed to verify that these microbes were in fact in YOUR biopsy tissue, and that therefore Doc had better darn well think about trying some antibiotics to get rid of them... 

Click on the images to get enlarged versions.

	CWD Bacteria in the connective tissue of the skin biopsy sample taken from a skin sarcoidosis patient
	Culture of CWD staph bacteria from this patient (cultures of these CWD bacteria typically take months to grow)
	Bacteria in the lung tissue of a patient with systemic sarcoidosis
	Bacteria in a sweat gland of the skin of the same (lung sarc) patient
	Culture from the second patient