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Recovery of Cell Wall-Deficient Organisms From Blood Does Not Distinguish Between Patients With Sarcoidosis and Control Subjects^*

Sheldon T. Brown, MD; Ian Brett, BS; Peter L. Almenoff, MD, FCCP; Marvin Lesser, MD; Michael Terrin, MD, MPH, FCCP and Alvin S. Teirstein, MD, FCCP; for the ACCESS Research Group

^* From the Department of Internal Medicine, The Mount Sinai Medical Center, and Bronx Veterans Affairs Medical Center (Drs. Brown, Almenoff, Lesser, and Teirstein, and Mr. Brett), Bronx NY; and Clinical Trials and Surveys Corporation (Dr. Terrin), Baltimore MD. Members of A Case Control Etiologic Study of Sarcoidosis (ACCESS) are listed in the ^Appendix.

Correspondence to: Sheldon Brown, MD, Chief, Infectious Disease Section, Bronx VA Medical Center (111F), 130 West Kingsbridge Rd, Bronx, NY 10468; e-mail: sheldon.brown{at}med.va.gov

Study objective: To determine if cell wall-deficient forms (CWDF) of mycobacteria can be grown in culture of blood from subjects with sarcoidosis.

Design: A special multicenter study of sarcoidosis (A Case Control Etiologic Study of Sarcoidosis), supported by the National Heart, Lung, and Blood Institute.

Patients and control subjects: Patients and control subjects were recruited at 10 institutions in the United States. Control subjects (controls) were of the same gender and race, and within 5 years of age as matching patients with sarcoidosis (cases).

Results: Cultures were incubated from 347 blood specimens (197 cases, 150 controls). Two investigators trained to recognize CWDF mycobacteria examined material obtained from culture tubes after 3 weeks. Structures thought to be CWDF were seen with equal frequency in cases (38%) and controls (41%). Thirty-nine percent of cases and 37% of controls were read as negative for CWDF.

Conclusion: This study fails to confirm earlier reports that CWDF mycobacteria can be grown from the blood of patients with sarcoidosis, but not from control subjects.

Key Words: A Case Control Etiologic Study of Sarcoidosis • cell wall-deficient forms • mycobacterium • sarcoidosis

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