Giant Cocci

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         One night, one of my colleagues approached me about something he hadn't seen before in the microscope. He was working on blood cultures and doing the preliminary workups.

         He thought they could be yeast at first look, but further inspection suggested otherwise. They were much bigger than the usual gram-positive bacteria we come across daily. These guys were at least 2-3x the size! (We are talking about things 1.8 to 3.0 microns.) And no, yeasts don't look like that in the gram stain.

         The rapid molecular method didn't yield clear identification, but the instrument leaned towards Sarcina species. I had never seen this organism in a septic patient before, so this became a learning experience.

         A quick internet search told us that Sarcina species are anaerobic organisms. That made sense since it was the anaerobic bottle that became positive. They are rare pathogens in humans but seem to be problematic in livestock. One of the unique descriptions for this organism was "anaerobic giant gram-positive cocci". Surprisingly, one of the sources that documented human cases was sepsis. I would say we were on the right track.

         When the culture grows, we could do more tests to identify and perform susceptibilities on the organism. For the moment, I was content with the information I learned with my coworker.

For further reading:

Other Sarcina cases
Wiki info - apparently, Sarcina species are related to Micrococcus species.

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29 comments
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They are rare pathogens in humans but seem to be problematic in livestock.

This part made me come up with a story: a person that is involved in food production, livestock breeding, and logistics that happen to be immunocompromised caused by another disease process and got this as an opportunistic infection. Male, working age group, and wounds on the limb extremities. An alternative story is the patient already immunocompromised and got contaminated by some that is within the line of work mentioned above.

It's just one of the silly techniques my consultants used to teach me in medschool where we create stories that are close to textbook examples and what the patient has to help include or exclude possible angles to diagnose during history taking.

Still can't get over the part where I missed the variability in sizes and just reflexively called in under the Staph spp.

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Could also be some sort of gastrointestinal ulcer gone bad.

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Good job, germs are tiny and sometimes good sometimes bad. The bacteria were larger so it would be animal bacteria.

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Damn!!!
So we all come across an amount of bacteria daily
I wish I could just use a microscope to see what’s on my body

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Is it those bacterias that are huge in appearance like this?

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Yes.

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I never saw Sarcina in all my years in medicine. Interesting!
!BBH

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It's the first time I've seen it in blood.

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Guess they were working with livestock or something weird. I've never seen a septicemia with it... weird!

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The marvels of modern science and tools like the microscope, show that the more we learn the more there is to learn. hey I notice you have a couple of spare witness votes, appreciate it if you can send me one.

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You actually do really important work. Wow!

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