JCF-01197; No of Page 1
Journal of Cystic Fibrosis xx (2015) xxx –xxx www.elsevier.com/locate/jcf
Letter to the Editor
The microbiology of the cystic fibrosis upper and lower airway Amrita Dosanjh UCSD Medical Center, United States Received 1 May 2015; accepted 4 May 2015
Keywords: Pseudomonas; Cystic fibrosis
Dear Editors, The recently published study by Kidd TJ and the ACFBAL study investigators, Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5 years S1569-1993, demonstrates that 155 CF children aged ≤ 5 years who underwent a bronchoalveolar lavage (BAL) did not demonstrate that oropharyngeal cultures were reliably predictive of the lower airway cultures. Of the paired samples though, 72% were reported to have an indistinguishable ERIC-PCR genotype between the upper and lower airways [1]. In an earlier study, the results shown by Dosanjh A, Lakhani S, Elashoff D, et al. in a study of sinus, endotracheal and sputum sampling performed to identify concordance in microbiology between mid-tracheal, lower airway and sinus samples in the CF population, demonstrated significant correlation between sputum and endotracheal samples (p b 0.008) [2]. The findings of the earlier study and the study by Kidd and colleagues indicate that upper airway colonization may serve as a reservoir of infection for the lung. The BAL findings described by Kidd et al. show that the lower airway infection by Pseudomonas potentially can be distinct from the upper airway Pseudomonas profile. Clinically, all areas of the CF airway including sinus passages should be considered when developing a therapeutic plan.
The CF transplantation patient is susceptible to infection, and the upper airway remains a potential source of lung allograft infection. Thus, utilization of the latest technologies to detect bacteria in the lower airway has relevance in the management of the CF transplantation recipient. For CF transplant patients, these findings have implications for surveillance testing. The therapeutic plan in the transplanted population should consider treatment of CF sinusitis as well as the lower airway infection of the allograft. The findings of the earlier study and that of Kidd et al. may support the use of more precise molecular diagnostic studies in the care of the CF lung transplant patient. Sincerely, A. Dosanjh M.D. Pediatric Respiratory San Diego, CA References [1] Kidd T, Ramsay K, Vidmar S, Carlin JB, Bell SC, Wainwright CE, et al. Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5 years. J Cyst Fibros 2014:1569–993. [2] Dosanjh A, Lakhani S, Elashoff D, Chin C, Hsu V, Hilman B. Comparison of microbiologic flora of the sinuses and airway among cystic fibrosis patients with maxillary antrostomies. Pediatr Transplant 2000:182.
http://dx.doi.org/10.1016/j.jcf.2015.05.001 1569-1993© 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved. Please cite this article as: Dosanjh A, The microbiology of the cystic fibrosis upper and lower airway, J Cyst Fibros (2015), http://dx.doi.org/10.1016/j.jcf.2015.05.001
Journal of Cystic Fibrosis xx (2015) xxx –xxx www.elsevier.com/locate/jcf
Letter to the Editor
The microbiology of the cystic fibrosis upper and lower airway Amrita Dosanjh UCSD Medical Center, United States Received 1 May 2015; accepted 4 May 2015
Keywords: Pseudomonas; Cystic fibrosis
Dear Editors, The recently published study by Kidd TJ and the ACFBAL study investigators, Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5 years S1569-1993, demonstrates that 155 CF children aged ≤ 5 years who underwent a bronchoalveolar lavage (BAL) did not demonstrate that oropharyngeal cultures were reliably predictive of the lower airway cultures. Of the paired samples though, 72% were reported to have an indistinguishable ERIC-PCR genotype between the upper and lower airways [1]. In an earlier study, the results shown by Dosanjh A, Lakhani S, Elashoff D, et al. in a study of sinus, endotracheal and sputum sampling performed to identify concordance in microbiology between mid-tracheal, lower airway and sinus samples in the CF population, demonstrated significant correlation between sputum and endotracheal samples (p b 0.008) [2]. The findings of the earlier study and the study by Kidd and colleagues indicate that upper airway colonization may serve as a reservoir of infection for the lung. The BAL findings described by Kidd et al. show that the lower airway infection by Pseudomonas potentially can be distinct from the upper airway Pseudomonas profile. Clinically, all areas of the CF airway including sinus passages should be considered when developing a therapeutic plan.
The CF transplantation patient is susceptible to infection, and the upper airway remains a potential source of lung allograft infection. Thus, utilization of the latest technologies to detect bacteria in the lower airway has relevance in the management of the CF transplantation recipient. For CF transplant patients, these findings have implications for surveillance testing. The therapeutic plan in the transplanted population should consider treatment of CF sinusitis as well as the lower airway infection of the allograft. The findings of the earlier study and that of Kidd et al. may support the use of more precise molecular diagnostic studies in the care of the CF lung transplant patient. Sincerely, A. Dosanjh M.D. Pediatric Respiratory San Diego, CA References [1] Kidd T, Ramsay K, Vidmar S, Carlin JB, Bell SC, Wainwright CE, et al. Pseudomonas aeruginosa genotypes acquired by children with cystic fibrosis by age 5 years. J Cyst Fibros 2014:1569–993. [2] Dosanjh A, Lakhani S, Elashoff D, Chin C, Hsu V, Hilman B. Comparison of microbiologic flora of the sinuses and airway among cystic fibrosis patients with maxillary antrostomies. Pediatr Transplant 2000:182.
http://dx.doi.org/10.1016/j.jcf.2015.05.001 1569-1993© 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved. Please cite this article as: Dosanjh A, The microbiology of the cystic fibrosis upper and lower airway, J Cyst Fibros (2015), http://dx.doi.org/10.1016/j.jcf.2015.05.001
