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Colonisation with Pseudomonas aeruginosa is common in adults with cystic fibrosis (CF) and there is increasing evidence that transmissible strains may cross colonise patients. However, transmission of these strains by social contact to healthy non-CF individuals has not been described. A case is presented where an adult CF patient colonised by an epidemic P aeruginosa strain infected her parents with subsequent morbidity. P seudomonas aeruginosa is a well recognised pathogen in patients with cystic fibrosis (CF) and up to 80% of the adult population are chronically colonised.1 While it was assumed that patients were infected by individual unique strains, with shared strains only occurring between CF siblings, 2 there is now increasing evidence that many patients with CF may be colonised by the same (epidemic) strains, with transmission occurring between unrelated CF patients. However, healthy non-CF relatives of these patients are not thought to be at risk from cross infection by P aeruginosa as this organism is not described as a primary pathogen in non-CF lungs. We present a case in which a patient with CF chronically colonised with an epidemic P aeruginosa strain cross infected her non-CF parents with subsequent significant morbidity.We subsequently looked for P aeruginosa carriage in the relatives of a group of our CF patients colonised by this epidemic strain. CASE REPORT Index caseThe index case (age 22 years, DF508/G551D) was diagnosed with CF at birth due to meconium ileus. She became chronically colonised with P aeruginosa in 1981 while attending the local paediatric hospital. In 1995 genotyping of her P aeruginosa isolates (by pulsed field gel electrophoresis (PFGE)) revealed that she was colonised by a multiresistant epidemic P aeruginosa strain which was prevalent in the paediatric unit at the time.3 She is currently stable with a good nutritional state (BMI 22 kg/m 2 ) and spirometric status (FEV 1 95% predicted), and usually requires three courses of intravenous antibiotics per year. She lives with her parents who assist with chest physiotherapy twice daily. When well she produces small amounts of sputum only. Regular genotypic analysis of her sputum cultures reveals that she is chronically colonised by two different P aeruginosa strains, the epidemic strain and a second unique β-lactam resistant strain. Infection of the motherIn February 2000 her mother aged 56 years presented to her GP with a 5 month history of flu-like symptoms and pleuritic chest pain. She had no past illnesses of note apart from mild asthma and was previously well. She had lost 6 kg in 2 months and was producing 30 ml sputum/day. A sputum sample was sent for microbiological analysis. She was commenced on amoxycillin 250 mg tds for 7 days and ciprofloxacin 500 mg bd for 7 days by her GP with no clinical improvement. Sputum samples grew fully sensitive Streptococcus pneumoniae and a P aeruginosa strain resistant to ceftazidime (MIC >32), and she was referred to our unit.At presentation she was pyrexial with bilateral chest wheez...

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