A case of failed eradication of cystic fibrosis-related sinus colonisation by Pseudomonas aeruginosa

Abstract

BackgroundPseudomonas aeruginosa is a pathogen associated with cystic fibrosis that has potential to decrease lung function and cause respiratory failure. Paranasal sinuses are increasingly recognised as potential reservoirs for intermittent colonisation by P. aeruginosa. This case documents investigation and outcome of P. aeruginosa recurrence in a male paediatric patient over an eight year period.Case presentationA 12 year old Irish male paediatric cystic fibrosis patient experienced intermittent culturing of P. aeruginosa from the oropharyngeal region, indicating chronic infection of the sinuses despite absence of symptoms, retaining good lung function, and normal bronchoscopy and bronchoalveloar lavage. However, P. aeruginosa was isolated from a sinus wash-out and was identified as a unique strain of P. aeruginosa that was also cultured from cough swabs. Despite treatment, successful eradication from the paranasal sinuses was not achieved.ConclusionsFew reports have addressed the paranasal sinuses as a reservoir for lung infection in cystic fibrosis patients despite increased recognition of the need to investigate this niche. In this case, attempts at eradication of P. aeruginosa present in paranasal sinuses including oral and nebulised antimicrobials proved unsuccessful. However, detection of P. aeruginosa in the paranasal sinuses instigated antimicrobial treatment which may have contributed to prevention of migration to the lower airways. Our outcome provides additional insight and may indicate utility of nasal lavage or nasal endoscopy in paediatric cystic fibrosis patients’ annual review clinic visits.

Sinus Bacteriology in Patients with Cystic Fibrosis or Primary Ciliary Dyskinesia: A Systematic Review

“…Forty-one percent of the studies 13,17,[20][21][22]24,26,27,29,30,[38][39][40][41][42]45,50,52,53 provided information about the use of antibiotics before or during the sampling procedure. In four studies, 14,16,25,33 it was unclear whether the patients received antibiotics before or during sampling. Fifty percent of the studies 10,11,13,14,17,[22][23][24][26][27][28][29][30][31][32][33]36,38,39,42,45,47,49 provided information about culture methods.…”

“…In four studies, 14,16,25,33 it was unclear whether the patients received antibiotics before or during sampling. Fifty percent of the studies 10,11,13,14,17,[22][23][24][26][27][28][29][30][31][32][33]36,38,39,42,45,47,49 provided information about culture methods. Most studies 10,11,14,17,[22][23][24][27][28][29][30][31][32]38,39,42,45,47,49 used conventional culture methods (41%).…”

Inhalable Antimicrobials for Treatment of Bacterial Biofilm-Associated Sinusitis in Cystic Fibrosis Patients: Challenges and Drug Delivery Approaches

“…Bacterial infections in the sinuses caused by P. aeruginosa are especially challenging for CF patients, as a Pseudomonas sinus infection is thought to spread easily from the sinuses into the lower respiratory tract and colonize the lungs [6,21]. The unified airway model considers the whole respiratory system as one functional unity, which consists of the nose, paranasal sinuses, pharynx, larynx, trachea, bronchi and distal lungs [15].…”

“…The most frequently isolated bacterial pathogens from CF patient lungs are Haemophilus influenza , Staphylococcus aureus and Pseudomonas aeruginosa [3,5]. Lung infections with P. aeruginosa increase the mortality risk in this patient group almost three times as compared to CF patients without a P. aeruginosa infection [6]. The number of P. aeruginosa infections increases drastically to over 70% in patients aged 25–34 years (Figure 1) and chronic lung infections with this pathogen cause a more rapid pulmonary function decline, contributing to early death of CF patients [3,7].…”

“…Treatment soon after diagnosis has shown to be successful in delaying occurrence of chronic infections with P. aeruginosa and thus improving quality of life for CF patients [3,12,13,14]. Other studies have shown that the sinuses in CF patients constitute a reservoir for P. aeruginosa from which the bacteria can be transmitted into the lungs, even after the initial infection in the lungs has been cleared [6,15,16,17]. Although the importance of eradication of P. aeruginosa from sinuses has been recognized, long-term clinical trials for treatments of CF sinus infections are still lacking.…”