A controversy exists concerning the adequate specimen to characterise colonisation of cystic fibrosis (CF) airways by Pseudomonas aeruginosa. Oropharyngeal, sputum and bronchoalveolar lavage samples were evaluated from 38 stable CF patients for the detection of P. aeruginosa, genetically different isolates within the same host and longitudinal variations in the genotype during repeated examinations.Bacterial isolates were typed by pulsed-field gel electrophoresis of deoxyribonucleic acid macrorestriction fragments.Sensitivity, negative and positive predictive values and specificity to detect P. aeruginosa were 35.7, 73.5, 83.3 and 96.2% for oropharyngeal cultures in nonexpectorating patients and 91.7, 94.1, 100 and 100% for sputum cultures from expectorating patients, respectively. Genotypes of Pseudomonas isolates recovered from oropharyngeal swabs and sputum differed to the strains recovered by bronchoscopy in 55% and 40%, respectively. In 62% longitudinal variations in the genotype occurred. One-half of these alterations were detectable by bronchoscopy only.In conclusion, sputum samples were of equal value as specimens from bronchoalveolar lavage to detect Pseudomonas aeruginosa colonisation. Cultures from the oropharynx are not suitable for characterising bacterial conditions in the cystic fibrosis lung. Different genotypes within the same host and longitudinal genetic alterations are common and may be detectable in the bronchoalveolar lavage fluid exclusively.
Cystic fibrosis (CF) is associated with a neutrophil dominated airway inflammation. So far bronchoalveolar lavage (BAL) studies in CF have used pooled BAL samples which may be more representative of the alveolar compartment rather than the airways. To assess whether the first sample of a BAL is more sensitive in the evaluation of airway inflammation, the authors have studied 105 stable CF patients aged 5-37 yrs with a mean forced expiratory volume in one second (FEV1) of 96+/-15% (mean+/-SD). BAL cytology of the first and pooled samples were compared to reference values obtained in children without respiratory disease. Absolute cell counts and the percentage of neutrophils were significantly increased in CF patients. If the 95% confidence interval was used as a cut-off point, 17/105 CF patients had a normal percentage of neutrophils in pooled BAL samples, but only three also had a normal percentage of neutrophils in the first BAL aliquot. Therefore, neutrophil dominated airway inflammation is more pronounced in the first, mainly bronchial, bronchoalveolar lavage sample suggesting that sequential analysis of bronchoalveolar lavage fluid may have a higher sensitivity to detect early inflammatory changes in CF patients.
To study in vivo monitoring variables for bronchial allergen challenges, we investigated the time course of the eosinophil granule proteins, eosinophil cationic protein (ECP) and eosinophil protein X (EPX) after allergen provocation in serum. Thirty-two asthmatic children sensitive to house-dust mites and six healthy young adult controls were challenged by bronchial allergen provocations with Dermatophagoides pteronyssinus and D. farinae. Blood samples were taken at regular intervals up to 24 h. Base-line concentrations of ECP (P < 0.004), EPX (P < 0.002), and eosinophils (P < 0.001) were found to be increased in asthmatic children, as compared with healthy controls. ECP and EPX concentrations showed a uniform pattern with two characteristic features: 1) a rapid increase for both mediators up to 30 min after provocation over base-line values (P < 0.0001 and P < 0.001), followed by a rapid decrease nearly to base-line values in the next 30 min; and 2) a steady increase for ECP and EPX up to 10 h (P < 0.02 and P < 0.01), and even higher levels at 24 h, after challenge (P < 0.002 and P < 0.003). We conclude that although eosinophils are activated in asthmatic children after bronchial allergen challenge, ECP and EPX concentrations are not suitable monitoring variables. Base-line eosinophils seem to predict the occurrence of a late-phase asthmatic reaction after allergen provocation.
Summary:ducts/alveoli, and areas of organizing pneumonia. In addition, the clinical manifestations of bronchiolitis obliterans and bronchiolitis obliterans organizing pneumonia are We report an 8-year-old boy who developed cough and respiratory failure 7 months after bone marrow transquite distinct. Patients with bronchiolitis obliterans organizing pneumonia report dyspnoea, and late inspiratory plantation (BMT) coinciding with the onset of chronic graft-versus-host disease (GVHD). Lung function data, crackles are present on physical examination. They have abnormal gas exchange and show a restrictive lung function imaging studies, lung biopsy and bronchoalveolar lavage were consistent with the diagnosis of bronchiolitis pattern. The chest radiograph in bronchiolitis obliterans organizing pneumonia often shows patchy areas of consoliobliterans organizing pneumonia. While this has been reported in association with chronic graft-versus-host dation. In contrast to bronchiolitis obliterans, bronchiolitis obliterans organizing pneumonia has a fair to excellent disease in one adult case previously, we report the simultaneous occurrence of BOOP and chronic GVHD in prognosis on steroid therapy. 2Recently, bronchiolitis obliterans organizing pneumonia a child after bone marrow transplantation for the first time.has also been reported after bone marrow transplantation. 3Since patients with bronchiolitis obliterans organizing Keywords: bone marrow transplantation; children; interstitial pneumonia pneumonia usually present with multiple pulmonary infiltrates resembling an infectious process, it may be underrecognized after marrow transplantation. However, if a definitive diagnosis of bronchiolitis obliterans organizing There has been extensive progress in clinical bone marrow pneumonia can be established, treatment with prednisolone transplantation over the last decade. Long-term relapse-free may reduce the morbidity and mortality usually associated survival is now a reality for many children, so that late with this syndrome. sequelae like pulmonary complications are becoming a sig-A number of reports indicate an association of chronic nificant cause for morbidity and mortality.1 While infec-GVHD with various pulmonary pathologies such as tious processes are a major source of these complications in bronchiolitis obliterans. [4][5][6] While there is one reported adult the early post-transplant period, non-infectious pulmonary case with bronchiolitis obliterans organizing pneumonia in disorders have been described later, predominantly in connection with chronic GVHD, a previous report about patients with chronic graft-versus-host disease (GVHD).three children with bronchiolitis obliterans organizing Bronchiolitis obliterans organizing pneumonia, also pneumonia showed no such association. 7,8 We report a termed cryptogenic organizing pneumonia, is a clinicochild who developed bronchiolitis obliterans organizing pathologic syndrome distinct from bronchiolitis obliterans pneumonia coinciding with chronic GVHD. and was first desc...
Neutrophil-dominated endobronchial inflammation is a major characteristic of cystic fibrosis (CF) and there is increasing demand for easy-to-perform noninvasive monitoring for prediction and intervention.Fourteen stable paediatric CF patients (8-17 yrs; mean forced expiratory volume in one second 86.7% of the predicted value) were investigated once by fractional bronchoalveolar lavage (BAL) and by sputum induction on three occasions, 2-6 weeks apart. Sputum was induced by consecutive 10-min inhalations of 3, 4 and 5% saline. CF sputum cellular profiles were compared with BAL fluid cell counts and samples from agematched healthy children, and between different time points to assess reproducibility.Adequate sputum was recovered on w95% of occasions. In all sputum fractions, CF patients showed higher neutrophil counts than healthy children. Neutrophil percentages were highest in the first BAL fraction (median 92%), followed by sputum, in which the percentages decreased in consecutive fractions (72, 66 and 64%), whereas counts were lowest in the pooled BAL fraction (53%). Increasing percentages of macrophages mirrored the decreases in neutrophil percentage. Results of sputum induction at different time points in the CF patients showed good reproducibility and nonoverlap with counts from healthy children.In conclusion, the results of sputum induction in children with mild stable cystic fibrosis adequately describe airway inflammation by providing cellular profiles with lower relative neutrophil counts than in the first ("bronchial") bronchoalveolar lavage fraction and higher relative neutrophil counts than in subsequent pooled ("more peripheral") bronchoalveolar lavage fractions. Eur Respir J 2003; 22: 497-502.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.