Infection with Burkholderia cepacia due to social contact is well described in patients with cystic fibrosis. However, social transmission to non-cystic fibrosis individuals or chronic colonisation in non-cystic fibrosis individuals has not been described. A report of B cepacia bronchiectasis is presented where a previously healthy mother of two cystic fibrosis children colonised with B cepacia became infected by the same epidemic strain. The implications of this for parents, siblings, and partners of individuals with cystic fibrosis are discussed. (Thorax 1998;53:430-432) Keywords: Burkholderia cepacia; cross infection Burkholderia cepacia is a well recognised pathogen in patients with cystic fibrosis, immunocompromised patients, and those undergoing mechanical ventilation.1 Rare cases of acute non-pulmonary B cepacia infection have also been described in immunocompetent patients. 2 Transmission is either nosocomial 3 or, in the case of cystic fibrosis, by social contact. 4 5 However, social transmission to or chronic colonisation in non-cystic fibrosis individuals has not been described. We present a case of chronic B cepacia bronchiectasis in the mother of two children with cystic fibrosis already colonised with B cepacia. Case reportA 47 year old non-smoking woman with an unremarkable previous medical history presented to her GP with persistent right pleuritic chest pain in September 1995. A chest radiograph showed vague shadowing in the right upper zone and she was treated with analgesia and oral co-amoxiclav. A repeat chest radiograph showed little change and, although her symptoms remained, no immediate further action was taken. Three months later she was referred to her local district general hospital complaining of increasing malaise and more chest pain. A further chest radiograph showed progression of the right upper zone shadowing and a diagnosis of tuberculosis was considered.She was not producing sputum and fibreoptic bronchoscopy was carried out in order to obtain microbiological samples. This revealed an inflamed right upper lobe orifice, washings from which grew a fully sensitive strain of Haemophilus influenzae. She had a two week course of co-amoxiclav with no benefit. Direct smear examination of the washings showed no evidence of tuberculosis.One month later she presented to the local accident and emergency department complaining of progressive malaise, weight loss, and pyrexia and a further chest radiograph showed marked worsening of the right lung shadowing (fig 1). She was transferred to our unit because of the possibility that she was suffering from tuberculosis. On admission she was pyrexial (38.5°C), tachypnoeic, and mildly hypoxaemic (PaO 2 9.6 kPa). She had lost 6 kg in weight over the preceding two months. There were crackles over the right upper lobe. Her white cell count was 15 400 (82% neutrophils, rest of diVerential count normal). A Mantoux test was negative and she was unable to produce sputum. An HIV test was negative, serum immunoglobulins showed a non-specific p...
This study shows that IV Fosfomycin is well tolerated by adult patients with CF and can be useful in the treatment of those colonised with multiresistant P. aeruginosa.
aa Most adult patients with cystic fibrosis (CF) are colonized with Pseudomonas aeruginosa [1] and usually require i.v. antibiotic therapy to treat pulmonary exacerbations with this organism. Strains of P. aeruginosa are showing increasing resistance to conventional antipseudomonal antibiotics [2, 3], yet despite this 98.8% are still sensitive to colomycin sulphomethate, an antibiotic which is easy to administer intravenously. Colomycin is a cationic cyclic polypeptide (sometimes known as polymixin E) isolated from the soil organism Bacillus colistinus [4]. The i.v. preparation is colomycin sulphomethate, formulated by treating the colistin base with sodium bisulphite in the presence of a formaldehyde [5]. It is bactericidal to many Gram-negative pathogens and works by disrupting the protein and phospholipid layers of the bacterial cell wall [6, 7], causing it to become porous with subsequent cell death [8]. This predominantly physiochemical action may account for the low levels of bacterial resistance seen to this antibiotic [9, 10]. Following parenteral administration , it penetrates most tissues but does not readily cross the blood-brain barrier. Excretion is mainly renal (65-75%) [11]. Despite the apparent suitability of this antibiotic as an antipseudomonal agent, i.v. colomycin sulphomethate is not now commonly used, since studies in the 1970s using large doses (up to 26 megaunits (MU)·day-1) demonstrated significant renal and neurotoxic side-effects [12, 13]. Thus, there have been few recent studies reviewing the use of this antibiotic. Often in combination with other antibiotics, i.v. colo-mycin sulphomethate has been used in more moderate doses to treat pseudomonal chest disease in our adult CF patients for the last 4 yrs. The efficacy and side-effects of this therapy have been reviewed in these patients over this period. Patients and methods Fifty-nine CF patients attending the Liverpool adult centre (72% of the clinic) are colonized by P. aeruginosa, and 52 of these (88%) have received i.v. antibiotics (28 male, 24 female; mean age 26 yrs, range 17-39 yrs, body mass index (BMI) mean 21.8, range 16.4-26.7) for pulmonary exacerbations with the organism. The notes of all 52 patients were reviewed and the number and length of i.v. colomycin courses, dose prescribed, other i.v. antibiotics concurrently used, use of nebulized colomycin, organisms cultured from sputum and their sensitivities, pre-and post-i.v. treatment spirometry and pre-and post-i.v. treatment renal function and any side-effects were noted. Results Over the study period 135 courses of i.v. colomycin at a dose of 2 MU t.d.s. were administered to these 52 adult CF patients. Every patient had received at least one course of i.v. colomycin (mean two courses each, range 1-7, median length 14 days, longest continuous course 210 days in a severely ill patient). In total, 2,414 patient days of i.v. Four years' experience of intravenous colomycin in an adult cystic fibrosis unit. M.J. Ledson, M.J. Gallagher, C. Cowperthwaite, R.P. Convery, M.J. Wal...
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.