Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis

Burkholderia cepacia: medical, taxonomic and ecological issues

“…aeruginosa [62]. Finally, one of the most striking results from the first microbiological studies in transgenic CF mice showed that 70% of CF mice exposed to B. cepacia succumbed to more severe broncho-pulmonary infection than control animals P I - …”

“…In epidemic outbreaks in which patients are colonised by the same strain, some patients may remain asymptomatic whilst other individuals succumb to rapid and unexpected fatal deterioration [37,62]. In the case of transmission, epidemiological evidence has clearly identified lineages with enhanced transmissibility [25,46,62,691; however, based on present knowledge, it cannot be stated with confidence that a strain inherently lacks the ability for epidemic spread. Furthermore, apparently 'non-transmissible' strains that have not spread even to a patient's CF sibling have been responsible for fatal infection [72].…”

“…Finally, it could be argued that transmission is not strain-dependent, but is associated with nosocomial or social opportunities for transmission. This hypothesis is certainly not supported by the behaviour of the particular B. cepacia lineage with a notorious ability to spread in CF centres in the UK [46,62] and North America [25,69], referred to as the Edinburgh/Toronto lineage [69] or ET 12 intercontinental clone (multilocus enzyme electrophoresis type 12) [25]. For convenience, this particular B. cepacia lineage will be referred to as the ET12 lineage in the remainder of this review.…”

“…Clarification of the clinical relevance of B. cepacia is also thwarted by the fact that the available scientific evidence requires particularly careful analysis. There is an inclination to link bacterial transmissibility and virulence, and to categorise individual B. cepacia Thomassen et al [57] LiPuma et al [58] LiPuma et al [59] Anderson et al [60] Millar-Jones et al [61] Govan et al [62] Smith et al [63] Bingen et al [64] Corkill et al [65] Pegues et al [66] Johnson et al [25] LiPuma et al [67] Ryley et al [68] Sun et al [69] Revets et al [70] Whiteford et al [71] Pitt et al [46] Seminal strains as either transmissible and virulent, or nontransmissible and avirulent. There is no scientific justification for this view.…”

“…However, by the early 1990s, the availability of selective culture media [48] and awareness of the organism's cultural idiosyncrasies [56] indicated that regional variation in the prevalence of B. cepacia colonisation could not be explained simply by laboratory methodology. Furthermore, the development and use of bacterial fingerprinting techniques-including multilocus enzyme electrophoresis (MLEE), pyrolysis mass spectroscopy, PCRribotyping and pulsed-field gel electrophoresis (PFGE)-provided compelling evidence for personto-person spread of B. cepacia through nosocomial and social contacts (Table 2) [25, 37,46,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] and, occasionally, in the absence of proven sputum colonisation [67]. Epidemiological data also provided scientific justification for the introduction of guidelines by national CF organisations to improve personal and hospital hygiene and, more controversially, for the implementation of segregation policies to limit contact between colonised and non-colonised individuals [76].…”