Inflammatory markers in cystic fibrosis patients with transmissiblePseudomonas aeruginosa

Abstract

Chronic Pseudomonas aeruginosa infection in cystic fibrosis (CF) leads to a damaging host inflammatory response. There are an increasing number of reports of P. aeruginosa cross-infection at CF centres. The clinical significance of acquisition of a transmissible strain for patients who already harbour P. aeruginosa is unclear. In this study, levels of inflammatory markers in clinically stable adult CF patients who harbour transmissible and sporadic strains of P. aeruginosa have been compared.Patients with CF and chronic P. aeruginosa infection were grouped into those who harbour a transmissible P. aeruginosa and those who harbour their own sporadic strains. Total white cell and differential counts, sputum neutrophil elastase (NE), interleukin (IL)-8, tumour necrosis factor (TNF)-a, plasma IL-6 and NE/a 1 -antitrypsin complexes, serum C-reactive protein, and urine TNF receptor 1 were all measured in clinically stable patients 4-6 weeks following completion of intravenous antibiotic therapy.The two groups (both n=20) were well matched for per cent predicted forced expiratory volume in one second, per cent predicted forced vital capacity and body mass index. There were no significant differences in levels of white cell counts or inflammatory markers between the two groups.At times of clinical stability, cystic fibrosis patients infected with transmissible Pseudomonas aeruginosa do not have a heightened inflammatory response above that of those harbouring sporadic strains. Eur Respir J 2003; 22: 503-506 The major cause of morbidity and mortality for individuals with cystic fibrosis (CF) is pulmonary disease due to chronic infection and a damaging host inflammatory response. The major bacterial pathogen involved is Pseudomonas aeruginosa [1]. Recently, there have been a number of reports of P. aeruginosa cross-infection outbreaks at CF centres and holiday camps [2][3][4][5][6][7][8]. Isolates of many of the transmissible strains commonly exhibit unusual phenotypic features; morphotypes of the most prevalent transmissible strain at the Manchester Adult CF Centre, P. aeruginosa strain MA, are associated with an unusual pyocin type, are nonpigmented, nonmotile and are often resistant to the majority of usual anti-pseudomonal antibiotics [3]. The clinical significance of acquisition of a transmissible strain for patients who already harbour their own sporadic strain of P. aeruginosa is unclear, although some clinicians have reported an increase in morbidity [2,8,9] and mortality [2] among CF patients infected with a transmissible strain of P. aeruginosa.Airway inflammation is a major factor in the pathogenesis of CF lung disease. Inflammatory mediators as markers of the host response to infection may reflect the intensity of lung injury and relate to changes in clinical status. When clinically stable, CF patients with chronic P. aeruginosa infection are known to have increased levels of inflammatory markers compared to the non-CF population [10,11]. If transmissible strains of P. aeruginosa are more virulent ...

Antipseudomonal Bacteriophage Reduces Infective Burden and Inflammatory Response in Murine Lung

“…However, none of these studies investigated the impact of phage-targeted pseudomonal killing on lung inflammation. This is highly relevant as persistent neutrophilic inflammation has been associated with lung injury (25) and, even during periods of stability, CF patients with chronic P. aeruginosa infection have higher inflammatory indices than subjects without CF (26). The reduction in the bacterial load demonstrated in previous studies does not necessarily equate to attenuation of inflammatory damage.…”

Transmissible strains ofPseudomonas aeruginosain cystic fibrosis lung infections

“…Inflammatory markers have been compared between patients with sporadic P. aeruginosa and patients with the MES, showing that there was no significant difference between the two groups. This suggests that infection with the MES is not associated with a heightened inflammatory response [108]. However, there is evidence from the same CF centre that infection with a transmissible strain is associated with healthcare need and antibiotic usage [109].…”

Azithromycin for cystic fibrosis

“…WOLTER et al [20] reported a significant effect on the "time trend" of C-reactive protein over the course of the study with a fall in the azithromycin group. However, this systemic measure of inflammation is not a valid predictor of the local inflammatory process in the airways [23]. SAIMAN et al [22] measured interleukin-8 and neutrophil elastase (both markers of inflammation in CF) in sputum and demonstrated no clinically significant difference between the groups at the end of the study period.…”