Linnane Barry, Kearse Linda, O'Connell Nuala H, Fenton John, Kiernan Miranda G, Dunne Colum P
Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
University Hospital Limerick, Dooradoyle, Limerick, Ireland.
BMC Pulm Med. 2015 Oct 6;15:114. doi: 10.1186/s12890-015-0113-0.
Pseudomonas 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.
A 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 bronchoalveolar 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.
Few 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.
铜绿假单胞菌是一种与囊性纤维化相关的病原体，有降低肺功能并导致呼吸衰竭的潜在风险。鼻窦越来越被认为是铜绿假单胞菌间歇性定植的潜在储存库。本病例记录了一名男性儿科患者在八年期间铜绿假单胞菌复发的调查及结果。
一名12岁的爱尔兰男性儿科囊性纤维化患者口咽区域多次培养出铜绿假单胞菌，这表明鼻窦存在慢性感染，尽管没有症状，肺功能良好，支气管镜检查和支气管肺泡灌洗也正常。然而，从鼻窦冲洗液中分离出了铜绿假单胞菌，经鉴定为一种独特的菌株，咳嗽拭子培养中也发现了该菌株。尽管进行了治疗，但鼻窦中的铜绿假单胞菌并未成功根除。
尽管越来越认识到有必要对这一部位进行调查，但很少有报告将鼻窦视为囊性纤维化患者肺部感染的储存库。在本病例中，包括口服和雾化抗菌药物在内的根除鼻窦中铜绿假单胞菌的尝试均未成功。然而，鼻窦中铜绿假单胞菌的检测促使进行抗菌治疗，但这可能有助于预防其向气道下部迁移。我们的结果提供了更多见解，并可能表明鼻腔灌洗或鼻内镜检查在儿科囊性纤维化患者年度复诊中的作用。
