Pseudomonas cepacia: a new pathogen in patients with cystic fibrosis referred to a large centre in the United Kingdom

Article Abstract:

Patients with cystic fibrosis often develop chronic bacterial infections from the organisms Pseudomonas aeruginosa, Staphylococcus aureus, or Hemophilus influenzae. These patients usually die from respiratory failure due to these infections. Pseudomonas cepacia is an increasingly important new disease-causing type of bacteria responsible for infections in cystic fibrosis patients. Several risk factors have been suggested as predisposing these patients to infection with P. cepacia: increased severity of disease, older age, recent use of aminoglycoside, recent hospital admission, or a sibling who already is infected by the organism. Of particular concern is the use of nebulized aminoglycoside antibiotics, which may be a factor in the development of infection with P. cepacia; however, there are no data to substantiate a true association between the two. The rate of infection from P. cepacia was determined from cystic fibrosis patients who were seen in three cystic fibrosis clinics in Great Britain. There were 160 patients seen during the six-year study period. P. cepacia alone was only isolated in one patient, while a combination of P. aeruginosa and P. cepacia was isolated in 10 patients. Most P. cepacia isolates were resistant to the aminoglycosides. The pattern of infections in the patients studied was similar to that seen in North America. Patients either remained clinically stable, deteriorated gradually, or deteriorated rapidly. Once the patients had reduced lung function, intensive treatment and even eradication of P. cepacia could not prevent respiratory failure as a consequence of the extensive lung damage. There was an increased prevalence of P. cepacia; however, the reason is still not clear. Laboratory analysis must be specifically concerned with P. cepacia; otherwise, the bacteria will not be discovered because of overgrowth with other cystic fibrosis pathogens, particularly S. aureus and P. aeruginosa. The role of patient-to-patient transmission of P. cepacia is controversial; however, the experience in the study supports findings that the organism is not transmitted from one patient to another and that the use of nebulized aminoglycosides to treat lung infections by other organisms does not seem to associated with increased risk of infection with P. cepacia. P. cepacia is an important new pathogen in patients with cystic fibrosis. Further study is needed to identify the specific risk factors. Cystic fibrosis patients with severe lung damage have lower chances of survival once infected with P. cepacia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Reports, Risk factors, Drug resistance in microorganisms, Microbial drug resistance, Aminoglycosides, Pseudomonas infections

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Clinical monitoring of steatorrhoea in cystic fibrosis

Article Abstract:

Measuring the amount of fat in the feces is the common method of assessing fat absorption by the body. The effectiveness of treatment with pancreatic enzyme can be assessed by repeated measurements of fecal fat. However, many laboratories do not have the appropriate facilities for fecal fat tests. As a consequence, the fecal fat in patients with cystic fibrosis, an inherited disease of exocrine glands, often goes unmeasured. Various methods of assessing fat, including the administration of radioactive elements and measurement of radioactivity in the breath and feces, and blood sampling cannot be appropriately used in children. The severity of steatorrhea, or fatty stools, was assessed in 100 patients with cystic fibrosis using three different methods. The standard test was the fecal fat assay, and results from this test were compared with those from two other methods. One of the tests, the steatocrit method, was not reliable and was not useful in indicating the severity of steatorrhea. The use of a simple microscope was found to be 97 percent sensitive, and missed the diagnosis of steatorrhea in only three of 80 patients. Patients with severe steatorrhea, indicated by a fat level of greater than 60 millimoles of fat per day, were easily diagnosed. The simple microscopy method can be used with small fecal samples and can be performed on an outpatient basis. Hence, the simple, inexpensive microscopic examination can be used to monitor treatment with pancreatic enzyme and identify patients who are not appropriately following the prescribed treatment regimen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Medical examination, Celiac disease, Feces

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Cystic fibrosis and allergic bronchopulmonary aspergillosis

Article Abstract:

Improved management of cystic fibrosis has led to a longer life-span for these young patients. However, these same patients are at increased risk for allergic bronchopulmonary aspergillosis, which is a serious allergic response to the common mold Aspergillus fumigatus. Just how important this threat is, however, remains controversial among those who treat cystic fibrosis patients. In order to determine the prevalence of this reaction among cystic fibrosis patients, 137 patients were prospectively screened for allergic aspergillosis over a three-year period. A total of 11 episodes were observed in 8 patients, which represented one-fifth of the respiratory problems involving pulmonary infiltrates. A prevalence of 5.8 percent in this population is almost certainly an underestimate, since some episodes may have been missed. Allergic bronchopulmonary aspergillosis is relatively common among patients with cystic fibrosis, and should be suspected when a pulmonary infiltrate is present. Regular chest X-ray and testing for allergic reaction with A. fumigatus antigen may result in the early diagnosis and treatment of this condition in patients with cystic fibrosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Drug therapy, Aspergillosis

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