Abstract
Airway infections are a key component of cystic fibrosis (CF) lung disease. The approach to common pathogens such as Pseudomonas aeruginosa or Staphilococcus aureus is guided by a significant evidence base, but the treatment of other infections is significant challenge to pharmacotherapy teams. Here we present a specific approach to treatment of chronic infections with non-tuberculous mycobacteria (NTM) anaerobic bacteria and fungi in a 25 year old patient with CF and severely decreased lung function. Also, allergic bronchopulmonary aspegillosis (ABPA) was diagnosed in the patient. Key words: cystic fibrosis, non-tuberculous mycobacteria, allergic bronchopulmonary aspegillosis, antibiotics, systemic steroids
Highlights
IntroductionBriard et al (2016) showed that P. aeruginosa stimulates Aspergillus fumigatus growth via volatile communication mediators, while Reece et al (2018) that both pathogens had mutually antagonistic effect at the biofilm formation stage
cystic fibrosis (CF) airway disease is characterized by a continuous cycle of persistent infection and inflammation contributing to morbidity and mortality in CF
During the last two decades, an increasing prevalence of M. abscessus in sputum samples from CF patients has been noticed, causing up to 95% of nontuberculous mycobacteria (NTM) infections
Summary
Briard et al (2016) showed that P. aeruginosa stimulates Aspergillus fumigatus growth via volatile communication mediators, while Reece et al (2018) that both pathogens had mutually antagonistic effect at the biofilm formation stage These co-infecting microbes contribute to altered inflammatory response, evasion of the immune system and and to the establishment chronic colonization, which could have a significant impact on their treatment in patients with CF. The diagnosis of CF was established at the age of 5 years and confirmed genetically: patient is double heterozygote one copy of F508del and one copy of 3839G>A in the CFTR gene His lung function was relatively stable until age of yrs (end of 2015), when alongside with multiple admissions for pulmonary exacerbations/massive pneumonia and episodes of haemoptysis, he began to experience a serious decline in pulmonary function demonstrated by a fall in FEV1 from 46% predicted (FEV1/FVC 55%) at the age of yrs (in 2016) to less than 26% predicted (FEV1/FVC less than 40%) by the age of 24 yrs (end of 2018). The patient was listed for lung transplantation, which was performed at his age of 25 yrs (April, 2019)
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