Am. J. Respir. Crit. Care Med., Vol 152, No. 1, Jul 1995, 169-173.
Progression of pulmonary disease after disappearance of Pseudomonas in cystic fibrosis
GD Sharma, MF Tosi, RC Stern and PB Davis
Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106, USA.
Once cystic fibrosis (CF) patients become chronically colonized,
eradication of Pseudomonas aeruginosa (PA) is rare. We report five
patients, each colonized for at least 6 yr, whose subsequent cultures did
not reveal PA or any other gram-negative pathogen for at least 2 yr. Two
patients harbored yeast, normal throat flora, and occasional colonies of
Aspergillus fumigatus, but no PA, Haemophilus influenzae, or other
gram-negative pathogens. In two patients, sputum cultures revealed
Staphylococcus aureus. Sputum smear showed no gram-negative organisms in
any patient. Antipseudomonal antibody titers in all patients decreased
during the noncolonized period. However, titers increased in four other CF
patients who had continued PA colonization. Despite disappearance of PA,
four of five patients had clinical progression of lung disease with
deterioration of FEV1. We conclude that (1) PA, even after it has
chronically colonized the airways of CF patients, can occasionally
disappear; and (2) lung disease can progress despite the disappearance of
PA. Thus, the elimination of a milieu favorable to PA, such as might be
anticipated with therapy directed at the basic defect, may not be
sufficient to halt the pulmonary disease progression in CF.
