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Anaerobic Bacterial Infection in Patients with Cystic Fibrosis

The article by Dr. Tunney and colleagues (1) demonstrates that anaerobic bacteria are frequently present in airway specimens. In cystic fibrosis (CF), the significant relationship identified between coinfection with anaerobes and Pseudomonas aeruginosa may be of pathogenic importance, even though, in Tunney and coworkers' study, there was no difference in lung function between those with or without infection with P. aeruginosa or anaerobes (2). Nevertheless, the possibility of coinfection raises the question about chronological timing of infection and needs further evaluation. Interestingly, the findings of the presence of anaerobic bacteria in the pediatric bronchoalveolar lavage (BAL) specimens, even in the absence of P. aeruginosa infection, appear to contradict the hypothesis that P. aeruginosa infection generates hypoxic conditions that promote anaerobic colonization (3).

The study by Tunney and coworkers (1) is the first to assess anaerobic bacteria in children with CF by means of BAL specimens, but the indications for bronchoscopy and the clinical state of the children undergoing testing were not reported. For example, assessments of synergy in causing infection and disease are compounded by attempts to eradicate P. aeruginosa when this organism is identified.

Airway inflammation is also an important component of airway infection in those with CF (4), but was not reported by Tunney and coworkers. Therefore, a prospective longitudinal study is required to clarify the chronological timing of airway infection with anaerobic and aerobic bacteria in young children with CF. The potential clinical significance of this could be estimated by identifying the association between the presence of anaerobes in the lower airway with markers of pulmonary inflammation and with the subsequent clinical evolution of pulmonary disease.

Andrew Tai and Sarath Ranganath

Royal Children's Hospital Melbourne
Melbourne, Australia

FOOTNOTES

Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Tunney MM, Field TR, Moriarty TF, Patrick S, Doering G, Muhlebach MS, Wolfgang MC, Boucher R, Gilpin DF, McDowell A, et al. Detection of anaerobic bacteria in high numbers in sputum from patients with cystic fibrosis. Am J Respir Crit Care Med 2008;177:995–1001.[Abstract/Free Full Text]
2. Pamukcu A, Bush A, Buchdahl R. Effects of Pseudomonas aeruginosa colonization on lung function and anthropometric variables in children with cystic fibrosis. Pediatr Pulmonol 1995;19:10–15.[Medline]
3. Palmer KL, Brown SA, Whiteley M. Membrane-bound nitrate reductase is required for anaerobic growth in cystic fibrosis sputum. J Bacteriol 2007;189:4449–4455.[Abstract/Free Full Text]
4. Armstrong DS, Grimwood K, Carlin JB, Carzino R, Gutierez JP, Hull J, Olinsky A, Phelan EM, Robertson CF, Phelan PD. Lower airway inflammation in infants and young children with cystic fibrosis. Am J Respir Crit Care Med 1997;156:1197–1204.[Abstract/Free Full Text]

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