Published ahead of print on February 1, 2005, doi:10.1164/rccm.200408-1044SO
American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 1209-1223, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200408-1044SO
Pathogen–Host Interactions in Pseudomonas aeruginosa Pneumonia
Ruxana T. Sadikot,
Timothy S. Blackwell,
John W. Christman and
Alice S. Prince
Department of Veterans Affairs Medical Center; Division of Allergy, Pulmonary, and Critical Care Medicine, Departments of Medicine and Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee; Section of Pulmonary, Critical Care, and Sleep Medicine, University of Illinois at Chicago, Chicago, Illinois; and Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
Correspondence and requests for reprints should be addressed to Ruxana T. Sadikot, M.D., Assistant Professor of Medicine, Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, T-1217 MCN, Nashville, TN 37232-2650. E-mail: ruxana.sadikot{at}vanderbilt.edu
Pseudomonas aeruginosa is an important pathogen causing a wide range of acute and chronic infections. P. aeruginosa rarely causes infection in the normal host, but is an efficient opportunistic pathogen causing serious infections in patients who are mechanically ventilated, individuals who are immunocompromised, and patients with malignancies or HIV infection. Among these risk groups, the most vulnerable hosts are neutropenic and patients who are mechanically ventilated. In addition, P. aeruginosa is the most prevalent chronic infection contributing to the pathogenesis of cystic fibrosis. Because of the ubiquitous nature of P. aeruginosa and its ability to develop resistance to antibiotics, it continues to be problematic from a treatment perspective. The pathogenicity of P. aeruginosa is largely caused by multiple bacterial virulence factors and genetic flexibility enabling it to survive in varied environments. Lung injury associated with P. aeruginosa infection results from both the direct destructive effects of the organism on the lung parenchyma and exuberant host immune responses. This article focuses on the major bacterial virulence factors and important aspects of the host immunity that are involved in the pathogenesis of serious P. aeruginosa infection. In addition to antibiotic therapy, strategies directed toward enhancing host defense and/or limiting excessive inflammation could be important to improve outcome in P. aeruginosa lung infections.
Key Words: cystic fibrosis • cytokines • epithelium • host defense • nosocomial
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