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Published ahead of print on February 1, 2005, doi:10.1164/rccm.200408-1044SO

Am. J. Respir. Crit. Care Med., Volume 171, Number 11, June 2005, 1209-1223

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Submitted on August 12, 2004
Accepted on January 21, 2005

Pathogen-Host Interactions in Pseudomonas aeruginosa Pneumonia: The State of the Art

Ruxana T Sadikot1*, Timothy S Blackwell2, John W Christman2, and Alice S Prince3

1 Department of Veterans Affairs Medical Center and Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA, 2 Section of Pulmonary, Critical Care, and Sleep Medicine, University of Illinois, Chicago, IL, USA, 3 Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA

* To whom correspondence should be addressed. 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 normal host, but is an efficient opportunistic pathogen causing serious infections in mechanically ventilated patients, immunocompromised individuals and patients with malignancies or HIV infection. Among these risk groups, the most vulnerable hosts are neutropenic and mechanically ventilated patients. Additionally, P.aeruginosa is the most prevalent chronic infection contributing to the pathogenesis of cystic fibrosis. Due to 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 due to 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 review is focused 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 towards enhancing host defense and/or limiting excessive inflammation could be important to improve outcome in P.aeruginosa lung infections.
Key words: cystic fibrosis, nosocomial, host defense, cytokines, epithelium




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