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- IRMS - Nicolae Testemitanu SUMPh
- REVISTE MEDICALE NEINSTITUȚIONALE
- The Moldovan Medical Journal
- Curierul Medical 2009 - 2016
- Curierul Medical, 2012
- Curierul Medical, 2012, Vol. 327, Nr. 3
Please use this identifier to cite or link to this item:
http://hdl.handle.net/20.500.12710/9034
Title: | The role of pulmonary infection in progression of cystic fibrosis lung disease |
Authors: | Stan, I. |
Keywords: | cystic fibrosis;pulmonary infection;lung disease |
Issue Date: | 2012 |
Publisher: | Ministerul Sănătăţii al Republicii Moldova, Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu” |
Citation: | STAN, I. The role of pulmonary infection in progression of cystic fibrosis lung disease. In: Curierul Medical. 2012, nr. 3(327), p. 402. ISSN 1875-0666. |
Abstract: | Cystic fibrosis (CF) is a life-shortening genetic disease characterized by variability in the age of death. This is largely due to
variability in the rate of progression of lung disease, the primary
cause of mortality. In most patients with cystic fibrosis (CF) life
expectancy is limited due to a progressive loss of functional lung
tissue. 80% of premature deaths continue to result directly or
indirectly from loss of lung function.
The factors associated with an increased risk of lung disease
progression are: young age, high lung function, being of the female sex, certain CFTR genotypes, pancreatic insufficiency, poor
nutritional status, lower socioeconomic status, respiratory viral
infections, and infection of Pseudomonas aeruginosa or Burkholderia cepacia.
Virtually all patients with CF are chronically infected with one
or more bacterial species, and the inflammatory response to infection appears to be more intense in patients with CF. Early infection
of CF in the airways is mostly caused by Staphylococcus aureus and
Haemophilus influenza, than from P. aeruginosa or other gram
negative stains. Recent studies, especially those following patients
diagnosed by neonatal screening, have shown that infection of P.
aeruginosa usually occurs at very young age. Positive antibody
response to P. aeruginosa was found in children, with the mean age
of 15 months, about 12 months before first cultures were positive.
Also in young, non-sputum producing children it was found that
throat swabs frequently showed positive cultures for P. aeruginosa.
Chronic infection is prevalent in about 80% of all patients with
CF. In patients with chronic infection and alginate-coated mucous
strains of Ps. aeruginosa, eradication is nearly impossible. CF and
Ps. aeruginosa, an unfavorable relationship, can be explained by the
possibility of CFTR acting as a specific receptor for Ps. aeruginosa.
CFTR may influence bacterial adherence to epithelial cells. The
“overproduction” of pro-inflammatory cytokines and significantly
lower levels of the anti-inflammatory cytokine IL-10, which inhibits the production of pro-inflammatory cytokines, results in
excessive and persistent inflammation in the CF airways. As a
result, lung functioning deteriorates more rapidly in Ps. aeruginosa-positive CF patients compared with Ps. aeruginosa-negative
CF patients. Patients with cystic fibrosis are often colonized with
bacteria other than PA, causing bronco-pulmonary infections that
lead to the deterioration of lung functioning such as: Burkholderia
cepacia complex, Achromobacter xylosoxidans and Stenotrophomonas maltophilia. Patients chronically infected with S. maltophilia
are cable of rising a specific antibody response against this bacteria
associated with worsening lung function. Chronic infection of S.
maltophilia is correlated with a decline in lung functioning, but this
decline was already present prior to the chronic infection, where
the high prevalence of Aspergillus and ABPA and NTM may have
contributed a role in this result.
Staphylococcus aureus (S. aureus) is one of the earliest bacteria
detected in infants. Treatment with anti-staphylococcal agents
reduces the infection rate of MSSA but may lead to a higher rate
of infection of Ps. aeruginosa. S. aureus which isolates harbor to
a multitude of virulence factors, overlapping to a large degree in
MSSA and MRSA. To date there are no conclusive studies demonstrating that the early aggressive treatment of MRSA respiratory
infection can prevent chronic infection or if this approach ultimately improves outcomes. |
metadata.dc.relation.ispartof: | Curierul Medical: Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica Moldova |
URI: | http://moldmedjournal.md/wp-content/uploads/2016/09/18.pdf http://repository.usmf.md/handle/20.500.12710/9034 |
ISSN: | 1875-0666 |
Appears in Collections: | Curierul Medical, 2012, Vol. 327, Nr. 3
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