Rare germ Inquilinus limosus

Question

Dear expert team,
My son 11 year-old son, suffering from CF, has been diagnosed to bear the germ Inquilinus limosus. (Apart from that he is from time to time colonized with Staphylococci, Candida or Aspergillus).
As this germ seems to be very seldom, some statements contradict, therefore I ask for your advice.
At first I would like to know if a treatment is necessary even if it does not cause any problems up to now? Lung function results up to now are about 110-120%, no increased mucus production, no cough.
Furthermore I would like to know, how this germ has to be regarded concerning rehabilitation, physiotherapy or hospital stays. Are there any restrictions?
I am looking forward to an answer,
Yours sincerely,
Daniela H.

Answer

Dear Mrs. H.
you report, that the germ Inquilinus limosus has been detected in your 11 year-old son. About the general condition of your child you report that the lung function results with 110-120% of the age norm are normal and that there is no increased cough nor mucus production. Apart from Inquilinus limosus only a recurrent colonization with Staph. aureus as well as Candida and Aspergillus has been observed.
You request, if in this situation a treatment to eliminate the germ is necessary and if because of the colonization with this germ your son has any restrictions e.g. concerning a rehabilitation measure or at pyhsiotherapy.
In general it has to be said about this germ, that it belongs to the group of the so-called seldom germs in CF. It is assumed that it deals with a general environmental germ, without knowing its natural reservoir up to now. Only via the modern molecularbiological investigation methods in microbiology this germ has been detected more frequently in CF patients. In order to be able to cultivate it, one needs special agars in the lab and a longer lasting cultivation time. Similar to Pseudomonas aeruginosa this germ is a mucus productive germ. It belongs to the multiresistant germs.
In the literature, only small groups of patients with Inquilinus limosus-infections are described in CF-patients.
At sputum investigations of 47 CF-patients from 16 CF centers Inquilinus limosus could be deteted by instance in 7 patients in a specialized laboratory for Cepacia-diagnostics. In this paper there is no detailed information on the clinical significance of the infection of this germ.
2005 a working-group from Munich reported about 6 patients with an infection with Inquilinus limosus. The patients were between 15 and 32 years of age. All patients were simultaneously colonized with Pseudomonas aeruginosa. 5 patients showed signs of an acute infection: one patient of this subgroup was clinically severly ill; one patient was in a stable situation.
The authors judged the situation of the 5 patients with acute signs of infection to be worth treating it with regard to the germ Inquilinus limosus. This judgment was founded on the finding of positive serum antibodies in those patients.
Other authors report about the random finding of Inquilinus limosus and the spontaneous disappearance of the germ without a targeted therapy.
In case one wants to judge these alltogether very limited experience reports with regard to the situation of your son, a waiting strategy seems at the moment to be justified, especially as your son is up to now not colonized with Pseudomonas aeruginosa and we have an absolute normal lung function. Controls of the signs of infection in the blood (e.g. CRP, ESR, leucocyte count and IgM) and of the lung function should be performed absolutely consequently every 3 months.
This of course should be coordinated with the physicians of your CF-center.
On the question of the consequences concerning a rehabilitation measure the following can be said. As your child is up to now not colonized with Pseudmonas aeruginosa, only a Pseudomonas-negative rehab comes into question. The potential rehabilitiation clinic should be informed about the germ status. Under performance of the general hygiene measures nothing speaks against a participation at such a rehab-measure at the moment. Also concerning the physiotherapy only the hints at the strict adherence to the general hygiene rules pertain.
Dr. H.-G. Posselt

12.08.2013