Viral infection- Pseudomonas

Question

Hello,

How can it be explained, that in case of a cystic fibrosis patient (a toddler) a harmless viral infection can cause every time a pseudomonas colonization?
Till now, the pseudomonas could be eradicated every time; but as the next viral infection followed, the pseudomonas could be proved again in the routine smear. Is the mucosa more vulnerable for pseudomonas during a viral infection? Or is it just explained because of the increased mucus?
Observing such a regular relation between a viral infection and pseudomonas colonization, is it reasonable to treat such a viral infection immediately with an antibiotic (Ciprobay®?) in the beginning, in order to have a prophylaxis against pseudomonas?
How are the current guidelines for a pseudomonas eradication (not mucoid, pseudomonas antibody negative)?
Thank you very much!

Answer

Hello,

The affinity between the respiratory tract and the pseudomonas germ is high.
The pseudomonas germs occur ubiquitously, so they are everywhere. A viral infection can lead to an inflammation of the respiratory tract. Therefore the pseudomonas germs have an easier entry to the mucosa and the lung tissue.
Your observation of a relation between a viral infection and pseudomonas colonization is well comprehensible and known. When every time after or with a viral infection, pseudomonas germs are detected, then possibly there is a beginning pseudomonas infection existing, at least there is an intermitting pseudomonas colonization.
In your case my first advice would be:
Inhalation of Gernebcin® (Tobramycin)/Colistin®/Cayston® (Aztreonam) in every infection.
My second advice would be:
An inhalative antibiotic treatment in an on/off procedure.
My third advice would be:
Testing of the pseudomonas antibodies in the serum. A chronic pseudomonas infection exists e.g. if in 12 months pseudomonas germs are detected in more than 50% of the smears.
Why these bacteria are found is not the question, but rather that they are found.
According to the guidelines, in this case a consequent anti-pseudomonas treatment is initiated. In addition to this, there could be also an intravenous antibiosic treatment with anti-pseudomonas antibiotics.
So your question is really justified.
There are some out-patient departments, which have already taken this into account and which are initiating anti-pseudomonas treatments with viral infections preventively.
The first considerations concerning this came from Mrs. Dr. Bertele-Harms from the Cystic Fibrosis centre in Munich (Dr. Von Haunersche Universitätskinderklinik) in the eighties of the last century. [Pls note that the original question and answer where asked on the German platform; this is only a translation]
Besides the anti-pseudomonas inhalative antibiotic treatment one can also consider an additional antibiotic treatment with Ciprofloxacin.
With these therapeutic steps, definitely the time of an eventually chronical pseudomonas infection can be postponed, possibly even an eradication of the pseudomonas germ can be achieved.
Please discuss your thoughts with your cystic fibrosis clinic/outpatient department.

Kind regards,
Dr.H.-E. Heuer

13.09.2015