CF difficulties

Question

My child is coughing up phlegm, and swabs made by the local pediatrician show staphyloccus epidermidis in the nose. The child has had pseudomonas in the past and is now coughing. Two weeks ago she had Sumamed prescribed when she had a cold. We're afraid that the cough will turn into pneumonia. Please advise us on what to do; we have a checkup in a week at our CF center. We have 2 such patients and are unclear as to how to proceed. What is serious and what isn't? Is it possible that a 2-year-old child would cough without anything showing up in the swabs? Thank you

Answer

Hello.
I'm sorry for the delayed answer to your question, but our Slovak colleagues did not send a reaction to your question.
This forum is not intended for the resolution of acute difficulties requiring medical checkups, which is certainly your case.
As regards your question about the presence of a cough and negative swabs: Changes in the character of the cough, the amount of sputum produced or only a change in the child's behaviour in the sense of increased tiredness could mean an acute exacerbation of a basic sickness. The causes very frequently tend to be viruses which are not caught in the swabs because the technique for examining viruses is completely different than for bacteria, and for this reason it is possible that the swab test from the nose or throat would be negative during a viral infection. Which laboratory is carrying out the test is also very important. Not all microbiological laboratories examine certain pathogens specific to CF. It is also very important whether this is a swab test from the nose, throat, suction from the upper respiratory tract or sputum – therefore from a secretion from the lower respiratory tract. A cough can reflect infections in the lower respiratory tract and a throat swab can be completely negative, as has been documented in many expert publications on the topic. You also mention that your child has had pseudomonas in the past. In such a case, if your child is not coughing up sputum, a regular checkup should be carried out with suction from the upper respiratory tract, as well as bronchoscopy to rule out the presence of a pseudomonas infection. It would be good to complement these tests with a blood sample to determine the level of antibodies against pseudomonas.
It can be seen from your question that it would be very good to discuss your questions in more detail with a CF specialist.
I don't know the situation very well in Slovakia, but in the Czech Republic, when a diagnosis of CF is made, the family is given a publication on CF and we send the attending physician expert literature on the topic. Each family with CF is offered cooperation with the patient organisation - in the Czech Republic it is called the CF Club.
On the Czech market, the book by doc. MUDr. Věra Vávrová is available on the topic (Grada publishing house, 2006).
Best regards, Jitka Brazova

22.01.2009