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B. Dolosa

If two siblings have CF and B. dolosa and one of them is getting a lung transplantation, is there a risk for the sibling who had a transplantation because of B. dolosa and the other sibling who had no transplantation? Are there any research results, we could get information from?
Many thanks
Dear questioner,
Burkholeria are wide spread environmental, respectively humid germs. The so-called B. cepacia complex (BCK) comprises more than 20 near related species (among those Burkholderia dolosa). B. mulitvorans and B. cenocepacia are the most frequent ones in case of CF, and are associated with a worse course of the illness, whereby different clinical courses may occur. The relevance of the more seldom BCK species is however not totally clear, yet.
For B. cencepaica, more seldom for B. multivorans, but also for B. dolosa, more severe clinical courses have been described. After lung transplantation, only for B. cencocepacia a worse outcome has been described. For the other species this does not seem to be true. In many older investigations for several BCK species (also for B. dolosa) a transmission from patient to patient has been shown. Today, however, patient to patient transmission has become rare, as strict hygiene measures are done for years in case of BCK positive CF patients staying in hospital. Via the close contact between siblings there is without doubt a special transmissional risk.
Both children are already colonized with B. dolosa. Therefore it is the question, how the "preexisting" colonization with B. dolosa affects the course after transplantation. A reinfection from the upper airways (sinuses) as well as a new transmission form the other sibling is possible. As said above, there is no reliable data in connection with a lung transplantation and B. dolosa (as it is so rare), so that one can hardly judge the consequences. For the upper airways it is possible to investigate the microbiological germ status and to intervene therapeutically (local antibiotics, surgery). The best regimen is however here not completely clear, either and should best be discussed with the transplant center.
Best regards,
Michael Hogardt