Pseudomonas putida

Question

Dear expert team,

I have a question concerning a germ.

I have a CF-like disease; allergic ABPA, by now somewhat profoundly deforming bronchitis with recurring shifting of secretion. One-time detection of M. intracellulare in 2005. Repeated detection of alicagenes xylosoxidans/sarratia. Antibiosis very rarely, since low CRP, but lung loss.

Recent cultures:
- Aspergillus fumigatus: not worth treating, since apparently the other parameters do not require it
- Klebsiella pneumoniae: low germ count
- Pseudomonas putida: high germ count
- Candida albicans: low germ count

I assume “pseudomonas” usually has a deterring effect on all patients, but this one would be harmless! Only I have so much pus all the time that I cannot keep up with the coughing. Furthermore, I have a germ in the bladder that only – and just for a short time – reacts to oral cyclosporines (constant germs despite surgery, microhematuria, incontinence; the urologist recommends two further surgeries!).

On top of this, I have some troubles (72 years old) that do not make treatment easier: arterial hypertonia, coxarthrosis on the right side, necrosis of the femoral head (should not be treated for now due to the lungs), sleep disturbance, all of which are a huge burden.

Is the germ I mentioned really not worth treating? I would like to know more about this.

Thank you for your effort and kind regards.

Answer

Dear questioner,

Many thanks for this really interesting question which, unfortunately, is not easy to answer. When reading your description, several questions come to mind. You seem to suffer repeatedly from non-“typical” germs which also seem to affect different organs, and I am therefore not quite sure what the diagnosis “CF-like disease” means and for what other diseases you have been checked already with this so-called system disorder. For instance, have you been tested for immunoglobulin insufficiency (common variable immunodeficiency syndrome), alpha-1 antytrypsin deficiency, etc.? Do you have any particular hobbies that may explain why you get infected with these rather typical environmental germs (e.g. in connection with water)? There is also the question whether it would not make sense to do an antibiotics therapy even with your “normal” CRP (since, after all, you do have symptoms and, as far as I understand, the lungs are also deteriorating). All these are questions which are hard to answer via the internet.

Concerning your question about P. putida: this germ is also an environmental germ and usually so-called apathogenic, i.e. it does not cause diseases. There are nevertheless cases in the literature that have shown – mostly in newborns, but also in elderly patients – this germ to be relevant particularly concerning the lungs. I would therefore definitely suggest treating this germ in the way resistant germs are treated, with a double therapy (as is usual with the typical pseudomonas aeruginosa).

I hope I could be of help with this answer.

Kind regards
Dr. M. Hofer
Senior physician, adult CF clinic and department of rare lung diseases
Zurich University Hospital

22.03.2012