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West SEH, Zeng L, Lee BL, et al. Respiratory Infections With Pseudomonas aeruginosa in Children With Cystic Fibrosis: Early Detection by Serology and Assessment of Risk Factors. JAMA. 2002;287(22):2958–2967. doi:10.1001/jama.287.22.2958
Author Affiliations: Department of Pathobiological Sciences and School of Veterinary Medicine (Dr West), Departments of Pediatrics (Drs Kosorok, Rock, and Farrell, and Mss Laxova and Zeng) and Biostatistics and Medical Informatics (Drs Lee and Kosorok and Ms Zeng), Medical School, University of Wisconsin, Madison; and Department of Pediatrics, Medical College of Wisconsin, Milwaukee (Dr Splaingard).
Context Patients with cystic fibrosis (CF) are susceptible to lower respiratory
tract infections with Pseudomonas aeruginosa and
typically acquire this organism in early childhood. Once P aeruginosa infection is established, eradication may be impossible,
and progressive lung disease often aggravates morbidity and mortality risks.
The ability to diagnose CF by genetic testing at birth makes it possible to
determine the temporal sequence of events that result in P aeruginosa–associated pulmonary infections.
Objective To evaluate the longitudinal relationship between the production of
an antibody response against P aeruginosa and clinical
factors associated with P aeruginosa pulmonary infections
in patients with CF diagnosed in early life.
Design, Setting, and Patients Serum samples and oropharyngeal cultures (protocol cultures) were obtained
at 6-month intervals from April 15, 1985, to April 15, 2000 (or for up to
180 months depending on their enrollment date) from 68 patients at 2 centers
in Madison and Milwaukee, Wis, diagnosed through the Wisconsin CF Neonatal
Screening Project, a longitudinal cohort study. Additional cultures were obtained
at examining physicians' discretion (all cultures).
Main Outcome Measures Time to serum IgG, IgA, and IgM antibody titer of at least 1:256 against P aeruginosa, assessed by enzyme-linked immunosorbent assay
using cell lysate, exotoxin A, and elastase as antigens; time to organism
isolation from respiratory samples; time to Wisconsin Cystic Fibrosis Radiograph
(WCXR) score of 5 or more.
Results The median time to an antibody titer of at least 1:256 was 17.8, 24.2,
and 70.9 months for cell lysate, exotoxin A, and elastase, respectively. The
rise of anti–cell lysate and anti–exotoxin A titers to 1:256 or
more occurred a mean of 11.9 (P<.001) and 5.6
(P = .04) months, respectively, before the isolation
of P aeruginosa for all cultures and 18.2 (P<.001) and 11.9 (P = .006)
months, respectively, before protocol cultures. There was no significant difference
between the rise of anti–cell lysate and anti–exotoxin A titer
and a WCXR score of 5 or more (P = .24 and .32, respectively).
Treatment with long-term, non-Pseudomonas oral antibiotics
and integration of CF infants with older, chronically infected patients were
associated with a significantly increased risk of P aeruginosa pulmonary infection.
Conclusions In CF patients diagnosed through neonatal screening, P aeruginosa pulmonary infections occurred 6 to 12 months before the
organism was isolated from respiratory secretions. The longitudinal monitoring
of P aeruginosa antibody titers, in concert with
WCXR score, should facilitate diagnosis and treatment of P aeruginosa pulmonary infections in young children with CF.
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