Lower airway microbiota and decreasing lung function in young Brazilian cystic fibrosis patients with pulmonary Staphylococcus and Pseudomonas infection.

Cystic fibrosis (CF) is a genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene that leads to respiratory complications and mortality. Studies have shown shifts in the respiratory microbiota during disease progression in individuals with CF. In addition, CF patients experience short cycles of acute intermittent aggravations of symptoms called pulmonary exacerbations, which may be characterized by a decrease in lung function and weight loss. The resident microbiota become imbalanced, promoting biofilm formation, and reducing the effectiveness of therapy. The aim of this study was to monitor patients aged 8-23 years with CF to evaluate their lower respiratory microbiota using 16S rRNA sequencing. The most predominant pathogens observed in microbiota, Staphylococcus (Staph) and Pseudomonas (Pseud) were correlated with clinical variables, and the in vitro capacity of biofilm formation for these pathogens was tested. A group of 34 patients was followed up for 84 days, and 306 sputum samples were collected and sequenced. Clustering of microbiota by predominant pathogen showed that children with more Staph had reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) compared to children with Pseud. Furthermore, the patients' clinical condition was consistent with the results of pulmonary function. More patients with pulmonary exacerbation were observed in the Staph group than in the Pseud group, as confirmed by lower body mass index and pulmonary function. Additionally, prediction of bacterial functional profiles identified genes encoding key enzymes involved in virulence pathways in the Pseud group. Importantly, this study is the first Brazilian study to assess the lower respiratory microbiota in a significant group of young CF patients. In this sense, the data collected for this study on the microbiota of children in Brazil with CF provide a valuable contribution to the knowledge in the field.

Respostas fisiológicas em adolescentes obesos submetidos à broncoprovocação com solução salina hipertônica / Physiological responses in obese adolescents submitted to bronchial provocation with hypertonic saline

INTRODUÇÃO: A hiper-responsividade brônquica é a resposta do aumento dos mecanismos fisiológicos protetores das vias aéreas em indivíduos atópicos e não atópicos. Além disso, a magnitude da hiperresponsividade aérea apresenta influência conforme o grau de obesidade. OBJETIVO: Avaliar as respostas fisiológicas em adolescentes obesos submetidos a hiper-responsividade brônquica a solução salina hipertônica. MATERIAIS E MÉTODOS: Estudo descritivo, transversal e correlacional composto por 15 adolescentes obesos, de ambos os gêneros. O diagnóstico de asma foi realizado por meio de histórico clínico e questionário ISAAC, e a obesidade pelo IMC acima do percentil 95. Utilizou-se o teste de broncoprovocação por solução salina hipertônica para avaliação da hiper-responsividade brônquica, considerando positiva uma diminuição do volume expiratório forçado no primeiro segundo (VEF1) > 15% do valor pré-solução salina e a intensidade da hiper-responsividade brônquica foi calculada pela queda percentual máxima do VEF1 (% Queda máxVEF1). Foram utilizados o teste t independente ou U de Mann-Whitney e a correlação de Spearman rho (p < 0,05). RESULTADOS: Não foram encontradas diferenças significativas entre os asmáticos e não asmáticos para as variáveis antropométricas, espirométricas, lipídicas e hemodinâmicas. Verificaram-se moderadas correlações positivas e diferenças significativas entre o % Queda máxVEF1 com o IMC (p = 0,040) e IMC escore-Z (p = 0,028). Foram detectadas correlações negativas e diferenças significativas para a Queda máxVEF1 e leucócitos (p = 0,005) e para o % Queda máxVEF1 com o sulfato de dehidropiandrosterona (p = 0,032). CONCLUSÃO: Pode-se concluir que os adolescentes obesos submetidos a hiper-responsividade brônquica apresentam alterações espirométricas que estão associadas às inflamações sistêmicas da obesidade.

INTRODUCTION: The bronchial hyperresponsiveness is the response of increased physiological protective mechanisms in the airways of atopic and non-atopic individuals. Furthermore, the magnitude of hyperresponsiveness influences provider submits with the degree of obesity. OBJECTIVE: To evaluate the physiological responses in obese adolescents undergoing bronchial hyperresponsiveness to hypertonic saline. MATERIALS AND METHODS: Cross-sectional and correlation study consisted of 15 obese adolescents of both genders. The diagnosis of asthma was made by clinical history and ISAAC, and obesity as BMI above 95th percentile. We used the bronchial provocation test by hypertonic saline for the assessment of bronchial hyperresponsiveness, considering positive a decrease in forced expiratory volume in one second (FEV1) > 15% of pre-saline and the intensity of bronchial hyperresponsiveness was calculated as the percentage fall maximum of FEV1 (% Fall máxFEV1). We used the independent T or Mann-Whitney U test and Spearman's rho correlation (p < 0.05). RESULTS: There were no significant differences between asthmatics and non-asthmatics for anthropometric, spirometric, lipid and hemodynamic variables. There were positive correlations and significant differences between the % Fall máxFEV1 with BMI (p = 0.040) and BMI Z-score (p = 0.028). There were detected negative correlations with significant differences for Fall máxFEV1 and leukocytes (p = 0.005) and the % Fall máxFEV1 with dehydropiandrosterone sulfate (p = 0.032). CONCLUSION: It can be concluded that obese adolescents have bronchial hyperresponsiveness presented spirometric changes that are associated with systemic inflammation of obesity.

Nebulizers in cystic fibrosis: a source of bacterial contamination in cystic fibrosis patients?

OBJECTIVE: To determine whether nebulizers are a source of microbial contamination in patients with cystic fibrosis, as well as whether the technique and frequency of disinfection of these devices is appropriate. METHODS: This was a cross-sectional, uncontrolled observational study. Samples were collected from 28 patients with cystic fibrosis. Samples were collected at the homes of the patients, who were not previously informed of the purpose of the visit. Three samples were collected from each patient: one from the nebulizer chamber, one from the mask/mouthpiece, and one from the patient (oropharyngeal swab /sputum). The samples were properly stored and taken for analyses. The patients, their parents, or their legal guardians completed a questionnaire regarding nebulizer cleaning and disinfecting methods. RESULTS: We collected 84 samples from the 28 patients. Of those 28 patients, 15 (53.5%) were male. The median age of the patients was 11 years (range, 1-27 years). Of the 28 patients, 15 presented with positive oropharyngeal swab /sputum sample cultures. The most common bacterial isolates were Staphylococcus aureus (in 8 patients) and Pseudomonas aeruginosa (in 4 patients). Although the samples obtained from the nebulizers presented with various pathogens in culture, no specific species predominated. In 27 cases (96.7%), there were no associations between the samples obtained from the nebulizers and those obtained from the patients in terms of the results of the cultures. Cleaning and disinfection of nebulizers were inappropriate in 22 cases (78.6%). CONCLUSIONS: In this sample of patients, despite the inappropriate disinfection techniques, nebulizers were not found to be a source of microbial contamination.

Nebulizadores: fonte de contaminação bacteriana em pacientes com fibrose cística? / Nebulizers in cystic fibrosis: a source of bacterial contamination in cystic fibrosis patients?

OBJETIVO: Determinar se os nebulizadores de pacientes com fibrose cística são fonte de contaminação microbiana e verificar se a técnica e a frequência de desinfecção dos nebulizadores é apropriada. MÉTODOS: Estudo de corte transversal observacional, sem grupo controle. Foram coletadas amostras de 28 pacientes com fibrose cística, no domicílio do paciente, sem aviso prévio sobre o motivo da visita. Foram colhidas três amostras por paciente: do reservatório do nebulizador, da máscara/bocal e do próprio paciente (swab da orofaringe/escarro). As amostras foram acondicionadas adequadamente e levadas para análise. Os pacientes, seus pais ou responsáveis preencheram um questionário sobre métodos de limpeza e desinfecção dos nebulizadores. RESULTADOS: Foram obtidas 84 amostras dos 28 pacientes. Destes, 15 (53,5 por cento) eram do gênero masculino. A mediana de idade foi de 11 anos (variação: 1-27 anos). Dos 28 pacientes, 15 apresentaram culturas de escarro/orofaringe positivas. As bactérias encontradas com maior frequencia foram Streptococcus aureus (8/15) e Pseudomonas aeruginosa (4/15). A cultura obtida dos nebulizadores identificou diversos patógenos, sem nenhum predominante. Não houve associações entre os resultados das culturas obtidas dos nebulizadores e aquelas dos pacientes em 27 casos (96,7 por cento). A limpeza e a desinfecção não eram realizadas de forma adequada em 22 casos (78,6 por cento). CONCLUSÕES: Nesta amostra de pacientes, apesar das técnicas de desinfecção inadequadas, os nebulizadores não foram uma fonte de contaminação microbiana.

OBJECTIVE: To determine whether nebulizers are a source of microbial contamination in patients with cystic fibrosis, as well as whether the technique and frequency of disinfection of these devices is appropriate. METHODS: This was a cross-sectional, uncontrolled observational study. Samples were collected from 28 patients with cystic fibrosis. Samples were collected at the homes of the patients, who were not previously informed of the purpose of the visit. Three samples were collected from each patient: one from the nebulizer chamber, one from the mask/mouthpiece, and one from the patient (oropharyngeal swab /sputum). The samples were properly stored and taken for analyses. The patients, their parents, or their legal guardians completed a questionnaire regarding nebulizer cleaning and disinfecting methods. RESULTS: We collected 84 samples from the 28 patients. Of those 28 patients, 15 (53.5 percent) were male. The median age of the patients was 11 years (range, 1-27 years). Of the 28 patients, 15 presented with positive oropharyngeal swab /sputum sample cultures. The most common bacterial isolates were Staphylococcus aureus (in 8 patients) and Pseudomonas aeruginosa (in 4 patients). Although the samples obtained from the nebulizers presented with various pathogens in culture, no specific species predominated. In 27 cases (96.7 percent), there were no associations between the samples obtained from the nebulizers and those obtained from the patients in terms of the results of the cultures. Cleaning and disinfection of nebulizers were inappropriate in 22 cases (78.6 percent). CONCLUSIONS: In this sample of patients, despite the inappropriate disinfection techniques, nebulizers were not found to be a source of microbial contamination.

Avaliação da hiperresponsividade brônquica à solução salina hipertônica em crianças e adolescentes / Bronchial hyperresponsiveness to hypertonic saline challenge in children and adolescents

OBJETIVO: Avaliar a hiperresponsividade brônquica à solução salina hipertônica a 4,5 por cento como método alternativo a outros agentes broncoconstritores e sua relação com a sensibilização alérgica do paciente. MÉTODOS: Estudo transversal, experimental, com 85 indivíduos assim distribuídos: 45 no grupo de asmáticos e 17 no grupo controle não asmáticos e não alérgicos, que completaram o teste. Para nebulizar a solução salina hipertônica foi utilizado um nebulizador ultra-sônico de grande volume, sucessivamente durante 0,5, 1, 2, 4 e 8 minutos até haver queda > 15 por cento em relação ao volume expiratório forçado no primeiro segundo basal. A dosagem de imunoglobulina E específica ao Dermatophagoides pteronyssinus por ImmunoCap foi considerada positiva quando > 0,35 kU/L. RESULTADOS: No grupo de asmáticos, 36 apresentaram queda média do volume expiratório forçado no primeiro segundo de 27,4 por cento após nebulização de solução salina hipertônica. Nenhum do grupo controle (imunoglobulina E < 0,35 kU/L) apresentou resposta à solução salina hipertônica e a queda média do volume expiratório forçado no primeiro segundo foi de 9 por cento. Nove asmáticos tiveram provocação brônquica negativa. A freqüência de provocação brônquica positiva foi maior nos indivíduos com imunoglobulina E específica elevada, o que indica uma relação entre hiperresponsividade brônquica e o nível sérico de imunoglobulina E específica. A sensibilidade do teste foi de 80 por cento e a especificidade de 92 por cento. CONCLUSÃO: A inalação de solução salina hipertônica é um método de provocação útil para avaliar hiperresponsividade brônquica em crianças e adolescentes, com adequadas sensibilidade e especificidade, além do baixo custo e necessidade de poucos equipamentos.

OBJECTIVE: To assess airway hyperresponsiveness to 4.5 percent hypertonic saline solution in comparison to that obtained through challenge with other bronchoconstriction agents and in relation to patient allergic sensitization. METHODS: A cross-sectional, experimental study was conducted, initially involving 85 subjects. After exclusions, the final sample consisted of 62 patients, divided into two groups: a study group of those with asthma (n = 45) and a control group of those with no asthma or allergies (n = 17). Hypertonic saline was nebulized using an ultrasonic nebulizer and administered successively for 0.5, 1, 2, 4 and 8 minutes until a drop in forced expiratory volume in one second of = 15 percent was achieved in relation to the baseline value. The level of specific immunoglobulin E to Dermatophagoides pteronyssinus level was determined by ImmunoCAP assay and was considered positive when > 0.35 kU/L. RESULTS: In the 36 asthma group subjects presenting a response, the mean drop in forced expiratory volume in one second after hypertonic saline nebulization was 27.4 percent. None of control group subjects (immunoglobulin E < 0.35 kU/L) presented a positive response to hypertonic saline. The mean forced expiratory volume in one second for control group subjects was 9 percent. The results of a bronchial provocation test were negative in 9 of the asthma group subjects. The frequency of bronchial provocation test positivity was higher in the subjects presenting elevated levels of specific immunoglobulin E, indicating that there is a relationship between bronchial hyperresponsiveness and the level of specific immunoglobulin E. The sensitivity and specificity of the test were 80 percent and 92 percent, respectively. CONCLUSION: Bronchial provocation with hypertonic saline presents satisfactory sensitivity and specificity. Therefore, in addition to being a low cost procedure that requires very little equipment, it is a useful means of assessing ...

Bronchial hyperresponsiveness to hypertonic saline challenge in children and adolescents.

OBJECTIVE: To assess airway hyperresponsiveness to 4.5% hypertonic saline solution in comparison to that obtained through challenge with other bronchoconstriction agents and in relation to patient allergic sensitization. METHODS: A cross-sectional, experimental study was conducted, initially involving 85 subjects. After exclusions, the final sample consisted of 62 patients, divided into two groups: a study group of those with asthma (n = 45) and a control group of those with no asthma or allergies (n = 17). Hypertonic saline was nebulized using an ultrasonic nebulizer and administered successively for 0.5, 1, 2, 4 and 8 minutes until a drop in forced expiratory volume in one second of = 15% was achieved in relation to the baseline value. The level of specific immunoglobulin E to Dermatophagoides pteronyssinus level was determined by ImmunoCAP assay and was considered positive when > 0.35 kU/L. RESULTS: In the 36 asthma group subjects presenting a response, the mean drop in forced expiratory volume in one second after hypertonic saline nebulization was 27.4%. None of control group subjects (immunoglobulin E < 0.35 kU/L) presented a positive response to hypertonic saline. The mean forced expiratory volume in one second for control group subjects was 9%. The results of a bronchial provocation test were negative in 9 of the asthma group subjects. The frequency of bronchial provocation test positivity was higher in the subjects presenting elevated levels of specific immunoglobulin E, indicating that there is a relationship between bronchial hyperresponsiveness and the level of specific immunoglobulin E. The sensitivity and specificity of the test were 80% and 92%, respectively. CONCLUSION: Bronchial provocation with hypertonic saline presents satisfactory sensitivity and specificity. Therefore, in addition to being a low cost procedure that requires very little equipment, it is a useful means of assessing hyperresponsiveness in children and adolescents.