Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans.

Infection with Burkholderia cepacia complex in patients with cystic fibrosis (CF) results in highly variable clinical outcomes. The purpose of this study was to determine if there are genomovar-specific disparities in transmission and disease severity. B. cepacia complex was recovered from 62 patients with CF on > or =1 occasions (genomovar III, 46 patients; genomovar II [B. multivorans], 19 patients; genomovar IV [B. stabilis], 1 patient; genomovar V [B. vietnamiensis], 1 patient; and an unclassified B. cepacia complex strain, 1 patient). Patient-to-patient spread was observed with B. cepacia genomovar III, but not with B. multivorans. Genomovar III strains replaced B. multivorans in 6 patients. Genomovar III strains were also associated with a poor clinical course and high mortality. Infection control practices should be designed with knowledge about B. cepacia complex genomovar status; patients infected with transmissible genomovar III strains should not be cohorted with patients infected with B. multivorans and other B. cepacia genomovars.

Newly diagnosed cystic fibrosis in adults: pattern and distribution of bronchiectasis in 12 cases.

OBJECTIVE: The aim of this study was to analyse the type and distribution of bronchiectasis at computed tomography (CT) in adults with recently diagnosed cystic fibrosis. METHODS: The CT examinations of 12 consecutive patients diagnosed with cystic fibrosis in adulthood (six male, six female; age range at diagnosis 25-63 years) were analysed retrospectively using a modified Bhalla scoring system. Bronchiectasis was catergorized by Reid type and by location within the affected lobe (peripheral, central or mixed). RESULTS: Bronchiectasis was identified in 70 of 71 lobes. Two or more bronchopulmonary segments were involved in 67 of 71 lobes. The majority of lobes demonstrated cylindrical bronchiectasis as the predominant type (n = 51), with varicose (n = 11) and cystic (n = 8) less commonly seen. Bronchiectasis was mainly central in 16 lobes, and both central and peripheral in 54 lobes. The severity of bronchial dilatation was greatest for the upper lobes (mean score, 1.75 right, 1.58 left) compared with the middle lobe/lingula (mean score, 1.42 right, 1.17 left) and lower lobes (mean score, 1.09 right, 1.17 left). CONCLUSION: Bronchiectasis in patients with cystic fibrosis diagnosed in adulthood is usually widespread, predominantly cylindrical, and is more severe in the upper lobes. The diagnosis of cystic fibrosis should be considered in adults with 'idiopathic' bronchiectasis showing these features on CT.

Bioactive tumor necrosis factor in the sputa of cystic fibrosis patients.

Eighty sputum samples from 37 cystic fibrosis patients were assayed for tumor necrosis factor alpha (TNF-alpha) in the L929 bioactivity assay. In addition, the presence of TNF-alpha-specific mRNA in the sputum was determined by using TNF-alpha-specific DNA probes in a PCR amplification step after reverse transcription of the mRNA to cDNA. Bioactive TNF-alpha was detected in 69 (86%) of the 80 sputum samples tested and, on at least one occasion, in 35 (95%) of the 37 cystic fibrosis patients sampled. The highest levels of TNF-alpha were observed in sputa obtained from patients presenting with an exacerbation of their disease.