Letizia Corinna Morlacchi1,2, Mark Greer3, Igor Tudorache4, Francesco Blasi1,2, Tobias Welte3,5, Axel Haverich4, Jochen G Mainz6, Jens Gottlieb3,5. 1. Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. 2. Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. 3. Department of Respiratory Medicine, Lungentransplantation, Hannover Medical School, Hanover, Germany. 4. Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hanover, Germany. 5. Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hanover, Germany. 6. CF-Centre for Children and Adults, Department of Paediatrics, Jena University Hospital, Jena, Germany.
Abstract
INTRODUCTION: Sinus disease (SD) in cystic fibrosis (CF) is a known risk factor for disease progression, the upper airways (UAW) being a site of primary colonization with Pseudomonas aeruginosa. UAW may function as reservoir for graft colonization after lung transplantation (LuTx), increasing risk of rejection. Aims of this study were to assess the burden of sinus disease in CF LuTx recipients, considering patient-reported symptoms, endoscopically documented signs and microbiological isolates, comparing colonization between upper and lower airways. METHODS: A prospective, observational study was performed on consecutive CF LuTx recipients, recording history, symptoms, and management of SD. Nasal lavage (NL) was evaluated for UAW colonization, with nasal inspection during bronchoscopy and bronchoalveolar lavage (BAL) used to assess lower airways if clinically indicated. RESULTS: Hundred and fifty-four patients were included. Symptoms of SD were reported in 96 (62%) individuals; 87 (56%) had prior sinus surgery. Only 8 (13%) of 60 individuals undergoing bronchoscopy presented completely normal findings of the nasal cavity. Thirty-six (60%) patients presented the same isolates on both NL and BAL. Polyps and mucosal alterations were significantly less frequently seen endoscopically in patients with normal flora in NL microbiology (respectively, 26% vs 70%, P = .003, and 35% vs 68%, P = .013). CONCLUSIONS: Symptoms of SD affected more than 60% of CF LuTx recipients. Nasal endoscopic inspection identified alterations in 55%. The majority of patients presented the same isolates both on NL and BAL performed on the same visit. These results strongly support a role of paranasal sinuses as "reservoir" for descending re-colonization of the lung graft.
INTRODUCTION:Sinus disease (SD) in cystic fibrosis (CF) is a known risk factor for disease progression, the upper airways (UAW) being a site of primary colonization with Pseudomonas aeruginosa. UAW may function as reservoir for graft colonization after lung transplantation (LuTx), increasing risk of rejection. Aims of this study were to assess the burden of sinus disease in CF LuTx recipients, considering patient-reported symptoms, endoscopically documented signs and microbiological isolates, comparing colonization between upper and lower airways. METHODS: A prospective, observational study was performed on consecutive CF LuTx recipients, recording history, symptoms, and management of SD. Nasal lavage (NL) was evaluated for UAW colonization, with nasal inspection during bronchoscopy and bronchoalveolar lavage (BAL) used to assess lower airways if clinically indicated. RESULTS: Hundred and fifty-four patients were included. Symptoms of SD were reported in 96 (62%) individuals; 87 (56%) had prior sinus surgery. Only 8 (13%) of 60 individuals undergoing bronchoscopy presented completely normal findings of the nasal cavity. Thirty-six (60%) patients presented the same isolates on both NL and BAL. Polyps and mucosal alterations were significantly less frequently seen endoscopically in patients with normal flora in NL microbiology (respectively, 26% vs 70%, P = .003, and 35% vs 68%, P = .013). CONCLUSIONS: Symptoms of SD affected more than 60% of CF LuTx recipients. Nasal endoscopic inspection identified alterations in 55%. The majority of patients presented the same isolates both on NL and BAL performed on the same visit. These results strongly support a role of paranasal sinuses as "reservoir" for descending re-colonization of the lung graft.
Authors: Lorriana E Leard; Are M Holm; Maryam Valapour; Allan R Glanville; Sandeep Attawar; Meghan Aversa; Silvia V Campos; Lillian M Christon; Marcelo Cypel; Göran Dellgren; Matthew G Hartwig; Siddhartha G Kapnadak; Nicholas A Kolaitis; Robert M Kotloff; Caroline M Patterson; Oksana A Shlobin; Patrick J Smith; Amparo Solé; Melinda Solomon; David Weill; Marlies S Wijsenbeek; Brigitte W M Willemse; Selim M Arcasoy; Kathleen J Ramos Journal: J Heart Lung Transplant Date: 2021-07-24 Impact factor: 13.569
Authors: Renan Marrichi Mauch; Claudio Lucio Rossi; Marcos Tadeu Nolasco da Silva; Talita Bianchi Aiello; José Dirceu Ribeiro; Antônio Fernando Ribeiro; Niels Høiby; Carlos Emilio Levy Journal: Med Microbiol Immunol Date: 2019-01-31 Impact factor: 3.402
Authors: Arm Luthful Kabir; Sudipta Roy; Rahat Bin Habib; Kazi Selim Anwar; Md Abid Hossain Mollah; Ruhul Amin; Al Amin Mridha; Jasim Uddin Majumder; Md Delwar Hossain; Nazmul Haque; Shakil Ahmed; Mohammod Jobayer Chisti Journal: Glob Pediatr Health Date: 2020-10-30