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| __NOTOC__ | | __NOTOC__ |
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| {{CMG}} {{AE}} | | {{CMG}} {{AE}} |
| {{Cystic fibrosis}} | | {{Cystic fibrosis}} |
| ==Overview== | | ==Overview== |
| ==Causes== | | ==Causes== |
| The lungs of individuals with cystic fibrosis are colonized and infected by bacteria from an early age. These bacteria, which often spread amongst individuals with CF, thrive in the altered mucus, which collects in the small airways of the lungs. This mucus encourages the development of bacterial microenvironments ([[biofilm]]s) that are difficult for immune cells (and antibiotics) to penetrate. The lungs respond to repeated damage by thick secretions and chronic infections by gradually remodeling the lower airways ([[bronchiectasis]]), making infection even more difficult to eradicate.<ref name="Saiman">Saiman L. ''Microbiology of early CF lung disease.'' Paediatr Respir Rev. 2004;5 Suppl A:S367-9. PMID 14980298</ref>
| | [[Image:Aspergillus fumigatus 01.jpg|thumb|center|300px|'''Aspergillus fumigatus -''' A common fungus which can lead to worsening lung disease in people with CF]] |
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| Over time, both the types of bacteria and their individual characteristics change in individuals with CF. In the initial stage, common bacteria such as ''[[Staphylococcus aureus]]'' and ''[[Hemophilus influenzae]]'' colonize and infect the lungs. Eventually, however, ''[[Pseudomonas aeruginosa]]'' (and sometimes ''[[Burkholderia cepacia complex|Burkholderia cepacia]]'') dominates. Once within the lungs, these bacteria adapt to the environment and develop [[antibiotic resistance|resistance]] to commonly used antibiotics. ''Pseudomonas'' can develop special characteristics that allow the formation of large colonies, known as "mucoid" ''Pseudomonas'' and rarely seen in people that do not have CF.<ref name="Saiman" />
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| One way in which infection has spread is by passage between different individuals with CF.<ref>Tummler B, Koopmann U, Grothues D, Weissbrodt H, Steinkamp G, von der Hardt H. ''Nosocomial acquisition of Pseudomonas aeruginosa by cystic fibrosis patients.'' J Clin Microbiol. 1991 Jun;29(6):1265–7. PMID 1907611</ref> In the past, people with CF often participated in summer "CF Camps" and other recreational gatherings.<ref>Centers for Disease Control and Prevention (CDC). ''Pseudomonas cepacia at summer camps for persons with cystic fibrosis.'' MMWR Morb Mortal Wkly Rep. 1993 Jun 18;42(23):456-9. PMID 7684813</ref><ref>Pegues DA, Carson LA, Tablan OC, FitzSimmons SC, Roman SB, Miller JM, Jarvis WR.''Acquisition of Pseudomonas cepacia at summer camps for patients with cystic fibrosis. Summer Camp Study Group.'' J Pediatr. 1994 May;124(5 Pt 1):694–702. PMID 7513755</ref> Hospitals grouped patients with CF into common areas and routine equipment (such as [[nebulizer]]s)<ref>Pankhurst CL, Philpott-Howard J. ''The environmental risk factors associated with medical and dental equipment in the transmission of Burkholderia (Pseudomonas) cepacia in cystic fibrosis patients.'' J Hosp Infect. 1996 Apr;32(4):249-55. PMID 8744509</ref> was not sterilized between individual patients.<ref>Jones AM, Govan JR, Doherty CJ, Dodd ME, Isalska BJ, Stanbridge TN, Webb AK. ''Identification of airborne dissemination of epidemic multiresistant strains of Pseudomonas aeruginosa at a CF centre during a cross infection outbreak.'' Thorax. 2003 Jun;58(6):525-7. PMID 12775867</ref> This led to transmission of more dangerous strains of bacteria among groups of patients. As a result, individuals with CF are routinely isolated from one another in the healthcare setting and healthcare providers are encouraged to wear gowns and gloves when examining patients with CF in order to limit the spread of virulent bacterial strains.<ref>Hoiby N. ''Isolation and treatment of cystic fibrosis patients with lung infections caused by Pseudomonas (Burkholderia) cepacia and multiresistant Pseudomonas aeruginosa.'' Neth J Med. 1995 Jun;46(6):280-7. PMID 7643943</ref> Often, patients with particularly damaging bacteria will attend clinics on different days and in different buildings than those without these infections.[[Image:Aspergillus fumigatus 01.jpg|thumb|center|300px|'''Aspergillus fumigatus -''' A common fungus which can lead to worsening lung disease in people with CF]]
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| ==References== | | ==References== |
