title: Colonisation and infection of the paranasal sinuses in cystic fibrosis patients is accompanied by a reduced PMN response.
abstract: BACKGROUND
  We studied whether the sinuses might be foci for Pseudomonas aeruginosa lung infection.
  
  
  METHODS
  Endoscopic Sinus Surgery was performed in 78 CF patients; PFGE was used for bacterial genotyping. Material from sinuses and lungs were Gram-stained to detect biofilms. Immunoglobulins were measured in serum and saliva.
  
  
  RESULTS
  When P. aeruginosa was cultured simultaneously from the sinuses and the lungs they were genetically identical in 38 of the 40 patients (95%). In the sinuses, P. aeruginosa formed biofilms with minimal cellular inflammation, probably because of a significantly higher local production of secretory IgA compared with IgG (p<0.001).
  
  
  CONCLUSIONS
  We have shown that P. aeruginosa form biofilm in the sinuses, which constitute an important bacterial reservoir for subsequent lung infection. The high amount of IgA in the upper airways probably protects P. aeruginosa from the inflammatory immune system, and they can proceed unnoticed into a permanent infectious focus that cannot be eradicated with antibiotics.
authors.affiliation: Department of Clinical Microbiology, afsnit 9301, Rigshospitalet, Juliane Maries Vej 22, DK-2100 Copenhagen Ø, Denmark. hkj@cochrane.dk
authors.forename: Helle Krogh
authors.initials: HK
authors.lastname: Johansen
authors.forename: Kasper
authors.initials: K
authors.lastname: Aanaes
authors.forename: Tania
authors.initials: T
authors.lastname: Pressler
authors.forename: Kim Gjerrum
authors.initials: KG
authors.lastname: Nielsen
authors.forename: Jacob
authors.initials: J
authors.lastname: Fisker
authors.forename: Marianne
authors.initials: M
authors.lastname: Skov
authors.forename: Niels
authors.initials: N
authors.lastname: Høiby
authors.forename: Christian
authors.initials: C
authors.lastname: von Buchwald
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood / Q000378:metabolism; D018441:Biofilms; D002648:Child; D003550:Cystic Fibrosis / Q000276:immunology* / Q000382:microbiology*; D004724:Endoscopy; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000276:immunology / Q000601:surgery; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000378:metabolism; D007074:Immunoglobulin G / Q000097:blood / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D010256:Paranasal Sinuses / Q000276:immunology* / Q000382:microbiology* / Q000601:surgery; D011552:Pseudomonas Infections / Q000276:immunology / Q000601:surgery; D011550:Pseudomonas aeruginosa / Q000235:genetics / Q000302:isolation & purification; D012852:Sinusitis / Q000276:immunology / Q000382:microbiology / Q000601:surgery; D013183:Sputum / Q000276:immunology / Q000382:microbiology; D013290:Streptococcal Infections / Q000276:immunology / Q000601:surgery; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G