title: A case of failed eradication of cystic fibrosis-related sinus colonisation by Pseudomonas aeruginosa.
abstract: BACKGROUND
  Pseudomonas aeruginosa is a pathogen associated with cystic fibrosis that has potential to decrease lung function and cause respiratory failure. Paranasal sinuses are increasingly recognised as potential reservoirs for intermittent colonisation by P. aeruginosa. This case documents investigation and outcome of P. aeruginosa recurrence in a male paediatric patient over an eight year period.
  
  
  METHODS
  A 12 year old Irish male paediatric cystic fibrosis patient experienced intermittent culturing of P. aeruginosa from the oropharyngeal region, indicating chronic infection of the sinuses despite absence of symptoms, retaining good lung function, and normal bronchoscopy and bronchoalveolar lavage. However, P. aeruginosa was isolated from a sinus wash-out and was identified as a unique strain of P. aeruginosa that was also cultured from cough swabs. Despite treatment, successful eradication from the paranasal sinuses was not achieved.
  
  
  CONCLUSIONS
  Few reports have addressed the paranasal sinuses as a reservoir for lung infection in cystic fibrosis patients despite increased recognition of the need to investigate this niche. In this case, attempts at eradication of P. aeruginosa present in paranasal sinuses including oral and nebulised antimicrobials proved unsuccessful. However, detection of P. aeruginosa in the paranasal sinuses instigated antimicrobial treatment which may have contributed to prevention of migration to the lower airways. Our outcome provides additional insight and may indicate utility of nasal lavage or nasal endoscopy in paediatric cystic fibrosis patients' annual review clinic visits.
authors.affiliation: Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland. barry.linnane@hse.ie.|University Hospital Limerick, Dooradoyle, Limerick, Ireland. barry.linnane@hse.ie.|National Children's Research Centre (NCRC), SHIELD CF, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland. barry.linnane@hse.ie.
authors.forename: Barry
authors.initials: B
authors.lastname: Linnane
authors.affiliation: Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland. linda.kearse@ul.ie.|National Children's Research Centre (NCRC), SHIELD CF, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland. linda.kearse@ul.ie.
authors.forename: Linda
authors.initials: L
authors.lastname: Kearse
authors.affiliation: Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland. nualah.oconnell@hse.ie.|University Hospital Limerick, Dooradoyle, Limerick, Ireland. nualah.oconnell@hse.ie.
authors.forename: Nuala H
authors.initials: NH
authors.lastname: O'Connell
authors.affiliation: Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland. john.fenton@hse.ie.|University Hospital Limerick, Dooradoyle, Limerick, Ireland. john.fenton@hse.ie.
authors.forename: John
authors.initials: J
authors.lastname: Fenton
authors.affiliation: Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland. miranda.kiernan@ul.ie.
authors.forename: Miranda G
authors.initials: MG
authors.lastname: Kiernan
authors.affiliation: Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland. colum.dunne@ul.ie.
authors.forename: Colum P
authors.initials: CP
authors.lastname: Dunne
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy*; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D010256:Paranasal Sinuses / Q000382:microbiology; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa; D012008:Recurrence; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents