RESPIRATORY INFECTION

Pulmonary infection in Wegener granulomatosis and idiopathic pulmonary fibrosis

A G Richter¹, R A Stockley¹, L Harper², D R Thickett¹

¹ Lung Injury and Fibrosis Treatment Programme and Lung Immunobiology Group, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
² Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

Dr D Thickett, Lung Investigation Unit, 1st floor Nuffield House, Birmingham B15 2TH, UK; d.thickett{at}bham.ac.uk

Rationale: Wegener granulomatosis (WG) has previously been associated with increased nasal carriage of Staphylococcus aureus, but no studies have investigated the occurrence of pathogen growth in the lower airways.

Objectives: To culture bronchoalveolar lavage fluid (BALF) from patients with WG, patients with idiopathic pulmonary fibrosis (IPF) and normal controls.

Methods: 33 patients with WG, 22 with IPF and 8 normal controls underwent bronchoscopy and bronchoalveolar lavage. Quantitative culture established bacterial levels in the lower airways. Culture experiments were designed to investigate whether BALF is a supportive environment for S aureus growth. BALF cytokines were measured by ELISA.

Results: Pathogens were commonly grown from BALF of patients with WG and those with IPF. S aureus was particularly associated with patients with WG both in relapse and in remission. BALF levels of interleukin 1 receptor antagonist (IL1ra) were statistically significantly elevated in those patients who grew a pathogen from lavage fluid. BALF from patients with WG and IPF stimulated S aureus growth compared with normal lavage fluid.

Conclusions: Pathogens are more commonly isolated from BALF from patients with WG than from that of patients with IPF or normal controls, and with a different culture profile. IL1ra was associated with pathogen growth in WG and IPF. WG BALF is a trophic environment for S aureus growth. Pulmonologists treating patients with acute or relapsing WG should consider bronchoscopic microbiological sampling and consider antibiotics with antistaphylococcal activity.

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Pulmonary infection in Wegener's granulomatosis and idiopathic pulmonary fibrosis

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This article has been cited by other articles:

• Harrison, N. K. (2009). Pulmonary infection in Wegener's granulomatosis and idiopathic pulmonary fibrosis. Thorax 64: 647-649 [Full Text]