Background Primary ciliary dyskinesia (PCD) is characterised by chronic nasal discharge and lower respiratory tract infections. We aimed to assess the prevalence and concordance of pathogens present in samples from the upper (UA) and lower airway (LA) of children with PCD.
Method Microbiology samples from UA (naso-sinal lavage or nasal swab) and LA (sputum or cough swabs) were taken at the same time from children attending a specialist PCD centre, diagnosed on standard criteria (Eur Respir J 2009:34:1264–1276).
Results 70 children (30 male), median age 10.7 yrs (range 1–18), were studied. 36/70 were prescribed long term prophylactic oral antibiotics. 42 (60%) of UA samples were culture positive compared to 21 (30%) positive LA samples. The UA positive group were not statistically different in age or FEV1% pred (11.1 vs 10 yrs and 78% vs 75%). 14 patients were culture positive in both UA and LA, 10 of which had matched pathogens and 4 were unmatched. 20 were matched culture negative. The range of pathogens and where they were isolated are shown in the Table, some samples had more than one isolate.
Note the Table shows concordance for same pathogens
Conclusion In PCD, pathogens are isolated far more commonly from the UA than the LA. The clinical impact of these pathogens in the long term is unknown. 11 (16%) had PA in UA with only 2 of these having PA in their LA. We speculate that the UA may be, at least in some children, the source of LA infection. Clinical trials of eradication therapy after positive nasal cultures are indicated