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Pulmonary infection in Wegener’s granulomatosis and Idiopathic pulmonary fibrosis
  1. Alex G Richter (alex.richter{at}blueyonder.co.uk)
  1. Birmingham University, United Kingdom
    1. Robert A Stockley (r.a.stockley{at}bham.ac.uk)
    1. Queen Elizabeth Hospital, United Kingdom
      1. Lorraine Harper (l.harper{at}bham.ac.uk)
      1. Birmingham University, United Kingdom
        1. David R Thickett (d.thickett{at}bham.ac.uk)
        1. Birmingham University, United Kingdom

          Abstract

          Rationale: Wegener’s 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 WG, idiopathic pulmonary fibrosis (IPF) patients 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 bronchoalveolar lavage fluid (BALF) is a supportive environment for S. aureus growth. BALF cytokines were measured by ELISA.

          Results: Pathogens were commonly grown from both WG and IPF patients BALF. S. aureus was particularly associated with WG patients both in relapse and in remission. BAL levels of IL-1ra were statistically significant elevated in those patients who grew a pathogen from lavage fluid. BALF from WG and IPF patients stimulated S. aureus growth compared to normal lavage fluid.

          Conclusions: Pathogens are more commonly isolated from WG BALF than from IPF or normal controls and with a different culture profile. IL-1ra 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 anti-staphylococcal activity.

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