Article Text

Pulmonary infection in Wegener granulomatosis and idiopathic pulmonary fibrosis
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  1. A G Richter1,
  2. R A Stockley1,
  3. L Harper2,
  4. D R Thickett1
  1. 1Lung 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. 2Department of Renal Immunobiology, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Dr D Thickett, Lung Investigation Unit, 1st floor Nuffield House, Birmingham B15 2TH, UK; d.thickett{at}bham.ac.uk

Abstract

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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Footnotes

  • Competing interests: None.

  • Funding: AR was supported by a Wellcome entry level fellowship. DRT is supported by a Wellcome Intermediate Fellowship.

  • ▸ Additional methods are published online only at http://thorax.bmj.com/content/vol64/issue8

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