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Microbiological outliers in cystic fibrosis: resolving uncertainty.
The Lancet Respiratory Medicine ( IF 38.7 ) Pub Date : 2019-11-11 , DOI: 10.1016/s2213-2600(19)30405-9
Steve Cunningham 1
Affiliation  

Despite the best efforts of all concerned, the clinical course of some patients with cystic fibrosis is more difficult and damaging than might be anticipated from current understanding of the disease. The fact that we are only on the cusp of adequately explaining the underlying mechanistic causes of deterioration in patients with cystic fibrosis is clear; while progressive exploration in many areas (ie, genetic modifiers, epigenetics, inflammatory pathways) is active, most clinicians believe that the cause of deterioration is most likely microbiological. Of emerging micro-organisms, the reported consequences of some, such as Burkholderia cenocepacia, on the clinical course of patients with cystic fibrosis have been substantial, and the clinical risk associated with such infections has rapidly become clear. However, in the past 20 years, many microbiological outliers have emerged—eg, Alcaligenes xylosoxidans, Serratia marcescens, and Stenotrophomonas maltophilia—that were initially considered as commensals, selectively upheld by frequent antibiotic use, and might now be considered as pathogens.

中文翻译:

囊性纤维化中的微生物异常值:解决不确定性。

尽管所有有关方面都做出了最大努力,但某些囊性纤维化患者的临床病程比目前对疾病的理解所预期的要困难得多且更具破坏性。我们仅能充分解释囊性纤维化患者病情恶化的潜在机制,这一事实很明显;尽管在许多领域(例如,基因修饰剂,表观遗传学,炎性途径)中进行了逐步探索,但大多数临床医生认为,导致这种情况恶化的原因很可能是微生物。在新兴的微生物中,据报道某些后果,例如伯克霍尔德菌(Burkholderia cenocepacia),囊性纤维化患者的临床病程已经很长,并且与此类感染相关的临床风险已迅速变得明朗。但是,在过去的20年中,出现了许多微生物异常值,例如木生产碱杆菌,粘质粘质沙雷氏菌嗜麦芽窄食单胞菌,最初被认为是共性的,通过频繁使用抗生素有选择地坚持下来,现在可能被认为是病原体。
更新日期:2019-11-26
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