Colonisation and infection of the paranasal sinuses in cystic fibrosis patients is accompanied by a reduced PMN response

Background: We studied whether the sinuses might be foci for Pseudomonas aeruginosa lung infection. Methods: Endoscopic Sinus Surgery was performed in 78 CF patients; PFGE was used for bacterial genotyping. Material from sinuses and lungs were Gram-stained to detect biofilms. Immunoglobulins were measured in serum and saliva. Results: When P. aeruginosa was cultured simultaneously from die sinuses and the lungs they were genetically identical in 38 of the 40 patients (95%). In the sinuses, P. aeruginosa formed biofilms with minimal cellular inflammation, probably because of a significantly higher local production of secretory IgA compared with IgG (p<0.001). Conclusions: We have shown that P. aeruginosa form biofilm in the sinuses, which constitute an important bacterial reservoir for subsequent lung infection. The high amount of IgA in the upper airways probably protects P. aeruginosa from the inflammatory immune system, and they can proceed unnoticed into a permanent infectious focus that cannot be eradicated with antibiotics. (C) 2012 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.