Effects of airway infection by Pseudomonas aeruginosa: A computed tomographic study

Background - Pseudomonas aeruginosa commonly infects the airways of patients with bronchiectasis. A study was undertaken to examine the relationship between infection of the airways with this pathogen, the morphological pattern of bronchiectasis an thin section computed tomographic (CT) scanning, symptom duration, smoking habits of the patients, send the presence of airflow obstruction. Methods - Thin section CT scans of 22 adult patients with bronchiectasis and concurrent sputum infected by P aeruginosa (Pa+ve) and those of 45 randomly selected patients not infected by P aeruginosa (Pa-ve) were analysed independently by two thoracic radiologists, Patients with cystic fibrosis were excluded. Each scan was scored at a lobar level for extent of bronchiectasis, severity of branchial wall thickening and dilatation, predominant pattern of bronchiectasis, presence of mucus plugging, and degree of decreased attenuation of the lung parenchyma. Results - The Pa+ve group had more extensive bronchiectasis and a greater degree of branchial wall thickening and dilatation on the CT scan than the Pa-ve group; more extensive decreased attenuation was seen in the Pa+ve group. These findings were robust on multivariate analysis; decreased attenuation was also independently related to the duration of sputum production. Conclusions - Patients with bronchiectasis infected by P aeruginosa have more extensive and severe bronchiectasis on thin section CT scanning than those without P aeruginosa infection. The bronchi and small airways are both involved, reflecting the end result of complex interactions between host airways and the numerous virulence factors produced by P aeruginosa.