PRESENTING FELLOW
Dr.
Steve Ponde
Respiratory Fellow, Hospital
for Sick Children
Toronto,
Ontario, Canada
THE CASE
Exacerbations
in a girl with cystic fibrosis.
HISTORY
Initial PresentationETV is a 14-year-old girl with moderately severe pulmonary manifestations of cystic fibrosis. She is Canadian born of El Salvadorian parents and an older sibling had died of CF related lung complications at the age of 3 years in El Salvador.
She has pancreatic insufficiency but no CF related glucose intolerance or insulin dependent diabetes mellitus. ETV's usual CF treatment consists of pancreatic enzyme replacements, vitamins, an aerosol regime (budesonide, salbutamol and tobramycin) together with regular chest physiotherapy. Compliance with treatment and follow up is excellent and she has no major adverse psychosocial factors.
ETV
has grown staph aureus, and Aspergillus fumigatus from her sputum in
the last year but no Pseudomonas aeruginosa. During the last 10 months,
ETV's clinical status has worsened. She has had more frequent pulmonary
exacerbations and has been hospitalized 6 times in this period. She
has more cough, sputum production without haemoptysis, fevers, malaise,
loss of appetite, poor weight gain and is missing more school. Her pulmonary
function has deteriorated. Her FEV1 has dropped from a baseline of 61%
in May 2002 to 47% in April 2003.She has no significant bronchodilator
response and has only transient improvement following her hospitalizations.
WHAT ARE THE INFECTIOUS CAUSES OF DETERIORATION OF PULMONARY STATUS IN CYSTIC FIBROSIS?
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