Secretory IgA-mediated immune response in saliva and early detection of Pseudomonas aeruginosa in the lower airways of pediatric cystic fibrosis patients

Abstract

Pseudomonas aeruginosa (Pa) detection in the paranasal sinuses may help to prevent or postpone bacterial aspiration to the lower airways (LAW) and chronic lung infection in cystic fibrosis (CF). We assessed the ability of an ELISA test for measurement of specific Pa secretory IgA (sIgA) in saliva (a potential marker of sinus colonization) to early detect changes in the Pa LAW status (indicated by microbiological sputum or cough swab culture and specific serum IgG levels) of 65 patients for three years, in different investigation scenarios. Increased sIgA levels were detected in saliva up to 22 months before changes in culture/serology. Patients who remained Pa-positive had significantly increased sIgA levels than patients who remained Pa-negative, both at the baseline (39.6 U/mL vs. 19.2 U/mL; p = 0.02) and at the end of the follow-up (119.4 U/mL vs. 25.2 U/mL; p < 0.001). No association was found between sIgA levels in saliva and emergence or recurrence of Pa in the LAW. A positive median sIgA result in the first year of follow-up implied up to 12.5-fold increased risk of subsequent Pa exposure in the LAW. Our test detected early changes in the P. aeruginosa LAW status and risk of exposure to P. aeruginosa in the LAW with two years in advance. Comparison with sinus culture is needed to assess the test’s ability to identify CF patients in need of a sinus approach for Pa investigation, which could provide opportunities of Pa eradication before its aspiration to the lungs.

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Acknowledgements

We thank all the CF patients who accepted to participate in this study and their families. We also thank the staff of the HC Unicamp Pediatric Outpatient Clinic and of the HC Unicamp Division of Clinical Pathology (in particular, the Laboratory of Microbiology) for their help with sample collection and processing.

Funding

This study was financed by the São Paulo Research Foundation (FAPESP) (Grant number 2014/00007-8) and by the Unicamp Support Fund for Teaching, Research and Community Issues (FAEPEX) (Grant number 0112/17).

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Correspondence to Carlos Emilio Levy.

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Mauch, R.M., Rossi, C.L., Nolasco da Silva, M.T. et al. Secretory IgA-mediated immune response in saliva and early detection of Pseudomonas aeruginosa in the lower airways of pediatric cystic fibrosis patients. Med Microbiol Immunol 208, 205–213 (2019). https://doi.org/10.1007/s00430-019-00578-w

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Keywords

  • Cystic fibrosis
  • Pseudomonas aeruginosa
  • Respiratory tract infections
  • Diagnosis
  • Secretory IgA
  • Saliva