Diabetic Cystic Fibrosis Patients Effected by “Superbug”

A common procedure to treat cystic fibrosis (CF), in which a specific type of sugar is inhaled into the lungs, might lead to dangerous complications, especially for diabetics. A bacteria, known as burkholderia cepacia complex (Bcc), appears to create further mucus buildup for CF patients as a result of this procedure, and has been labeled a “superbug.”

Cystic fibrosis is characterized by the buildup of easily infected mucus within the lungs. Certain bacterias, such as Bcc, are responsible for infection and further mucus buildup, which is extremely difficult to treat. Specifically, Bcc has been observed to create a very thick substance, exopolysaccharide (EPS), that worsens lung function for CF patients.

This buildup of EPS as a result of Bcc infection appears to often be a byproduct of a common treatment that utilizes the sugar mannitol. In this treatment, mannitol is inhaled into the lungs, which has the effect of “attracting moisture,” and making it easier to clear out the dangerous mucus. Unfortunately, with the observation of Bcc buildup, this treatment may have to be curtailed or abandoned.

Speaking of the dangers of Bcc, study author Professor John Govan says, “Burkholderia make other superbugs look like wimps. They not only have larger genomes (hence genetic potential) and are resistant to almost all antibiotics, they can even use antibiotics such as penicillin as a nutrient.”

It’s not known exactly why Bcc results from mannitol treatment, but it’s been further suggested that because of the increased buildup of sugar in the body, CF patients with diabetes are more susceptible to Bcc infections. This potential explanation is of particular concern because there is an established link between CF and diabetes. Commenting on the recent research, Dr. David Reid explains that “CF-related diabetes affects almost one-third of adults with CF.”

This research could create a fair amount of confusion and uncertainty in how to treat CF patients, especially the one-third who have diabetes. Mannitol treatment, in some cases, might just be the progenitor of a dangerous cycle. Mannitol thins out the mucus (including that created by Bcc, occasionally), but with Bcc being a byproduct, further, potentially more dangerous, mucus, is created. Further research, especially pertaining to mannitol treatments in diabetics, is needed.

Source: Defeat Diabetes Foundation: Govan, John. Reid, David. Stilwell, Diane. Microbiology news release. March 2009.