Pseudomonas putida; watch and wait?

Posted by pacathy @pacathy, Dec 16, 2023

Three weeks ago, I had a cold resulting in another sinus infection with large amounts of post nasal drainage and fevers. I coughed out dark brownish yellow sputum from lungs one morning and sent it for a culture-standing order at Penn. I saw primary doc, was treated with Augmentin for sinusitis and improved.

That culture grew out rare (quantity) pseudomonas putida (not aeruginosa). I saw result and reviewed the literature, but didn’t hear anything from pulmonologist until my appointment this week. He said we could try nebulized gentamicin for 4 weeks. I was caught by surprise that he would treat it due to “rare” quantity and the very rare number of infections in community pulmonary patients. I’ve had a couple different organisms docs didn’t think were significant in past. I guess I had convinced myself that no news about the culture was good news. 😀 I declined the treatment and he seemed fine with that. I’ll get a CT in 3 months and send another sputum if I can.
I still THINK I made correct decision, but am second guessing it and wish I’d asked more about his reasons for suggesting it. Thoughts?? Anyone had this type pseudomonas? Does the old “watch and wait” sound Ok?

Pertinent info: I have mild bronchiectasis and can’t usually get a speciman. I do albuterol nebs and airway clearance daily. I was thought to have MAC for several months based on CT’s then went to Mayo in March. They did a bronch and cultures were negative. Sinus issues are chronic and I’m on medicated rinses and sprays. Asthma is mild. Lungs sounded good and PFT’s are good.

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@pacathy The people in this community continue to amaze me with the rare things that crop up! I reviewed the medical literature for pseudomonas putida and bronchiectasis - wow - I only found two reported cases:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549101

I think in your place, I too would watch and wait. It seems if you become symptomatic, there are numerous antibiotic choices.
Sue
PS Pseudomonas putida is, like other strains, pretty well endemic - found mostly in water.
Interesting factoid: P. putida is used in labs to as a medium for growing other "bugs"

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@pacathy as an aside, do you have reflux/GERD? Reflux issues can exacerbate sinusitis. Given that the kind of pseudomonas that you have is mostly waterborne, possibly you aspirated it? I’ve learned recently that aspirations are more common than we would think. In healthy people, a cough or clearing of the throat clears it. In our population, where we have a difficult time clearing, it can turn into a yucky infection.

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@sueinmn

@pacathy The people in this community continue to amaze me with the rare things that crop up! I reviewed the medical literature for pseudomonas putida and bronchiectasis - wow - I only found two reported cases:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549101

I think in your place, I too would watch and wait. It seems if you become symptomatic, there are numerous antibiotic choices.
Sue
PS Pseudomonas putida is, like other strains, pretty well endemic - found mostly in water.
Interesting factoid: P. putida is used in labs to as a medium for growing other "bugs"

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Hey Sue-
Thank you your volunteerism. My son is a physics Ian so I have him review my labwork even though he refuses to treat me, not just because I’m his mother (I’m a bad patient.😂)
My 1st sputum car back with MAC. My 2nd came back with no MAC but an assortment is other goodies. He felt that a lot of this was random stuff that was pretty normal. My 3rd was one mo th ago and thus far has grown nothing. My point is, can’t you have some random bacterium in your sputum due to eating or mild gerd, and not necessarily MAC? Not every result means you have problems is my point.

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@sueinmn

@pacathy The people in this community continue to amaze me with the rare things that crop up! I reviewed the medical literature for pseudomonas putida and bronchiectasis - wow - I only found two reported cases:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549101

I think in your place, I too would watch and wait. It seems if you become symptomatic, there are numerous antibiotic choices.
Sue
PS Pseudomonas putida is, like other strains, pretty well endemic - found mostly in water.
Interesting factoid: P. putida is used in labs to as a medium for growing other "bugs"

Jump to this post

Thank you, Sue. Im glad you agree. I also found the uses of putida interesting, especially bioremediation and biocontrol. Maybe it’ll clean up those trees in bud my lungs. 😀

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@lcwilkie

Hey Sue-
Thank you your volunteerism. My son is a physics Ian so I have him review my labwork even though he refuses to treat me, not just because I’m his mother (I’m a bad patient.😂)
My 1st sputum car back with MAC. My 2nd came back with no MAC but an assortment is other goodies. He felt that a lot of this was random stuff that was pretty normal. My 3rd was one mo th ago and thus far has grown nothing. My point is, can’t you have some random bacterium in your sputum due to eating or mild gerd, and not necessarily MAC? Not every result means you have problems is my point.

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You asked, "...can’t you have some random bacterium in your sputum due to eating or mild gerd, and not necessarily MAC..." and the answer is "Absolutely" Often it is noted as "Normal flora" or "clinically insignificant [whatever they find]" Once my results even read "random artifacts including [some unusual bacteria in small quantity]"
Remember, our noses serve to trap bacteria, pollen, etc and keep it out of our lungs - and often sputum can be contaminated with mucus from our nose/sinuses.

This is why it is a good idea not to panic whenever we read preliminary ;ab results. It's important to wait for the doc to decide what is meaningful.
Sue

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@scoop

@pacathy as an aside, do you have reflux/GERD? Reflux issues can exacerbate sinusitis. Given that the kind of pseudomonas that you have is mostly waterborne, possibly you aspirated it? I’ve learned recently that aspirations are more common than we would think. In healthy people, a cough or clearing of the throat clears it. In our population, where we have a difficult time clearing, it can turn into a yucky infection.

Jump to this post

I think it very possible I aspirated, but it seems more likely that I aspirated some of the sinus drainage. After MAC was ruled out, my sinus issues became the working theory for my lung problems.
I did have reflux in the spring when I was doing the postural drainage recommended by Mayo and Tobrax drops in head hanging position for an opaque frontal sinus (last ditch effort to avoid surgery-it worked). I took reflux meds until sinus cleared and I stopped the postural drainage as well.

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@sueinmn

You asked, "...can’t you have some random bacterium in your sputum due to eating or mild gerd, and not necessarily MAC..." and the answer is "Absolutely" Often it is noted as "Normal flora" or "clinically insignificant [whatever they find]" Once my results even read "random artifacts including [some unusual bacteria in small quantity]"
Remember, our noses serve to trap bacteria, pollen, etc and keep it out of our lungs - and often sputum can be contaminated with mucus from our nose/sinuses.

This is why it is a good idea not to panic whenever we read preliminary ;ab results. It's important to wait for the doc to decide what is meaningful.
Sue

Jump to this post

Thanks Sue and I apologize for the spelling. Will definitely proofread prior to posting next time.

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@pacathy

I think it very possible I aspirated, but it seems more likely that I aspirated some of the sinus drainage. After MAC was ruled out, my sinus issues became the working theory for my lung problems.
I did have reflux in the spring when I was doing the postural drainage recommended by Mayo and Tobrax drops in head hanging position for an opaque frontal sinus (last ditch effort to avoid surgery-it worked). I took reflux meds until sinus cleared and I stopped the postural drainage as well.

Jump to this post

@pacathy A frequent debate I have with myself, is it sinus or gerd/reflux related? In my case, maybe both!

I'd be interested to learn more about what you did to clear your frontal sinuses. Tobrax drops? Please tell more.

Since I've been taking long acting mucinex twice daily, I'm imagining sinuses draining bit by bit, encouraged by this case study.

https://academic.oup.com/omcr/article/2018/9/omy060/5079196?login=false
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I’ve tried to include all the things that’ve helped. I wish you luck!
After the sinus CT showed the opaque frontal sinus, the ENT doc agreed to try Amoxicillin and tapering prednisone, which had been my treatment in other states and had worked well. I improved-I’d forgotten how much air could move through there! He said he still saw green mucus (I’ve only seen yellow) and referred me to the Penn frontal sinus specialist and prescribed Tobrax eye drops for nasal use. I put them in with my head hanging off the side off the bed and kept the position 15 min twice a day for 6 weeks while I waited for appt. My CT had cleared! 😀. I was still hoarse and the Penn doc looked at vocal cords and said I still had a lot of drainage. (White to light yellow). He ordered Mometazone for my twice daily sinus flushes. Btw, he prefers NeilMed bottles to Neti pots. Penn ENT has a video on line demonstrating the use (say k… and no tilting head).

I was already using Mayo’s “triple spray” with Mometasone, diphenhydramine and Ipratropium. This and the similar Azelastine with steroids had been my miracle meds, mostly eliminating my horrid coughing episodes I had before my chest CT got their attention.

I saw my Penn pulmonologist in the bronchiectasis clinic Wed. and he added Ipratropium spray prn because the triple spray wears off before next dose. The Ipratropium has 6 hr duration. He said I can also try Claritin.

Thanks for the article. Mayo stopped the guaifenesin when I was there in March since I couldn’t even get an induced sputum. I’ll keep in mind.

Another thing I’ve found helpful was allergy testing. I requested it in March after an old friend who’d had that horrid cough told me how much allergy shots helped. My ENT doc who did it wasn’t keen on treating due to age, but knowing I have severe birch and oak pollen allergies kept me from walking in the trees every day last spring. 😀

I probably need to pay more attention to reflux. I stopped taking the meds a month or so ago and doc said take as needed.
Thanks for reminder.

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