# Pseudomonas Reinfection in a Patient With Primary Ciliary Dyskinesia: How a Toothbrush Could Make You Sick

## TL;DR

A patient with a rare genetic disorder had recurring lung infections from bacteria on his toothbrush, highlighting the need for better hygiene practices.

## Contribution

This is the first reported case linking toothbrush colonization to recurrent Pseudomonas infections in a patient with primary ciliary dyskinesia.

## Key findings

- A 53-year-old patient with PCD had Pseudomonas aeruginosa infections traced to his toothbrush.
- Modifying oral hygiene practices led to significant clinical improvement and no further hospitalizations.
- The case suggests hygiene tools like toothbrushes should be evaluated to prevent reinfections in PCD patients.

## Abstract

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder characterized by impaired mucociliary clearance, leading to recurrent respiratory tract infections, chronic rhinosinusitis, and progressive bronchiectasis. Pseudomonas aeruginosa is a common pathogen associated with poorer clinical outcomes in patients with PCD. While environmental sources of P. aeruginosa are well-documented in cystic fibrosis (CF) patients, to our knowledge, this is the first reported case implicating toothbrush colonization as a likely source of recurrent P. aeruginosa infections in a patient with PCD. We present a case of a 53-year-old Puerto Rican male with a history of sinusitis, bronchiectasis, hearing loss, and chronic cough, diagnosed with PCD, having a positive genetic testing for RSPH4A (c.921+3_921+6del (intronic)) founder mutation. Despite aggressive treatment, the patient continued to experience recurrent P. aeruginosa infections. Investigation into potential environmental sources revealed that the patient's toothbrush was colonized with P. aeruginosa, making it a likely source of reinfection. After modifying his oral hygiene practices, the patient showed significant clinical improvement with no subsequent hospitalizations. This case highlights the novel identification of a toothbrush as a source of recurrent P. aeruginosa infections in a patient with PCD. It underscores the importance of considering environmental factors in the management of chronic respiratory infections in patients with PCD. These findings suggest that routine evaluation and disinfection of hygiene tools, such as toothbrushes, may be critical in preventing recurrent infections and their long-term consequences in patients with PCD. Future research should aim to establish clinical guidelines for preventing bacterial transmission from the built environment in this vulnerable population.