Burkholderia cepacia: current clinical issues, environmental controversiesand ethical dilemmas

Burkholderia cepacia is a plant phytogen and is known as a hardy and versat ile organism, Over the past two decades it has emerged as a pathogen in the cystic fibros is (CF) community, with devastating effects. Pulmonary colonisation can lea d to an accelerated decline in lung function. In some cases, it causes a ra pid and progressive pneumonic illness termed "cepacia syndrome", which is u ntreatable and fatal. B, cepacia is inherently resistant to multiple antibiotics and highly trans missible and virulent strains have been identified. CF patients colonised w ith the organism have to be segregated from their peers to try to prevent c ross-infection. However, the pathogenicity of B, cepacia is not limited to CF, Other groups , such as individuals with chronic granulomatous disease and immunocompromi sed patients are vulnerable and it has caused disease in healthy individual s. However, the agricultural and petrochemical industries are attempting to exploit properties of B, cepacia for use as a biopesticide and biodegradat ion agent. This article provides an up to date review of clinically based literature o n the Burkholderia cepacia complex, highlighting clinical management issues for both cystic fibrosis and non-cystic fibrosis patients. The article als o addresses the potential conflict between medicine and agriculture on plan s to reintroduce strains of Burkholderia in cepacia back into the environme nt.