Microbial ecology of the cystic fibrosis lung

Understanding the microbial flora of the cystic fibrosis (CF) respiratory tract is of considerable importance, as patient morbidity and death are primarily caused by chronic respiratory infections. However, chronically colonized CF airways represent a surprisingly complex and diverse ecosystem. The precise contributions of different microbes to patient morbidity, and in particular the importance of inter-specific interactions, remain largely unelucidated. The importance of within-species genetic and phenotypic variation has similarly received limited explicit attention. While a host of studies provide data on the microbial species recovered from patients, these are often incomparable due to differences in sampling and data reporting, or do not present the data in a way that aids our understanding of the ecosystem within each patient. This review brings together a cross-section of recent research on the CF airways and the microbes which infect them. The results presented suggest that understanding the CF lung in terms of its community and evolutionary ecology could benefit our understanding of disease progression and influence treatment regimens.