Immunologically, patients in DSII, which had the highest prevalence of CRS+CF patients, exhibited increases in genes associated with neutrophil and macrophage activation, including TNF-α and IL-8, which is consistent with CF airway immune responses associated with strains of P. aeruginosa specifically adapted to the lung environment [62, 63]. Here, CXCL8 is linked to congenital rubella syndrome.