Intensive Care Medicine

, 32:1022 | Cite as

Virus infection in exacerbations of chronic obstructive pulmonary disease requiring ventilation

  • Robert J. Cameron
  • Deo de Wit
  • Toni N. Welsh
  • John Ferguson
  • Terry V. Grissell
  • Peter J. Rye



We aimed to characterise and quantify the incidence of common infectious agents in acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring ventilation, with a focus on respiratory viruses.


An epidemiological study conducted over 3 years.


A 12-bed intensive care unit (ICU).


ICU patients over 45 years of age with a primary diagnosis of COPD exacerbation requiring non-invasive ventilation (NIV) or ventilation via endotracheal tube (ETT).

Materials and methods

Nasopharyngeal aspirates (NPA) and posterior pharyngeal swabs (PS) were tested for viruses with immunofluorescence assay (IFA), virus culture (VC) and polymerase chain reaction (PCR). Paired virus and atypical pneumonia serology assays were taken. Blood, sputum and endotracheal aspirates were cultured for bacteria.


107 episodes in 105 patients were recorded. Twenty-three (21%) died within 28 days. A probable infectious aetiology was found in 69 patient episodes (64%). A virus was identified in 46 cases (43%), being the sole organism in 35 cases (33%) and part of a mixed infection in 11 cases (10%). A probable bacterial aetiology was found in 25 cases (23%). There was no statistically significant difference in clinical characteristics or outcomes between the group with virus infections and that without.


Forty-six (43%) of the patients with COPD exacerbation requiring mechanical ventilation had a probable viral pathogen. Prodromal, clinical and outcome parameters did not distinguish virus from non-virus illness. PCR was the most sensitive whilst virus culture was the least of virus assays.


COPD exacerbation Ventilation Infection Virus 

Supplementary material


  1. 1.
    Walsh E, Falsey A, Hennessey P (1999) Respiratory syncytial and other virus infections in persons with chronic cardiopulmonary disease. Am J Resp Crit Care Med 160:791–795PubMedGoogle Scholar
  2. 2.
    Upshur R, Knight K, Goel V (1999) Time series analysis of the relation between influenza virus and hospital admissions of the elderly in Ontario, Canada, for pneumonia, chronic lung disease, and congestive heart failure. Am J Epidem 149:85–92Google Scholar
  3. 3.
    Smith C, Kanner R, Golden C, Klauber M, Renzetti A Jr (1980) Effect of viral infections in patients with chronic obstructive pulmonary diseases. J Infect Dis 141:271–280PubMedGoogle Scholar
  4. 4.
    Lowenburg A, Orie N, Sluiter H, de Vries K (1986) Bronchial hyperreactivity and bronchial obstruction in respiratory viral infection. An attempt to evaluate the relationship. Respiration 49:1–9PubMedCrossRefGoogle Scholar
  5. 5.
    Bandi V, Jakubowycz M, Kinyon C, Mason EO, Atmar RL, Greenberg SB, Murphy TF (2003) Infectious exacerbations of chronic obstructive pulmonary disease associated with respiratory viruses and non-typeable Haemophilus influenzae. FEMS Immunol Med Microbiol 37:69–75PubMedCrossRefGoogle Scholar
  6. 6.
    Rohde G, Wiethege A, Borg I, Kauth M, Bauer TT, Gillissen A, Bufe A, Schultze-Werninghaus G (2003) Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax 58:37–42CrossRefPubMedGoogle Scholar
  7. 7.
    Soler N, Torres A, Ewig S, Gonzalez J, Celis R, El-Ebiary M, Hernandez C, Rodriguez-Roisin R (1998) Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respir Crit Care Med 157:1498–1505PubMedGoogle Scholar
  8. 8.
    Fagon JY, Chastre J, Trouillet JL, Domart Y, Dombret MC, Bornet M, Gibert C (1990) Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis. Use of the protected specimen brush technique in 54 mechanically ventilated patients. Am Rev Respir Dis 142:1004–1008PubMedGoogle Scholar
  9. 9.
    Mackie PL (2003) The classification of viruses infecting the respiratory tract. Paediatric Respiratory Reviews 42:84–90CrossRefGoogle Scholar
  10. 10.
    Folkerts G, Nijkamp FP (1995) Virus-induced airway hyperresponsiveness. Role of inflammatory cells and mediators. Am J Respir Crit Care Med 151:1666–1673PubMedGoogle Scholar
  11. 11.
    McKean MC, Leech M, Lambert PC, Hewitt C, Myint S, Silverman M (2001) A model of viral wheeze in nonasthmatic adults: symptoms and physiology. Eur Respir J 18:23–32CrossRefPubMedGoogle Scholar
  12. 12.
    Jacoby DB (2002) Virus-induced asthma attacks. JAMA 287:755–761CrossRefPubMedGoogle Scholar
  13. 13.
    Williams JV, Harris PA, Tollefson SJ, Halburnt-Rush LL, Pingsterhaus JM, Edwards KM, Wright PF, Crowe JE Jr (2004) Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med 350:443–450CrossRefPubMedGoogle Scholar
  14. 14.
    Jartti T, Lehtinen P, Vuorinen T, Osterback R, van den Hoogen B, Osterhaus AD, Ruuskanen O (2004) Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children. Emerg Infect Dis 10:1095–1099PubMedGoogle Scholar
  15. 15.
    Knipe D, Howley P (2001) Field's virology, 4th edn. Lippincott Williams & Wilkins, ch 24, p 755Google Scholar
  16. 16.
    Celli BR, MacNee W, Force AET (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 23:932–946PubMedGoogle Scholar
  17. 17.
    Committee, BTSSoC (2002) Non-invasive ventilation in acute respiratory failure. Thorax 57:192–211CrossRefGoogle Scholar
  18. 18.
    Eisenberg H (2004) Aerobic bacteriology – respiratory tract cultures. Clinical Microbiology Procedures Handbook, 2nd edn. ASM Press, Washington, DCGoogle Scholar
  19. 19.
    Ewig S, Soler N, Gonzalez J, Celis R, El-Ebiary M, Torres A (2000) Evaluation of antimicrobial treatment in mechanically ventilated patients with severe chronic obstructive pulmonary disease exacerbations. Crit Care Med 28:692–697CrossRefPubMedGoogle Scholar
  20. 20.
    Antonelli M, Conti G, Riccioni L, Meduri G (1996) Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest 110:724–728PubMedCrossRefGoogle Scholar
  21. 21.
    Borg I, Rohde G, Loseke S, Bittscheidt J, Schultze-Werninghaus G, Stephan V, Bufe A (2003) Evaluation of a quantitative real-time PCR for the detection of respiratory syncytial virus in pulmonary diseases. Eur Respir J 21:944–951PubMedCrossRefGoogle Scholar
  22. 22.
    Seemungal TA, Harper-Owen R, Bhowmik A, Jeffries DJ, Wedzicha JA (2000) Detection of rhinovirus in induced sputum at exacerbation of chronic obstructive pulmonary disease. Eur Respir J 16:677–683CrossRefPubMedGoogle Scholar
  23. 23.
    Chitkara RK, Sarinas PS (2002) Recent advances in diagnosis and management of chronic bronchitis and emphysema. Curr Opin Pulm Med 8:126–136CrossRefPubMedGoogle Scholar
  24. 24.
    Soto FJ, Varkey B (2003) Evidence-based approach to acute exacerbations of COPD. Curr Opin Pulm Med 9:117–124CrossRefPubMedGoogle Scholar
  25. 25.
    Miravitlles M (2002) Exacerbations of chronic obstructive pulmonary disease: when are bacteria important? Eur Respir J [Suppl] 36:9s–19sCrossRefGoogle Scholar
  26. 26.
    Banerjee D, Khair OA, Honeybourne D (2004) Impact of sputum bacteria on airway inflammation and health status in clinical stable COPD. Eur Respir J 23:685–691CrossRefPubMedGoogle Scholar
  27. 27.
    Patel IS, Seemungal TA, Wilks M, Lloyd-Owen SJ, Donaldson GC, Wedzicha JA (2002) Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax 57:759–764CrossRefPubMedGoogle Scholar
  28. 28.
    Johnston SL (1995) Natural and experimental rhinovirus infections of the lower respiratory tract. Am J Respir Crit Care Med 152:S46–S52PubMedGoogle Scholar
  29. 29.
    Sterk PJ (1993) Virus-induced airway hyperresponsiveness in man. Eur Respir J 6:894–902PubMedGoogle Scholar
  30. 30.
    Johnston SL, Papi A, Bates PJ, Mastronarde JG, Monick MM, Hunninghake GW (1998) Low grade rhinovirus infection induces a prolonged release of IL-8 in pulmonary epithelium. J Immunol 160:6172–6181PubMedGoogle Scholar
  31. 31.
    Gern JE, Galagan DM, Jarjour NN, Dick EC, Busse WW (1997) Detection of rhinovirus RNA in lower airway cells during experimentally induced infection. Am J Respir Crit Care Med 155:1159–1161PubMedGoogle Scholar
  32. 32.
    Seemungal T, Harper-Owen R, Bhowmik A, Moric I, Sanderson G, Message S, Maccallum P, Meade TW, Jeffries DJ, Johnston SL, Wedzicha JA (2001) Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 164:1618–1623PubMedGoogle Scholar
  33. 33.
    Garbino J, Gerbase MW, Wunderli W, Deffernez C, Thomas Y, Rochat T, Ninet B, Schrenzel J, Yerly S, Perrin L, Soccal PM, Nicod L (2004) Lower respiratory viral illnesses: improved diagnosis by molecular methods and clinical impact. Am J Respir Crit Care Med 170:1197–1203CrossRefPubMedGoogle Scholar
  34. 34.
    Glezen WP, Greenberg SB, Atmar RL, Piedra PA, Couch RB (2000) Impact of respiratory virus infections on persons with chronic underlying conditions. JAMA 283:499–505CrossRefPubMedGoogle Scholar
  35. 35.
    Ball P (1995) Epidemiology and treatment of chronic bronchitis and its exacerbations. Chest 108:43S–52SCrossRefGoogle Scholar
  36. 36.
    Greenberg SB (2002) Respiratory viral infections in adults. Curr Opin Pulm Med 8:201–208CrossRefPubMedGoogle Scholar
  37. 37.
    Greenberg SB, Allen M, Wilson J, Atmar RL (2000) Respiratory viral infections in adults with and without chronic obstructive pulmonary disease. Am J Respir Crit Care Med 162:167–173PubMedGoogle Scholar
  38. 38.
    Nijhuis M, van Maarseveen N, Schuurman R, Verkuijlen S, de Vos M, Hendriksen K, van Loon AM (2002) Rapid and sensitive routine detection of all members of the genus enterovirus in different clinical specimens by real-time PCR. J Clin Microbiol40 10:3666–3670CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Robert J. Cameron
    • 1
  • Deo de Wit
    • 2
  • Toni N. Welsh
    • 3
  • John Ferguson
    • 3
    • 4
  • Terry V. Grissell
    • 4
  • Peter J. Rye
    • 1
  1. 1.ICUGosford HospitalGosfordAustralia
  2. 2.Director of MicrobiologyGosford HospitalGosfordAustralia
  3. 3.Hunter Area Pathology ServiceJohn Hunter HospitalNewcastleAustralia
  4. 4.Hunter Medical Research InstituteUniversity of NewcastleNewcastleAustralia

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