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Viral pathogens in acute exacerbations of chronic obstructive pulmonary disease

  • Carlos A. CamargoJrEmail author
  • Adit A. Ginde
  • Sunday Clark
  • Charles P. Cartwright
  • Ann R. Falsey
  • Dennis E. Niewoehner
EM - Original

Abstract

The objective of this study is to determine the prevalence of respiratory syncytial virus (RSV) and other viral respiratory pathogens in emergency department (ED) patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). COPD patients presenting to the ED with <10 days of AECOPD symptoms were eligible. We used PCR to test nasal swabs for common viral respiratory pathogens. We completed viral studies on 76 patients from two EDs. Patients had a mean age of 72 years, and were 68% male, 99% white, and 29% current smokers. Influenza vaccination was reported by 87%. Viruses were detected in 19 of 76 patients (25%). These included RSV A (2) and B (4); parainfluenza 1 (1), 2 (0), and 3 (2); influenza A (3) and B (0); rhinovirus (4); and human metapneumovirus (3). A putative viral etiology was identified in 25% of AECOPD presenting for emergency care, of which approximately one-third were RSV-related.

Keywords

COPD Exacerbation Virus Infection Pulmonary Emergency department 

Notes

Acknowledgments

This study was supported by an investigator-initiated grant from Aventis Pasteur (Lyon, France). We thank Sunghye Kim, Heba Wassif, Fernanda Gazoni, and Patricia Foster for their assistance in this study.

Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.

References

  1. 1.
    Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC (2002) Chronic obstructive pulmonary disease surveillance—United States, 1971–2000. MMWR 51:1–16Google Scholar
  2. 2.
    Varkey JB, Varkey B (2008) Viral infections in patients with chronic obstructive pulmonary disease. Curr Opin Pulm Med 14:89–94PubMedCrossRefGoogle Scholar
  3. 3.
    Collins CL, Pollard AJ (2002) Respiratory syncytial virus infections in children and adults. J Infect 45:10–17PubMedCrossRefGoogle Scholar
  4. 4.
    Falsey AR, Hennessey PA, Formica MA, C Cox, Walsh EE (2005) Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med 352:1749–1759PubMedCrossRefGoogle Scholar
  5. 5.
    Mangtani P, Hajat S, Kovats S, Wilkinson P, Armstrong B (2006) The association of respiratory syncytial virus infection and influenza with emergency admissions for respiratory disease in London: an analysis of routine surveillance data. Clin Infect Dis 42:640–646PubMedCrossRefGoogle Scholar
  6. 6.
    Lamy ME, Pouthier-Simon F, Debacker-Willame E (1973) Respiratory viral infections in hospital patients with chronic bronchitis. Chest 63:336–341PubMedCrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    Seemungal T, Harper-Owen R, Bhowmik A et al (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
  9. 9.
    Rohde G, Wiethege A, Borg I et al (2003) Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case-control study. Thorax 58:37–42PubMedCrossRefGoogle Scholar
  10. 10.
    Martinello RA, Esper F, Weibel C, Ferguson D, Landry ML, Kahn JS (2006) Human metapneumovirus and exacerbations of chronic obstructive pulmonary disease. J Infect 53:248–254PubMedCrossRefGoogle Scholar
  11. 11.
    Ko FWS, Ip M, Chan PKS et al (2007) Viral etiology of acute exacerbations of COPD in Hong Kong. Chest 132:900–908PubMedCrossRefGoogle Scholar
  12. 12.
    Hutchinson AF, Ghimire AK, Thompson MA et al (2007) A community-based, time-matched, case-control study of respiratory viruses and exacerbations of COPD. Respir Med 101:2472–2481PubMedCrossRefGoogle Scholar
  13. 13.
    McManus TE, Marley AM, Baxter N et al (2008) Respiratory viral infection in exacerbations of COPD. Respir Med. doi: 10.1016/j.rmed.2008.06.006
  14. 14.
    Fan J, Henrickson KJ, Savatski LL (1998) Rapid simultaneous diagnosis of infections with respiratory syncytial viruses A and B, influenza viruses A and B, and human parainfluenzavirus types 1, 2, and 3 by multiplex quantitative reverse transcription polymerase chain reaction-enzyme hybridization assay (Hexaplex). Clin Infect Dis 26:1397–1402PubMedCrossRefGoogle Scholar
  15. 15.
    Hindiyeh M, Hillyard DR, Carroll KC (2001) Evaluation of the Prodesse Hexaplex multiplex PCR assay for direct detection of seven respiratory viruses in clinical specimens. Am J Clin Pathol 116:218–224PubMedCrossRefGoogle Scholar
  16. 16.
    Falsey AR, Formica MA, Treanor JJ, Walsh EE (2003) Comparison of quantitative reverse transcription-PCR to viral culture for assessment of respiratory syncytial virus shedding. J Clin Microbiol 4:4160–4165CrossRefGoogle Scholar
  17. 17.
    Andeweg AC, Bestebroer TM, Huybreghs M, Kimman TG, de Jong JC (1999) Improved detection of rhinoviruses in clinical samples by using a newly developed nested reverse transcription-PCR assay. J Clin Microbiol 37:524–530PubMedGoogle Scholar
  18. 18.
    Falsey AR, Criddle MC, Walsh EE (2006) Detection of respiratory syncytial virus and human metapneumovirus by reverse transcription polymerase chain reaction in adults with and without respiratory illness. J Clin Virol 35:46–50PubMedCrossRefGoogle Scholar
  19. 19.
    Borg I, Rohde G, Loseke S et al (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
  20. 20.
    Falsey AR, Formica MA, Hennessey PA, Criddle MM, Sullender WM, Walsh EE (2006) Detection of respiratory syncytial virus in adults with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173:639–643PubMedCrossRefGoogle Scholar
  21. 21.
    Wilkinson TMA, Donaldson GC, Johnston SL, Openshaw RJM, Wedzicha JA (2006) Respiratory syncytial virus, airway inflammation, and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 173:871–876PubMedCrossRefGoogle Scholar
  22. 22.
    Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Infectious Diseases. Respiratory and Enteric Viruses Branch. http://www.cdc.gov/surveillance/nrevss/resp-natl-trends.htm. Accessed 23 August 2008
  23. 23.
    Falsey AR, Formica MA, Walsh EE (2002) Diagnosis of respiratory syncytial virus infection: comparison of reverse transcription-PCR to viral culture and serology in adults with respiratory illness. J Clin Microbiol 40:817–820PubMedCrossRefGoogle Scholar
  24. 24.
    Monto AS (2002) The seasonality of rhinovirus infections and its implications for clinical recognition. Clin Ther 24:1987–1997PubMedCrossRefGoogle Scholar
  25. 25.
    Department of Health and Human Services. Centers for Disease Control and Prevention. http://www.cdc.gov/flu/weekly/fluactivity.htm. Accessed 23 August 2008
  26. 26.
    Boivin G, Abed Y, Pelletier G et al (2002) Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups. J Infect Dis 186:1330–1334PubMedCrossRefGoogle Scholar
  27. 27.
    Vicente D, Montes M, Cilla G, Pérez-Trallero E (2004) Human metapneumovirus and chronic obstructive pulmonary disease (letter). Emerg Infect Dis 10:1338PubMedGoogle Scholar
  28. 28.
    Hamelin ME, Côté S, Laforge J et al (2005) Human metapneumovirus infection in adults with community-acquired pneumonia and exacerbation of chronic obstructive pulmonary disease. Clin Infect Dis 41:498–502PubMedCrossRefGoogle Scholar

Copyright information

© SIMI 2008

Authors and Affiliations

  • Carlos A. CamargoJr
    • 1
    • 8
    Email author
  • Adit A. Ginde
    • 2
    • 3
  • Sunday Clark
    • 4
  • Charles P. Cartwright
    • 5
  • Ann R. Falsey
    • 6
  • Dennis E. Niewoehner
    • 7
  1. 1.Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraUSA
  3. 3.Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonUSA
  4. 4.Division of General Internal MedicineUniversity of PittsburghPittsburghUSA
  5. 5.Department of Laboratory Medicine and PathologyHennepin County Medical CenterMinneapolisUSA
  6. 6.Department of MedicineUniversity of RochesterRochesterUSA
  7. 7.Pulmonary SectionVeterans Affairs Medical CenterMinneapolisUSA
  8. 8.EMNet Coordinating CenterMassachusetts General HospitalBostonUSA

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