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The role of atypical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease

¹ Regional Laboratory of Public Health Haarlem, Haarlem, ² Dept of Pulmonary Medicine, Medisch Spectrum Twente, and ⁶ Regional Laboratory of Public Health, Enschede, ³ Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, and ⁴ Dept of Medical Microbiology and Infection Control, VU Medical University, Amsterdam, ⁵ Regional Laboratory of Public Health Haarlem, Haarlem, Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, The Netherlands.

CORRESPONDENCE: B. M. W. Diederen, Regional Laboratory of Public Health Haarlem, Boerhaavelaan 26, 2035 RC, Haarlem, The Netherlands. Fax: 31 135441264. E-mail: bramdiederen{at}gmail.com

Keywords: Atypical pathogens, Chlamydia pneumoniae, chronic obstructive pulmonary disease, exacerbation, Legionella, real-time PCR

Received: February 3, 2007
Accepted April 12, 2007

The aetiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) is heterogeneous and still under discussion. Serological studies have suggested that Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila may play a role in acute exacerbations of COPD.

The presence of these atypical pathogens in sputum samples was investigated in patients with stable COPD and with acute exacerbations of COPD using real-time PCR. The present study was part of a randomised, double-blind, single-centre study and a total of 248 sputum samples from 104 COPD patients were included. In total, 122 samples obtained during stable disease (stable-state sputa) and 126 samples obtained during acute exacerbations of COPD (exacerbation sputa) were tested.

Of the 122 stable-state sputa, all samples were negative for M. pneumoniae and C. pneumoniae DNA, whereas one sample was positive for Legionella non-pneumophila DNA. Of the 126 exacerbation sputa, all samples were negative for M. pneumoniae and C. pneumoniae DNA, whereas one sample was positive for Legionella non-pneumophila DNA.

The possible relationship between the presence of atypical pathogens and the aetiology of acute exacerbations in chronic obstructive pulmonary disease was investigated in patients with stable disease and in those with acute exacerbations using real-time PCR. No indication was found of a role for Legionella spp., Chlamydia pneumoniae or Mycoplasma pneumoniae in stable, moderately severe chronic obstructive pulmonary disease and in its exacerbations.

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