BacteriologyInfectious etiologies in acute exacerbation of COPD
Introduction
In the setting of the prolonged, chronic course of chronic obstructive pulmonary disease (COPD), patients often have acute exacerbations (AECOPD). The principal and dominant etiology in the overwhelming majority of episodes is infectious (McHardy et al., 1980). Despite the high frequency of AECOPD in both ambulatory and hospital settings, few studies have determined in a comprehensive manner the frequency distribution of the various infectious etiologies in these episodes. This paucity of studies is particularly striking in light of the very large body of work that has been done on another infectious pulmonary disease, community-acquired pneumonia (CAP). Even among the few studies that attempted to assess the issue of infectious etiologies of AECOPD, most were based primarily on cultures of respiratory tract secretions, an approach that entails serious methodological problems (Murphy & Sethi, 1992). Attempts to study the issue of etiology indirectly by evaluating responses to various antibiotic therapies for AECOPD Anthonisen et al 1987, Elmes et al 1957 are no less problematic since the response rate to placebo therapy is 55% (Anthonisen et al., 1987).
Technological developments that have taken place over the last decade have significantly improved serologic diagnostic tools for infectious diseases in general and for respiratory infections in particular. This development has enabled investigators to diagnose respiratory infections caused by classic bacteria, atypical bacteria and viruses with satisfactorily reliable serologic methods. The aim of this prospective study was to use these serologic tools to identify the spectrum of infectious etiologies for AECOPD among patients hospitalized for these episodes, and to determine their distribution in terms of the baseline severity of the COPD and the clinical manifestations of the exacerbation.
Section snippets
Patients
All patients hospitalized for AECOPD during the period between November 1, 1997 and March 15, 1999 in the internal medicine and intensive care wards of the Soroka Medical Center in Beer-Sheva Israel who met the inclusion criteria, and gave consent to participate, were included in the study. All first hospitalizations in the study period were included as well as repeat hospitalizations for AECOPD of patients in the study population, if the hospitalization took place at least six months after the
Results
The study consisted of 250 hospitalizations for AECOPD among 219 different COPD patients during the 16.5-month period. In 241 cases (96.4%) a convalescence serum sample was obtained at a mean of 24.7 ± 5.6 days (range 17–53 days) after the first sample was taken at the beginning of the hospitalization. Since the etiologic diagnoses in this study were based on changes in antibody titer between the acute phase serum and the convalescence serum, we did not include in the frequency distribution
Discussion
A comprehensive review on the subject of infectious etiologies for AECOPD was published in 1992 by Sethi and Murphy (1992). Although nine years have passed since then, their conclusions are still valid and have been confirmed by the results of studies published recently. The vast majority of studies on etiologies of AECOPD were based almost solely on bacteria isolated from cultures of patients’ sputum. These studies have consistently found that the bacteria isolated from patients’ sputum are H.
References (23)
- et al.
Infective exacerbations of chronic bronchitis. Relation between bacteriologic etiology and lung function
Chest
(1998) - et al.
Measurement of antibody responses to pneumolysin - a promising method for the presumptive aetiological diagnosis of pneumococcal pneumonia
J Infection
(1989) - et al.
Demonstration of pneumolysin antibodies in circulating immune complexes - a new diagnostic method for pneumococcal pneumonia
Serodiag Immunother Inf Dis
(1990) Atypical pathogens in community-acquired pneumonia
Clin Chest Med
(1999)- et al.
A study of infective and other factors in exacerbations of chronic bronchitis
Br J Dis Chest
(1980) - et al.
Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease
Ann Intern Med
(1987) - et al.
Use of serological methods to diagnose pneumonia caused by noncapsulated Haemophilus influenzae and Moraxella catarrhalis
J Infect Dis
(1994) - et al.
Moraxella (Branhamella) catarrhalis - an uncommon cause of community acquired pneumonia in Swedish children
Scand J Infect Dis
(1994) - et al.
Prophylactic use of oxytetracycline for exacerbations of chronic bronchitis
BMJ
(1957) - et al.
Spread of Streptococcus pneumoniae in families. I. Carriage rates and distribution of types
J Infect Dis
(1975)
Demonstration of circulating pneumococcal immunoglobulin G immune complexes in patients with community-acquired pneumonia by means of an enzyme-linked immunosorbent assay
J Clin Microbiol
Cited by (79)
Elevated levels of circulating exosome in COPD patients are associated with systemic inflammation
2017, Respiratory MedicineCitation Excerpt :A significant cause for decline in COPD are acute exacerbation (AECOPD), which is a severe sudden worsening in airway function and respiratory symptoms beyond normal daily variation, ranging from self-limited illness to critical respiratory failure requiring mechanical ventilation [1,2]. The commonest cause of AECOPD are bacterial and/or viral infections [3–5], however specific causes could not be identified in about 30% of AECOPD cases [6]. Systemic inflammatory changes in COPD and AECOPD have a strong correlation with co-morbidities such as cardiovascular disease [7,8].
Chronic bronchial infection in COPD. Is there an infective phenotype?
2013, Respiratory MedicineCitation Excerpt :Atypical bacteria such as C. pneumoniae, Mycoplasma pneumoniae and Legionella spp. are intracellular pathogens that share some characteristics of viruses.78 Their contribution in the emergence of exacerbations is not completely clear because the data on their prevalence significantly differ depending on the diagnostic methods and study populations involved.6,92–95 It is commonly accepted that atypical bacteria cause 5–10% of ECOPD,11,78 either as independent pathogens or, more frequently, as co-pathogens.80,93,94
Q fever in Japan: An update review
2011, Veterinary MicrobiologyExtracellular vesicles and COPD: foe or friend?
2023, Journal of NanobiotechnologyHow and when to manage respiratory infections out of hospital
2022, European Respiratory Review