Viral Etiology of Acute Exacerbations of COPD in Hong Kong* (original) (raw)
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Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease
Lung India, 2017
countries already shoulder much of the burden of COPD with almost 90% of COPD deaths taking place in these countries. [1] Spirometrically documented COPD is common in Kashmir, the northern Indian state of Jammu and Kashmir, with a prevalence of about 19% among males and 14% among females above the age of 40 years; [2] much higher than reported previously on the basis of questionnaire surveys. [3] Original Article Objective: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) cause significant morbidity, mortality, and an inexorable decline of lung function. Data from developed countries have shown viruses to be important causes of AECOPD, but data from developing countries like India are scant. We set out to determine the contribution of viruses in the causation of hospitalized patients with AECOPD. Methods: Twin nasopharyngeal/oropharyngeal swabs collected from 233 patients admitted with an acute AECOPD and tested for respiratory viruses including respiratory syncytial virus A and B, parainfluenza were (PIV) 1, 2, 3, and 4, human metapneumovirus (hMPV) A and B, influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses, adenovirus 2 and 4, rhinovirus, and bocavirus, by duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using CDC approved primers and probes. Samples positive for influenza A were subtyped for A/H1N1pdm09 and A/H3N2 whereas influenza B samples were subtyped into B/Yamagata and B/Victoria subtypes, using primers and probes recommended by CDC, USA. Results: Respiratory viruses were detected in 46 (19.7%) cases, influenza A/H3N2 and rhinoviruses being the most common viruses detected. More than one virus was isolated in four cases consisting of hMPV-B + adeno-2 + Inf-B; rhino + H3N2, PIV-1 + rhino; and PIV-1+ hMPV-B in one case each. Ancillary supportive therapeutic measures included bronchodilators, antibiotics, steroids, and ventilation (noninvasive in 42 and invasive in 4). Antiviral therapy was instituted in influenza-positive patients. Three patients with A/H3N2 infection died during hospitalization. Conclusions: We conclude that respiratory viruses are important contributors to AECOPD in India. Our data calls for prompt investigation during an exacerbation for viruses to obviate inappropriate antibiotic use and institute antiviral therapy in viral disease amenable to antiviral therapy. Appropriate preventive strategies like influenza vaccination also need to be employed routinely.
International Journal of Research in Medical Sciences, 2015
The severity of AECOPD without respiratory failure can be classified traditionally according to Winnipeg criteria. The three-stage system is based on three principal symptoms: ABSTRACT Background: The aim of our study was to analyse the hospital data on AECOPD in patients with special reference in males and female cases, the pathogens involved, antibiotic susceptibility pattern. Methods: 107 patients (72 males, 35 females) aged between 45 and 85 years were included in the study. A detail history was elicited and complete examination was done. The sputum specimen was collected using sterile sputum cups and subjected to Gram's stain, culture and biochemical reactions. Results: Our study shows 44 positive sputum cultures out of total 107 cases. Out of 107 cases 67% were males and 33% were females. The predominant clinical feature observed in our study was cough with expectoration, exertional dyspnoea and production of mucopurulent sputum. The prevalence of Gram negative bacteria was 55% and Gram positive bacteria was 45%. Klebsiella pneumoniae was the commonest bacteria isolated (38%) followed by Staphylococcus aureus (18%). The drug sensitivity reveals that 79.55% of the isolates were sensitive to amikacin followed by 68.18% sensitive to amoxyclavulinic acid and 54.55% of the isolates were sensitive to ciprofloxacin. Conclusions: In a developing country like India AECOPD is more common in adults more than 55 years of age due to smoking habits and high indoor pollution. This leads to a major impact on the quality of life of patients with the condition. They are a major cause of hospital admission and health care utilization.
Respiratory Medicine, 2008
Aim: This study assessed the infectious etiology of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with concomitant pneumonia. Methods: Patients admitted to medical wards in an acute hospital were recruited prospectively from May 1, 2004 to April 30, 2005. Sputum culture, blood culture, paired serology, and nasopharyngeal aspirates (NPA) viral culture and polymerase chain reaction (PCR) studies were performed. Spirometry was assessed in stable phase at 2e3 months post-hospital discharge. Results: Seventy eight subjects were admitted for AECOPD with concomitant pneumonia. The mean (SD) age was 77.1 (7.5) years, with FEV 1 of 41.5 (20.8)% predicted normal. Overall, an infectious etiology could be established in 48.7% of the subjects. Among the 71 subjects with sputum collected, 40.8% had positive bacterial culture. The commonest bacteria identified were Streptococcus pneumoniae (8[11.3%]), Pseudomonas aeruginosa (7[9.9%]) and Haemophilus influenzae (7[9.9%]). Among the 66 subjects with NPA collected, 9.0 and 12.2% had positive viral culture and PCR results, respectively. The commonest viruses identified by NPA PCR were influenza A (4[6.1%] subjects) and rhinovirus (2[3.0%]). Paired serology was positive in 4.4%. Patients on high dose inhaled corticosteroid (ICS) (>1000 mcg beclomethasone-equivalent/day) had a higher rate of positive sputum bacterial culture than those on low-medium dose of ICS (50.0% vs 18.2%, p Z 0.02). a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r m e d Respiratory Medicine (2008) 102, 1109e1116
Viral epidemiology of acute exacerbations of chronic obstructive pulmonary disease
Pulmonary Pharmacology & Therapeutics, 2012
The role of viruses in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) needs further elucidation. The aim of the present study was to evaluate the molecular epidemiology of viral pathogens in AECOPD. Patients presenting to the Emergency Room with AECOPD needing hospitalization were recruited. Oropharyngeal and sputum samples were collected in order to perform microarrays-based viral testing for the detection of respiratory viruses. A total of 200 (100%) patients were analyzed and from them in 107 (53.5%) a virus was detected. The commonest identified viruses were the human Respiratory Syncytial Virus (subtypes A and B) (40.5%), influenza virus (subtypes A, B, C) (11%), rhinovirus (8%) and human Parainfluenza Virus (subtypes A and B) (7.5%). A bacterial pathogen was isolated in 27 (14%) patients and a dual infection due to a bacterial and a viral pathogen was recognised in 14/107 patients. Patients with AECOPD and a viral infection had a lengthier hospital stay (9.2 AE 4.6 vs 7.6 AE 4.3, p < 0.01) while the severity of the disease was no related with significant differences among the groups of the study population. In conclusion, the isolation of a virus was strongly associated with AECOPD in the examined population. The stage of COPD appeared to have no relation with the frequency of the isolated viruses while dual infection with a viral and a bacterial pathogen was not rare.
Early Warning Signs and Prodromal Symptoms of AECOPD Patients
IntechOpen eBooks, 2023
An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a major problem leading to the most cause of death in chronic obstructive pulmonary disease (COPD) patients. Most cases of AECOPD occurred at home and outside the hospital. The COPD patients have the pattern of AECOPD according to their individual experiences. When the patients had AECOPD, also the warning signs and prodromal symptoms were happened differently. However, the characteristics of warning signs and prodromal symptoms could be described in three categories: 1) early signs and symptoms, 2) signs and symptoms that make the patients worse, and 3) time of occurrence. If the patients have been ill with COPD for a period of time until they can learn his/her early warning signs and prodromal symptoms of AECOPD by themselves or/and with their caregivers or/and with healthcare professionals, they will be able to quickly recognize their signs and symptoms when they occur and will be able to manage them as soon as according to their competency individually.
Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations
Chest, 2010
A mong the infl ammatory processes triggering COPD exacerbations, respiratory tract viral infections are prime suspects. Although fi rst localized in the upper-respiratory tract (URT), these infections could trigger a cascade of infl ammatory events 1,2 that lead to clinically signifi cant exacerbations. Current guidelines recommend the administration of antibiotics based mainly on clinical criteria, 1 leading inevitably to an overuse of antibiotics, which is estimated to occur in approximately 55% of all acute exacerbations of COPD (AECOPD). 3 The participation of viral infections in AECOPD has been confi rmed in many studies. 4-7 The most recent reports using polymerase chain reaction (PCR)-based methods led to a positive detection of viral nucleic acids in 30% to 60% of AECOPD cases. 5,8-12 However, the role of recently identifi ed viruses, such as coronavirus NL63 and HKU1 and human bocavirus as well as the new human rhinoviruses C, which are reported as the most frequent ones circulating in the community, 13,14 has not yet been fully established. Biomarkers such as procalcitonin (PCT), when elevated, have been proposed as surrogate markers of bacterial disease and, when within normal values, often are considered in clinical practice as the signature of a viral infection. Although PCT has been studied Background: Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerbations of COPD (AECOPD), but their role as contributing pathogens remains unclear. The usefulness of procalcitonin and C-reactive protein as indicators of the presence or absence of viral infection in this setting also needs to be evaluated. Methods: The study was of a prospective cohort of patients with COPD admitted to the ED for AECOPD. Reverse transcriptase-polymerase chain reaction (RT-PCR) for 14 respiratory viruses was performed on nasopharyngeal swabs collected at admission and after recovery in stable condition. Results: Eighty-six patients (mean age, 72 years; male, 64%) were included. During AECOPD, upper-respiratory viral infections were detected in 44 (51%) patients: picornavirus in 22, metapneumovirus in seven, coronavirus in eight, infl uenza A/B in two, parainfl uenza in two, and respiratory syncytial virus in three. A dual infection was present in three patients. After recovery, viruses were detected in only eight (11%) of 71 patients (P , .001 compared with AECOPD phase). In fi ve of these patients, no virus had been identifi ed during the initial exacerbation, thus suggesting a new viral infection acquired during follow-up. During AECOPD, procalcitonin and C-reactive protein levels did not differ signifi cantly between patients with or without a proven viral infection. Conclusions: Prevalence of upper-respiratory viral infection, as detected from nasopharyngeal swab by RT-PCR, is high in AECOPD and low after clinical recovery, suggesting that AECOPD frequently are triggered by viral infections initiated in the upper-respiratory tract. In our study, serum procalcitonin and C-reactive protein did not discriminate virus-associated exacerbations from others. Trial registration: clinicaltrials.gov; Identifi er: NCT00448604.
Viral epidemiology of acute exacerbations of chronic obstructive pulmonary disease 1
Pulmonary Pharmacology & Therapeutics
The role of viruses in Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) needs further elucidation. The aim of the present study was to evaluate the molecular epidemiology of viral pathogens in AECOPD.Patients presenting to the Emergency Room with AECOPD needing hospitalization were recruited. Oropharyngeal and sputum samples were collected in order to perform microarrays-based viral testing for the detection