Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations

Kherad, Omar; Kaiser, Laurent; Bridevaux, Pierre‐Olivier; Sarasin, François; Thomas, Yves; Janssens, Jean–Paul; Rutschmann, Olivier Thierry

doi:10.1378/chest.09-2225

Cited by 96 publications

(101 citation statements)

References 36 publications

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“…In our study, patients with mixed detection of viruses and bacteria behaved similarly to the patients with viruses only detected suggesting that the viral component was responsible for the associations between mixed detection, CRP and temperature. Unlike some previous studies, markers of severity including duration of hospital stay were not higher in patients with mixed infection compared to other groups [11].…”

Section: Discussioncontrasting

confidence: 96%

“…As with asthma exacerbations, it seems likely that respiratory viruses are the principal initiating infectious agent in exacerbations of COPD, with new bacterial infections being of lesser importance. The reasons as to the relatively low rate of viral detection in exacerbations of COPD compared to asthma are unclear, although the overall detection rate of 38% in this study is highly consistent with other studies [9][10][11].…”

Section: Discussionsupporting

confidence: 89%

“…Studies demonstrating the development of strain-specific antibodies to bacteria following exacerbation suggest that acquisition of a different strain of the same bacterial species may play a role [5][6][7], although new strain acquisition is not invariably associated with exacerbation [8]. Studies using modern sensitive molecular methods have demonstrated that viruses are commonly detected in patients with exacerbations of COPD [9][10][11][12]. In addition, the changes in inflammatory profile, less frequent detection in steady state and the seasonal changes in exacerbation rate suggest that viral acquisition is causally related to exacerbation [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Studies using modern sensitive molecular methods have demonstrated that viruses are commonly detected in patients with exacerbations of COPD [9][10][11][12]. In addition, the changes in inflammatory profile, less frequent detection in steady state and the seasonal changes in exacerbation rate suggest that viral acquisition is causally related to exacerbation [9][10][11][12]. Furthermore, recent challenge studies with human rhinovirus in patients with COPD have replicated the symptoms and inflammatory profile changes associated with naturally occurring exacerbations [13].…”

Section: Introductionmentioning

confidence: 99%

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C-reactive protein level and microbial aetiology in patients hospitalised with acute exacerbation of COPD

et al. 2014

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Both viruses and bacteria are thought to cause exacerbations of chronic obstructive pulmonary disease (COPD); however, the relative importance of each remains uncertain. C-reactive protein (CRP) levels increase during exacerbations but the relationship with aetiology is not established. We aimed to explore the relationship between serum CRP and the rate of detection of viruses and bacteria.This was a prospectively recruited, observational study of patients hospitalised with exacerbations of COPD. Nasopharyngeal swabs were tested for respiratory viruses by reverse transcriptase-PCR. Sputum and blood were collected for bacterial culture and urine tested for pneumococcal antigen. CRP levels were measured on sera. CRP and other factors associated with viral, bacterial or mixed detection were assessed using multiple logistic regression analysis.264 patients with exacerbations of COPD were studied: 26% tested positive for respiratory viruses only, 13% had bacteria only, 12% had mixed viral/bacterial detection, and 49% had no pathogens detected. CRP level and temperature were strongly associated with viral detection rate ( p<0.001 and p=0.004, respectively) and mixed viral/bacterial detection rate ( p=0.02 and p=0.03, respectively) on multivariate analysis. Bacterial detection rate was not associated with CRP level or body temperature.This study supports the role of viruses as important aetiological agents causing exacerbations of COPD.@ERSpublications Detection of respiratory viruses strongly associated with CRP level and temperature in hospitalised COPD patients

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Section: Discussioncontrasting

confidence: 96%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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C-reactive protein level and microbial aetiology in patients hospitalised with acute exacerbation of COPD

et al. 2014

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“…RSV is the second leading cause of winter morbidity in the elderly, after influenza virus (15). Moreover, influenza virus and RSV are frequent contributors to acute exacerbations of chronic obstructive pulmonary disease (COPD), for which the elderly are treated with antibiotics and hospitalized, especially during the winter season (13,25,31). Advanced age and comorbidities are also established risk factors for CDAD.…”

mentioning

confidence: 99%

Seasonal Variations in Clostridium difficile Infections Are Associated with Influenza and Respiratory Syncytial Virus Activity Independently of Antibiotic Prescriptions: a Time Series Analysis in Québec, Canada

Gilca

Fortin

Frenette

et al. 2012

Antimicrob Agents Chemother

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Seasonal variations in Clostridium difficile-associated diarrhea (CDAD), with a higher incidence occurring during winter months, have been reported. Although winter epidemics of respiratory viruses may be temporally associated with an increase in CDAD morbidity, we hypothesized that this association is mainly due to increased antibiotic use for respiratory infections. The objective of this study was to evaluate the effect of the two most frequent respiratory viruses (influenza virus and respiratory syncytial virus [RSV]) and antibiotics prescribed for respiratory infections (fluoroquinolones and macrolides) on the CDAD incidence in hospitals in the province of Québec, Canada. A multivariable Box-Jenkins transfer function model was built to relate monthly CDAD incidence to the monthly percentage of positive tests for influenza virus and RSV and monthly fluoroquinolone and macrolide prescriptions over a 4-year period (January 2005 to December 2008). Analysis showed that temporal variations in CDAD incidence followed temporal variations for influenza virus (P ‫؍‬ 0.043), RSV (P ‫؍‬ 0.004), and macrolide prescription (P ‫؍‬ 0.05) time series with an average delay of 1 month and fluoroquinolone prescription time series with an average delay of 2 months (P ‫؍‬ 0.01). We conclude that influenza virus and RSV circulation is independently associated with CDAD incidence after controlling for fluoroquinolone and macrolide use. This association was observed at an aggregated level and may be indicative of other phenomena occurring during wintertime.

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Rhinovirus frequently detected in elderly adults attending an emergency department

Pierangeli

Scagnolari

Selvaggi

et al. 2011

Journal of Medical Virology

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The general aim was to investigate the burden of respiratory virus illness in a hospital emergency department, during two different epidemic seasons. Consecutive patients attending an emergency department during two study periods (February/March 2009 and 2010) were enrolled using broad inclusion criteria (fever/preceding fever and one of a set of ICD-9 codes suggestive of respiratory illness); nasopharyngeal washes were tested for the most common respiratory viruses using PCR-based methods. Influenza A virus was detected in 24% of samples collected in February/March 2009, whereas no samples tested positive for influenza during February/March 2010 (pandemic H1N1 Influenza A having circulated earlier in October-December 2009). Rhinovirus (HRV) was detected in 16% and 8% of patients recruited over the two study periods, respectively. Other respiratory viruses were detected rarely. Patient data were then analyzed with specific PCR results, comparing the HRV-positive group with virus-positive and no virus-detected groups. Individuals over 65 years old with HRV presented with signs, symptoms and underlying conditions and were admitted to hospital as often as the other enrolled patients, mainly for dyspnoea and chronic obstructive pulmonary disease acute exacerbation. Conversely, younger individuals with HRV, although presenting with respiratory signs and symptoms, were generally diagnosed with non-respiratory conditions. HRV was detected frequently in elderly patients attending the emergency department for respiratory distress without distinguishing clinical features. Molecular diagnosis of lower respiratory tract infections and surveillance of infectious diseases should include tests for HRV, as this virus is associated frequently with hospitalization of the elderly.

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Upper-Respiratory Viral Infection, Biomarkers, and COPD Exacerbations

Abstract: clinicaltrials.gov; Identifier: NCT00448604.

Cited by 96 publications

References 36 publications

C-reactive protein level and microbial aetiology in patients hospitalised with acute exacerbation of COPD

C-reactive protein level and microbial aetiology in patients hospitalised with acute exacerbation of COPD

Seasonal Variations in Clostridium difficile Infections Are Associated with Influenza and Respiratory Syncytial Virus Activity Independently of Antibiotic Prescriptions: a Time Series Analysis in Québec, Canada

Rhinovirus frequently detected in elderly adults attending an emergency department

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