Abstract
BackgroundRespiratory tract infection is a major cause of acute exacerbation of bronchial asthma (AEBA). Although recent findings suggest that common bacteria are causally associated with AEBA, a comprehensive epidemiologic analysis of infectious pathogens including common/atypical bacteria and viruses in AEBA has not been performed. Accordingly, we attempted to detect pathogens during AEBA by using real-time polymerase chain reaction (PCR) in comparison to conventional methods.MethodsWe prospectively enroled adult patients with AEBA from August 2012 to March 2014. Infectious pathogens collected in nasopharyngeal swab and sputum samples were examined in each patient by conventional methods and real-time PCR, which can detect 6 bacterial and 11 viral pathogens. The causal association of these pathogens with AEBA severity and their frequency of monthly distribution were also examined.ResultsAmong the 64 enroled patients, infectious pathogens were detected in 49 patients (76.6%) using real-time PCR and in 14 patients (21.9%) using conventional methods (p < 0.001). Real-time PCR detected bacteria in 29 patients (45.3%) and respiratory viruses in 28 patients (43.8%). Haemophilus influenzae was the most frequently detected microorganism (26.6%), followed by rhinovirus (15.6%). Influenza virus was the significant pathogen associated with severe AEBA. Moreover, AEBA occurred most frequently during November to January.ConclusionsReal-time PCR was more useful than conventional methods to detect infectious pathogens in patients with AEBA. Accurate detection of pathogens with real-time PCR may enable the selection of appropriate anti-bacterial/viral agents as a part of the treatment for AEBA.
Highlights
Respiratory tract infection is a major cause of acute exacerbation of bronchial asthma (AEBA)
Several recent reports have shown that infections with bacteria such as Haemophilus influenzae and Streptococcus pneumoniae may have a pathogenic role in the development of AEBA [18, 19]
In the situations in which antibiotics have already been administered for AEBA patients, real-time polymerase chain reaction (PCR) using sputum samples may be useful in the detection of associated bacteria because the pathogen detection rate by real-time PCR was higher than that by sputum culture in patients with community-acquired pneumonia receiving prior antibiotic treatment [20]
Summary
Respiratory tract infection is a major cause of acute exacerbation of bronchial asthma (AEBA). Recent findings suggest that common bacteria are causally associated with AEBA, a comprehensive epidemiologic analysis of infectious pathogens including common/atypical bacteria and viruses in AEBA has not been performed. Acute exacerbation of bronchial asthma (AEBA) is the acute worsening of clinical symptoms caused by various factors, including respiratory infections, which are associated with the Respiratory tract infection is one of the major causes of AEBA, and respiratory viruses and atypical bacteria have attracted attention as causative pathogens of AEBA [7,8,9,10,11,12,13,14]. Comprehensive epidemiologic analysis of infectious pathogens, including these common bacteria, atypical bacteria, and viruses, during AEBA has not been performed. A causal link between these pathogens and disease severity and the seasonality of AEBA remains elusive
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