Jahan Rahat, Mishra Baijayantimala, Behera Bijayini, Mohapatra Prasanta Raghab, Praharaj Ashok Kumar
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Lung India. 2021 Jan-Feb;38(1):53-58. doi: 10.4103/lungindia.lungindia_273_20.
Patients with chronic obstructive pulmonary disease (COPD) develop acute exacerbations (AE), with varying natural history. The exacerbation is triggered by infection, leading to increased morbidity and mortality. The study on infectious aetiology of AECOPD is largely restricted to only viral or only bacterial aetiology. There are no studies from India that have investigated multiple viral, bacterial, and fungal associations from the same group of patients. This prospective study was conducted over 2 years to estimate the incidence and profile of viral infections in AECOPD patients, their coinfection with other bacterial and fungal agents, and association of the type and pattern of infective agent with the clinical severity.
Seventy-four AECOPD cases were included in the study. Multiplex polymerase chain reaction was performed from nasopharyngeal swab using Fast Track Diagnostics Respiratory Pathogens 21 Plus Kit. Ziehl-Neelsen (ZN) stain, Modified ZN, and potassium hydroxide (KOH) mount were performed for Mycobacteria, Nocardia, and fungal elements. Bacterial cultures and fungal cultures were done as per the standard techniques. Serum samples were tested for Mycoplasma and Chlamydia pneumoniae immunoglobulin M enzyme-linked immunosorbent assay.
The number of AECOPD events involving only viral infection, only bacterial infection, bacterial-viral coinfection, and no infection were 43 (58.1%), 32 (43.2%), 20 (27%), and 19 (25.7%), respectively. Influenza A virus was the most common virus (22/43, 51%) identified. In 26 patients, monoviral infections were found, and in 17 patients, polyviral infections were identified, the most common pattern being influenza A and B virus, followed by human rhinovirus and human parainfluenza. The most common bacteria isolated were Pseudomonas aeruginosa (9/32,28%) followed by Acinetobacter baumanii and Klebsiella pneumoniae (7/32, 21%). Among the viral-bacterial coinfection, human coronavirus NL63 infection was always associated with a bacterial infection.
This information on the various viral and bacterial etiologies of respiratory infections in AECOPD in this part of India will improve the understanding of the management of AECOPD using a timely institution of antivirals and reduce the overuse of antibiotics and the implementation of routine influenza vaccination.
慢性阻塞性肺疾病（COPD）患者会出现急性加重（AE），其自然病史各不相同。急性加重由感染引发，导致发病率和死亡率增加。关于慢性阻塞性肺疾病急性加重期（AECOPD）感染病因的研究主要局限于仅病毒或仅细菌病因。印度尚无研究调查同一组患者中的多种病毒、细菌和真菌关联情况。本前瞻性研究持续了2年，以评估AECOPD患者病毒感染的发生率和特征、其与其他细菌和真菌病原体的合并感染，以及感染病原体的类型和模式与临床严重程度的关联。
本研究纳入了74例AECOPD病例。使用快速诊断呼吸道病原体21 Plus试剂盒对鼻咽拭子进行多重聚合酶链反应。对分枝杆菌、诺卡菌和真菌成分进行萋-尼（ZN）染色、改良ZN染色和氢氧化钾（KOH）涂片检查。按照标准技术进行细菌培养和真菌培养。采用支原体和肺炎衣原体免疫球蛋白M酶联免疫吸附试验检测血清样本。
仅涉及病毒感染、仅细菌感染、细菌-病毒合并感染和无感染的AECOPD事件数量分别为43例（58.1%）、32例（43.2%）、20例（27%）和19例（25.7%）。甲型流感病毒是最常见的病毒（22/43，51%）。在26例患者中发现了单病毒感染，在17例患者中发现了多病毒感染，最常见的模式是甲型和乙型流感病毒，其次是人鼻病毒和人副流感病毒。分离出的最常见细菌是铜绿假单胞菌（9/32，28%），其次是鲍曼不动杆菌和肺炎克雷伯菌（7/32，21%）。在病毒-细菌合并感染中，人冠状病毒NL63感染总是与细菌感染相关。
印度这一地区关于AECOPD呼吸道感染各种病毒和细菌病因的这些信息，将有助于更好地理解通过及时使用抗病毒药物来管理AECOPD，减少抗生素的过度使用，并推动常规流感疫苗接种的实施。
