Prevalence of viral infection detected by PCR and RT-PCR in patients with acute exacerbation of COPD: a systematic review

Anant Mohan, Subhash Chandra, Dipti Agarwal, Randeep Guleria, Shobha Broor, Bharti Gaur, Ravindra Mohan Pandey, Anant Mohan, Subhash Chandra, Dipti Agarwal, Randeep Guleria, Shobha Broor, Bharti Gaur, Ravindra Mohan Pandey

Abstract

Background and objective: Viruses are important aetiological agents of acute exacerbation of COPD (AECOPD). Their reported prevalence varies from region to region. This systematic review calculated the prevalence of respiratory viral infections in AECOPD.

Methods: A systematic search was performed using Medline, and references of relevant articles and conference proceedings were hand searched. Articles for review were selected based on the following criteria: (i) prospective or cross-sectional study, (ii) original research, (iii) viral detection used the highly sensitive techniques of PCR and/or Reverse Transcriptase PCR (RT-PCR), (iv) viral prevalence in AECOPD defined, and (v) full paper available in English. We assessed the study quality and extracted data independently and in duplicate using a pre-defined data extraction form. Weighted mean prevalence (WMP) was calculated and a forest plot was constructed to show the dispersion.

Results: Eight studies met the inclusion criteria. The WMP of respiratory viral infection in AECOPD was 34.1% (95% CI: 23.9-44.4). picornavirus was the most commonly detected virus with WMP 17.3% (95% CI: 7.2-27.3), followed by influenza; 7.4% (95% CI: 2.9-12.0), respiratory syncytial virus; 5.3% (95% CI: 1.6-9.0), corona viruses; 3.1% (95% CI: 0.4-5.8), parainfluenza; 2.6% (95% CI: 0.4-4.8), adenovirus; 1.1% (95% CI: -1.1 to 3.3), and human metapneumovirus; 0.7% (95% CI: -0.3 to 1.8). Maximum WMP was observed in studies from Europe followed by the USA, Australia and Asia. Picorna was the most common virus detected in Western countries whereas influenza was most common in Asia.

Conclusions: This systematic review demonstrated that viruses are strongly associated with AECOPD, with the highest detection rates of viruses being in Europe. The geographical epidemiology of viruses may have important therapeutic implications for management of AECOPD.

Figures

Figure 1
Figure 1
The selection process for the systematic review.
Figure 2
Figure 2
Bar chart showing the number of patients reported to have () viral positivity, () viral negativity and () infection with more than one virus by various authors.

References

    1. World Health Organization . The 10 leading causes of death by broad income group, 2004. Fact sheet No 310/November 2008.
    1. Buist AS, Vollmer WM, McBurnie MA. Worldwide burden of COPD in high‐ and low‐income countries. Part I. The burden of obstructive lung disease (BOLD) initiative. Int. J. Tuberc. Lung. Dis. 2008; 12: 703–8.
    1. Connors AF Jr, Dawson NV, Thomas C et al. Outcomes following acute exacerbations of severe chronic obstructive lung disease. Am. J. Respir. Crit. Care Med. 1996; 154: 959–67.
    1. Seemungal TAR, Donaldson GC, Paul EA et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1998; 157: 1418–22.
    1. Sullivan SD, Ramsey SD, Lee TA. The economic burden of COPD. Chest 2000; 117 (Suppl. 2): 5S–9S.
    1. Sethi S. Infectious etiology of acute exacerbations of chronic bronchitis. Chest 2000; 117 (5 Suppl. 2): 380S–5S.
    1. Kuypers J, Campbell AP, Cent A et al. Comparison of conventional and molecular detection of respiratory viruses in hematopoietic cell transplant recipients. Transpl. Infect. Dis. 2009; 11: 298–303.
    1. Von Elm E, Altman DG, Egger M et al. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J. Clin. Epidemiol. 2008; 61: 344–9.
    1. Beckham JD, Cadena A, Lin J et al. Respiratory viral infections in patients with chronic, obstructive pulmonary disease. J. Infect. 2005; 50: 322–30.
    1. Camargo CA Jr, Ginde AA, Clark S et al. Viral pathogens in acute exacerbations of chronic obstructive pulmonary disease. Intern. Emerg. Med. 2008; 3: 355–9.
    1. Ko FW, Ip M, Chan PK et al. Viral etiology of acute exacerbations of COPD in Hong Kong. Chest 2007; 132: 900–8.
    1. Rohde G, Wiethege A, Borg I et al. Respiratory viruses in exacerbations of chronic obstructive pulmonary disease requiring hospitalisation: a case‐control study. Thorax 2003; 58: 37–42.
    1. Hutchinson AF, Ghimire AK, Thompson MA et al. A community‐based, time‐matched, case‐control study of respiratory viruses and exacerbations of COPD. Respir. Med. 2007; 101: 2472–81.
    1. Papi A, Bellettato CM, Braccioni F et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations. Am. J. Respir. Crit. Care Med. 2006; 173: 1114–21.
    1. McManus TE, Marley AM, Baxter N et al. Respiratory viral infection in exacerbations of COPD. Respir. Med. 2008; 102: 1575–80.
    1. Seemungal T, Harper‐Owen R, Bhowmik A et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2001; 164: 1618–23.
    1. Anthonisen NR, Manfreda J, Warren CP et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann. Intern. Med. 1987; 106: 196–204.
    1. Rabe KF, Hurd S, Anzueto A et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am. J. Respir. Crit. Care Med. 2007; 176: 532–55.
    1. American Thoracic Society . ATS statement: standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 1995; 152: S78–S83.
    1. Nichol KL, Baken L, Nelson A. Relation between influenza vaccination and outpatient visits, hospitalization and mortality in elderly persons with chronic lung disease. Ann. Intern. Med. 1999; 130: 397–403.
    1. Poole PJ, Chacko E, Wood‐Baker RW et al. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2006; (1): CD002733.
    1. Rohde G, Borg I, Arinir U et al. Relevance of human metapneumovirus in exacerbations of COPD. Respir. Res. 2005; 6: 150.
    1. Wedzicha JA, Seemungal TA, MacCallum PK et al. Acute exacerbations of chronic obstructive pulmonary disease are accompanied by elevations of plasma fibrinogen and serum IL‐6 levels. Thromb. Haemost. 2000; 84: 210–5.
    1. Nichol KL, Nordin J, Mullooly J et al. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N. Engl. J. Med. 2003; 348: 1322–32.
    1. Van den Hoogen BG, De Jong JC, Groen J et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat. Med. 2001; 7: 719–24.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren