Respiratory Viruses in Acute Exacerbations of Bronchiectasis

다국어 초록 (Multilingual Abstract)

Background: Bacterial infections are well known factors underlying acute exacerbations in bronchiectasis. However, viral infections may also contribute to acute exacerbations. We aimed to assess the rate of viral detection in acute exacerbations of bronchiectasis, and the associated clinical factors.
Methods: Diagnostic tests for viral and bacterial etiologies were performed in 792 patients with bronchiectasis who visited the emergency room or the respiratory care inpatient unit in a tertiary referral center in South Korea. All patients were diagnosed with bronchiectasis by chest computerized tomography and were prescribed antibiotics for a minimum of 3 days.
Results: Viral pathogens were detected in 202 of the 792 enrolled patients (25.5%). The most common viral pathogen isolated was influenza A virus (24.8%), followed by rhinovirus (22.4%), influenza B virus (9.8%), respiratory syncytial virus B (8.9%), and human metapneumovirus (6.1%). In 145 patients, a viral, but not bacterial, pathogen was detected, whereas no pathogens were found in 443 patients with exacerbations. Multivariable analysis revealed that female sex and chronic heart disease as a comorbidity were positively associated with viral detection in acute exacerbations of patients with bronchiectasis, whereas the presence of radiographic infiltration was negatively associated.
Conclusion: Respiratory viruses were identified in approximately 25% of the acute exacerbations observed among patients with bronchiectasis. Of the viruses detected, influenza viruses and rhinovirus made up over 50%. More attention to viruses as possible causative pathogens for acute deteriorating symptoms in patients with bronchiectasis is warranted.

참고문헌 (Reference)

1 Mitchell AB, "Viruses in bronchiectasis : a pilot study to explore the presence of community acquired respiratory viruses in stable patients and during acute exacerbations" 18 (18): 84-, 2018

2 Gao YH, "The role of viral infection in pulmonary exacerbations of bronchiectasis in adults : a prospective study" 147 (147): 1635-1643, 2015

3 Goeminne PC, "The impact of acute air pollution fluctuations on bronchiectasis pulmonary exacerbation : a case-crossover analysis" 52 (52): 1702557-, 2018

4 Chalmers JD, "The bronchiectasis severity index. An international derivation and validation study" 189 (189): 576-585, 2014

5 Chalmers JD, "The EMBARC European Bronchiectasis Registry : protocol for an international observational study" 2 (2): 00081-2015-, 2016

6 Fisman D, "Seasonality of viral infections : mechanisms and unknowns" 18 (18): 946-954, 2012

7 Altizer S, "Seasonality and the dynamics of infectious diseases" 9 (9): 467-484, 2006

8 Dowell SF, "Seasonal variation in host susceptibility and cycles of certain infectious diseases" 7 (7): 369-374, 2001

9 Wedzicha JA, "Role of viruses in exacerbations of chronic obstructive pulmonary disease" 1 (1): 115-120, 2004

10 Mehta J, "Risk factors for respiratory syncytial virus illness among patients with chronic obstructive pulmonary disease" 10 (10): 293-299, 2013

11 Seemungal T, "Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease" 164 (164): 1618-1623, 2001

12 Volling C, "Respiratory syncytial virus infectionassociated hospitalization in adults : a retrospective cohort study" 14 (14): 665-, 2014

13 Widmer K, "Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults" 206 (206): 56-62, 2012

14 Hill AT, "Pulmonary exacerbation in adults with bronchiectasis : a consensus definition for clinical research" 49 (49): 1700051-, 2017

15 Wark PA, "Neutrophil degranulation and cell lysis is associated with clinical severity in virus-induced asthma" 19 (19): 68-75, 2002

16 Loebinger MR, "Mortality in bronchiectasis : a long-term study assessing the factors influencing survival" 34 (34): 843-849, 2009

17 Murray PR, "Microscopic and baceriologic analysis of expectorated sputum" 50 (50): 339-344, 1975

18 Jacobs SE, "Human rhinoviruses" 26 (26): 135-162, 2013

19 Polverino E, "European Respiratory Society guidelines for the management of adult bronchiectasis" 50 (50): 1700629-, 2017

20 Shek LP, "Epidemiology and seasonality of respiratory tract virus infections in the tropics" 4 (4): 105-111, 2003

21 Greer A, "Climate change and infectious diseases in North America : the road ahead" 178 (178): 715-722, 2008

22 Hill AT, "British Thoracic Society guideline for bronchiectasis in adults" 74 : 1-69, 2019

23 Price RHM, "Association between viral seasonality and meteorological factors" 9 (9): 929-, 2019

24 Dela Cruz CS, "Adenovirus infection and outbreaks : what you need to know" 199 (199): P13-P14, 2019