KOAH ATAKLARINDA VİRAL VE ATİPİK ETKENLERİN ROLÜ
KOAH akut alevlenmelerinin %80'inden enfeksiyonlar sorumludur. Bunların %47'sinde bakteriler, %30'unda virüsler, %5-10'unda atipik ajanlar etkendir. Amacımız; KOAH akut ataklarında atipik ajanların ve virüslerin yerini araştırmaktı. Çalışmamızda prospektif olarak 6 aylık süreç içinde KOAH akut atakla başvuran 86 olguda iki viral ve üç atipik ajana ait çift serum örneklerinde Enzyme İmmune Assay (EIA) yöntemiyle antikor titrelerini inceledik. Toplam 86 olgunun %29'unda Respiratuar Sinsityal Virüs (RSV), %15'inde mikoplazma, %7'sinde adenovirüs, %3 klamidya, %2.5 legionella, %5 RSV+mikoplazma ve %2.5 oranında da RSV+klamidya birlikteliği izlendi. Olguların %36'sında etken saptanmadı. 20 adet sağlklı kontrol grubunun %5'inde RSV, %5'inde de adenovirüs bulundu. İki grup arasında RSV ve adenovirüs açısından anlamlı fark izlendi (p≤0.066). Sonuç olarak, KOAH akut ataklarında özellikle virüslerin önemini vurgulamak istedik.
THE ROLE OF VIRUSES AND ATYPICAL AGENTS IN ACUTE EXACERBATIONS OF COPD
Infections are responsible for 80% of COPD acute exacerbations. Bacteries are responsible for 47%, viruses are found in 30% and atypical agents are responsible in 5-10%. Our aim is, to research the role of viruses and atypical agents in acute exacerbations of COPD. In our study we studied prospectively the antibody titres of 86 patients who admitted with COPD acute exacerbation in a six month period. Antibody titres were measured by using Enzyme Immune Assay method with double serum samples for two viral and three atypical agents. Among 86 patients, 29% had Respiratory Syncitial Virus (RSV), 15% had mycoplasma, 7% had adenovirus, 3% had chlamydia, 2.5% had Legionella, 5% had RSV + mycoplasma and 2.5% had RSV + chlamydia combination Agent could not be determined in 36%. Among 20 healthy control group, 5% had RSV and 5% had adenovirus. There was a statistical difference when compared with the control group (p≤0.066). In conclusion,we would like to impress the importance of viruses in acute exacerbations of COPD.
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- 1. Seemungal TAR, Donaldson GC, Paul EA ve
ark. Effect of exacerbation on quality of life
in patients with chronic obstructive pulmonary
disease. Am J Respir Crit Care Med
1988; 157: 1418-22.
- 2. Kocabafl A. Kronik obstrüktif akci¤er hastal›¤›nda
alevlenme: ‹nfeksiyonlar›n rolü. Ekim
N, Uçan ES ve ark, eds. Solunum sistemi
infeksiyonlar›. Ankara. Turgut Yay›nc›l›k 2001;
377-412.
- 3. Fagon JY, Chastre J, Gibert C. Acute respiratory
failure in chronic obstructive pulmonary
disease. In: Dereme JP, Whitelaw WA,
Simillawski T, eds. Acute respiratory failure
in chronic obstructive pulmonary diseaseVol:
92. New York: Marcel Dekker; 1996;
337.
- 4. Voelkel N, Tuder R. COPD, exacerbation.
Chest 2000; 117(2): 376-8.
- 5. Schelhamer JH, Gill VJ, Quinn TC, et al. The
laboratory evaluation of opportunistic
pulmonary infections. Ann Int Med 1996;
124: 585-8.
- 6. Toraks Derne¤i Kronik Obstrüktif Akci¤er
Hastal›¤› Tan› ve Tedavi Rehberi. Toraks
Dergisi 2000: 1.
- 7. Greenberg S. Viral respiratory infections in
elderly patients and patients with chronic
obstructive pulmonary disease. Am J Med
2002; 112(6A): 28-32.
- 8. Arseven O. Kronik obstrüktif akci¤er hastal›¤›nda
antibiyotik kullan›m› ve afl›lar. Toraks
Derne¤i yay›nlar›, Turgut Yay›nc›l›k, ‹stanbul
2000; 2: 113-6.
- 9. Sethi S. Infectious etiology of acute exacerbations
of chronic bronchitis. Chest 2000;
117 (Suppl 2): 380-4.
- 10. Seemungal TAR, Harper –Owen R, Bhowemic
A, et al. Respiratory viruses, symptoms and
inflamatory markers in acute exacerbations
and stable chronic obstructive pulmonary
disease. Am J Respir Crit Care Med 2001; 164:
1618-23.
- 11. Walsh EE, Falsey AR, Hennessey PA. Respiratory
syncytial and other virus infection in
persons with chronic ca rdiopulmonary disease.
Am J Respir Crit Care Med 1999; 160: 791-5.
- 12. Wark PAB, Johnston SL, Moric I, et al.
Neutrophil degranulation and cell lysis is
associated with clinical severity in virusinduced
astma. Eur Respir J 2002, 19: 68-75.
- 13. Matsuse T, Hahashi S, Kuwana K, et al.
Latent adenoviral infections in the pathogenesis
of chronic airway obstruction. Am Rev
Respir Dis 1992; 146: 177-84.
- 14. Blasi F, Legnani D, Lambarda UM, et al.
Chlamidia pneumonia infection in acute
exacerbations of COPD. Eur Respir J 1993;
6: 19-22.
- 15. Mogulkoç N, Karakurt S, Isalska B, et al.
Acute purulent exacerbations of chronic
obstructive pulmonary disease and Chlamydia
pneumoniae infection. Am J Respir Crit Care
Med 1999; 160: 349-53.
- 16. Beaty CD, Gynaston JT, Wang SP, et al.
Chlamydia pneumoniae, strain TWAR, infection
in patients with chronic obstructive pulmonary
disease. Am Rev Respir Dis 1991;
144: 1408-13.
- 17. Torres A, Dorca J, Zalacain R, et al.
Community-acquired pneumonia in chronic
obstructive pulmonary disease: a Spanish
multicenter study. Am J Respir Crit Care
Med. 1996; 154(5): 1456-61.
- 18. Taflbakan S, Baflo¤lu ÖK, Say›ner AA ve ark.
KOAH alevlenmelerinde etken patojenler.
Toraks Ulusal Akci¤er ve Sa¤l›¤› 3. Kongre
kitap盤›, Antalya 2000; 191.
- 19. Uzun K, Özbay B, Buzgan T ve ark. KOAH
akut ata¤›nda Chlamydiae pneumoniae,
Mycoplasma pneumoniae, Legionella spp ve
‹nfluenza A s›kl›¤›. Toraks Dergisi, 2002;
3121: 146-50.
- 20. Buscha RO, Saxtan D, Shultz PS, et al.
Infections with viruses and Mycoplasma
pneumoniae during exacerbations of chronic
bronchitis. J Infect Dis 1978; 137: 377-81.
- 21. Lieberman D, Ben-Yaakov M, Lazarovich Z,
et al. Infectious etiologies in acute exacer
bation of COPD. Diagn Microbial Infect Dis
2001; 40: 95-102.
- 22. Gah SK, Johan A, Cheang JH, Wang YE. A
prospective study of infections with atypical
pneumonia organisms in acute exacerbations
of chronic bronchitis. Ann Acad Med
Singapore 1999; 28: 476-80 (Abstract).