The Role of Atypical Pathogens in Acute
Exacerbations of Bronchial Asthma

Gamal Rabie Agmy , MD, FCCP
Professor of Chest ...
Introduction
Atypical pathogens are recognized as causes of
RTI, but their role in AEBA is not clear. Some
studies found a...
Introduction
To our knowledge, there was only one study in
which the association between either Coxiella
burnetii or Legio...
Aim of Work
The main objective of this study was to evaluate
the rate of acute infections with 4 atypical
organisms
(Mycop...
Aim of Work

Our second aim was to assess the role of acute
viral infections in AEBE in both adults and
children.
Patients and Methods
Acute infections with 4 atypical pathogens and
viruses were evaluated in 2 groups of patients
with AE...
Inclusion Criteria
(1)A past history of typical bronchial asthma;
(2)Reversibility of at least 12% of the FEV1 value with
...
Patients and Methods
Pneumo-slide (Vircell-slide) was used
for indirect microimmunofluorescent
assay for the simultaneous ...
Table 1: Demographic data of asthmatic patients and
their controls included in this study:
Variable

Asthmatic
adults

Con...
Figure 1: Role of Chlamydia in acute exacerbations
of bronchial asthma in adults and children:
25%
20%

Athmatic
15%

Cont...
Figure2 :Role of Mycoplasma in acute exacerbations of
bronchial asthma among adults and children:

15%
Athmatic

10%

Cont...
Figure3 :Role of Legionella pneumophillia& Coxilla Burniti
in acute exacerbations of bronchial asthma among adults
and chi...
Table 2:The percentage rate of acute viral infection among
adults with AEBA
Pathogen

Asthma

Control

p Value

Influenza ...
Table 3:The percentage rate of acute viral infection
among children with AEBA
Pathogen

Asthma

Control

p Value

Influenz...
Conclusions
1-Acute infection with either Chlamydia
pneumoniae or Mycoplasma pneumoniae has
an important role in acute exa...
Recommendation
• The therapeutic significance of the
findings of this study need to be
evaluated in future studies designe...
Role of atypical pathogens in acute exacerbation of asthma
Role of atypical pathogens in acute exacerbation of asthma
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Role of atypical pathogens in acute exacerbation of asthma

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Role of atypical pathogens in acute exacerbation of asthma

  1. 1. The Role of Atypical Pathogens in Acute Exacerbations of Bronchial Asthma Gamal Rabie Agmy , MD, FCCP Professor of Chest Diseases, Assiut University
  2. 2. Introduction Atypical pathogens are recognized as causes of RTI, but their role in AEBA is not clear. Some studies found an association between acute infection with either Mycoplasma pneumoniae or Chlamydia pneumoniae and AEBA, but others did not.
  3. 3. Introduction To our knowledge, there was only one study in which the association between either Coxiella burnetii or Legionella species and AEBA was investigated.
  4. 4. Aim of Work The main objective of this study was to evaluate the rate of acute infections with 4 atypical organisms (Mycoplasma pneumoniae, Chlamydia pneumoniae, Coxiella burnetii or Legionella pneumophilla) among adults and children hospitalized with AEBA compared with a matched control groups.
  5. 5. Aim of Work Our second aim was to assess the role of acute viral infections in AEBE in both adults and children.
  6. 6. Patients and Methods Acute infections with 4 atypical pathogens and viruses were evaluated in 2 groups of patients with AEBA, and compared with the corresponding rate in a matched control group. The first group of patients included 96 adults while the second one incorporated 88 children. Paired sera were tested using microimmunofloresent method to establish the serological diagnosis.
  7. 7. Inclusion Criteria (1)A past history of typical bronchial asthma; (2)Reversibility of at least 12% of the FEV1 value with the patient in stable condition; (3) No history of smoking (4) Negation during the hospitalization of causes of dyspnea other than bronchial asthma; (5) Ruling out of pneumonia by admission chest X-ray. (6) No known or suspected immunodeficiency, hypergammaglobulinaemia, connective tissue disease, other autoimmune disease ;and positive rheumatoid factor
  8. 8. Patients and Methods Pneumo-slide (Vircell-slide) was used for indirect microimmunofluorescent assay for the simultaneous diagnosis of the main etiological agents of AEBA.
  9. 9. Table 1: Demographic data of asthmatic patients and their controls included in this study: Variable Asthmatic adults Control adults Asthmatic children Control children 20–54 39.3 ± 10.5 19–57 37.8 ± 11.7 4–12 8.9 ± 3.6 3–12 9.1± 3.1 64/32 62/34 52/36 47/35 Chronic oral steroid therapy, % 30 0 15 0 % baseline FEV1 reversibility, mean ± SD* 20 ±5.3 - 25 ± 4.9 - ICU admission% 20 0 18 0 Mechanical ventilation %: Invasive Non-invasive 8 5 0 0 10 0 0 0 90±6.6 96±2.3 91±5.3 96±1.4 Age: Range Mean± SD Male/Female O2 saturation %,, mean ± SD*
  10. 10. Figure 1: Role of Chlamydia in acute exacerbations of bronchial asthma in adults and children: 25% 20% Athmatic 15% Control 10% 5% 0% Adults Childern
  11. 11. Figure2 :Role of Mycoplasma in acute exacerbations of bronchial asthma among adults and children: 15% Athmatic 10% Control 5% 0% Adults Childern
  12. 12. Figure3 :Role of Legionella pneumophillia& Coxilla Burniti in acute exacerbations of bronchial asthma among adults and children: 3% 2% 1% 0% Athmatic adults Control adults Legionella Asthmatic children Coxilla Control children
  13. 13. Table 2:The percentage rate of acute viral infection among adults with AEBA Pathogen Asthma Control p Value Influenza virus type A 18 0 <0.0001 Influenza virus type B 3 0 NS Parainfluenza virus type 1 5 1 NS Parainfluenza virus type 2 4 0 NS Parainfluenza virus type 3 1 0 NS Adenovirus 11 1 <0.0001 Respiratory syncytial virus 8 0 <0.001 One or more of the above 20 2 <0.0001 Adenovirus& Chlamydia 8 0 <0.001
  14. 14. Table 3:The percentage rate of acute viral infection among children with AEBA Pathogen Asthma Control p Value Influenza virus type A 20 3 <0.0001 Influenza virus type B 0 0 NS Parainfluenza virus type 1 6 2 NS Parainfluenza virus type 2 0 0 NS Parainfluenza virus type 3 2 1 NS Adenovirus 18 1 <0.0001 Respiratory syncytial virus 10 0 <0.001 One or more of the above 14 2 <0.0001
  15. 15. Conclusions 1-Acute infection with either Chlamydia pneumoniae or Mycoplasma pneumoniae has an important role in acute exacerbations of bronchial asthma among adults. 2-Acute infection with the 4 atypical pathogens has no position in acute exacerbations of bronchial asthma among Children. 3-Viral infections plays an important role in AEBA in both adults and children.
  16. 16. Recommendation • The therapeutic significance of the findings of this study need to be evaluated in future studies designed specifically to address this issue.

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