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Published ahead of print on November 8, 2002, doi:10.1164/rccm.200209-996OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 3, February 2003, 406-410

A more recent version of this article appeared on February 1, 2003
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Submitted on September 10, 2002
Accepted on October 28, 2002

Atypical Pathogen Infection in Adults with Acute Exacerbation of Bronchial Asthma

David Lieberman1*, Devora Lieberman2, Shmuel Printz3, Miriam Ben-Yaakov4, Zilia Lazarovich4, Bella Ohana5, Maureen G Friedman6, Bella Dvoskin6, Maija Leinonen7, and Ida Boldur8

1 Pulmonary Unit, Soroka Medical Center, Beer-Sheva, Israel; The Division of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 2 The Division of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 3 The Division of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel, 4 The Microbiology Laboratory, Asaf Harofeh Medical Center, Zerifin, Israel, 5 Savyon Diagnostics Ltd., Ashdod, Israel, 6 The Department of Virology, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, 7 The National Public Health Institute, Oulu, Finland, 8 The Microbiology Laboratory, Asaf Harofeh Medical Center, Zerifin, Israel; Bar-Ilan University, Ramat-Gan, Israel

* To whom correspondence should be addressed. E-mail: Lieberma{at}bgumail.bgu.ac.il.

In a serologically based prospective study, acute infections with four atypical pathogens were determined in 100 adults hospitalized for acute exacerbation of bronchial asthma and compared with the corresponding rate in a matched control group. Paired sera were tested using immunofluorescence or enzyme immunoassay methods to establish the serological diagnosis. In 18 patients (18%) there was evidence of acute infection with Mycoplasma pneumoniae compared with 3% in the control group (p=0.0006). In 10 of these patients there was evidence of infection with at least one additional pathogen, a respiratory virus in seven. There was no significant difference between the study groups in the rates of acute infection by Chlamydia pneumoniae (8% in the hospitalized patients vs. 6% in the controls), Legionella spp. (5% vs. 3%, respectively), or Coxiella burnettii (no patients in either group). We conclude that of these four atypical pathogens only infection with M. pneumoniae is associated with hospitalization for acute exacerbation of bronchial asthma. In most of these M. pneumoniae-infected patients there is evidence of infection with a respiratory virus as well. The pathophysiologic and therapeutic significance of these findings should be tested in further studies specifically designed to address these questions.
Key words: Serology, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella spp., Coxiella burnettii




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