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Published ahead of print on April 29, 2004, doi:10.1164/rccm.200401-094OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 408-413

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Submitted on January 23, 2004
Accepted on April 27, 2004

Association of Chronic Obstructive Pulmonary Disease Severity and Pneumocystis Colonization

Alison Morris1*, Frank C Sciurba2, Irina P Lebedeva3, Andrew Githaiga2, W. Mark Elliott4, James C Hogg4, Laurence Huang5, and Karen A Norris3

1 Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California, Los Angeles, CA, USA; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA, 2 Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA, 3 Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA, 4 McDonald Research Laboratories, University of British Columbia, Vancouver, BC, Canada, 5 Department of Medicine, University of California, San Francisco General Hospital, San Francisco, CA, USA

* To whom correspondence should be addressed. E-mail: alison.morris{at}usc.edu.

Factors modulating the variable progression of chronic obstructive pulmonary disease (COPD) are largely unknown, but infectious agents may play a role. Because Pneumocystis has previously been shown to induce a CD8+ lymphocyte- and neutrophil-predominant response similar to that in COPD, we explored the association of the organism with accelerated disease progression. We examined Pneumocystis colonization rates in lung tissue obtained during lung resection or transplantation in smokers with a range of airway obstruction severity and in a control group with lung diseases other than COPD. Using nested polymerase chain reaction, Pneumocystis colonization was detected in 36.7% of patients with very severe COPD (Global Health Initiative on Obstructive Lung Disease [GOLD] stage IV) compared to 5.3% of smokers with normal lung function or less severe COPD (stages 0, I, II, and III)(p=0.004) and to 9.1% of controls (p=0.007). Colonized subjects exhibited more severe airway obstruction (median FEV1=21% predicted vs. 62% in non-colonized, p=0.006). GOLD IV was the strongest predictor of Pneumocystis colonization (odds ratio=7.3, 95% confidence interval=2.4-22.4, p<0.001) and was independent of smoking history. We conclude that there is a strong association between Pneumocystis colonization and severity of airflow obstruction in smokers, suggesting a possible pathogenic link with COPD progression.
Key words: Pneumocystis jiroveci, colonization, chronic obstructive pulmonary disease, emphysema, epidemiology




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