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Published ahead of print on April 29, 2004, doi:10.1164/rccm.200403-354OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 3, August 2004, 266-272

A more recent version of this article appeared on August 1, 2004
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Submitted on March 19, 2004
Accepted on April 26, 2004

Persistent Colonization by Haemophilus influenzae in Chronic Obstructive Pulmonary Disease

Timothy F Murphy1*, Aimee L Brauer2, Andrew T Schiffmacher2, and Sanjay Sethi3

1 Division of Infectious Diseases, Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA; Department of Microbiology, University at Buffalo, State University of New York, Buffalo, NY, USA; Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA, 2 Division of Infectious Diseases, Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA, 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA; Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA

* To whom correspondence should be addressed. E-mail: murphyt{at}acsu.buffalo.edu.

Nontypeable Haemophilus influenzae colonizes the respiratory tract of adults with chronic obstructive pulmonary disease (COPD) and causes intermittent exacerbations. Isolates of H. influenzae collected monthly in a prospective study were subjected to molecular typing. During a 7 year study, 122 episodes of negative cultures of >=1 month that were preceded and followed by isolation of an apparently identical strain of H. influenzae spanning 345 patient-months of observation were found. Seventeen such episodes of negative cultures of >= 6 months spanning 203 patient months were studied in detail to test the hypothesis that these periods of negative cultures represented continuous colonization by the same strain of H. influenzae. Molecular typing by three independent methods established that the strains preceding and following the episode of negative cultures were indeed the identical strain. Strain specific H. influenzae DNA was detected in a portion of the sputum samples which yielded negative cultures. These results indicate that a subset of patients with COPD are persistently colonized with H. influenzae and that sputum cultures underestimate the frequency of colonization of the respiratory tract by H. influenzae in COPD. This observation has a significant impact on understanding bacterial colonization in COPD.
Key words: sputum culture, respiratory tract infection, molecular epidemiology, pulsed field gel electrophoresis, outer membrane protein




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