title: Viruses are frequently present as the infecting agent in acute exacerbations of chronic obstructive pulmonary disease in patients presenting to hospital.
abstract: BACKGROUND
  Viral causes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are well recognised but only recently have rapid tests become available.
  
  
  OBJECTIVE
  To identify respiratory viruses in the general population and those associated with hospitalisation in AECOPD using polymerase chain reaction (PCR) on nasopharyngeal aspirate (NPA), and the relationship between symptoms, viral detection and inflammatory markers.
  
  
  METHODS
  A review of viruses detected in the general population in a health district between August 2014 and July 2015, using multiplex PCR for viruses from NPA samples. In addition, a single hospital, retrospective audit of patients admitted with suspected AECOPD was conducted.
  
  
  RESULTS
  Of the 8811 NPA tested, 5599 (64%) were positive for at least one virus and 2069 of these were obtained from adults. In adults, the most common viruses identified were Influenza A (31%), Rhinovirus (27%) and respiratory syncytial virus A/B (10%). Most patients with AECOPD (102 of 153) had NPA sent for viral PCR testing and 59 (58%) were positive. The most common viruses identified were Influenza A (31%), Rhinovirus (24%) and respiratory syncytial virus A/B (17%) with co-infecting bacteria cultured in 22 sputum samples. Patients with influenza-like symptoms were more likely to have a positive viral PCR than those without symptoms (P < 0.004). The median C-reactive protein on admission was lower in the virus-infected than uninfected AECOPD (28 vs 60 mg/L, P < 0.026).
  
  
  CONCLUSIONS
  The spectrum of viruses detected in patients with AECOPD is similar to that of the general population. Viruses are more likely to be identified in patients with AECOPD who present with influenza-like symptoms and a low C-reactive protein.
authors: Department of Respiratory Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia. edwinabiancardi@gmail.com.
authors: E
authors: E
authors: Biancardi
authors: Serology and Virology Division (SAViD) SEALS Microbiology, Prince of Wales Hospital, Sydney, New South Wales, Australia.|School of Medical Sciences and School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, New South Wales, Australia.
authors: M
authors: M
authors: Fennell
authors: Serology and Virology Division (SAViD) SEALS Microbiology, Prince of Wales Hospital, Sydney, New South Wales, Australia.|School of Medical Sciences and School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, New South Wales, Australia.
authors: W
authors: W
authors: Rawlinson
authors: Department of Respiratory Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.|Prince of Wales Clinical School and Inflammation Infection Research, School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
authors: P S
authors: PS
authors: Thomas
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002097:C-Reactive Protein / Q000032:analysis; D060085:Coinfection / Q000453:epidemiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D009980:Influenza A virus / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000821:virology; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012189:Retrospective Studies; D012229:Rhinovirus / Q000302:isolation & purification; D012621:Seasons; D012720:Severity of Illness Index; D013183:Sputum / Q000821:virology
chemical_list: D002097:C-Reactive Protein
keywords: C-reactive protein; PCR; acute exacerbation of COPD; flu-like symptoms; nasopharyngeal aspirate; respiratory viruses