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Clinical Trial
. 2014 May;133(5):1301-7, 1307.e1-3.
doi: 10.1016/j.jaci.2014.02.030. Epub 2014 Apr 1.

Detection of pathogenic bacteria during rhinovirus infection is associated with increased respiratory symptoms and asthma exacerbations

Kirsten M Kloepfer  1 , Wai Ming Lee  2 , Tressa E Pappas  2 , Theresa J Kang  2 , Rose F Vrtis  3 , Michael D Evans  4 , Ronald E Gangnon  4 , Yury A Bochkov  2 , Daniel J Jackson  5 , Robert F Lemanske Jr  5 , James E Gern  5
Affiliations
Clinical Trial

Detection of pathogenic bacteria during rhinovirus infection is associated with increased respiratory symptoms and asthma exacerbations

Kirsten M Kloepfer et al. J Allergy Clin Immunol. 2014 May.

Abstract

Background: Detection of either viral or bacterial pathogens is associated with wheezing in children; however, the influence of both bacteria and viruses on illness symptoms has not been described.

Objective: We evaluated bacterial detection during the peak rhinovirus season in children with and without asthma to determine whether an association exists between bacterial infection and the severity of rhinovirus-induced illnesses.

Methods: Three hundred eight children (166 with asthma and 142 without asthma) aged 4 to 12 years provided 5 consecutive weekly nasal samples during September and scored cold and asthma symptoms daily. Viral diagnostics and quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were performed on all nasal samples.

Results: Detection rates were 53%, 17%, and 11% for H influenzae, S pneumoniae, and M catarrhalis, respectively, with detection of rhinovirus increasing the risk of detecting bacteria within the same sample (odds ratio [OR], 2.0; 95% CI, 1.4-2.7; P < .0001) or the following week (OR, 1.6; 95% CI, 1.1-2.4; P = .02). In the absence of rhinovirus, S pneumoniae was associated with increased cold symptoms (mean, 2.7 [95% CI, 2.0-3.5] vs 1.8 [95% CI, 1.5-2.2]; P = .006) and moderate asthma exacerbations (18% [95% CI, 12% to 27%] vs 9.2% [95% CI, 6.7% to 12%]; P = .006). In the presence of rhinovirus, S pneumoniae was associated with increased moderate asthma exacerbations (22% [95% CI, 16% to 29%] vs 15% [95% CI, 11% to 20%]; P = .01). Furthermore, M catarrhalis detected alongside rhinovirus increased the likelihood of experiencing cold symptoms, asthma symptoms, or both compared with isolated detection of rhinovirus (OR, 2.0 [95% CI, 1.0-4.1]; P = .04). Regardless of rhinovirus status, H influenzae was not associated with respiratory symptoms.

Conclusion: Rhinovirus infection enhances detection of specific bacterial pathogens in children with and without asthma. Furthermore, these findings suggest that M catarrhalis and S pneumoniae contribute to the severity of respiratory tract illnesses, including asthma exacerbations.

Keywords: Rhinovirus; asthma; bacteria.

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Figures

Figure 1
Figure 1
Weekly pathogen detection compared to concurrent weekly respiratory symptoms. Weekly specimens of nasal secretions were analyzed for RV and bacteria, and pathogen detection was compared to weekly measures of respiratory symptoms, incuding (A–C) cold symptoms; (D–F) asthma symptoms; and (G–I) moderate asthma exacerbations. x: p<0.05 vs. no pathogen, +: p<0.05 vs. bacteria only, #: p<0.05 vs. RV only
Figure 2
Figure 2
Probability of experiencing illness symptoms according to patterns of pathogen detection (A–C). Each illness was matched with an asymptomatic period of the same length, and the probability of pathogen detection was compared. Within the asthma group, the probability of experiencing an asthma exacerbation with pathogen detection was also compared (D–F). *:p<0.05
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