哮喘联盟

   摘要
   背景：病毒性或细菌性病原体的检出与儿童喘息相关；然而，病毒和细菌对疾病症状的影响尚未被研究。
   目的：评估伴或不伴哮喘的儿童在鼻病毒高峰季节期间细菌的检出情况，以明确细菌感染与鼻病毒所引起疾病的严重程度之间是否存在关联。
   方法：纳入308例(166 例患有哮喘142例无哮喘者)4～12岁儿童，在9月份期间连续5周提取鼻腔样本，并每日记录感冒和哮喘症状。对所有鼻腔样本采用病毒诊断法和定量PCR检测肺炎链球菌、流感嗜血杆菌和卡他莫拉菌。
   结果：流感嗜血杆菌、肺炎球菌以及卡他莫拉菌的检出率分别为53%、17%、和11%，且在同一样本中(比值比 [OR], 2.0; 95% CI, 1.4-2.7; P < .0001)或第二周内(OR, 1.6; 95% CI, 1.1-2.4; P = .02)鼻病毒的检出增加了细菌检出的风险。在未检出鼻病毒的情况下，肺炎球菌与感冒症状(平均值, 2.7 [95% CI, 2.0-3.5] vs 1.8 [95% CI, 1.5-2.2]; P = .006)和中度哮喘急性发作(18% [95% CI, 12% to 27%] vs 9.2% [95% CI, 6.7% to 12%]; P = .006)的增加相关。在检出鼻病毒的情况下，肺炎球菌与中度哮喘急性发作的增加相关(22% [95% CI, 16% to 29%] vs 15% [95% CI, 11% to 20%]; P = .01)。此外，与单纯检出鼻病毒相比，同时检出鼻病毒和卡他莫拉菌增加了出现感冒症状、哮喘症状或两者症状的可能性 (OR, 2.0 [95% CI, 1.0-4.1]; P = .04)。无论鼻病毒检出情况如何，流感嗜血杆菌与呼吸道症状均无相关性。
   结论：鼻病毒感染增加了伴或不伴哮喘的儿童特异性细菌病原体的检出。此外，研究结果表明卡他莫拉菌和肺炎球菌可促进呼吸道疾病的严重程度，包括哮喘急性发作。
 

（苏楠 审校）
JAllergyClinImmunol.2014Apr1.pii:S0091-6749(14)00295-4.doi:10.1016/j.jaci.2014.02.030. [Epub ahead of print]

 

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

Kloepfer KM1, Lee WM2, Pappas TE2, Kang TJ2, Vrtis RF3, Evans MD4, Gangnon RE4, Bochkov YA2, Jackson DJ5, Lemanske RF Jr5, Gern JE5.
 

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, Haemophilusinfluenzae, 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.
 

JAllergyClinImmunol.2014Apr1.pii:S0091-6749(14)00295-4.doi:10.1016/j.jaci.2014.02.030. [Epub ahead of print]