Detection of respiratory syncytial virus in adults with chronic obstructive pulmonary disease

Abstract

Rationale: Recently, respiratory syncytial virus (RSV) RNA has been identified by reverse transcriptase-polymerase chain reaction (RT-PCR) from a high percentage of patients with stable chronic obstructive pulmonary disease (COPD). These data raise the possibility of persistent low-grade infection in this population, which could have implications in COPD pathogenesis.

Objectives: RSV persistence was investigated by testing respiratory secretions from subjects with COPD during illness and at regular intervals over 1 yr.

Methods: Nasal and sputum samples from subjects with COPD were tested by one-tube nested RT-PCR for RSV every 2 mo and during respiratory illnesses for 1 yr. Subjects positive for RSV were evaluated weekly until negative in two consecutive samples. Nasal secretions and serum were tested for RSV antibody. A rise of fourfold or greater was defined as evidence of RSV infection.

Results: A total of 112 patients were enrolled and the illnesses of 92 patients were evaluated. RSV was detected by RT-PCR in 6/92 (6.5%) illness nasal samples versus 0/685 routine nasal samples and in 5/69 (7.2%) illness sputum samples versus 3 /315 (0.9%) routine. Four additional RSV infections were identified by serum antibody responses. Of the RSV infections 86% were associated with serum or nasal antibody responses and 73% had symptoms of acute respiratory illness.

Conclusions: Most RSV infections in patients with COPD are associated with symptomatic respiratory illnesses and measurable immune responses. Our data do not support the concept of RSV persistence in this population.

Figure 1.

Distribution of respiratory synctial virus (RSV) cases by month of identification. Cases associated with illness and reverse transcriptase–polymerase chain reaction (RT-PCR) positive nasal or sputum specimens are shown in black. Cases associated with illness and serologic response but RT-PCR negative nasal or sputum specimens are shown in gray. Asymptomatic RSV infections identified by RT-PCR are shown by diagonally lined bars. One asymptomatic infection identified by serology during the fall of 2004 is not displayed because it could not be assigned to a specific month.