Emergency. 2018; 6 (1): e18 LE T T E R TO ED I TO R Prevalence of Mycoplasma Pneumoniae Infection in Pa- tients with COPD Exacerbation; a Letter to the Editor Ali Reza Amiri1, Kiarash Ghazvini2, Hamid Zamani Moghadam1∗ 1. Emergency Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2. 1. Antimicrobial Resistance Research Center, Department of Microbiology and Virology, Medical School, Mashhad University of Medical Sciences, Mashhad, Iran. Received: Feruary 2018; Accepted: March 2018; Published online: 15 March 2018 Cite this article as: Prevalence of Mycoplasma Pneumoniae Infection in Patients with COPD Exacerbation; a Letter to the Editor. Emergency. 2018; 6(1): e18. Dear editor; Currently, control and prevention of respiratory illnesses is considered a health priority in most developed countries and managing the risk factors is necessary for im- proving the population’s health (1, 2). Chronic obstructive pulmonary disease (COPD) is the 5th cause of death around the world and estimations have indicated that due to an in- crease in environmental pollution, this disease will become the 3rd cause of death in the future (1, 3). In previous studies, pulmonary infection with mycoplasma pneumoniae has been introduced as one of the causes for COPD exacerbation. Mycoplasma pneumoniae affects the upper and lower respiratory tract and its clinical manifesta- tion is trachea-bronchitis accompanied by restlessness and dry coughs (4, 5). The pathogenesis spectrum of this bac- terium ranges from mild pharyngitis and trachea-bronchitis to acute pneumonia. Epidemiologic studies have shown that this bacterium is responsible for more than 20% of commu- nity acquired pneumonias (6). In a cross-sectional study by the authors of the present let- ter, 66 patients over the age of 18 years who had presented to the emergency department of Imam Reza Hospital, Mash- had, Iran, with diagnosis of COPD exacerbation were eval- uated. Sputum sample of the patients was obtained and sent to the laboratory for performing polymerase chain re- action (PCR). Mean age of the patients participating in this study was 67.28 ± 13.68 years (60.6% male). The result of PCR was positive in 6 patients out of the total of 66 patients (9.1%). The results of the present study showed that there was no correlation between age (p=0.18), sex (p=0.25), duration of being affected with COPD (p=0.20), consumption of an- ∗Corresponding Author: H Zamani; Emergency Department, Imam Reza Hospital, Bahar Avenue, Mashhad, Iran. Tel: 09155811238 Email: zaman- imh@mums.ac.ir tibiotics (p=0.35), smoking (p=0.62), opioid abuse (p=0.44), corticosteroid use (p=0.57), underlying illness (p=0.94) and health care–associated pneumonia (HCAP) (p=0.46) with mycoplasma infection. However, prevalence of leukocytosis (p=0.01) and myalgia (p=0.02) was significantly higher in the mycoplasma group. Numerous studies have confirmed the presence of my- coplasma pneumoniae in exacerbation of COPD using sero- logic diagnosis. For instance, in a study by Lieberman et al. (7) prevalence of mycoplasma pneumoniae in patients with COPD exacerbation was reported as 14.2% and in Meloni et al. (8) study the prevalence of this infection was expressed to be 6.7%. These rates were reported between 5% and 14% in other studies (9-11). Thus, it seems that prevalence of mycoplasma is high in COPD exacerbation, but there is still no answer to the ques- tion if this infection results in exacerbation of COPD or not and there is controversy between the studies in this regard (4, 7, 12). Therefore, it is suggested to design case-control or cohort studies to find the answer to this question. 1. Appendix 1.1. Acknowledgements All the personnel of the emergency department of Imam Reza Hospital are thanked for their cooperation in performance of this project. 1.2. Author’s contribution All the authors of this article met the criteria of authorship based on the recommendations of the international commit- tee of medical journal editors. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: www.jemerg.com A. Amiri et al. 2 1.3. Conflict of interest Hereby, the authors declare that there is no conflict of interest regarding the present study. 1.4. Funding and support All the costs of the present study were paid by the researchers. References 1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease 2017 report. Respirology. 2017;22(3):575-601. 2. Rootmensen GN, van Keimpema AR, Looysen EE, van der Schaaf L, de Haan RJ, Jansen HM. The effects of addi- tional care by a pulmonary nurse for asthma and COPD patients at a respiratory outpatient clinic: results from a double blind, randomized clinical trial. Patient Educa- tion and Counseling. 2008;70(2):179-86. 3. Hobbs B, Zhou J, Castaldi P, Hawrylkiewicz I, Sliwinski P, Yim J, et al. Variants Tagging Serpina1 And Il27 Show Sig- nificant Association With COPD In A Meta-Analysis With Over 16,700 Subjects. Medico. 2016;8(9):10. 4. Muro S, Tabara Y, Matsumoto H, Setoh K, Kawaguchi T, Takahashi M, et al. Relationship Among Chlamydia and Mycoplasma Pneumoniae Seropositivity, IKZF1 Geno- type and Chronic Obstructive Pulmonary Disease in A General Japanese Population: The Nagahama Study. Medicine. 2016;95(15):e3371. 5. Layani-Milon M-P, Gras I, Valette M, Luciani J, Stag- nara J, Aymard M, et al. Incidence of Upper Respira- tory TractMycoplasma pneumoniae Infections among Outpatients in Rhone-Alpes, France, during Five Suc- cessive Winter Periods. Journal of clinical microbiology. 1999;37(6):1721-6. 6. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clinical microbiology re- views. 2004;17(4):697-728. 7. Lieberman D, Lieberman D, Ben-Yaakov M, Shmarkov O, Gelfer Y, Varshavsky R, et al. Serological evidence of My- coplasma pneumoniae infection in acute exacerbation of COPD. Diagnostic Microbiology and Infectious Disease. 2002;44(1):1-6. 8. Meloni F, Paschetto E, Mangiarotti P, Crepaldi M, Mo- rosini M, Bulgheroni A, et al. Acute Chlamydia pneu- moniae and Mycoplasma pneumoniae infections in community-acquired pneumonia and exacerbations of COPD or asthma: therapeutic considerations. Journal of chemotherapy. 2004;16(1):70-6. 9. Papaetis G, Anastasakou E, Tselou T, Sotiriou A, Rarra V, Roussou P, et al. Serological evidence of Mycoplasma pneumoniae infection in patients with acute exacerba- tion of COPD: analysis of 100 hospitalizations. Advances in medical sciences. 2010;55(2):235-41. 10. Diederen BM, Van der Valk P, Kluytmans JA, Peeters MF, Hendrix R. The role of atypical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease. European Respiratory Journal. 2007;30(2):240-4. 11. Varma-Basil M, Dwivedi SK, Kumar K, Pathak R, Ras- togi R, Thukral S, et al. Role of Mycoplasma pneumo- niae infection in acute exacerbations of chronic obstruc- tive pulmonary disease. Journal of medical microbiology. 2009;58(3):322-6. 12. Varma-Basil M, Dwivedi SK, Kumar K, Pathak R, Rastogi R, Thukral SS, et al. Role of Mycoplasma pneumoniae in- fection in acute exacerbations of chronic obstructive pul- monary disease. J Med Microbiol. 2009;58(Pt 3):322-6. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: www.jemerg.com Appendix References