Diagnosis of asthma: Laboratory procedures for identifying respiratory pathogens

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Abstract

In the past, research on the effects of infection in asthma has been hampered by difficulties in identifying respiratory pathogens. The viruses most commonly involved in asthma exacerbations are rhinovirus, coronavirus, influenza, parainfluenza, adenovirus and respiratory syncytial virus. Among bacteria, recent data have drawn attention to Mycoplasma pneumoniae and Chlamydia pneumoniae. Typical viral culture methods take 5-7 days. More recently, antigen detection methods, enzyme immunoassay (EIA), direct fluorescent antigen detection (DFA), and Latex agglutination have been proposed with variable sensitivity and specificity. Molecular biology techniques, particularly for rhinovirus, have proved to be highly sensitive and specific in the aetiological diagnosis of asthma exacerbations. Microbiological techniques for identification of M. pneumoniae and C. pneumoniae are based on culture, antigen detection, serology and deoxyribonucleic acid (DNA) detection by polymerase chain reaction (PCR). M. pneumoniae culture is time-consuming and requires specialized media M. pneumoniae antigen may be detected by several methods with suboptimal sensitivity. DNA detection still lacks sensitivity and must be combined with serology. The human line HL cells demonstrate high sensitivity for C. pneumoniae isolation and propagation. Cycloheximide-treated Hep-2 or NCl-H 292 monolayers also seem to be highly sensitive for isolation. Serology, particularly microimmunofluorescence, seems to be the gold standard for C. pneumoniae diagnosis, but requires paired serum samples. Antigen detection by means of DFA shows a very low sensitivity. DNA detection by PCR presents high sensitivity and specificity. New laboratory procedures, including molecular methods, should greatly improve the aetiological diagnosis of asthma exacerbations and clarify the role of chronic infection in asthma inflammation and hyperresponsiveness.

Original languageEnglish
Pages (from-to)235-239
Number of pages5
JournalEuropean Respiratory Review
Volume6
Issue number38
Publication statusPublished - 1996

Keywords

  • Asthma
  • Chlamydia pneumoniae
  • Culture
  • Mycoplasma pneumoniae
  • Polymerase chain reaction
  • Serology

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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