The role of Bordetella infections in patients with acute exacerbation of chronic bronchitis

Background: Acute exacerbations of chronic bronchitis (AECB) are associated with a variety of viral and bacterial infectious agents, some of which are potentially preventable by immunization. Bordetella pertussis, which causes whooping cough, has not been studied in this context. We aimed to assess the role of Bordetella infections in patients with AECB. Patients and Methods: Patients with AECB, who presented to participating private practices in Basel, Switzerland, between October 2000 and June 2002, were evaluated by a standardized questionnaire, nasopharyngeal swabs for culture (Bordetella spp.), and PCR (Bordetella spp. and selected other respiratory pathogens) and paired blood samples for serologic diagnosis of Bordetella infection. Results: A total of 26 patients (34-86 years of age) were recruited. ALL culture and PCR samples were negative. Serology revealed Bordetella infection in eight (31 patients with Bordetella infection compared to those without Bordetello infection (mean 15 days vs 41 days, p = 0.04). Cough greater than or equal to 21 days duration was present in three (43 with evidence of Bordetello infection compared to 17 (94 controls (p = 0.012). Progression to convalescence from initial to follow-up visit after 4-6 weeks was comparable between both groups. Conclusion: Bordetella infections appear to play a significant rote in AECB and preventive measurements such as immunization with acellular pertussis vaccines should be considered. Extended investigations are necessary to confirm our preliminary and provocative findings.