الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic Obstructive Pulmonary Disease (COPD), a common preventable and treatable disease which is characterized by constant respiratory symptoms and airflow obstruction that is due to airway and/or alveolar abnormalities commonly occurred by significant exposure to noxious particles or gases. The chronic airflow obstruction that is characteristic of COPD is caused by a mixture of small airways disease (e.g., obstructive bronchiolitis) and parenchymal damage (emphysema), the relative contributions of which differ from person to person. COPD exacerbation is defined as an acute deteriorating of respiratory symptoms which need an additional therapy. They are classified as mild exacerbation (treated with short acting bronchodilators only, SABDs), moderate exacerbation (treated with SABDs plus antibiotics and/or oral corticosteroids), severe exacerbation (patient needs hospitalization or visits the emergency room). Severe exacerbations may also be associated with acute respiratory failure. Hospitalization for a COPD exacerbation is correlated with poor prognosis and elevated risk of death. There is also a significant association between spirometric severity and the risk of exacerbation and death. The aim of our study was to investigate the role of fungi and atypical mycobacteria in addition to the usual bacteria in acute exacerbation in patients with COPD in our locality. This is an observational cross sectional study conducted at chest medicine department, Mansoura University Hospital and Mansoura Chest Hospital over 24 months from May 2017 to May 2019 in collaboration with microbiology and immunology department, Mansoura University. It included 100 COPD patients diagnosed according to GOLD 2017 with acute exacerbation. Informed written consents were taken from all patients enrolled in the study after approval of IRB under code of MD/17.02.88. We found that the mean age was 62.5 years, 46 patients were current smokers (46%), 44 patients were ex-smokers (44%) and 10 patients were nonsmokers (10%). As regarding to occupation, 64 patients worked non risky occupations (64%) and 36 patients worked risky occupations (36%). As regards residence, 62 patients were resident in urban areas (62%) and 38 patients were resident in rural areas (38%). As regarding to exacerbation grade, 37 patients classified as mild exacerbation (37%), 53 patients classified as moderate exacerbation (53%) and 10 patients classified as severe exacerbation (10%). As regard sputum bacteriology of studied patients, all sputum samples were negative for typical and atypical mycobacteria whereas bacterial culture revealed (Klebseilla pneumoniae) in 14 patients (14%), (Hemophilus influenzae) was isolated from 3 patients (3%), (Staphylococcus aureus) was isolated from 9 patients (9%), (Streptococcus pneumonia) was isolated from 16 patients (16%), Pseudomonas spp. was isolated from 5 patients (5%), (Enterobacter spp.) was isolated from 5 patients (5%), (E.coli) was isolated from 3 patients (3%), normal flora (commensal flora) was isolated from 43 patients (43%), other bacteria were isolated from 5 patients (5%), no growth of bacteria was found in 8 patients (8%) and more than one organism was detected in 11 patients (11%). Conclusions: This study showed that fungal and bacterial isolates from the airway could have a role in COPD exacerbation. Non-tuberculous mycobacteria have no role in COPD exacerbation in our locality.