Validity of a clinical model to predict influenza in patients presenting with symptoms of lower respiratory tract infection in primary care

Vugt, S.F. van; Broekhuizen, Berna D L; Zuithoff, Nicolaas P. A.; Essen, G A van; Ebell, Mark H.; Coenen, Samuel; Ieven, Margareta; Lammens, Christine; Goossens, Herman; Butler, Christopher Collett; Hood, Kerenza; Little, Paul; Verheij, Theo

doi:10.1093/fampra/cmv039

Cited by 13 publications

(18 citation statements)

References 30 publications

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“…CDRs have been useful in other acute respiratory infections such as pharyngitis 36 and pneumonia. 37 They typically classify patients as low, moderate, and high risk; these categories correspond to patients in whom disease is ruled out, Figure 3. Summary receiver operating characteristic curves for overall impression (A), whooping cough (B), paroxysmal cough (C), and posttussive vomiting (D), stratified by vaccination status.…”

Section: Discussionmentioning

confidence: 99%

Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review

2017

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Background: Bordetella pertussis (BP) is a common cause of prolonged cough. Our objective was to perform an updated systematic review of the clinical diagnosis of BP without restriction by patient age.Methods: We identified prospective cohort studies of patients with cough or suspected pertussis and assessed study quality using QUADAS-2. We performed bivariate meta-analysis to calculate summary estimates of accuracy and created summary receiver operating characteristic curves to explore heterogeneity by vaccination status and age.Results

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Section: Discussionmentioning

confidence: 99%

Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review

2017

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“…Approaches that develop clinical decision rules integrating signs, symptoms, and point-of-care tests such as CRP are particularly promising. 88 Finally, research is needed to determine if and when antibiotics are helpful, since data regarding treatment of B pertussis and M pneumoniae from well designed, adequately powered contemporary clinical trials are lacking.…”

Section: Limitationsmentioning

confidence: 99%

Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis

Marchello

Dale

Thai

et al. 2016

The Annals of Family Medicine

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PURPOSE Community-acquired pneumonia (CAP), acute cough, bronchitis, and lower respiratory tract infections (LRTI) are often caused by infections with viruses or Streptococcus pneumoniae. The prevalence of atypical pathogens Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila, and Bordetella pertussis among patients with these illnesses in the ambulatory setting has not been previously summarized. We set out to derive prevalence information from the existing literature. METHODSWe performed a systematic review of MEDLINE for prospective, consecutive-series studies reporting the prevalence of M pneumoniae, C pneumoniae, L pneumophila and/or B pertussis in outpatients with cough, acute bronchitis, LRTI, or CAP. Articles were independently reviewed by 2 authors for inclusion and abstraction of data; discrepancies were resolved by consensus discussion. A meta-analysis was performed on each pathogen to calculate the pooled prevalence estimates using a random effects model of raw proportions.RESULTS Fifty studies met our inclusion criteria. While calculated heterogeneity was high, most studies reported prevalence for each pathogen within a fairly narrow range. In patients with CAP, the overall prevalences of M pneumoniae and C pneumoniae were 10.1% (95% CI, 7.1%-13.1%) and 3.5% (95% CI, 2.2%-4.9%), respectively. Consistent with previous reports, M pneumoniae prevalence peaked in roughly 6-year intervals. Overall prevalence of L pneumophila was 2.7% (95% CI, 2.0%-3.4%), but the organism was rare in children, with only 1 case in 1,765. In patients with prolonged cough in primary care, the prevalence of B pertussis was 12.4% (95% CI, 4.9%-19.8%), although it was higher in studies that included only children (17.6%; 95% CI, 3.4%-31.8%).CONCLUSIONS Atypical bacterial pathogens are relatively common causes of lower respiratory diseases, including cough, bronchitis, and CAP. Where surveillance data were available, we found higher prevalences in studies where all patients are tested for these pathogens. It is likely that these conditions are underreported, underdiagnosed, and undertreated in current clinical practice.

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“…[34] The clinical diagnosis of influenza is often difficult and unreliable and, where indicated, laboratory testing should be performed. [35] Situations where this is necessary include where there is a cluster of cases in institutions such as nursing homes, or in severe illness, where neuraminidase inhibitors (such as oseltamivir) are indicated. The latter appears to provide only marginal benefit in the non-hospitalised (in contrast to the hospitalised) patient in the community and is not recommended outside of highly immunocompromised patients or those with severe chronic respiratory, cardiac or neurological conditions.…”

Section: Influenzamentioning

confidence: 99%