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Br J Gen Pract
. 2021 Dec 13;BJGP.2021.0344.
doi: 10.3399/BJGP.2021.0344. Online ahead of print.
Clinical presentation and disease course in patients with flu-like illness: does microbiological aetiology matter?
Theo Verheij 1 , Daniela Cianci 2 , Alike van der Velden 2 , Christopher C Butler 3 , Emily Bongard 3 , Samuel Coenen 4 , Annelies Colliers 4 , Nick Francis 5 , Paul Little 5 , Maciek Godycki-Cwirko 6 , Carl Llor 7 , Slawomir Chlabicz 8 , Christos Lionis 9 , Pär-Daniel Sundvall 10 , Lars Bjerrum 7 , An De Sutter 11 , Rune Aabenhus 7 , Nicolay Jonassen Harbin 12 , Morten Lindbaek 12 , Dominik Glinz 13 , Heiner Bucher 13 , Bernadett Kovacs 14 , Bohumil Seifert 15 , Pia Touboul Lundgren 16 , Muireann de Paor 17 , Ruta Radzeviciene JUrgute 18 , Veerle Matheeussen 19 , Herman Goossens 19 , Margareta Ieven 19
Affiliations
- PMID: 34990385
- DOI: 10.3399/BJGP.2021.0344
Abstract
Background: There is little evidence about the relation between aetiology, illness severity and clinical course of respiratory tract infections (RTI) in primary care. Understanding these associations would aid to develop effective management strategies for these infections.
Aim: To investigate whether the clinical presentation and illness course differ between RTI in whom a viral pathogen was detected and those in whom a potential bacterial pathogen was found.
Design and setting: Post hoc analysis of data from a pragmatic randomised trial on the effects of oseltamivir in patients with influenza-like illness (ILI) in primary care (n=3266) in 15 European countries.
Methods: Patient characteristics, signs and symptoms were registered at baseline. Naso-pharyngeal (adults) or nasal and pharyngeal (children) swabs were taken for PCR analysis. Patients were followed up until 28 days after inclusion. Regression models and Kaplan-Meier curves were used to analyse the relation between aetiology, clinical presentation at baseline and course of disease including complications.
Results: Except for a less prominent congested nose (OR 0.55, CI 0.35 - 0.86) and acute cough (OR 0.52, CI 0.27 - 0.65) in ILI patients in whom a possible bacterial pathogen was isolated, there were no clear clinical differences in presentations between those with a possible bacterial aetiology than in those with a viral one. Also the course of disease and complications were not related to aetiology.
Conclusion: Given the currently available microbiological tests and antimicrobial treatments, and outside pandemics like COVID-19, microbiological testing in primary care patients with ILI seems to have limited value.
Keywords: Cancer; Cardiovascular disease; Clinical (general); Clinical (physical); Consultation skills; Continuity of care; Gastroenterology.