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

Abstract

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.

Demographic and seasonal characteristics of respiratory pathogens in neonates and infants aged 0 to 12 months in the Central‐East region of Tunisia

“…The qRT-PCR was shown as the best way to detect an EV or PeV, but still little is known about the prognosis of these viruses. 34,35 In the present study, it was of significance to describe the circulation of EV 37 In addition, S. pneumoniae could be found to colonize the nasopharynx during RSV A/B infection in young children, which was associated with increased severity. 38 In accordance, 82.6% of S. pneumoniae infections were coinfected with a respiratory virus in which RSV A/B was the most identified pathogen.…”

Viral and bacterial coinfection among hospitalized children with respiratory tract infections

“…The reported frequency of community-acquired pneumonia due to MP in pediatric patients worldwide varies from 1.5% to 17.6%. [21][22][23] Studies conducted in Latin America report frequencies ranging from 0.74% to 43.8%. [24][25][26] Most of the reports are from a previously healthy pediatric population.…”

Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review

“…1 A recent systematic review of the prevalence of BP infection in patients with prolonged cough found that the overall prevalence of BP infection among primary care patients with prolonged cough (typically Ͼ1 week) was 12.4%; it was 18% in studies of children-much higher than suggested by laboratory-based surveillance reports. 2 The recent large increase in pertussis cases in the United States has been described by the Centers for Disease Control and Prevention (CDC) as an epidemic. 3 For infants and young children, complications from pertussis may be life-threatening, and hospitalization may be warranted.…”