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Confusion between the management of community acquired pneumonia in hospital versus primary care: a case of friendly fire?
- Wei Shen Lim, Zara Hoare (9 May 2006)
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An essential differential diagnosis in community acquired pneumonia
- Takeharu Koga, Hisamichi Aizawa (9 May 2006)
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Wei Shen Lim, Consultant physician in general and respiratory medicine Nottingham City Hospital, Nottingham NG5 1PB, Zara Hoare
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The editorial by Goossens and Little takes issue with a number of recommendations offered in the BMJ Learning article “Pneumonia: update on diagnosis and management” published in the same journal. As authors of the latter article, we were somewhat saddened that Goossens and Little should choose to disagree with us, especially as the kernel of their criticisms appears to be based on the mistaken premise that our article related to community acquired pneumonia (CAP) in primary care. Our article was commissioned as a BMJ Learning module for juniors doctors managing patients admitted to hospital and consequently, does not attempt to address the diagnosis and management of CAP in primary care. In particular, as regards microbiological diagnostic testing, a careful reading will confirm that we only discussed “the tests … recommended for patients admitted with …pneumonia”. We uphold that there are clear differences in the management of CAP in the hospital setting versus lower respiratory tract infections (LRTI) in primary care. The primary care issues raised by Goossens and Little are important and deserve research attention. Equally, a number of areas relating to the diagnosis and management of CAP in hospitalised patients remain open for debate, including the optimal empirical antibiotic choice. More hospital based research in LRTI and CAP is also warranted. This pair of articles highlights the need to avoid confusing primary and secondary care issues when discussing the subject of CAP. “Community acquired pneumonia” is not “community managed” pneumonia. Competing interests: None declared |
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Takeharu Koga, Associate professor Kurume University School of Medicine, Department of Internal Medicine, Kurume, 830-0011 Japan, Hisamichi Aizawa
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One more disease should be added to the list of differential diagnosis in community acquired pneumonia1: pulmonary tuberculosis (TB). Active TB often presents clinical pictures including radiology2 indistinguishable from those of pneumonia. Chances to see patients with active TB are not negligible in community setting. Many people worldwide have latent tuberculosis 3 which has potentials to become reactivated, and those who were born in the area where TB is endemic have increased incidence of active TB4. Resurgence of active TB is warned among people infected with HIV5. Patients with active TB should promptly be managed and treated appropriately. Thus, TB should always be bear in mind when seeing patients with signs suggestive of community acquired pneumonia, and active diagnostic procedures such as sputum examination are encouraged whenever the disease could not be ruled out. References 1. Goossens H, Little P. Community acquired pneumonia in primary care. BMJ 2006;332(7549):1045-1046. 2. Kunimoto D, Long R. Tuberculosis: still overlooked as a cause of community-acquired pneumonia--how not to miss it. Respir Care Clin N Am 2005;11(1):25-34. 3. Chan ED, Iseman MD. Current medical treatment for tuberculosis. BMJ 2002;325(7375):1282-1286. 4. Trends in tuberculosis--United States, 2005. MMWR Morb Mortal Wkly Rep 2006;55(11):305-308. 5. Tanne J. Goal of eradicating tuberculosis is under threat from rise in HIV infection in Africa and eastern Europe. BMJ 2006;332(7541):570d. Competing interests: None declared |
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