Community acquired pneumonia in primary care
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7549.1045 (Published 04 May 2006) Cite this as: BMJ 2006;332:1045
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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
Competing interests: No competing interests
An essential differential diagnosis in community acquired pneumonia
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
Competing interests: No competing interests