Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Review ArticleSystematic Review

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

Christian Marchello, Ariella Perry Dale, Thuy Nhu Thai, Duk Soo Han and Mark H. Ebell
The Annals of Family Medicine November 2016, 14 (6) 552-566; DOI: https://doi.org/10.1370/afm.1993
Christian Marchello
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ariella Perry Dale
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Thuy Nhu Thai
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Duk Soo Han
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mark H. Ebell
Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: ebell@uga.edu
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    PRISMA diagram.

    BP = Bordetella pertussis; CP = Chlamydophila pneumoniae; LP = Legionella pneumophila; MP = Mycoplasma pneumonia; OECD = Organization for Economic Cooperation and Development.

  • Figure 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2

    Forest plot of the prevalence of Mycoplasma pneumoniae in adults and children with community-acquired pneumonia, sorted in reverse chronological order.

    Heterogeneity (I2) = 99.27

  • Figure 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 3

    Forest plot of the prevalence of Chlamydia pneumoniae in adults and children with community-acquired pneumonia, sorted by prevalence.

    Heterogeneity (I2) = 98.4

  • Figure 4
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 4

    Forest plot of the prevalence of Legionella pneumophila in adults and children with community-acquired pneumonia, sorted by prevalence.

    Heterogeneity (I2) = 91.18

  • Figure 5
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 5

    Forest plot of the prevalence of Bordetella pertussis in outpatients with prolonged cough or non-pneumonia lower respiratory tract infection, sorted by prevalence.

    Heterogeneity (I2) = 98.83

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1

    Reported Bordetella pertussis and Legionella pneumophila Prevalence in 2012 by Case-Based Surveillance Systems of High-Income Countries Belonging to the OECD

    CountryaBP CasesLP CasesPopulationbBP Rate per 100,000LP Rate per 100,000
    Australia24,06938222,918,688105.01.67
    Austria4251018,428,9155.01.20
    BelgiumND10610,787,788ND0.98
    Canada4,54048334,674,70813.11.39
    Chile4,237ND17,423,21424.3ND
    Czech Republic7075610,565,6786.70.53
    Denmark1,1361275,592,73820.32.27
    Estonia14931,339,76211.10.22
    Finland541105,402,62710.00.19
    FranceND1,29863,457,777ND2.05
    GermanyND62881,990,837ND0.33
    Greece402711,418,8780.350.77
    Hungary5339,949,5890.050.24
    Iceland362328,29011.00.61
    Ireland264154,579,4985.80.33
    Italy2621,33260,964,1450.432.18
    JapanND903126,434,653ND0.71
    Korea, Rep.1262548,588,3260.260.05
    Luxembourg115523,3622.10.96
    Netherlands12,86830416,714,22877.01.82
    New Zealand2,3201524,461,25752.03.41
    Norway4,243254,960,48285.50.50
    Polandc1,824838,317,0904.80.02
    Portugal23014010,699,3332.11.31
    Slovak Republic91745,480,33216.70.07
    Slovenia153822,040,0577.54.02
    Spain1,56597246,771,5963.32.08
    Sweden279129,495,3922.90.13
    SwitzerlandND917,733,709ND1.18
    United Kingdom11,99340162,798,09919.10.64
    United States48,2773,688315,791,28415.31.17
    • BP = Bordetella pertussis; LP = Legionella pneumophila; ND = no data; OECD = Organisation for Economic Cooperation and Development.

    • ↵a No data available for Israel.

    • ↵b Population based on Gapminder 2012.19

    • ↵c Poland used aggregated instead of case-based data.

    • View popup
    Table 2

    Characteristics of Studies of the Prevalence of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in Patients With Community-Acquired Pneumonia or Lower Respiratory Tract Infection

    Author, Year (Country)PopulationTotal/Confirmed CasesaSettingAgePathogenData Collection PeriodDiagnostic Method
    CAP in Adults
    Jain et al,18 2015b (United States)Adults ≥18 y with CAP2,320/853InpatientMedian 57 y,MP, CP, LP2010–2012PCR, Culture, UA
    Angeles et al,20 2006 (Spain)Adults ≥15 y with CAP198/112InpatientMedian 70 yMP, CP, LP2003–2004Serology, UA
    Beović et al,21 2003 (Slovenia)Adults ≥15 y with CAP (PSI = I or II)113/68NRMean 44.9 yMP, CP, LP1999–2001Serology
    Charles et al,22 2008 (Australia)Adults ≥18 y with CAP885/404InpatientMean 65.1 y, range 18 y–100 y)MP, CP, LP2004–2006Serology, UA
    Cilloniz et al,23 2012 (Spain)Adults ≥16 y with CAP568/188OutpatientMean 47.2 yMP, CP, LP2000–2010Serology, UA
    Diaz et al,24 2007 (Chile)Adults ≥16 y with CAP176/98InpatientMean 65.8 y, range 17 y–101 yMP, CP, LP2003–2005Serology, UA
    Espana et al,25 2012 (Spain)Adults ≥18 y with CAP344/15373 Inpatient, 271 outpatientMean 53.5 yMP, CP, LP2006–2007Serology, UA
    Falguera et al,26 2010 (Spain)Adults ≥18 y or older with CAP (PSI IV or V)88/25InpatientMean 64 yLP2006–2008Serology, UA
    Gutierrez et al,27 2006 (Spain)Adults ≥15 y with CAP493/250361 Inpatient, 132 outpatientMean 56.6 y, range 15 y–94 yMP, CP, LP1999–2001Serology, UA
    Herrera-Lara et al,28 2013 (Spain)Adults ≥18 y with CAP243/139InpatientMean 63.9 yMP, CP, LP2006–2009Serology, UA
    Holm et al,29 2007b (Denmark)Adults ≥18 y with CAP48/219 Inpatient, 39 outpatientMean 61 y, range 22 y–88 yMP, CP, LP2002–2003PCR
    Huijskens et al,30 2013 (Netherlands)Adults ≥20 y with CAP408/263NRMean 65 y, range 20 y–94 yMP, CP, LP2008–2009Serology, PCR, UA
    Johansson et al,31 2010 (Sweden)Adults ≥18 y with CAP184/124InpatientMean 61.3 y, range 18 y–93 yMP, CP, LP2004–2005Serology, PCR, UA
    Lee et al,32 2002 (South Korea)Adults ≥16 y with CAP81/15InpatientMean 66.3 y, range 17 y–92 yMP, CP, LP1999–2000Serology
    Luchsinger et al,33 2013 (Chile)Adults ≥18 y with CAP356/232330 Inpatient, 26 outpatientMean 59.3 ycMP, CP, LP2005–2007Serology, PCR, UA
    Marrie et al,34 2005 (Canada)Adults ≥18 y with CAP507/245OutpatientMean 47.8 yMP, CP2003Serology
    Miyashita et al,35 2005 (Japan)Adults >16 y with CAP506/318400 Inpatient, 106 outpatientMean 58.3 y, range 16 y–97 yMP, CP, LP1998–2003Serology, UA
    Molinos et al,36 2009 (Spain)Patients with CAPd710/274InpatientMean 67.1 yMP, CP, LP2003–2004Serology, UA
    Prat et al,37 2006 (Spain)Patients with CAPd217/116InpatientMean 56.6 yLP2005–2005UA
    Saito et al,38 2006 (Japan)Adults ≥17 y with CAP232/170200 Inpatient, 32 outpatientMean 60.2 y, range 17 y–99 yMP, CP, LP1999–2000Serology, PCR, UA, Culture
    Sangil et al,39 2012 (Spain)Adults ≥18 y with CAP131/92InpatientMean 64.4 y, range 48 y–80MP, CP, LP2009–2010Serology, PCR, UA
    Shibli et al,40 2010 (Israel)Adults ≥18 y with CAP126/84InpatientMean 58.3, range 18 y–93 yMP, CP, LP2006–2007Serology, PCR
    Stralin et al,41 2010 (Sweden)Adults ≥18 y with CAP235/133InpatientMedian 71 y, range 18 y–96 yMP, CP, LP1999–2002Serology, PCR, UA
    Templeton et al,42 2005 (Netherlands)Adults ≥18 y with CAP105/8092 inpatient, 13 outpatientNRMP, CP, LP2000–2002PCR
    van de Garde et al,43 2008 (Netherlands)Patients with CAPd201/128InpatientMean 63 yMP, LP2004–2006PCR
    von Baum et al,44 2008 (Germany [CAPNETZ])Adults ≥18 y with CAP2,503/8771,727 Inpatient, 776 outpatientMean 61 yLP2002–2005PCR, UA, Culture
    von Baum et al,45 2009 (Germany [CAPNETZ])Adults ≥18 y with CAP4,532/9282,922 Inpatient, 1,610 outpatientMean 60 yMP2002–2005Serology, PCR
    Wellinghausen et al,46 2006 (Germany [CAPNETZ])Adults ≥18 y with CAP546/NR364 Inpatient, 182 outpatientMedian 62 y;CP2002–2004PCR
    Andreo et al,47 2006 (Spain)Adults ≥16 y with CAP107/39InpatientMean 58.6 y, range 16 y–86 yMP, CP, LP2000–2001Serology
    Capelastegui et al,48 2012 (Spain)Adults ≥18 y with CAP700/390276 Inpatient, 424 outpatientMean 59.7 yMP, CP, LP2006–2007Serology, UA
    CAP in Children
    Cantais et al,49 2014 (France)Children age 1 mo to 16.5 y with CAP85/81InpatientMedian 2.8 y, range 1 mo to 16.5 yMP, CP2012–2013PCR
    Cevey-Macherel et al,50 2009 (Switzerland)Children 2 mo to 5 y with CAP99/85InpatientMean 29 mo, range 2 mo to 5 yMP, CP2003–2005Serology, PCR
    Don et al,51 2005 (Italy)Children 4 mo to 16 y with CAP101/66InpatientMean 4.7 y, range 0.3 y–16 yMP, CP2001–2002Serology
    Hamano-Hasegawa et al,52 2008 (Japan)Children <19 y with CAP1,700/1,316NRMedian 6.1 y for MP; Median 5.4 y for CP, Range 0 y–19 yMP, CP, LP2005–2006PCR
    Jain et al,53 2015a (United States)Children <18 y with CAP2,222/1,802InpatientMedian 2 y, range 0 y–17 yMP, CP2010–2012PCR
    Kurz et al,54 2013 (Austria)Children 2 mo to 17 y with CAP279/190InpatientMedian 36 mo, range 2 mo to 17 yMP, CP2005–2008PCR
    Laundy et al,55 2003 (England)Children <5 y with CAP51/2542 Inpatient, 9 outpatientMedian 1.3 y, range 2 wk to 4,8 yMP, CP2001–2002PCR
    Maltezou et al,56 2004e (Greece)Children 6 mo to 14 y with CAP (n = 60), cough >3 weeks (n = 1) or infectious asthma exacerbation (n = 4)65/19InpatientMean 6 y, range 10 mo to 13 yMP, CP, LP2001Serology
    Numazaki et al,57 2004b (Japan)Children <15 y with CAP398/383362 Inpatient, 36 outpatientNRMP, CP2000–2001Serology, PCR
    Tsolia et al,58 2004 (Greece)Children 5y–14 y with CAP75/58InpatientMedian 86.5 mo, range 5 y–14 yMP, CP2003Serology, PCR
    Nonpneumonia LRTI
    Graffelman et al,59 2008f (Netherlands)Adults ≥18 y consulting GP with LRTI; 26 of 129 had CAP129/84OutpatientMean 50 yMP1998–2001Serology, PCR, Culture
    Numazaki et al,57 2004b (Japan)Children <15 y with non-pneumonia LRTI523/470436 Inpatient, 87 outpatientNRMP, CP2000–2001Serology, PCR
    Holm et al,29 2007b (Denmark)Adults ≥18 y with non-pneumonia LRTI316/12410 Inpatient, 306 outpatientMedian 48 y, range 18 y–94 yMP, CP, LP2002–2003PCR
    Various
    Defilippi et al,60 2008 (Italy)Children with LRTI (acute bronchitis, wheezy bronchitis, pneumonia, or bronchiolitis) admitted to the hospital886/NRMean 6.2 y, range 1 mo to 13.5 yMP2005–2006PCR
    • AP = community-acquired pneumonia; CP = Chlamydia pneumoniae; LP = Legionella pneumophila; LRTI = lower respiratory tract infection; MP = Mycoplasma pneumoniae; NR = not reported; PCR = polymerase chain reaction; PSI = pneumonia severity index; UA = urine antigen testing.

    • ↵a Total = number of patients included in study. Confirmed = number of patients with a pathogen identified.

    • ↵b Study findings reported separately for patients with CAP and those with non-pneumonic LRTI.

    • ↵c Estimated from median using method of Hozo.61

    • ↵d Age not reported but presumably adult based on hospital and mean age.

    • ↵e Classified as study of CAP if at least 85% of patients in the series were diagnosed with CAP.

    • ↵f In this study, LRTI was defined as abnormal lung sounds plus 2 of 3 of: (1) fever; (2) dyspnea or cough; (3) tachypnea, malaise or confusion.

    • View popup
    Table 3

    Characteristics of Studies of the Prevalence of Bordetella pertussis in Outpatients With Prolonged Cough or Non-Pneumonia Lower Respiratory Tract Infection

    Author, YearPopulationAgeYear of Data CollectionDiagnostic Method
    Adults and children
    Park et al,64 2014 (South Korea)Adolescents and adults age 11 y and older presenting to GP with bothersome cough up to 30 days durationMean 44.3 y2011–2012PCR
    Philipson et al,65 2013 (New Zealand)Children and adults age 5 to 49 y with cough for 2 weeks or longerRange 5–49 y2011Serology
    Riffelmann et al,66 2006 (Germany)Patients presenting to GP with at least 7 days coughNot reported (all ages)2001–2004Serology or PCR
    Children
    Wang et al,67 2014 (United Kingdom)Children with cough of 2–8 weeks duration presenting to GPMean 9.6 y2010–2012Serology
    van den Brink et al,68 2014 (Netherlands)Children age 12 y and under with RTI referred for evaluation of suspected BP<12 y2007–2009PCR
    Harnden et al,69 2006 (England, United Kingdom)Children 5–16 y presenting to their GP with cough for at least 2 weeksMean age 9.4 y, range 5–172001–2005Serology
    Diez Domingo et al,70 2004 (Spain)Children age 15 y and under presenting with cough for at least 2 weeksMean 6.2 y, range 0–15 y2001–2002Serology
    Adults
    Teepe et al,17 2015 (12 European countries)Adults with acute cough <28 days duration presenting to GPMean age 50 y2007–2010Serology or PCR
    • BP = Bordetella pertussis; GP = general practitioner; PCR = polymerase chain reaction.

    • View popup
    Table 4

    Accuracy of Signs and Symptoms for Respiratory Infections With Atypical Pathogens

    Symptom or Sign (number of studies)Sensitivity (95%CI)Specificity (95%CI)Positive LR (95%CI)Negative LR (95%CI)
    Mycoplasma pneumoniaea
    Cough (5)  0.89
    (0.67–0.97)
    0.15
    (0.05–0.37)
    1.04
    (0.95–1.13)
    0.78
    (0.44–1.39)
    Wheeze (6)  0.25
    (0.17–0.36)
    0.67
    (0.56–0.76)
    0.76
    (0.60–0.97)
    1.12
    (1.02–1.23)
    Coryza (4)  0.32
    (0.08–0.72)
    0.66
    (0.28–0.91)
    0.95
    (0.71–1.26)
    1.03
    (0.90–1.17)
    Crepitations (5)  0.84
    (0.78–0.88)
    0.22
    (0.14–0.32)
    1.06
    (0.96–1.18)
    0.77
    (0.52–1.12)
    Fever (5)  0.53–0.940.02–0.43
    Rhonchi (4)  0.11–0.740.33–0.81
    Chest pain (2)  0.08–0.190.93–0.97
    Diarrhea (2)  0.14–0.210.79–0.85
    Chlamydophila pneumoniae
    Adultsb
     History of cough  0.81
     History of sore throat  0.52
     Abnormal breathing sounds  0.38
     History of fever  0.24
    Childrenc
     Rales  0.85
     Fever  0.80
     Cough  0.50
     Rhinitis  0.30
     Tachypnea  0.25
     Wheezes  0.20
     Rhonchi  0.15
    Legionella pneumophiladaOR (95% CI)
    C-reactive protein >187 mg, L  4.4 (2.0–9.6)
    Sodium <133 mmo/L  4.5 (2.2–9.0)
    Temperature >39.4°C  4.3 (1.9–9.8)
    Platelet count <171 × 103/mL  1.2 (0.6–2.5)
    Lactate dehydrogenase >225 mmol/L  1.7 (0.4–7.6)
    Dry cough  0.6 (0.3–1.4)
    Bordetella pertussise
    Paroxysmal cough1.1 (1.1–1.2)0.52 (0.27–.0)
    Posttussive emesis1.8 (1.4–2.2)0.58 (0.44–0.77)
    Inspiratory whoop1.9 (1.4–2.6)0.78 (0.66–0.93)
    • aOR = adjusted odds ratio from multivariate analysis; CAP = community-acquired pneumonia; LR = likelihood ratio.

    • ↵a Cochrane systematic review of 7 moderate quality studies with a total of 1,491 children, although each sign and symptom was only reported by a subset of studies. Pooled results from 4 to 6 studies are shown for cough, wheeze, coryza, and crepitations; for the other signs and symptoms, a range or the results of a single study are shown.81

    • ↵b Data from a study of 21 adult primary care patients diagnosed with Chlamydophila pneumoniae infection (7 primary infections and 14 with reinfection based on the antibody pattern).82

    • ↵c Data from a study of 20 children hospitalized for CAP and diagnosed with Chlamydophila pneumoniae.83

    • ↵d Data from 37 patients hospitalized with CAP due to Legionella pneumophila. A clinical rule that included 6 variables had an area under the receiver operating curve of 0.73.84

    • ↵e Systematic review of 3 studies with a total of 486 adults and children set in South Korea, United Kingdom, and United States.85

Additional Files

  • Figures
  • Tables
  • The Article in Brief

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

    Mark H. Ebell , and colleagues

    Background In most primary care patients with cough, the cough is caused by a virus. In about 5% of cases, patients with cough have community-acquired pneumonia. In addition, some coughs are caused by an atypical bacterial infection, which has the potential to cause serious complications. This study analyzes existing research to describe the prevalence of atypical pathogens among two groups: 1) patients with cough, acute bronchitis, or lower respiratory tract infection in the ambulatory setting and 2) patients with community-acquired pneumonia.

    What This Study Found The study found high rates of atypical bacterial pathogens in patients with acute lower respiratory tract diseases, including cough, bronchitis and community-acquired pneumonia (CAP). Among adults with CAP, 14 percent had an atypical pathogen: 7 percent had mycoplasma pneumoniae, 4 percent had Chlamydophila pneumoniae, and 3 percent had Legionella pneumophila. Among children with CAP, 18 percent had Mycoplasma pneumoniae, only 1 percent had Chlamydophila pneumoniae, and Legionella pneumophila was extremely rare (only one case in 1,765 patients). Among patients with prolonged cough, 9 percent of adults and 18 percent of children had Bordetella pertussis.

    Implications

    • The findings suggest these conditions are underreported, underdiagnosed and undertreated in current clinical practice.
    • The authors call for future research to help clinicians more accurately diagnose these pathogens and determine if and when antibiotic treatment is helpful.
  • Supplemental Appendixes 1-2

    Supplemental Appendixes 1-2

    Files in this Data Supplement:

    • Supplemental data: Appendixes 1-2 - PDF file
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 14 (6)
The Annals of Family Medicine: 14 (6)
Vol. 14, Issue 6
November/December 2016
  • Table of Contents
  • Index by author
  • Front Matter (PDF)
  • Back Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
10 + 6 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis
Christian Marchello, Ariella Perry Dale, Thuy Nhu Thai, Duk Soo Han, Mark H. Ebell
The Annals of Family Medicine Nov 2016, 14 (6) 552-566; DOI: 10.1370/afm.1993

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis
Christian Marchello, Ariella Perry Dale, Thuy Nhu Thai, Duk Soo Han, Mark H. Ebell
The Annals of Family Medicine Nov 2016, 14 (6) 552-566; DOI: 10.1370/afm.1993
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Application of a Chlamydia trachomatis Expression System To Identify Chlamydia pneumoniae Proteins Translocated into Host Cells
  • In Vitro and Intracellular Activities of Omadacycline against Legionella pneumophila
  • Response: Re: Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review
  • Clinical Diagnosis of Bordetella Pertussis Infection: A Systematic Review
  • In This Issue: Social Context; Disease Causes
  • Google Scholar

More in this TOC Section

  • Examining How Social Risk Factors Are Integrated Into Clinical Settings Using Existing Data: A Scoping Review
  • Barriers and Facilitators to the Use of Clinical Decision Support Systems in Primary Care: A Mixed-Methods Systematic Review
  • Rural Patient Experiences of Accessing Care for Chronic Conditions: A Systematic Review and Thematic Synthesis of Qualitative Studies
Show more Systematic Review

Similar Articles

Subjects

  • Domains of illness & health:
    • Acute illness
    • Disease pathophysiology / etiology
  • Methods:
    • Quantitative methods

Keywords

  • community acquired pneumonia
  • cough
  • respiratory tract infection
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Legionella pneumophila
  • Bordetella pertussis

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine