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) | 0.53–0.94 | 0.02–0.43 | ||
| Rhonchi (4) | 0.11–0.74 | 0.33–0.81 | ||
| Chest pain (2) | 0.08–0.19 | 0.93–0.97 | ||
| Diarrhea (2) | 0.14–0.21 | 0.79–0.85 | ||
| 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 pneumophilad | aOR (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 cough | 1.1 (1.1–1.2) | 0.52 (0.27–.0) | ||
| Posttussive emesis | 1.8 (1.4–2.2) | 0.58 (0.44–0.77) | ||
| Inspiratory whoop | 1.9 (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