A report from STAT News examines how the novel coronavirus pandemic can bring awareness to how providers diagnose other infections that may lead to a cough.
Around the world, cough is the most common reason for primary care visits and has a wide differential diagnosis which includes, but is not limited to, upper respiratory tract infections, asthma, allergies, gastroesophageal reflux, post-nasal drip, and lower respiratory tract infections such as pneumonia. And now, of course, Covid-19.
Even in the United States, where pneumonia is a leading cause of hospitalization among children, with medical costs estimated at almost $1 billion (and exceeding $10 billion in adults), there is a need for new diagnostic tools. Despite the use of current comprehensive diagnostic methods in the Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community project, a large population-based study of community-acquired pneumonia in the United States, no pathogen was detected in most adult pneumonia patients. In children, multiple pathogens were identified (although primarily in the upper respiratory tract, not the lungs). These results highlight the need for sensitive, inexpensive, and rapid diagnostics to accurately detect and distinguish among pneumonia pathogens.
In resource-constrained settings, an inadequate supply or a lack of laboratory and clinical imaging capacity and, even more critically, of trained health care providers makes it difficult to diagnose pneumonia. Because of that, a child with fast breathing in the setting of a cough or difficulty breathing is said to have pneumonia and is empirically treated with an antibiotic.
This might work well if most of the infections were bacterial, but the epidemiology of pneumonia is changing and respiratory viruses are increasingly becoming the most commonly detected causes of pneumonia. Antibiotics cannot treat viral infections, and when used inappropriately can promote the emergence of antimicrobial resistance. Yet not treating bacterial pneumonia with antibiotics can result in death.