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Title: The diagnosis of respiratory tract infection in children presenting to primary care : exploring the relationship between clinical presentation and upper respiratory tract microbes
Author: Thornton , Hannah Victoria
ISNI:       0000 0004 5920 9650
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2014
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Introduction Diagnostic uncertainty in the treatment of respiratory tract infections (RTls) in children contributes to over-prescription of antibiotics, with detrimental effects on the global population. Improved treatment accuracy could be achieved with an improved understanding of underlying microbiology. This thesis explores the relationships between the information available to primary care clinicians during the consultation, the clinical symptoms and signs, and detection of microbes from the upper respiratory tract. Methods Evidence was systematically reviewed for associations between clinical presentation and microbial detection. Changes in RTI-related microbe prevalence from throat swabs in children with and without RTI were investigated at two time points in a small prospective cohort study known as the 'MASS' study. Results from the MASS study were used to guide cross-sectional investigation of the relationship between clinical symptoms and signs and microbe detection in a larger cohort of children. Results The systematic review demonstrated a marked absence of evidence. Meta-analysis found consistent associations between cl inical signs and respiratory syncytial virus. The MASS study found strong evidence that two RTI -related microbes were more prevalent when children were symptomatic than at asymptomatic follow-up. A further five RTI related microbes were more prevalent when children were symptomatic, but evidence was weak; the prevalence of a further three did not change. The seven microbes detected with greater prevalence at baseline than follow-up were associated with clinical presentation in cross-sectional analyses. None of the three microbes with similar baseline and follow-up rates were associated with clinical presentation. Discussion This work demonstrates associations between clinical presentation and seven RTI related microbes detected from the throat in children with RTI. These associations are not sufficient to definitively establish causality. They provide some evidence that these microbes could have an aetiological role in paediatric RTI, and are therefore potential candidates for future diagnostic, prognostic and point-of-care testing research to improve targeted antimicrobial treatment.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available