TY - JOUR T1 - Managing infectious disease in primary care: using real-time syndromic and microbiological surveillance JF - British Journal of General Practice JO - Br J Gen Pract SP - 266 LP - 267 DO - 10.3399/bjgp18X696293 VL - 68 IS - 671 AU - Alastair D Hay AU - Isabel Lane Y1 - 2018/06/01 UR - http://bjgp.org/content/68/671/266.abstract N2 - In this personal commentary, we will describe the ‘what’, ‘why’, and ‘how’ of a visionary system we believe could improve the diagnosis and management of infectious disease in primary care.Consider Ahmed: a 4-year-old brought to see you on Friday evening with a 5-day history of runny nose, chesty cough, fever (described by his mother as severe and not improving), 1/2 normal fluid intake, loose stools, and not eating. The family are exhausted from the sleepless nights, but mostly his mother is worried about the chesty cough and fever, and asks if Ahmed needs antibiotics.You complete the history — no vomiting, no rash, up-to-date with immunisations, no chronic diseases — and you examine Ahmed. He is listless and looks at you warily with red (conjunctivitis?) eyes while clinging to his mother. His breathing rate is normal (30 breaths per minute) and he does not have any cyanosis, respiratory recession, or rash. He has a temperature of 38.2°C, a pulse of 135 beats per minute, and oxygen saturation of 98%. His peripheries are well perfused with a capillary refill rate of <2 seconds. On auscultation, you hear some moist crackles with expiratory wheezing (bilaterally and not confined to a single zone); and, finally risking his wrath, you check Ahmed’s ears and throat: normal tympanic membranes and some redness of his pharynx, but no pus or enlarged tonsils.Summing up, you know he has an infectious disease affecting mainly his respiratory tract (coryza, chesty cough, pharyngitis, … ER -