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Influenza

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Topic updated on 09/26/16 10:13pm

Snapshot
  • A 55-year-old maCXRn experienced dyspnea over the past 10 months preventing him from climbing more than a flight of stairs. Examination of the chest shows an increased antero-posterior diameter and hyperresonance to percusion. Breath sounds are distant with faint end-expiratory wheezes. What annual vaccination should this patient receive?
Introduction
  • Acute respiratory infection
  • Caused by influenza virus
  • Transmitted via respiratory droplet
  • Epidemiology
    • serious concern exists regarding avian and swine (H1N1) flus, which have in the recent past resulted in devastated population-wide consequences in Asia, Europe, and North America
    • approximately 35,000 people die of flu-related illness every year in the US alone
  • Risk factors for severe disease include
    • advanced age (>65 years)
    • infancy (<2 years old)
    • pregnancy (usually first trimester)
    • long-term care or hospitalization
    • chronic diabetes, respiratory, cardiac, renal, or immunodeficiency disease
Presentation
  • Symptoms
    • presents acutely within 1-7 days of exposure with characteristic complaints including
      • high fever
      • chills
      • severe headache
      • myalgia
      • arthralgia
      • nausea
      • vomiting
      • malaise
      • dizziness
    • following resolution of fever and myalgias (2-4 days later), patients often present with
      • dyspnea
      • dry cough
      • sore throat
      • common cold-like symptoms
  • Physical exam
    • physical exam usually not required for diagnosis of flu
    • findings match symptoms above
    • notably high fever (102-106 F)
Evaluation
  • Diagnosis is based primarily on patient history
  • No further testing (and often no clinical exam) is necessary
Differential
  •  Common cold (often confused by patients as flu), parainfluenza, mononucleosis, hepatitis
Treatment
  • Medical management
    • acetominophen and/or ibuprofen
      • indicated for fever reduction
    • OTC cold medications
      • may palliate symptoms including sore throat and congestion
    • antiviral medication
      • may be indicated and prescribed for patients are particularly high risk of developing complications with severe flu illnesses
      • amantadine and rimantadine administered for acute protection of high risk groups
      • especially those with underlying respiratory compromise
    • DO NOT TAKE ASPIRIN
      • can result in Reyes disease leading to hepatorenal failure and death
Prognosis, Prevention, and Comlications
  • Prognosis
    • very good to excellent in vast majority of cases
    • most flu illnesses resolve spontaneously in 1-2 weeks
  • Prevention
    • good hand hygeine
    • annual vaccinations
      • influenza A vaccine
        • patients with cardiopulmonary disease, diabetes, elderly, renal disease, immunocompromised, and healthcare workers
  • Complications
    • may exacerbate underlying asthma or other respiratory or chronic illnesses
    • pneumonia or encephalitis/meningitis
    • aspirin can cause Reyes disease and be fatal


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