Influenza: Difference between revisions
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####Higher fever, productive cough, radiographic evidence of infiltrates | ####Higher fever, productive cough, radiographic evidence of infiltrates | ||
###Microbiology | ###Microbiology | ||
####Pneumococcus, S. aureus (including [[MRSA]]), H. flu | ####[[Pneumococcus]], [[S. aureus]] (including [[MRSA]]), H. flu | ||
#[[Otitis Media]] | #[[Otitis Media]] | ||
##More common in children | ##More common in children |
Revision as of 22:42, 15 April 2014
Background
- Transmission
- Occurs in 6ft radius around infected pt who is sneezing and/or coughing
- Viral shedding lasts ~5d (starts 24-48hr before onset of symptoms)
- Longer duration of shedding occurs in children, elderly, pts w/ chronic illnesses
- Shedding from asymptomatic individuals doesn't contribute significantly to transmission
- Convalescence
- Most pts gradually improve over 2-5d, although may last for one week or more
- Some pts have persistent weakness lasting several weeks (postinfluenza asthenia)
Clinical Features
- Constitutional
- Fever
- Headache
- Myalgia
- Malaise
- Respiratory
- Non-productive cough
- Sore throat
- Rhinorrhea
Diagnosis
- During outbreaks clinical criteria alone is sufficient for otherwise healthy pts
- Rapid tests
- Specific but not sensitive (cannot be used to rule-out)
- Do not wait for results before initiating treatment
- Consider in:
- Inpatients w/ acute febrile respiratory illness
- All immunocompromised pts
Treatment
- Antiviral therapy
- Efficacy
- Shortens symptoms by approximately 1 day in those recieving neuraminidase inhibitor in <48 hours[1]
- Little to no benefit when tx is started 2d or more after symptom onset
- Do not wait for test results (if obtained) before beginning treatment
- Controversial whether tx significantly prevents influenza-associated complications
- Shortens symptoms by approximately 1 day in those recieving neuraminidase inhibitor in <48 hours[1]
- Indications:
- Illness requiring hospitalization
- Severe, complicated, or progressive illness
- High risk for complications:
- Age <2yr OR age >65yr
- Chronic illnesses:
- Pulmonary (including asthma), CV (except HTN), renal, hepatic, hematological, DM
- Immunosuppression (meds and HIV)
- Pregnant or within 2wk after delivery
- Morbidly obese (BMI >40)
- Pts age <19yr who are receiving long-term aspirin therapy
- American Indians/Alaska Natives
- Residents of nursing homes / chronic care facilities
- Can consider in pts w/ mild illness who are otherwise healthy to reduce length of sx
- Meds
- Neuraminidase inhibitors
- Oseltamivir 75mg PO BID x5d
- Zanamivir 10mg (2 inhalations) BID x5d
- Relatively contraindicated in pts w/ asthma, COPD, or pregnancy
- Adamantanes (amantadine, rimantadine) NOT recommended (high resistance rates)
- Neuraminidase inhibitors
- Efficacy
- Antibiotics
- Only recommended if secondary bacterial pneumonia
Complications
- Pneumonia
- Primary influenza PNA
- Most severe and least common type of PNA
- Rare in otherwise healthy adults
- Consider in pts w/ persistent and worsening symptoms (esp high fever, SOB, cyanosis)
- CXR shows b/l opacities w/ or w/o superimposed consolidation
- Secondary bacterial PNA
- Exacerbation of fever and respiratory symptoms after initial improvement
- Higher fever, productive cough, radiographic evidence of infiltrates
- Microbiology
- Pneumococcus, S. aureus (including MRSA), H. flu
- Exacerbation of fever and respiratory symptoms after initial improvement
- Primary influenza PNA
- Otitis Media
- More common in children
- Myositis and rhabdo
- More common in children
- Extreme tenderness of affected muscles (most commonly in the legs)
- Pericarditis/myocarditis
- Rare complication
Source
UpToDate
- ↑ Patel DM, Pitts SR. Should Neuraminidase Inhibitors Be Prescried for Patients with Influenza? Annals of Emergency Medicine. 63(1) January 2014.