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Influenza (Clinical presentation (Sore throat, Headache, Fatigue, Myalgia…
Influenza
Clinical
presentation
Sore throat
Headache
Fatigue
Myalgia
Malaise
Anorexia
Dry cough
Pathophysiology
Transmission
Respiratory droplet/aerosol
Mechanism
Infects the upper respiratory tract
Agents
Influenza A: common, most virulent
Influenza B: less severe illness
Influenza C: mild/asymptomatic
Diagnosis
Examination
Respiratory
Non-productive cough, clear chest
ENT
May have sore throat, no tonsillar swelling,
otherwise NAD
Investigations
Bedside
Obs (high fever)
History
DH
Current meds, allergies
FH
Recent ill contacts
PMH
Asthma/COPD, prev LRTI/URTI,
immunocompromised
SH
Living arrangements, occupation,
smoking, alcohol
PC/HPC
Acute onset sore throat, dry cough, malaise,
muscle aches, headache, fever, anorexia
May have photophobia, eye pain, rhinitis
Complications
Respiratory
Acute bronchitis
Pneumonia (viral or bacterial)
EO COPD/asthma
Lung abscess/empyema
Otitis media
Sinusitis
Non-respiratory
Neuro: febrile convulsions, GBS, encephalitis
Cardiovascular: HF, myocarditis
Musculoskeletal: myositis
Systemic: Reye's syndrome, toxic shock syndrome
Pregnancy
Perinatal mortality
Prematurity
SGA, LBW
Prevention
Hygeine
Hand washing, don't sneeze into hand, use and bin tissues
Avoid social events/isolation
Vaccination
Indications: age >65y, pregnancy, DM, heart/lung/kindey/liver/neuro disease,
immunosuppression, medical staff
MOA: trivalent flu vaccine, takes 2wk to work
SEs: pain, swelling, temperature, headache, GBS (rare)
Antivirals
Indication: exposure and at risk group
E.g. tamiflu (oseltamivir)
Epidemiology
Can cause epidemics
and pandemic outbreaks (A+B)
Winter months
Management
Conservative
Information, advice, support
Admit if seriously unwell or complications
Self care (fluids, rest)
Seek help if SOB, pleuritic chest pain, haemoptysis
or no improvement after 1 week
Medical
Analgesia
Indication: pain, fever
E.g. paracetamol, ibuprofen
Antivirals
Indication: influenza season, <48h onset and patient in at risk group (age>65y, pregnancy, chronic resp/heart/kidney/liver/neuro disease,
DM, immunosuppression, morbid obesity BMI>40)
E.g. PO oseltamivir (Tamiflu)
Indication: inhibits viral replication
Definition
Acute respiratory illness caused
by one of the influenza viruses
Differentials
Infection
Viral: common cold (coryza), glandular fever, pertussis
Bacterial: strep pharyngitis, meningitis,
pneumonia, acute bronchitis
Parasitic: malaria
Prognosis
Usually self limiting 1-2wk