++
“I feel achy and tired this morning. I woke up with a cough and I think I have a fever.”
+++
History of Present Illness
++
A 45-year-old woman presents to her primary care provider with a 12-24 hour history of nonproductive cough, fatigue, myalgias, and fever. Her signs and symptoms are consistent with influenza infection.
++
++
++
What signs and symptoms of influenza does this patient have?
Hint: Symptoms of influenza are similar to those of the common cold (fatigue, malaise, cough, fever) but it is typical to have higher fevers and muscle aches with influenza. See Common Cold in PPP.
What treatments could be considered for this patient?
Hint: Symptomatic therapy is recommended for viral upper respiratory tract infections. Antiviral therapy may reduce the duration of illness by 1-2 days if initiated within 48 hours of the first symptoms. See Treatment, Common Cold and Table 75-6 in PPP.
What counseling points should you discuss with this patient?
Hint: Many of the same principles that pertain to the common cold also apply to influenza. See Common Cold in PPP.
Is this patient a candidate for the influenza vaccine?
Hint: Documented influenza infection does not provide immunity to other influenza subtypes; therefore, if a patient is at risk for influenza and is infected in a particular season, it is recommended to vaccinate with the seasonal influenza vaccine to protect against other subtypes. See Prevention in PPP.
What if this patient has an allergy to eggs?
Hint: Patients with egg allergies can receive any age-appropriate influenza vaccines. Patients with severe egg allergies (e.g., anaphylaxis) should be vaccinated in a medical setting, supervised by a health care provider who is able to recognize and treat severe allergic reactions. See Flu Vaccine and People with Egg Allergies. CDC Influenza (Flu): United States. Available at: https://www.cdc.gov/flu/prevent/egg-allergies.htm. Accessed June 17, 2022.
++
What if this patient had evidence of pneumonia at the time of presentation?
++
Hint: See Treatment in PPP.
++
The global impact of seasonal influenza on morbidity and mortality is notable with 290,000 to 650,000 deaths occurring annually. Influenza infection rates peak in cold winter months in the Northern Hemisphere, and epidemics in the Southern Hemisphere usually occur 6 months before or after those in the Northern Hemisphere. There is also a high background rate of infection in tropical climates. Poor outcome is associated with secondary bacterial pneumonia or infection with specific influenza strains (e.g., H5N1 ...