emDocs - April 29, 2019 - Authors: Mendoza C and Fairbrother H
Edited by: Koyfman A and Long B
"Summary
- Influenza can present with wide variety of symptoms and can lead to multiple complications.
- Be aware of your local seasonal prevalence of influenza and specific strains, as it will help limit inappropriate testing and lead to timely therapy (https://www.cdc.gov/flu/weekly/fluactivitysurv.htm)
- Risk stratify patients depending on their comorbidities and previous medical problems
- A negative rapid antigen test does not rule out influenza, particularly when prevalence is high
- A purely clinical diagnosis of influenza (i.e. no confirmatory testing) during high influenza season is reasonable for low-risk patients who are likely to be discharged.
- For low risk patients with mild to moderate illness, treat as outpatients with oral antiviral if presenting within 48 hours of illness onset, otherwise supportive treatment is recommended.
- Hospital admission should be based on patient’s risk factors, age, respiratory status, clinical presentation, comorbidities, and access to outpatient follow up.
- Treatment with antiviral medications is recommended for all patients who are severely ill, have complicated illness, are at high risk for complications, or are hospitalized.
- Be aware that pneumonia (bacterial, CA-MRSA, viral), pediatric myositis/rhabdomyolysis, and MI in elderly patients are possible contributors to why your influenza patient may be so sick."