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Is Influenza an Influenza-Like Illness? Clinical Presentation of Influenza in Hospitalized Patients

Published online by Cambridge University Press:  21 June 2016

Hilary M. Babcock ,
Liana R. Merz  and
Victoria J. Fraser
Hilary M. Babcock*
Affiliation:
Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri
Liana R. Merz
Affiliation:
Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri
*
Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 ([email protected])
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Abstract

Background.

Early recognition of influenza virus infection in hospitalized patients can prevent nosocomial transmission.

Objective.

To determine the clinical presentation of influenza in hospitalized patients.

Design.

Case series. Data were collected retrospectively from medical records and included demographic information, comorbidities, clinical symptoms and signs, microbiologic test results, and outcomes (including pneumonia and intensive care unit [ICU] admission).

Setting.

A 1,400-bed teaching hospital.

Patients.

A total of 207 inpatients who received a diagnosis of influenza virus infection during 3 seasons from 2000 to 2003.

Results.

Over the course of 3 seasons, 207 patients received a diagnosis of influenza (186 were infected with influenza A virus, and 21 were infected with influenza B virus). The most commonly reported symptoms were cough (186 patients [90%]) and subjective fever (137 patients [66%]); 124 patients (60%) had a documented temperature of 37.8°C or greater before influenza was diagnosed. Sore throat was uncommon (44 patients [21%]). Centers for Disease Control and Prevention (CDC) criteria for influenza-like illness (ILI)–temperature 37.8°C or greater and either cough or sore throat–were met by 107 patients (51%). There were no differences in the proportion of patients who met ILI criteria with respect to age, sex, season, influenza virus type, or time to diagnosis in the hospital. Most patients (150 [72%]) received acetaminophen. Only 41 patients (20%) had positive results of clinical cultures; 178 patients (86%) received antibiotic therapy. Fifty-six patients (27%) had pneumonia: 36 (17%) required admission to the ICU, and 25 (12%) required ventilatory support. Patients with pulmonary disease were more likely to require ventilatory support (12 [26%] vs 13 [8%]; P = .003).

Conclusions.

Only half of hospitalized patients with influenza met CDC criteria for ILI. These criteria may be more appropriate in outpatient settings. A high index of suspicion is needed to recognize influenza in hospitalized patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 3 , March 2006 , pp. 266 - 270
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Bridges, CB, Thompson, WW, Meltzer, MI, et al. Effectiveness and cost-benefit of influenza vaccination of healthy working adults: a randomized controlled trial. JAMA 2000; 284:1655–1663.CrossRefGoogle ScholarPubMed
2.Govaert, TM, Dinant, GJ, Aretz, K, Knottnerus, JA. The predictive value of influenza symptomatology in elderly people. Fam Pract 1998; 15:16–22.Google Scholar
3.Neuzil, KM, O'Connor, TZ, Gorse, GJ, Nichol, KL. Recognizing influenza in older patients with chronic obstructive pulmonary disease who have received influenza vaccine. Clin Infect Dis 2003; 36:169–174.CrossRefGoogle ScholarPubMed
4.Boivin, G, Hardy, I, Tellier, G, Maziade, J. Predicting influenza infections during epidemics with use of a clinical case definition. Clin Infect Dis 2000;31:1166–1169.CrossRefGoogle ScholarPubMed
5.Carrat, F, Tachet, A, Rouzioux, C, Housset, B, Valleron, A-J. Evaluation of clinical case definitions of influenza: detailed investigation of patients during the 1995-1996 epidemic in France. Clin Infect Dis 1999; 28:283–290.Google Scholar
6.Monto, AS, Gravenstein, S, Elliott, M, Colopy, M, Schweinle, J. Clinical signs and symptoms predicting influenza infection. Arch Intern Med 2000; 160:3243–3247.CrossRefGoogle ScholarPubMed
7.Ebell, MH, White, LL, Casault, T. A systematic review of the history and physical examination to diagnose influenza. J Am Board Fam Pract 2004; 17:1–5.Google Scholar
8.Monmany, J, Rabella, N, Margall, N, Domingo, P, Gich, I, Vazquez, G. Unmasking influenza virus infection in patients attended to in the emergency department. Infection 2004; 32:89–97.CrossRefGoogle ScholarPubMed
9.Friedman, MJ, Attia, MW. Clinical predictors of influenza in children. Arch Pediatr Adolesc Med 2004; 158:391–394.CrossRefGoogle ScholarPubMed
10.Monto, AS, Rotthoff, J, Teich, E, et al. Detection and control of influenza outbreaks in well-vaccinated nursing home populations. Clin Infect Dis 2004; 39:459–464.CrossRefGoogle ScholarPubMed
11.Falsey, AR, Cunningham, CK, Barker, WH, et al. Respiratory syncytial virus and influenza A infections in the hospitalized elderly. J Infect Dis 1995; 172:389–394.CrossRefGoogle ScholarPubMed
12.Oliveira, EC, Marik, PE, Colice, G. Influenza pneumonia: a descriptive study. Chest 2001; 119:1717–1723.Google Scholar
13.Walsh, EE, Cox, C, Falsey, AR. Clinical features of influenza A virus infection in older hospitalized persons. J Am Geriatr Soc 2002; 50:1498–1503.CrossRefGoogle ScholarPubMed
14.Bennett, NM. Diagnosis of influenza. Med J Aust 1973; Special Supplement: 19-22.CrossRefGoogle Scholar
15.Bisno, AL, Griffin, JP, Van Epps, KA, Niell, HB, Rytel, MW. Pneumonia and Hong Kong influenza: a prospective study of the 1968-1969 epidemic. Am J Med Sci 1971; 261:251–263.Google Scholar
16.Call, SA, Vollenweider, MA, Hornung, CA, Simel, DL, McKinney, WP. Does this patient have influenza? JAMA 2005; 293:987–997.CrossRefGoogle ScholarPubMed
17.Bradley, SF. Prevention of influenza in long-term-care facilities. Long-Term-Care Committee of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 1999; 20:629–637.Google Scholar