Whitebook: influenza

We published an article on the portal this week about epidemic of influenza in Rio de Janeiro. Thus, in our weekly publication of shared content from Whitebook Clinical Decision Let’s talk about the clinical approach to this disease.

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Initial considerations

During a flu outbreak, mainly in the winter months (although in Brazil, due to the tropical climate, this truth is partial with relatively constant prevalence throughout the year), the clinical diagnosis of influenza presents good performance, dispensing with any complementary exam.

Even outside the winter period, sporadic cases do not require detection virus for influenza, given the self-limiting nature of the infection, except in the presence of severe acute respiratory syndrome or in cases of epidemiological importance or pandemic diagnosis (such as in the H1N1 pandemic).

Laboratory tests:

Complete blood count, electrolytes, renal function, liver function, CRP, arterial blood gas and lactate. Indicated in cases of influenza or suspected influenza with evolution to severe acute respiratory syndrome, which requires hospitalization. Patients with suspected encephalopathy should undergo lumbar puncture and virus testing.

Results:

• CBC may show leukopenia with lymphopenia and thrombocytopenia (typical of viral infection);
• Arterial blood gas analysis may reveal hypoxemia in cases of severe evolution.

Chest X-ray :

• Indicated in cases of influenza or suspected influenza with changes on physical examination and/or progression to severe acute respiratory syndrome;
  
  You can indicate the presence ence of multifocal or diffuse ground-glass pulmonary infiltrate, interstitial infiltrate pattern, or lobular or segmental consolidation, making it impossible to distinguish from bacterial pneumonia.

  Viral detection:

  Based on the Epidemiological Surveillance Guide, from the Ministry of Health, the collection of nasopharyngeal secretion is indicated ( preferably between the third and seventh day of the onset of symptoms) for viral detection in all patients with suspected severe acute respiratory syndrome (with or without a risk factor for complications);

  The exam confirmatory for influenza infection is RT-PCR or culture of oropharyngeal secretions, but they are not widely available;
  

  Rapid tests (QuickVue Influenza A+B®; ZstatFlu®) are currently marketed and have high sensitivity and specificity.

  Blood culture: Should be requested in every patient with suspected severe acute respiratory syndrome to differential diagnosis with bacterial pneumonia or the risk of concomitant bacterial infection.

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