What influenza testing do you choose? — Influenza in the ED December 5, 2018

Posted by Andy Jagoda, MD in: What's Your Diagnosis , trackback

Your patient is a 32-year-old man with the following chief complaints: cough and fever. His maximum temperature over the past 5 days was 40˚C (103.9°F). He has been taking over-the-counter cold remedies without relief, and today he is markedly short of breath. The patient has no regular primary care provider and has no significant past medical history. His initial vital signs are: temperature 39.2˚C (102.5°F); heart rate, 118 beats/min; respiratory rate, 28 breaths/min; blood pressure, 134/78 mm Hg; and oxygen saturation, 88% on room air. On examination, he appears uncomfortable, with notable tachypnea. The oropharynx is clear and the neck supple. Crackles are noted in the right lower lung field, without any wheezing. The abdomen is soft and nontender. The patient is given oxygen via face mask, with an improvement in saturation to 100%. Chest x-ray reveals a right lower lobar pneumonia with a small pleural effusion. You start IV antibiotics and request an inpatient bed, as he is hypoxic with his pneumonia. 

You wonder whether influenza testing is indicated, and if so, what type of test to do?

Comments »

1. Valerie Dickey - December 5, 2018

Use the Influenza A . It cause of PNEUMONIA.

2. Sheila Smith - December 5, 2018

Rapid influenza diagnostic test

3. Steve McCornack DO - December 5, 2018

Given that this patient is already being treated for pneumonia, it would seem that influenza testing would not be of any diagnostic value or influence further treatment decisions

4. Andrew Abrass - December 5, 2018

Influenza A and B as they are being admitted

5. Steven W McCornack DO - December 5, 2018

Appropriateness of influenza testing depends on clinical prevalence and severity of symptoms

6. ROBERT - December 5, 2018

Is there a need to confirm? Does it change except for isolation? I think not

7. Melissa Schmidt - December 5, 2018

Yes for the purpose if you do not have a single isolation bed available. And no for the reason that you would not start Tamiflu Are there specific therapy for influenza as he’s 5 days out from symptoms.

8. Dr Suvasish Chakraberty - December 5, 2018

I would like to rule out an H1N1 infection

9. Alison R - December 5, 2018

Yes, i would want to cover for mrsa if i thought post viral pna and pt would be candidate for tamiflu as well if suspicion is high and hospitalize. Getting negative result may allow deescalation earlier if hospital has high sensitivity test

10. Fitri - December 6, 2018

Test tuberkulin mantoux
Test post nasal drip
Test functional lung capacity

11. Khadeejah Al-Arasi - December 6, 2018

Nasopharyngeal swab to exclude the most serious complication w H1N1

12. B. Cummings - December 6, 2018

It has been my experience that the hospitalists will request an Influenza rapid test be done for admission on this type of patient despite them being outside the antiviral treatment window. I honor that request if hospital room cohorting is a factor.

13. Deepa Quadir-Alam - December 7, 2018

Yes, rapid influenza diagnostic test for A and B

14. Ahmed Morsy - December 7, 2018

Yes you should test for influenza because:
1- clinical findings going with suspected influenza especially in influenza season.
2- if you admitted a case of pneumonia with possible influenza infection you should test for influenza ( other bacterial if suspected mixed infection) & start tamiflu before confirming influenza infection
3- if influenza A is positive you should test for subclass/subspecies for therapeutic purpose ( resistance to antiviral, sensitivity) & for epidemiological purpose.

15. Dr. Hanna - December 8, 2018

Influenza A &B by PCR
Sick patients with +ve Influenza infection can get better with anti-viral therapy even if it’s been 5 days

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