Clinical Features and Associated Findings

Influenza. The symptoms of influenza begin rapidly with fever, usually 101° to 102° F, associated with myalgias, headache, lethargy, and respiratory tract symptoms of dry cough, rhinorrhea, and sore throat. Eye pain and photophobia may occur. Influenza rarely causes gastrointestinal symptoms in adults; however, up to 50 percent of children have nausea, vomiting, and abdominal pain. Systemic symptoms and fever usually last 2 to 3 days and rarely more than 5 days. '»'

Reye's Syndrome. Reye's syndrome occurs primarily in children, most often in association with influenza B and varicella-zoster infections. Reye's syndrome is an acute, noninflammatory encephalopathy associated with hepatic dysfunction due to microvesicular fatty infiltration of the liver. y Reye's syndrome usually begins with severe vomiting, and this is one of the cardinal features of this syndrome. Vomiting is followed by or associated with lethargy progressing to stupor and coma. '»' The CDC's criteria for Reye's syndrome include (1) an alteration in the level of consciousness with the CSF containing less than 8 cells/ mm '3' ; or (2) an alteration in the level of consciousness and cerebral edema without perivascular or meningeal irritation; and, (3) either microvesicular fatty infiltration of the liver or a greater than threefold rise in serum glutamic- oxaloacetic transaminase (SGOT) level or ammonia. y

Postinfectious Polyneuritis. The clinical picture of Guillain-Barre syndrome following an influenza virus infection is indistinguishable from Guillain-Barre syndrome of other causes.

Acute Viral Myositis. Influenza A and B have been associated with myositis. Benign acute myositis is characterized by transient severe pain and weakness affecting the calves; it primarily affects children and occurs during epidemics of influenza. '»'

Differential Diagnosis. The influenza virus can be cultured from throat and nasopharyngeal swabs obtained within 3 days of onset of illness. Acute and convalescent sera should be sent to the laboratory to detect seroconversion or a fourfold or greater increase in virus-specific IgG between the serum samples. A fourfold rise in antibody titer indicates that the patient was recently infected with the influenza virus but is not definitive proof that the influenza virus is the etiological agent of the neurological syndrome.

Management and Prognosis. The majority of acute influenza infections are self-limited. The use of salicylates

(e.g., aspirin) should be avoided in children with flulike symptoms to decrease the risk of Reye's syndrome.

Inactivated and live attenuated influenza vaccines are available. Vaccination is presently recommended for individuals who are at risk for influenza-related complications (e.g., pneumonia, myocarditis, exacerbation of chronic medical conditions); these include individuals older than age 65, persons with chronic cardiopulmonary disease including children with asthma, and residents of chronic care facilities. In addition, persons with chronic illnesses such as diabetes or renal disease and those compromised by immunosuppression should be vaccinated. Individuals who can transmit influenza to high-risk persons such as health care workers, nursing home and chronic care facility employees, and household members of high-risk persons should also be vaccinated. y

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