Snapshot A 55-year-old man experienced dyspnea over the past 10 months preventing him from climbing more than a flight of stairs. Examination of the chest shows an increased antero-posterior diameter and hyperresonance to percusion. Breath sounds are distant with faint end-expiratory wheezes. What annual vaccination should this patient receive? Introduction Acute respiratory infection Caused by influenza virus Transmitted via respiratory droplet Epidemiology serious concern exists regarding avian and swine (H1N1) flus, which have in the recent past resulted in devastated population-wide consequences in Asia, Europe, and North America approximately 35,000 people die of flu-related illness every year in the US alone Risk factors for severe disease include advanced age (>65 years) infancy (<2 years old) pregnancy (usually first trimester) long-term care or hospitalization chronic diabetes, respiratory, cardiac, renal, or immunodeficiency disease Presentation Symptoms presents acutely within 1-7 days of exposure with characteristic complaints including high fever chills severe headache myalgia arthralgia nausea vomiting malaise dizziness following resolution of fever and myalgias (2-4 days later), patients often present with dyspnea dry cough sore throat common cold-like symptoms Physical exam physical exam usually not required for diagnosis of flu findings match symptoms above notably high fever (102-106 F) Evaluation Diagnosis is based primarily on patient history No further testing (and often no clinical exam) is necessary Differential Common cold (often confused by patients as flu), parainfluenza, mononucleosis, hepatitis Treatment Medical management acetominophen and/or ibuprofen indicated for fever reduction OTC cold medications may palliate symptoms including sore throat and congestion antiviral medication may be indicated and prescribed for patients are particularly high risk of developing complications with severe flu illnesses amantadine and rimantadine administered for acute protection of high risk groups especially those with underlying respiratory compromise DO NOT TAKE ASPIRIN can result in Reyes disease leading to hepatorenal failure and death Prognosis, Prevention, and Comlications Prognosis very good to excellent in vast majority of cases most flu illnesses resolve spontaneously in 1-2 weeks Prevention good hand hygeine annual vaccinations influenza A vaccine patients with cardiopulmonary disease, diabetes, elderly, renal disease, immunocompromised, and healthcare workers Complications may exacerbate underlying asthma or other respiratory or chronic illnesses pneumonia or encephalitis/meningitis aspirin can cause Reyes disease and be fatal