Case history #1
A 30-year-old woman presents in the winter months with a 2-day history of fever, cough, headache, and generalized weakness. She was in her usual state of health before an abrupt onset of these symptoms. A few viral illnesses have affected her during the current winter, but not to this severity. She says she has sick coworkers and did not receive the seasonal influenza vaccine this season.
Case history #2
A 12-month-old infant presents in the winter months to the pediatrician with a 2-day history of fever to 102°F (38.9°C), tachypnea, conjunctival erythema, and nasal congestion with clear discharge. There has been an associated loss of appetite, with one episode of emesis. Influenza has been reported recently in the locality. The parents are concerned that the child was not vaccinated, due to a known history of severe egg allergy.
Seasonal influenza may present rarely with an afebrile upper respiratory illness more typical of a common cold, or it may present predominantly with fever and myalgia, with few respiratory symptoms. Patients in high-risk populations (e.g., those with chronic cardiac or pulmonary conditions, diabetes mellitus, renal disease, hemoglobinopathy, immunosuppression, residence in chronic care facilities, age >50 years, or third trimester of pregnancy) may present with an established primary viral or secondary bacterial pneumonia. Characteristic features of primary viral pneumonia are persisting or worsening course of fever, with dyspnea or other respiratory distress. Secondary bacterial pneumonia should be suspected if there is an initial improvement in symptoms followed by a relapse of fever with productive cough and shortness of breath. A chest x-ray confirms pulmonary infiltrates.
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