Influenza, one of the most common infectious diseases, is a

highly contagious airborne disease that occurs in seasonal

epidemics and manifests as an acute febrile illness with variable
degrees of systemic symptoms, ranging from mild fatigue to
respiratory failure and death. Influenza causes significant loss of
workdays, human suffering, and mortality. The World Health
Organization estimates that worldwide annual influenza
epidemics result in about 3-5 million cases of severe illness and
about 250,000-500,000 deaths. The Centers for Disease Control
and Prevention (CDC) estimates that flu-associated deaths in the
United States ranged from about 3000 to 49,000 annually
between 1976 and 2006. During the 2017-2018 flu season,
900,000 people were hospitalized and 80,000 died in the United
States.

Which of the following is accurate regarding influenza transmission and infection?

Influenza B is generally more pathogenic than influenza A

Adults typically shed the influenza virus longer than children

Transmission of influenza from asymptomatic persons is possible

Eating poultry or pork infected with influenza may still transmit infection, even
when properly cooked

Influenza viruses spread from human to human via aerosols

created when an infected individual coughs or sneezes. Infection
occurs after an immunologically susceptible person inhales the
aerosol. As in other viral infections, systemic symptoms result
from release of inflammatory mediators. The incubation period of
influenza ranges from 1 to 4 days. Aerosol transmission may
occur 1 day before the onset of symptoms; thus, it may be
possible for transmission to occur from asymptomatic persons or
persons with subclinical disease who may be unaware that they
have been exposed to the disease.
Influenza results from infection with one of three basic types of
influenza virus: A, B, or C. Influenza A is generally more
pathogenic than influenza B. Epidemics of influenza type C have
been reported, especially in young children and military recruits;
however, the disease course is usually less severe than that
associated with influenza A. Fever is less prominent with type C.
Viral shedding occurs at the onset of symptoms or just before the
onset of illness (0-24 hours). Shedding continues for 5-10 days.
Young children may shed virus longer, placing others at risk of
contracting infection. In highly immunocompromised persons,
shedding may persist for weeks to months.
Transmission of influenza from poultry or pigs to humans
appears to occur predominantly as a result of direct contact with
infected animals. The risk is especially high during slaughter and
preparation for consumption; eating properly cooked meat poses
no risk.

Which of the following is accurate regarding the presentation and physical examination
of patients with influenza?

Diarrhea associated with influenza infection is more commonly seen in adults

than in children

Fever associated with influenza infection is generally lower in young adults than
in elderly patients

Nasal discharge is present in most patients with influenza, and rhinitis is

commonly the chief symptom

Onset of influenza symptoms can occur suddenly or can progress more slowly,
and patients who received vaccine may have milder symptoms

The presentation of influenza virus infection varies; however, it

usually includes many of the symptoms described below.
Patients with influenza who have preexisting immunity or who
have received vaccine may have milder symptoms. Onset of
illness can occur suddenly over the course of a day, or it can
progress more slowly over the course of several days. Typical
signs and symptoms include (not necessarily in order of
prevalence):
 Cough and other respiratory symptoms
 Fever
 Headache
 Myalgias
 Nasal discharge
 Red, watery eyes
 Sore throat
 Tachycardia
 Weakness and severe fatigue
Cough and other respiratory symptoms may be initially minimal
but frequently progress as the infection evolves. Patients may
report nonproductive cough, cough-related pleuritic chest pain,
and dyspnea. In children, diarrhea may be a feature.
The general appearance varies among patients who present with
influenza. Some patients appear acutely ill, with some weakness
and respiratory findings, whereas others appear only mildly ill.
Upon examination, patients may have some or all of the
following findings:
 Fever of 100-104°F; fever is generally lower in elderly
patients than in young adults
 Tachycardia, which most likely results from hypoxia, fever,
or both
 Pharyngitis—Even in patients who report a severely sore
throat, findings may range from minimal infection to more
severe inflammation
 Eyes may be red and watery
 Skin may be warm to hot, depending on core temperature
status; patients who have been febrile with poor fluid intake
may show signs of mild volume depletion with dry skin
 Pulmonary findings may include dry cough with clear lungs
or rhonchi, as well as focal wheezing
 Nasal discharge is absent in most patients
 Fatigued appearance
endonuclease inhibitor that blocks influenza virus proliferation by
inhibiting the initiation of mRNA synthesis, has received approval
in Japan for the treatment of influenza and is under study in the
United States.