Complications

The complications of acute influenza infection include primary influenza pneumonitis, secondary bacterial pneumonia, croup, exacerbation of chronic obstructive pulmonary disease, and Reye's syndrome. Other rare complications include Guillain-Barre syndrome, myocarditis, and pericarditis.

Primary influenza pneumonitis occurs most commonly in those with preexisting cardiac or pulmonary disease, but in most large outbreaks it has been seen in previously healthy young adults. The initial symptoms are typical flulike symptoms with progression to cough and dyspnea. There is significant hypoxia. Radiologic findings are bilateral infiltrates similar to Adult Respiratory Distress Syndrome (ARDS). Bacterial cultures and Gram stains are negative, and antibiotics do not help. Treatment is primarily supportive. Most clinicians would support the use of anti-influenza agents, but there are no good studies demonstrating efficacy. The mortality rate of influenza pneumonitis remains high.

Secondary pneumonia is clinically similar to pneumonia occurring without antecedent flu. This complication presents 1 to 2 weeks after the flu, with a brief well period in between. Secondary pneumonia is most common in the elderly and in those with diabetes mellitus or preexisting cardiopulmonary disease. Treatment is initially with broad-spectrum antibiotics and pulmonary support, with narrowing of antibiotic coverage when culture results become available.

Reye's syndrome has been associated with influenza B and varicella zoster infections and with the use of aspirin. 5 It occurs primarily in children between the ages of 2 and 16 years and begins with vomiting and progresses to altered mental status or coma. There is hepatomegaly due to fatty infiltration of the liver. There are elevated levels of liver enzymes (alanine aminotransferase and aspartate aminotransferase), elevated ammonia levels, and an elevated prothrombin time. Hypoglycemia is common. The case fatality rate is from 10 to 40 percent. The American Academy of Pediatrics has recommended that aspirin not be used for fevers caused by influenza or varicella.67

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