Influenza can cause pneumonia directly or open the door to a bacterial infection, often with Staphylococcus aureus or Streptococcus pneumoniae. Older adults, pregnant patients, young children and people with chronic illness are at the highest risk.
Key symptoms
- Sudden fever, chills and body aches
- Cough, sore throat and runny nose
- Shortness of breath or chest pain
- Fever that returns after early improvement (bacterial infection)
- Marked fatigue
What you find on exam
- Fever, fast breathing and fast heart rate
- Low oxygen saturation
- Crackles or bronchial breath sounds
- Signs of dehydration or sepsis
Tests
- Nasopharyngeal swab for an influenza molecular (PCR) test
- Chest X-ray: infiltrates
- Blood count, metabolic panel, blood and sputum cultures
- Severity score such as CURB-65; lactate if sepsis is suspected
Treatment basics
- Oseltamivir as soon as possible for hospitalized or high-risk patients, even after 48 hours
- Ceftriaxone plus azithromycin if bacterial pneumonia is suspected; add MRSA coverage if severe
- Oxygen, fluids and fever control
- Droplet precautions
- Prevention: yearly flu vaccine and pneumococcal vaccine
Red flags
- Oxygen saturation below 92% or labored breathing
- Confusion, low blood pressure or signs of sepsis
- Rapid worsening after initial improvement
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Related guides
Sources: NCCPA PANCE Content Blueprint; CDC, Guideline for Isolation Precautions (2007) and PPE sequence; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.