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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Recognize the clinical presentation of influenza.

  • Discuss influenza-related complications.

  • Develop a patient-specific treatment plan for influenza.

  • Identify appropriate target populations for vaccination against influenza.

  • Compare and contrast available options for preventing influenza.

  • Discuss strategies to control influenza outbreaks.

PATIENT PRESENTATION

Chief Complaint

“I feel like a truck ran over me. Every muscle and bone hurts, and I am burning up.”

HPI

A 67-year-old male presents in mid-December to an urgent care clinic with complaints of 1-day history of fever, up to 39°C (102.2°F), muscle and bone aches, feeling tired, and headache. He has not had anything to eat in the past 12 hours due to loss of appetite and has not taken his glyburide this morning. He has been in his usual state of health previously and reports that some of his coworkers have been sick with the “flu.” He decided to come to the clinic in hopes that an antibiotic can allow him to recover sooner since his son is getting married next weekend. He missed his regular appointment 1 month ago because he was “too busy.”

PMH

  • Type 2 DM for 14 years

  • Hyperlipidemia

  • Hypertension

FH

Father and sister with type 2 DM

SH

Lives at home with his wife; works full time; quit smoking 10 years ago, but smokes occasionally when really stressed or in a social setting; drinks alcohol in a social setting.

Meds

  • Aspirin 81 mg PO daily

  • Hydrochlorothiazide 25 mg PO daily

  • Glyburide 5 mg PO every morning

  • Metformin 1 g PO twice daily

  • Lantus 35 units SC at bedtime

  • Atorvastatin 10 mg PO daily

  • Centrum Silver one tablet PO daily

All

NKDA

Review of Systems

Complains of severe fatigue, body aches, alternating between being too cold and sweating, sore throat, nonproductive cough, and a headache. He denies nasal congestion, nausea, vomiting, or diarrhea.

Physical Examination

Gen

WDWN overweight man in NAD

VS

BP 150/90 (patient reports similar readings at home), P 95 bpm, RR 18, T 38.5°C; Wt 95.5 kg, Ht 5′10″

Skin

Warm and moist secondary to diaphoresis, no lesions

HEENT

PERRLA; EOMI; TMs intact; wears ...

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