What is the appropriate therapy for influenza, how is it diagnosed, and what are the typical chest X‑ray findings?

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Last updated: October 8, 2026 • View editorial policy

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Terapi Influenza, Diagnosis, dan Gambaran Foto Toraks

Untuk influenza berat, berikan oseltamivir dalam 48 jam onset gejala; untuk kasus non-berat dengan risiko tinggi progresivitas, berikan baloxavir dalam 48 jam; diagnosis terbaik menggunakan NAAT (PCR), dan foto toraks menunjukkan ground-glass opacities bilateral dan konsolidasi multifokal terutama di zona tengah dan atas paru.

Terapi Antiviral

Influenza Berat

  • Oseltamivir adalah pilihan utama untuk influenza berat 1, 2
  • Mulai dalam 48 jam onset gejala untuk efektivitas maksimal
  • Rekomendasi ini berlaku untuk influenza musiman dan zoonosis (novel influenza A)

Influenza Non-Berat dengan Risiko Tinggi

  • Baloxavir direkomendasikan secara kondisional untuk pasien risiko tinggi progresivitas dalam 2 hari onset gejala 1, 2
  • Faktor risiko tinggi meliputi: usia lanjut, komorbid, immunocompromised, infeksi virus influenza A zoonosis 2

Influenza Non-Berat Tanpa Risiko Tinggi

  • Baloxavir TIDAK direkomendasikan 2
  • Antiviral lain (oseltamivir, laninamivir, peramivir, zanamivir, favipiravir, arbidol) juga tidak direkomendasikan 2

Catatan Penting

  • Amantadine dan rimantadine dianggap lebih berbahaya dibanding oseltamivir dan zanamivir 3
  • Terapi antiviral dalam 48 jam dapat mengurangi penggunaan antibiotik dan hospitalisasi 3

Profilaksis Pasca-Pajanan

Influenza Zoonosis

  • Berikan profilaksis untuk SEMUA yang terpajan menggunakan baloxavir, oseltamivir, laninamivir, atau zanamivir 1, 2

Influenza Musiman

  • Profilaksis direkomendasikan kondisional hanya untuk individu dengan risiko hospitalisasi sangat tinggi pasca-pajanan 1, 2
  • Profilaksis tidak menggantikan vaksinasi 2

Terapi Adjuvan - TIDAK DIREKOMENDASIKAN

Influenza Non-Berat

  • Rekomendasi kuat MENENTANG antibiotik kecuali ada bukti infeksi bakteri 1, 2

Influenza Berat

  • Rekomendasi kondisional MENENTANG 1, 2:
    • Kortikosteroid
    • Makrolida
    • mTOR inhibitor
    • NSAID
    • Terapi imun pasif (plasma konvalesen)
  • Antibiotik hanya jika ada bukti ko-infeksi bakteri 2

Diagnosis

Influenza Berat (Tersangka)

  • NAAT (Nucleic Acid Amplification Test/PCR) adalah gold standard 2
  • Tes sensitivitas dan spesifisitas tinggi diperlukan
  • Mulai terapi antiviral SEBELUM hasil tes tersedia jika kecurigaan klinis tinggi 2

Influenza Non-Berat Risiko Tinggi

  • Digital immunoassay (DIA) atau NAAT 2
  • Rapid testing dianjurkan, diikuti terapi antiviral jika positif 2

Keterbatasan Klinis

  • Sulit membedakan influenza dari pneumonia bakterial secara klinis 4
  • PCR sangat memfasilitasi identifikasi virus respiratori dengan implikasi penting untuk kontrol infeksi 4

Gambaran Foto Toraks (CXR)

Temuan Radiologis Khas

  • Ground-glass opacities bilateral dan multifokal (84.5% kasus) 5
  • Konsolidasi dengan predominasi peribronchovascular dan subpleural 5
  • Distribusi terutama di zona tengah dan atas paru 5
  • Opasitas retikular pada ~20% kasus 5

Pola Distribusi

  • Konsolidasi alveolar basal dan aksial 5
  • Opasitas multifokal bilateral berkorelasi dengan keparahan penyakit 5

Skor Keparahan

  • Jumlah lobus terlibat dan skor CXR berkorelasi ketat dengan:
    • Kebutuhan ventilasi mekanik
    • Keparahan penyakit secara keseluruhan 5

Catatan Penting

  • Foto toraks influenza tidak dapat dibedakan dari COVID-19 di setting gawat darurat 6
  • Mayoritas pasien (38-39%) memiliki foto toraks normal saat presentasi di IGD 6
  • 28-29% mildly abnormal, 21-22% moderately abnormal, 11-12% severely abnormal 6
  • Temuan radiologis bersifat non-spesifik dan tidak dapat membedakan viral dari bakterial pneumonia 4

Peringatan Klinis

Jendela Terapi

  • 48 jam dari onset gejala adalah kritis untuk efektivitas antiviral maksimal 3, 2
  • Untuk kasus berat tersangka, jangan tunda terapi menunggu hasil laboratorium 2

Antimicrobial Stewardship

  • Hindari antibiotik empiris tanpa bukti infeksi bakteri 1, 2
  • Terapi antiviral dini dapat mengurangi penggunaan antibiotik yang tidak perlu 3

Stratifikasi Risiko

  • Identifikasi faktor risiko progresivitas sejak awal untuk menentukan kebutuhan antiviral 2
  • Pasien dengan novel influenza A selalu dianggap risiko tinggi 2

References

1
Research

Summary of WHO clinical practice guidelines for influenza.

BMJ (Clinical research ed.), 2026

4
Research

Influenza and Viral Pneumonia.

Clinics in chest medicine, 2018

5
Research

Chest radiological findings of influenza A H1N1 pneumonia.

Revista portuguesa de pneumologia, 2012

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