What is the treatment plan for a patient with acute pyrexia, cephalgia, chills, and weakness, with recent Influenza (Flu) infection?

Clinical Note: Acute Febrile Illness with Recent Influenza History

Subjective

Chief Complaint: One-day history of fever (maximum 103°F), headache, chills, and weakness.

History of Present Illness: [PATIENT] year-old male presents with acute onset fever reaching 103°F, associated with headache, chills, and generalized weakness. Fever responds to ibuprofen 600mg (last dose at 12pm). Patient had laboratory-confirmed influenza one month prior. Denies recent travel or sick contacts.

Review of Systems:

• Constitutional: Positive for fever, chills, generalized weakness
• Neurological: Positive for headache
• Respiratory: Denies shortness of breath, cough, wheezing
• Negative for other pertinent symptoms

Past Medical History: Influenza infection one month ago

Objective

Vital Signs:

• Temperature: 103°F (initial, now afebrile with antipyretics)
• Blood pressure: 146/86 mmHg
• Heart rate: 94 bpm
• Respiratory rate: 20/min
• Oxygen saturation: 96% on room air

Physical Examination:

• General: Alert, no acute distress
• HEENT: No lymphadenopathy
• Respiratory: Clear to auscultation bilaterally, no wheezing, rhonchi, or crackles
• Cardiovascular: Regular rate and rhythm

Diagnostic Testing:

• Influenza A/B rapid test: Negative
• COVID-19 test: Negative

Assessment

Acute febrile illness of unclear etiology in a patient with recent influenza infection one month prior. Current presentation does not meet criteria for influenza treatment given negative testing and symptom onset >48 hours would be approaching treatment window limits.

Clinical Reasoning

The prescribed Tamiflu is NOT indicated in this clinical scenario. 1, 2

Why Tamiflu Should Not Be Prescribed:

Antiviral treatment criteria are NOT met because guidelines specify that oseltamivir should only be considered when patients have: (1) acute influenza-like illness, (2) fever >38°C, AND (3) been symptomatic for two days or less. 1 Additionally, both Influenza A and B testing are negative, making influenza infection unlikely as the current etiology. 2

The recent influenza infection one month ago does not justify current antiviral treatment, as this represents a resolved prior illness rather than active infection. 2 Reinfection with influenza within one month is uncommon, and the negative testing supports an alternative diagnosis.

Appropriate Management Strategy:

This patient requires symptomatic management only given the absence of pneumonia, normal oxygen saturation (96%), stable vital signs, and no evidence of bacterial infection. 1, 3

Antibiotics are NOT indicated because previously well adults with acute febrile illness without pneumonia do not routinely require antibiotics. 1, 2 The physical examination shows no crackles, wheezing, or other signs of lower respiratory tract infection, and the patient has no high-risk features requiring empiric antibacterial therapy. 1

The patient does NOT require hospital referral based on CRB-65 scoring (score = 0: no confusion, respiratory rate 20/min, blood pressure 146/86, age likely <65 years). 1 Patients with CRB-65 score of 0 are suitable for home treatment. 1

Monitoring Parameters:

Patients should be instructed to return for reassessment if they develop:

• New or worsening shortness of breath 1, 3
• Recrudescent fever not responding to antipyretics 1, 3
• Respiratory rate >24/min 1, 3
• Oxygen saturation <90% 1, 3
• Inability to maintain oral intake 1
• Altered mental status 1, 3

Plan

Diagnostic Testing:

• Respiratory viral panel (RVP) as ordered to identify alternative viral etiologies 3

Pharmacologic Management:

• Discontinue Tamiflu prescription - not indicated given negative influenza testing and failure to meet treatment criteria 1, 2
• Ibuprofen 600mg every 6 hours as needed for fever and pain (continue current regimen) 3
• Over-the-counter cold medications for symptomatic relief as needed 3

Non-Pharmacologic Management:

• Maintain adequate hydration - essential for supportive care in acute febrile illness 1, 3
• Rest and activity modification until symptoms resolve 3

Follow-up:

• Return visit in one week or sooner if warning symptoms develop 1, 3
• Immediate return if patient develops any of the concerning features listed above 1, 3

Patient Education:

• Explained that current illness does not appear to be influenza based on negative testing 2
• Reviewed warning signs requiring immediate medical attention 1, 3
• Discussed expected illness duration and symptomatic management strategies 3