Correct Statements About Influenza
Statement (b) is correct: immunocompromised patients may experience worsening of their underlying disease when infected with influenza. 1
Analysis of Each Statement
a. The virus does not infect immunocompromised individuals - FALSE
- Influenza virus readily infects immunocompromised patients, who are actually at higher risk for severe complications and death compared to immunocompetent individuals 2, 3, 4
- Immunocompromised patients with influenza progress to pneumonia in more than half of cases, with mortality occurring exclusively in those who develop pneumonia 4
- Patients with hematological malignancies and influenza A infection face particularly elevated risk for pneumonia progression 4
b. Immunocompromised patients may experience worsening of their underlying disease - TRUE
- Guidelines explicitly recognize that immunocompromised patients should be monitored for "significant worsening of their underlying disease" during influenza infection 1
- Follow-up clinical review is specifically recommended for all patients who suffered significant complications or experienced worsening of underlying conditions 1
- Immunocompromised patients demonstrate prolonged viral shedding (up to 14 days or more) and may require extended antiviral treatment duration beyond the standard 5 days 5
c. Diagnosis is exclusively clinical - FALSE
- Diagnosis is NOT exclusively clinical; laboratory confirmation is recommended through multiple modalities 1
- CDC guidelines recommend performing rapid influenza virus testing on nasopharyngeal swab or nasal-wash specimens early in outbreaks 1
- Viral cultures should be obtained from a subset of patients to determine the infecting virus type and subtype 1
- RT-PCR is the gold standard diagnostic test, though treatment should not be delayed while awaiting results 5
- Rapid antigen tests have poor sensitivity, and negative results should not exclude treatment in high-risk patients 5
d. Antiviral drugs are administered only in cases of pneumonia - FALSE
- Antivirals are indicated for a much broader range of presentations, not limited to pneumonia 1, 5
- Treatment criteria include: acute influenza-like illness (ILI), fever (>38°C), and symptom duration ≤2 days 1
- All hospitalized patients with suspected or confirmed influenza should receive oseltamivir regardless of pneumonia presence 5
- High-risk patients (immunocompromised, elderly, pregnant, chronic disease) warrant treatment even without pneumonia 5
- Otherwise healthy outpatients may receive treatment to reduce illness duration and complications 5
e. Individuals caring for patients with influenza should receive prophylactic treatment - PARTIALLY TRUE with important caveats
- Prophylaxis is NOT universally recommended for all caregivers, but rather targeted to specific high-risk scenarios 1
- During facility outbreaks, antiviral prophylaxis should be offered to unvaccinated personnel caring for patients at high risk 1
- Healthcare workers in involved units or caring for high-risk patients should receive prophylaxis when an outbreak is confirmed 1
- Prophylaxis may be considered for all healthcare personnel (regardless of vaccination status) if the outbreak is caused by a vaccine-mismatched variant 1
- Routine prophylaxis for all caregivers outside outbreak settings is NOT recommended 5
Key Clinical Pitfalls to Avoid
- Never assume immunocompromised patients are protected from influenza - they face the highest risk for severe disease and death 2, 4
- Do not wait for laboratory confirmation before initiating antiviral therapy in high-risk or severely ill patients 5
- Do not withhold antivirals from immunocompromised patients presenting >48 hours after symptom onset - they may still derive significant mortality benefit 1, 5
- Monitor immunocompromised patients closely for treatment failure and oseltamivir resistance, particularly if viral shedding persists beyond 5 weeks 6