Which physical findings suggest influenza?

Updated: Aug 07, 2020
  • Author: Hien H Nguyen, MD, MS; Chief Editor: Michael Stuart Bronze, MD  more...
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The general appearance varies among patients who present with influenza. Some patients appear acutely ill, with some weakness and respiratory findings, whereas others appear only mildly ill. Upon examination, patients may have some or all of the following findings:

  • Fever of 100-104°F; fever is generally lower in elderly patients than in young adults

  • Tachycardia, which most likely results from hypoxia, fever, or both

  • Pharyngitis - Even in patients who report a severely sore throat, findings may range from minimal infection to more severe inflammation

  • Eyes may be red and watery

  • Skin may be warm to hot, depending on core temperature status; patients who have been febrile with poor fluid intake may show signs of mild volume depletion with dry skin

  • Pulmonary findings may include dry cough with clear lungs or rhonchi, as well as focal wheezing

  • Nasal discharge is absent in most patients

  • Fatigued appearance

Acute encephalopathy has been associated with influenza A virus infection. In a case series of 21 patients, Steininger et al described clinical, cerebrospinal fluid (CSF), magnetic resonance imaging (MRI), and electroencephalographic (EEG) findings. [27] Clinical features included altered mental status, coma, seizures, and ataxia. Of patients who underwent further testing, most had abnormal CSF, MRI, and EEG findings.

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