Clinical Characteristics of Influenza in Season 2017/2018 in a German Emergency Department: A Retrospective Analysis

Abstract

Introduction: Influenza infection is a viral disease with significant morbidity and mortality during the cold months. Clinical presentation typically includes cough, fever, and pain. Influenza disease is hardly diagnosed only on the basis of clinical symptoms due to similar clinical presentation of other diseases such as a typical cold or other flu-like diseases. We evaluated patients with proven influenza who presented at an emergency department of internal medicine in a university hospital according to the clinical presentation and different age groups. Materials and Methods: From October 2017 to April 2018, 723 reverse transcription-polymerase chain reaction (RT-PCR) tests for influenza were performed in the emergency department on patients with suspected influenza diagnosed clinically. A total of 240 influenza-positive patients were retrospectively assessed for documented main symptoms, vital parameters, risk factors for an unfavorable course, hospitalization, and death. Results: The mean age of influenza patients was 65 years. Overall, 30 patients were aged 18 to 39 years, 48 patients 40 to 59 years, and 162 patients ⩾60 years. Influenza B in 168 (70%) was predominant to 72 influenza A (mostly H1N1). In only 30% of the patients all three typical symptoms (cough, fever, and headache/myalgia) were documented. Headache or myalgia (with 34%) was rather uncommon in influenza B. Sudden onset was cited in only 5.4%; 57% of all influenza patients were in hospital for a mean of 7.1 days, and 5.8% of all influenza patients died. Patients aged above 60 years had more risk factors, showed typical symptoms less frequently, and were hospitalized longer than younger patients (<60 and <40 years). Conclusions: At an emergency department of internal medicine, influenza-diseased patients are of higher age, show an increased number of comorbidities, and are more likely to have milder symptoms documented. Elderly patients with influenza have a higher hospitalization rate with a longer hospital stay as compared with younger patients.

Influenza-associated in-hospital mortality during the 2017/2018 influenza season: a retrospective multicentre cohort study in central Germany

“…The in-hospital mortality in this group of patients was significantly higher (22.4%) than that in those who did not require admission to an ICU. Our observed in-hospital mortality rate of 6.7% was comparable to the in-hospital mortality rate of 5.8% reported by another German university hospital [5] but lower than the in-hospital mortality (8.3%) rate reported by a tertiary hospital in Austria [6]. Interestingly, the in-hospital mortality observed in this season was significantly lower compared to the in-hospital mortality in the 2014/2015 season (7.0% vs. 10.4%) in study hospital No.…”

Detection of influenza virus in air samples of patient rooms

“…Adults shed influenza virus for an average of one week with a peak on the second day of the illness, whereas shedding cessation in children can be prolonged with a noticeable decline in RNA detection in the samples collected in the subsequent days [ 27 , 64 , 65 ]. A study in Germany showed that the mean duration of symptoms before admission to the emergency department was 5.2 days and did not differ significantly between influenza A and B [ 66 ]. Similarly, a study in China estimated the duration from onset of symptoms to hospitalization for IAV patients to be 5.9 days; although it was longer than that for influenza B patients (3.7 days).…”

Systematically comparing COVID-19 with the 2009 influenza pandemic for hospitalized patients

“…Hospitalized pandemic H1N1 patients in our analysis appear to have higher frequencies of fever, fatigue, vomiting, shortness of breath and diarrhea compared with hospitalized seasonal influenza patients ( Zhang et al, 2020 ). However, comorbidities including diabetes, COPD, immunocompromised status and heart disease seem more common in seasonal influenza patients compared with pandemic H1N1 patients ( Mohammad et al, 2019 ). Nevertheless, future studies are required to comprehensively, for example by systematic review and meta-analysis, compare COVID-19 with pandemic and seasonal influenza.…”