Delay in Diagnosis of Influenza Virus in an Elderly Hospitalized Patient: A Fatal Outcome

Haber, Nicole; Khelili, Djamal; Martineau, Delphine; Dekimeche, Siham; Szekely, Carol; Lebon, Pierre

doi:10.4137/ccrep.s8460

Cited by 7 publications

(7 citation statements)

References 20 publications

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“…Strategies for early PHU intervention should include education of ACF staff around interventions such as encouragement of annual influenza vaccinations as a preventive measure and consistently monitoring and identifying residents with influenza-like symptoms. This is especially important as research has indicated that elderly residents can have atypical presentations of influenza, therefore periodic testing for influenza even in the absence of fever may be warranted during the influenza season [23,24]. Active surveillance by PHU staff, such as phone calls to the ACFs during influenza season, is also an important strategy for the early identification of influenza outbreaks and could potentially lead to less morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Dronavalli,

Lord,

Alexander

et al. 2020

JEGH

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Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08–0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34–0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05–0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Dronavalli,

Lord,

Alexander

et al. 2020

JEGH

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“…The small sample size of ARI residents reduced the statistical power of any comparison by subgroups, especially for respiratory viruses other than influenza A(H3N2). Syndromic diagnosis of ARI is often complex in elderly patients as a consequence of preexisting diseases, complications, and atypical manifestation of ARIs, and it thus remains a challenge for physicians [34]. These difficulties could lead to biased clinical assessments and decisions regarding whether to take a swab, thus underestimating the number of positive patients.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Respiratory Pathogens among Elderly Nursing Home Residents with Acute Respiratory Infections in Corsica, France, 2013–2017

Masse

Capai

Falchi

2017

BioMed Research International

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Background The current study aims to describe the demographical and clinical characteristics of elderly nursing home (NH) residents with acute respiratory infections (ARIs) during four winter seasons (2013/2014–2016/2017), as well as the microbiological etiology of these infections. Methods Seventeen NHs with at least one ARI resident in Corsica, France, were included. An ARI resident was defined as a resident developing a sudden onset of any constitutional symptoms in addition to any respiratory signs. Nasopharyngeal swabs from ARI residents were screened for the presence of 21 respiratory agents, including seasonal influenza viruses. Results Of the 107 ARI residents enrolled from NHs, 61 (57%) were positive for at least one of the 21 respiratory pathogens. Forty-one (38.3%) of the 107 ARI residents had influenza: 38 (92%) were positive for influenza A (100% A(H3N2)) and three (8%) for influenza B/Victoria. Axillary fever (≥38°C) was significantly more common among patients infected with influenza A(H3N2). Conclusion The circulation of seasonal respiratory viruses other than influenza A(H3N2) seems to be sporadic among elderly NH residents. Investigating the circulation of respiratory viruses in nonwinter seasons seems to be important in order to understand better the dynamic of their year-round circulation in NHs.

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“…55 Although influenza has been principally classified as one of the predominant clinical complications of elderly patients with co-morbidities, it is often under-assessed and, its diagnosis could be challenging. 74,75 In addition to this, the patient's predominant cause of morbidity obscures the identification of essential symptoms and signs of influenza; furthermore, medical professionals tend to focus more on patients' known pathology. 74,[76][77][78][79] Outcomes in these patients aging 65 years or over, are usually fatal, some even do not develop pneumonia, and 89% die either because of pneumonia and influenza; pneumonia was equally responsible for high death reports during the Spanish flu of 1918.…”

Section: Polypharmacy and The Risk Of Infections In The Elderly Populmentioning

confidence: 99%

“…74,75 In addition to this, the patient's predominant cause of morbidity obscures the identification of essential symptoms and signs of influenza; furthermore, medical professionals tend to focus more on patients' known pathology. 74,[76][77][78][79] Outcomes in these patients aging 65 years or over, are usually fatal, some even do not develop pneumonia, and 89% die either because of pneumonia and influenza; pneumonia was equally responsible for high death reports during the Spanish flu of 1918. 80,81 Morbidity increases considerably among survivors, and up to 10-12% of these aged patient groups need a higher level of support for day to day work after discharge from hospital for acute respiratory diseases.…”

Section: Polypharmacy and The Risk Of Infections In The Elderly Populmentioning

confidence: 99%

<p>The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population – Public Health Implications</p>

Rahman¹,

Singh²,

Dhingra³

et al. 2020

TCRM

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COVID-19 pandemic is inducing acute respiratory distress syndrome, multiorgan failure, and eventual death. Respiratory failure is the leading cause of mortality in the elderly population with pre-existing medical conditions. This group is particularly vulnerable to infections due to a declined immune system, comorbidities, geriatric syndrome, and potentially inappropriate polypharmacy. These conditions make the elderly population more susceptible to the harmful effects of medications and the deleterious consequences of infections, including MERS-CoV, SARS-CoV, and SARS-CoV-2. Chronic diseases among elderlies, including respiratory diseases, hypertension, diabetes, and coronary heart diseases, present a significant challenge for healthcare professionals. To comply with the clinical guidelines, the practitioner may prescribe a complex medication regimen that adds up to the burden of pre-existing treatment, potentially inducing adverse drug reactions and leading to harmful side-effects. Consequently, the geriatric population is at increased risk of falls, frailty, and dependence that enhances their susceptibility to morbidity and mortality due to SARS-CoV-2 respiratory syndrome, particularly interstitial pneumonia. The major challenge resides in the detection of infection that may present as atypical manifestations in this age group. Healthy aging can be possible with adequate preventive measures and appropriate medication regimen and follow-up. Adherence to the guidelines and recommendations of WHO, CDC, and other national/regional/international agencies can reduce the risks of SARS-CoV-2 infection. Better training programs are needed to enhance the skill of health care professionals and patient's caregivers. This review explains the public health implications associated with polypharmacy on the geriatric population with pre-existing comorbidities during the COVID-19 pandemic.

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Delay in Diagnosis of Influenza Virus in an Elderly Hospitalized Patient: A Fatal Outcome

Cited by 7 publications

References 20 publications

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care

Epidemiology of Respiratory Pathogens among Elderly Nursing Home Residents with Acute Respiratory Infections in Corsica, France, 2013–2017

<p>The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population – Public Health Implications</p>

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