Chest Infections: Student/Resident Case Report Poster - Chest Infections I |

It's Not Just the Flu... FREE TO VIEW

Sakshi Dutta, MD; Yinan Chen, MD; Amitpal Nat, MD; Brian Changlai, MD
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SUNY Upstate Medical University, Liverpool, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):169A. doi:10.1016/j.chest.2016.08.178
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SESSION TITLE: Student/Resident Case Report Poster - Chest Infections I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Often times we take Influenza, or the “flu” for granted, especially in the healthy population. Although we advocate for our patients to receive the influenza vaccination, there may be a general misconception that the healthy population won’t experience severe complications from influenza. Studies have shown that the flu could cause increased morbidity and mortality in high risk populations: patients over 65 yrs old, immunocompromised, and those with underlying chronic diseases. When a healthy male presents with respiratory distress, influenza should be on the differential, and we must keep in mind that it can be detrimental in the young and healthy.

CASE PRESENTATION: A 45-yr-old male, with no past medical history presented to the hospital with 10 days of flu like symptoms. CXR revealed pneumonia and he was discharged with Levofloxacin. He became increasingly dyspneic and returned to the hospital. He required 6 L of oxygen to maintain saturations. A repeat CXR at that time showed new left sided pleural effusion. CTA thorax revealed left lower lung collapse. Respiratory panel was positive for influenza A. Thoracentesis was performed, the pleural fluid was suggestive of an empyema (pH=7.0), and culture grew MRSA. He was started on Vancomycin and a chest tube was placed. The patient deteriorated, and a repeat CXR showed worsening effusion of the right lung. A second chest tube was placed on the right. Malignancy and immunodefiency were ruled out.

DISCUSSION: Influenza can adversely affect people of all ages, whether they are healthy or have underlying chronic comorbidities. A healthy male who presented to the hospital with flu-like symptoms was sent home without checking a respiratory panel. He was presumed to have a mild case of pneumonia when in fact his disease more virulent. Recent studies reveal that community acquired-MRSA (CA-MRSA) has been identified in outbreaks of severe pneumonia with a high mortality rate, especially in healthy patients with influenza. The median age of patients in the study was 16 yrs old, and 44% of these patients had no PMH. 51% of these patients died a median of 4 days after symptom onset. Only 43% of these patients were empirically treated with antimicrobial agents recommended for MRSA.

CONCLUSIONS: Our case illustrates the fact that influenza could lead to serious complications, even in the healthy. When a young patient with no PMH presents with the flu and develops respiratory failure, its important to keep in mind that this patient may have a superimposed CA-MRSA infection. A MRSA nasal swab PCR assay should be done. If negative, MRSA could be ruled out with a negative predictive value of 99.2%. In patients with severe complications such as acute respiratory failure, empirical MRSA coverage should be considered since CA-MRSA has proven to be fatal in young patients with influenza.

Reference #1: Severe MRSA community-acquired pneumonia associated with influenza--Louisiana and Georgia, Dec 2006-Jan 2007.CDC

DISCLOSURE: The following authors have nothing to disclose: Sakshi Dutta, Yinan Chen, Amitpal Nat, Brian Changlai

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