Case 3

Question 1

Patient A., a student, visited a doctor at the inter-university hospital on the first day of the disease with complaints of moderate headache in the forehead and behind the eyes, dry cough, unpleasant sensations behind the sternum, and nasal congestion. He became acutely ill, his body temperature rose to 38.5 °C. The patient reported sweating, a feeling of ache throughout the body, and pain in the muscles of the back and limbs and could not continue to attend classes. There were students with a runny nose and cough in his group. The examination revealed a condition of moderate severity, hyperhidrosis, hyperemia of the skin of the face, scleral and conjunctival injection, significant diffuse hyperemia and swelling of the oral mucosa, soft palate, and uvula. Breathing was vesicular, 18 breaths per minute, without rales. Heart tones were muffled, heart rate was 96 beats per minute, blood pressure was 110 / 80 mm Hg. The abdomen was soft and painless when palpated. The liver and spleen were not enlarged. There were no meningeal symptoms.
1. Make the most likely diagnosis and provide its justification

Answer 1

Influenza moderate severity
The patient’s symptoms, including fever, headache, cough, muscle pain, and nasal congestion, are consistent with influenza. The presence of other students in the patient’s group with similar symptoms suggests an outbreak of influenza.

Question 2

Provide a range of infectious diseases for differential diagnosis in this clinical case.

Answer 2

Other infectious diseases that may present with similar symptoms include:

•	Common cold
•	Acute bronchitis
•	Pneumonia
•	COVID-19
•	Adenovirus infection

Question 3

Determine the treatment strategy in this clinical case.

Answer 3

The patient should be advised to rest and stay hydrated. Symptomatic treatment with antipyretics eg paracetamol , ibuprofen. analgesics, and cough suppressants may be provided.
Antiviral therapy with oseltamivir or zanamivir or Amantidine or Rimantidine may be considered if the patient presents within 48 hours of symptom onset.
Antibiotics should not be prescribed unless there is evidence of bacterial co-infection. Ceftriaxone 1g Or levofloxacin .

We can diagnose using rapid influenza diagnostic test or point of care
And also PCR, microscopic exam

Question 4

Give a list of indications for hospitalization of patients with this disease

Answer 4

Indications for hospitalization: Hospitalization may be indicated for patients with severe influenza, such as those with respiratory distress, hypoxemia, or complications such as pneumonia or encephalitis. Patients with underlying medical conditions, such as asthma or diabetes, may also be at higher risk for complications and may require hospitalization.

Question 5

Explain antigenic drift and shift

Answer 5

HA and NA that changes frequently
and
When influenza A combines with B and produce another influenza eg C