Dyspnea, Fever, Hemoptysis, and Diabetes in a Tobacco User

Avnish Sandhu, DO; Pranatharthi Chandrasekar, MD


December 02, 2020

The influenza vaccine is approved for all persons aged ≥ 6 months and should be given yearly during each influenza season.[15] The composition of the influenza virus changes annually; hence, the vaccine is modified each year to best match the circulating viruses. For the 2020-2021 season, the options are a quadrivalent vaccine that protects against four strains of influenza virus (A/Guangdong-Maonan/SWL1536/2019H1N1 pdm 09, A/Hong Kong/2671/2019 [H3N2]) and two B viruses (B/Washington/02/209 [Victoria] and B/Phuket/3073/2013-like [Yamagata lineage]); and a trivalent vaccine that protects against three strains of influenza virus (A/Guangdon-Maonan/SWL1536/2019 [H1N1 pdm 09], A/Hong Kong/2671/2019 [H3N2]) and B virus (B/Washington/02/209 [Victoria lineage]). The Centers for Disease Control and Prevention (CDC) recommends any licensed, age-appropriate influenza vaccine for all persons. The high-dose vaccine, which contains four times the quantity of antigen, is reserved for adults age 65 years or older.[16]

Considering COVID-19 in patients who present with influenzalike illness is vital, because symptoms of influenza often overlap with those of COVID-19. Both illnesses can present with fever, cough, sore throat, muscle ache, headache, diarrhea, and shortness of breath. COVID-19 has a longer incubation period than that of influenza (1-14 days vs 1-4 days).[17] The secondary complications of both diseases are similar.[18,19] Of note, COVID-19 and influenza A can occur together.[20]

The patient in this case completed a 5-day course of oseltamivir, was extubated on day 5 of her admission, and was discharged a few days later to complete a 2-week course of intravenous vancomycin for uncomplicated methicillin-resistant S aureus bacteremia and pneumonia. She did not require any cardiac intervention or circulatory support for myopericarditis.


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