YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==INFLUENZA SYMPTOMS EXPLAINED== 1 AUTHOR Nicholson KG TITLE Clinical features of influenza. SOURCE Semin Respir Infect 1992 Mar;7(1):26-37 ABSTRACT Influenza, an acute, usually self-limited, febrile illness of global importance, appears virtually every year and infects the respiratory tract either sporadically, as a local outbreak, or as a widespread epidemic. The most severe outbreak known, the 1918 to 1919 influenza A pandemic, was responsible for an estimated 20 million deaths globally. In the United States, the influenza pandemics of 1957 and 1968 were associated with an attack rate of up to 50% and an estimated 100,000 deaths. Interpandemic influenza is responsible for considerable morbidity and mortality, which exceed that associated with the introduction of the pandemic strain. Influenza B infections resemble those due to influenza A, but are associated with fewer deaths. Features of influenza include headache, myalgia, malaise, anorexia, sore throat, nonproductive cough, sneezing, and nasal discharge; these symptoms are not pathognomic for influenza, and asymptomatic infection can occur. The pulmonary complications of influenza include pneumonia (viral and bacterial), croup, asthma, and bronchitis. Myocarditis and pericarditis are occasional cardiac complications. In addition to Reye's syndrome, a range of neurologic complications have been noted, including confusion, convulsions, psychosis, neuritis, Guillain-Barre syndrome, coma, transverse myelitis, and encephalomyelitis. Influenza has also been associated with the toxic shock syndrome, myositis, myoglobinuria, and renal failure. In view of its enormous human and economic toll, influenza remains a major target for improved vaccines and vaccine delivery, and antiviral treatment and prophylaxis. 23 AUTHOR Kim SW AUTHOR Pentel PR TITLE Flu-like symptoms associated with fluoxetine overdose: a case report. SOURCE J Toxicol Clin Toxicol; VOL 27, ISS 6, 1989, P389-93 ABSTRACT The serotonin reuptake inhibitor zimelidine may cause flu-like symptoms and Guillain-Barre syndrome. Guillain-Barre syndrome has not been reported with the use of the structurally related serotonin reuptake inhibitor fluoxetine. Flu-like symptoms are described in the manufacturer's literature on fluoxetine but are absent from published studies. We describe a patient who developed flu-like symptoms, urticaria and angioedema 2 days after fluoxetine overdose. There were no neurologic sequelae. This case confirms that fluoxetine may be associated with flu-like symptoms and suggests that, because these symptoms occurred after overdose, they may be dose related. The additional findings in this patient suggestive of allergy, an unusual feature of drug overdose, are discussed. 38 AUTHOR Dolan MC AUTHOR Haltom TL AUTHOR Barrows GH AUTHOR Short CS AUTHOR Ferriell KM TITLE Carboxyhemoglobin levels in patients with flu-like symptoms. SOURCE Ann Emerg Med; VOL 16, ISS 7, 1987, P782-6 ABSTRACT Subacute carbon monoxide poisoning is commonly misdiagnosed as an influenza-like viral illness. All patients presenting to the triage nurse at University Hospital with flu-like symptoms during February 1985 were asked to give blood samples for carboxyhemoglobin determination. Fifty-five patients (10% of those eligible) with headache, dizziness, nausea, vomiting, diarrhea, weakness, general malaise, or shortness of breath were enrolled in the study. Carboxyhemoglobin levels ranged from 0 to 21%. Thirteen patients (23.6%) of this self-selected subgroup had carboxyhemoglobin levels greater than or equal to 10%. There was no statistically significant difference in carboxyhemoglobin levels between smokers and nonsmokers. More patients using wood heat had elevated carboxyhemoglobin levels than patients using any other form of heating (P less than .05). No patient with a carboxyhemoglobin level greater than or equal to 10% was diagnosed as having subacute CO poisoning by emergency physicians. Physicians must seek out the possibility of CO toxicity in patients with flu-like illness, particularly in inner-city populations during the heating months. Fundoscopy and COHb levels may be useful in selected cases to correctly diagnose patients and avoid a return to a hazardous environment with potentially fatal consequences.