Warren's World: Journal Watch, Influenza Is More Virulent Among Cancer Patients

 

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SUMMARY AND COMMENT | GENERAL MEDICINE February 4, 2014 Influenza Is More Virulent Among Cancer Patients Abigail Zuger, MD Reviewing Memoli MJ et al., Clin Infect Dis 2014 Jan 15; 58:214 Yet many of the most common flu symptoms are less common in this group.

Influenza is particularly virulent among immunocompromised people, but studies have been largely retrospective, without point-by-point comparisons with immunologically normal people during the same flu season. Now, NIH investigators have prospectively evaluated 32 immunocompromised patients (25 with hematologic malignancies, 7 with solid tumors) who presented with culture-confirmed influenza between 2008 and 2011. Compared with 54 nonimmunocompromised influenza patients (a group that included patients with well-controlled HIV infection) treated during the same years, immunocompromised patients were less likely to be overweight and to be current smokers and also less likely to be vaccinated (25% vs. 60%). Fever was reported by about 80% of both groups, but most other flu symptoms were significantly less common among the immunocompromised, including dry cough (78% vs. 96%), chills (52% vs. 81%), shortness of breath (37% vs. 62%), and myalgias (40% vs. 68%). Conversely, radiologic abnormalities were more common among immunocompromised patients, more of whom also required intensive care unit admission, and the single fatality in the study was an immunocompromised patient. Average durations of viral shedding were significantly longer in the immunocompromised group. COMMENT No surprises here regarding the increased virulence of the flu and the higher likelihood of pneumonia in severely immunocompromised people. The relative dearth of common symptoms in this group is interesting and suggests that clinicians should consider flu in these patients even in the absence of many of the usual clinical indicators. EDITOR DISCLOSURES AT TIME OF PUBLICATION Disclosures for Abigail Zuger, MD at time of publicationEditorial boardsJournal Watch AIDS Clinical Care; Clinical Infectious DiseasesOtherNew York Times medical writer CITATION(S): Memoli MJ et al. The natural history of influenza infection in the severely immunocompromised vs nonimmunocompromised hosts. Clin Infect Dis 2014 Jan 15; 58:214. (http://dx.doi.org/10.1093/cid/cit725)