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Flu Diagnosis and Treatment: Mind the Gap Series

Core IM

In part 2 of our flu series, we explore the ins and outs of influenza testing and the complicated history of influenza treatment, just in time for flu season!

First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.

CME/MOC:

Up to 0.5 AMA PRA Category 1 Credits ™ and MOC Points
Expires February 19, 2023   active

Cost:

Free to Members

Format:

Podcasts and Audio Content

Product:

Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.

  • There are many influenza symptoms and most of them are not very helpful in confirming a case of the influenza. They have poor diagnostic odds ratios, which is defined as the ratio of the positive likelihood ratio over the negative likelihood ratio.
    • Fever has a diagnostic odds ratio of 4.5 for influenza
    • Cough has a diagnostic odds ratio of 2.8 for influenza
  • To confirm a case, the IDSA recommends an influenza PCR.
    • PCR has a diagnostic odds ratio of ~100, whereas the antigen test (rapid influenza detection test) has a lower diagnostic odds ratio of 25.
  • The influenza PCR can still have false positives. As with any test, apply the test to your pre-test probability - a number you come up with based on your local context - to get your post-test probability - the chance a patient truly has disease.
  •  The new 2018 influenza guidelines recommend:  
    • Treat any inpatient with suspected influenza, even without a confirmatory test, and even after they’ve had symptoms for 48 hours.
    • Consider testing outpatients if it will change management.
    • Consider treating outpatients who are likely to suffer complications from the flu, even without a confirmatory test
  • Neuraminidase inhibitors, such as oseltamivir and zanamavir, were originally thought to decrease symptoms by 24 hours, and reduce complications and hospitalizations
    •   But in a big pharmaceutical scandal, previously unseen data was revealed and analyzed by the Cochrane Group. It showed these results were not completely accurate or as convincing as originally thought.
  • Data from the 2009 influenza pandemic, when neuraminidase inhibitors were used broadly, generated new data which actually suggested a mortality benefit
    • However, this data comes from observational studies, rather than randomized control trials, so may be subject to bias.
  • Ultimately, neuraminidase inhibitors are the best and only option we currently have to treat the flu. This is why, despite their known side effects and questionable outcomes, IDSA guidelines have changed to recommend using them more broadly.

Contributors

Janine Knudsen, MD - Host, show notes

Steven R. Liu, MD - Host, CME questions

Reviewers

Denise McCulloch, MD

Jennifer Spicer, MD

Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

Release Date:  February 19, 2020

Expiration Date: February 19, 2023

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the Core IM.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.5 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz. To claim CME credit and MOC points you must achieve a minimum passing score of 66%. You may take the quiz multiple times to achieve a passing score.