Influenza A-associated Bronchospastic Pneumonia: A Case-based Review

Abstract

Pneumonia is the commonest influenza-associated respiratory complication in adults. The clinical presentation varies from mild to severe and may be complicated by secondary bacterial coinfection. Influenza can affect different areas of the respiratory tract (upper, lower, respiratory zones), giving rise to mixed symptoms and signs. This is due to the distribution of different types of sialic acid receptors within the respiratory tract, acting as viral binding sites with relative subtype specificity.

We present a case of an 87-year-old woman with multiple co-morbidities, diagnosed with primary influenza A pneumonia upon her return from Umrah. She had a prominent wheeze and was hypoxic, requiring bronchodilators with supplemental oxygen. Additional therapy consisted of oseltamivir, with antibiotic cover. She required a protracted hospital stay prior to recovery. This article will discuss the pathophysiology of influenza-associated respiratory complications, chest x-ray changes in influenza and related viral pneumonias, secondary bacterial co-infection management and the evolution of specific influenza antiviral therapy. We will also briefly touch upon novel antiviral agents awaiting clinical evaluation.