Case report on treatment ...

Patient Details

A 32-year-old female 

Presenting complaints

Fever, myalgia, headache, and nasal congestion.

Clinical examination 

• Signs of upper respiratory tract infection 
• Rhinorrhea and bilateral nasal congestion. 
• High fever spiking: 1020F
• Blood pressure: 145/79 mm Hg
• heart rate: 89 rate/min

Laboratory Investigations 

• C-reactive protein: 2.3 mg/dL [normal range, 0.3 to 1.0 mg/dL]) 
• Arterial oxygen partial pressure [PaO2]: 56.9 mm Hg [normal range, 83 to 108 mm Hg])
• WBCs: 2.98 million/mm3 [normal range,3.5-5.5 million/mm3])

Imaging Study findings

• Chest computed tomography (CT): Lower and right upper lobe pneumonic consolidation. 
• Echocardiography showed mild pulmonary hypertension. 
• PCR assays (pharyngeal swab and bronchoalveolar lavage): positive for viral genomes of the H3N2 virus.

Diagnosis

Seasonal flu caused by H3N2 virus with secondary bacterial pneumonia.

Treatment 

• Oseltamivir was prescribed for its efficacy against influenza viruses.
• Oxymetazoline (0.05%) nasal spray for nasal congestion.
• Acetaminophen (500 mg) every 6 hours for fever and headache.
• Rest and maintain adequate hydration.

Follow-up

• Within 24 hours of oxymetazoline initiation, the patient reported significant improvement in nasal congestion. 
• Subsequent physical examinations revealed improved airway patency and decreased rhinorrhea. 
• The patient's fever subsided on the third day of hospitalization.
• Laboratory investigations were within normal ranges.

Discussion

The flu, or seasonal influenza, is a sudden respiratory infection from influenza viruses and is prevalent globally. Typically, individuals recover without the need for medical intervention. Influenza is easily transmitted through coughing or sneezing, emphasizing the importance of vaccination as the most effective means of disease prevention. Influenza infections include a rapid onset of symptoms such as fever, cough, sore throat, body aches, and fatigue. Oxymetazoline is a selective alpha-adrenergic receptor agonist that acts as a potent vasoconstrictor in the nasal mucosa, reducing swelling and congestion. Oxymetazoline reduces nasal reactivity in patients with allergic rhinitis. The various studies showed the safe use of oxymetazoline and xylometazoline nasal spray, with or without benzalkonium chloride, for ten days in patients with untreated vasomotor rhinitis. This case report demonstrates the potential efficacy of oxymetazoline as an adjunct treatment for seasonal flu, particularly in providing rapid relief from nasal congestion.

References

1. World Health Organization. Influenza (Seasonal). Who.int. World Health Organization: WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
2. DeGeorge KC, Ring DJ, Dalrymple SN. Treatment of the Common Cold. American Family Physician. 2019 Sep 1;100(5):281–9. Available from: https://www.aafp.org/pubs/afp/issues/2019/0901/p281.html
3. Ten Days' Use of Oxymetazoline Nasal Spray With or Without Benzalkonium Chloride in Patients With Vasomotor Rhinitis | Research, Methods, Statistics | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network. jamanetwork.com. Available from: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/509865